Potential For Direct Access In Care Homes In Wales

Objectives: Many care home residents require simple dental treatment, complicated by the need for extra time to deliver dental care. The proportion of their care which could be delivered wholly by hygienists or therapists is unknown. This re-analysis of recently collected data aims to estimate the proportion of care home resident’s dental treatment needs which could be delivered wholly by hygienists or therapists.
Methods: 2010 Welsh dental care home survey data on clinical opinion of treatment need and special care skill level required for 655 residents was cross referenced with the General Dental Council Scope of Practice document for dental therapists, dental hygienists, clinical dental technicians and extended duties dental nurses.

Results: 22% and up to 27% of care home residents had treatment needs which could be wholly addressed by a generalist dental hygienist or therapist respectively. The percentages were 43% and up to 53% for hygienists or therapists with special care dental experience. Equivalent findings for clinical dental technicians were 6% for generalists and 12% for those with experience of special care. Extended duties dental nurses could not provide any residents with care needs. A large proportion of need in care homes could be wholly provided by hygienists or therapists, especially those with special care experience. The potential efficiency gain of direct access arises from individuals who do not need to see a dentist for any aspects of their care. This should be further explored.

Conclusions: Hygienists and therapists could make a large contribution to addressing dental treatment needs of care home residents. Direct access could be an efficient model of care for this setting. Direct access to hygienists/therapists for dental care of care home residents should be piloted and evaluated.