Special Care Dentistry: Empowering Patients with Dementia

In 2023, Andrew Geddis-Regan was nominated the prize winner of this award which was then presented in March 2024. Andrew’s research focused upon patients with Dementia and exploring how he could empower them to be actively involved in the decisions made about their oral health. Andrew’s passion for person-centred care echoes CPI’s core values.

We interviewed Andrew to find out more.

What area of practice was the research in?

Andrew works in special care dentistry and looks after those who are not able to have standard dental care in a standard dental practice. He cares for many different groups, including highly medically complex individuals, people with severe mental health problems, people with learning disabilities, people with autism and older people with dementia and cognitive impairments.

Andrew's role finds a way of best supporting people to have the care they need. Often this involves sedating patients or using general anaesthetic as it is challenging for some individuals to cope with difficult dental procedures.

Andrew has been trained in CPI's Clinical Holding^™ Training programme to assist his work and when asked about how this has helped in his role he said:

‘The training was thought-provoking: by getting quite up close and personal with colleagues and holding each other you can see how the patient would feel. Just last week we had to support someone and act in their best interest by holding their arm for no more than 10 seconds to allow us to give a sedative injection in their leg to allow them to then have anaesthesia.’

What was the chosen research topic?

The research focused on people with dementia and how to plan their dental treatment.

Two key issues are frequently acknowledged with dementia patients:

1. Patients are usually older and have had their teeth for a long time, so they're often fixed in complex ways. Fixing these problems in people living with dementia can be difficult or impossible and sometimes teeth have to be removed.
2. Dementia can impact care in many ways and make it harder for people to accept dental care. This can also coincide with ill health and frailty which make treatment decision-making more complicated.

Andrew decided to focus on how to make better decisions with or for people with dementia and how to get them involved with the decision making. He recognised that all patients will have historically had a preference of treatment and ideally, we would align care decisions with what the patient would have wanted.

The project lasted for three-years and involved interviewing both those with dementia and their carers to understand each stakeholders’ experiences and pain points.

The Dental Decisions Tool

The solution was the Dental Decisions Tool. This is a tool which can be used to identify the broad preferences of the patient and their priorities, such as pain relief or keeping teeth.

The premise is that this tool is completed as soon as someone receives a mental diagnosis, and these preferences then guide all future treatment. This empowers the patient as well as helps to manage stress levels, as each patient can be treated specific to their preferences.

Despite the research focusing on dementia patients, the tool can be used for all special care dentistry patients.

Picture: On the left Andrew Geddis-Regan and on the right Caoimhin Mac Giolla Phadraig from Trinity College Dublin. Caoimhin is the Group Programme Chair of The Dental Anaesthesiology and Special Care Research Group of the International Association for Dental Research  

What are the outcomes of the research?

The tool enables patients to feel empowered. Andrew wants people to be involved in the decisions made about their oral health. Often patients decide to have treatment because they opt for the dentists’ recommendations and just 'did what they were told' but with this tool they can access and complete the form prior to their appointment and the dentist already understands their preferences.

Andrew also believes that the tool will enable dentists to maximise their time with the patients, as they can focus on what matters to them such as pain relief over appearance. Dentists are time poor, but using this tool they can focus on what matters to the patient and make decisions based on the patients’ preferences.

How has/will the reward benefit the project?

Andrew recognises the tool he has created requires additional testing and evaluation to be fully inclusive. He wants to ensure the tool translate well to different languages and cultural groups as the research has so far been tested in just the Northeast of England and he would like to receive feedback from a broader, more diverse population.

This will determine whether the tool needs modifications overtime.

The money received because of winning the award will benefit Andrew by giving him the funding to continue to test and develop the tool and propel his work to the next step, such as integrating the tool into computerised systems, rather than only having it in paper format.