Foundation dentists’ attitudes and experiences in providing dental care for dependant older adults resident in care home settings

With a rapidly growing aging population, it is important to consider how dental needs can be met for dependant older adults residing in care home settings [14]. There is often the suggestion when considering oral health improvement and dental access initiatives, both nationally, regionally and within Integrated Care Boards (ICBs), that FDs represent an appropriate workforce to deliver such care because the workforce numbers are stable each year to facilitate planning; and they are salaried from a training rather than a dental commissioning budget. However, this service evaluation demonstrates some important findings which may impact upon the suitability of FDs to deliver dental care for dependant older adults who are resident in care home settings.

Experiences, knowledge and confidence of FDs to provide dental care for the dependant older adult residing in care home settings

During undergraduate training, there is limited experience in treating dependant older adults who are resident in care homes either within the dental school or the care home setting. This does improve slightly during the foundation year, with more participants treating dependant older adults who reside in care homes, but this experience is mostly limited to provision within the dental practice setting. This lack of contextually rich concrete experience limits FDs’ learning in relation to this vulnerable group [15]. Using the Kolb’s learning cycle, the lack of “active experimentation”, offered through treating residents from care homes throughout undergraduate and FD training, hinders the translation of theoretical knowledge to the applied setting [16, 17]. This has perhaps been most evident when considering the issue of valid consent. Whilst students understand the theory in relation to consent to dental treatment, one of the barriers to the provision of dental treatment within the dental practice context was how (in the practical sense) valid consent can be achieved for this cohort (particularly those patients with neurodegeneration).

The lack of “concrete experience” may have also contributed to the low confidence reported in providing dental care for dependant older adults residing in care home settings [18]. Increasing confidence, through experiential learning (e.g. simulations relating to specific real-world clinical problems, case-based discussions) has the potential to change FDs’ perceptions of training around dental care delivery for dependant older adults living in care homes [19]. A strong preference for training methods such as observations and workshops were observed in this study, fitting into the experiential method of learning. Furthermore, increased confidence improves clinical competence to deliver appropriate dental care [20]. Whilst clinical dental experience and high confidence have no predictive value in quality of dental care delivered, there is a need to consider how, at both undergraduate and FD training levels, experience and confidence for treating dependant older adults who reside in care home settings could be improved [21]. Experiential learning should be supplemented with specific knowledge around national and regional evidence-based guidance for dependant older adults as current levels of awareness within FDs are low [5, 8]. This will help to facilitate the delivery of evidence-based care across the primary dental care workforce.

FDs’ views on the value and relevance of providing dental care for the dependant older adults residing in care homes on their practice and career development

Overall, FDs’ views on the value and relevance of dentistry for dependant older adults residing in care homes was positive. Many agreed that it was relevant and applicable to their current and future practice, and an important and growing field of dentistry, which offered opportunities for professional growth and development. Many felt that dentistry for the dependant older population residing in care home settings “required specific knowledge and skills that are different from general dentistry”. Furthermore, dental care provision was deemed challenging and stressful but also rewarding and enjoyable. The national English guide for the commissioning of Special Care Dentistry outlines differing care descriptors based on which clinician should provide the clinical treatment [22]. Level 1 care outlines what should be delivered by the completion of undergraduate and FD training. This helps to determine an objective measure of care providers and should help to address FD concerns about the need for specialist treatment.

Limitations to this service evaluation were noted. Only NW FDs were invited to respond to the questionnaire during their regional study day, due to the limitations of this being a service evaluation and not a research project. There may be potential for selection bias among those who responded to the questionnaire, as non-respondents might have had less experience in treating this patient group or may not have considered it relevant or important.

Further work is therefore needed to explore how the findings and implications of this service evaluation can be applied across the English FD workforce. This is particularly important when considering regional variations in dental care delivery for dependent older adults living in care home settings which may impact on FDs’ experience and confidence in treating this patient group. Adopting this approach could facilitate shared learning at a national level, allowing best practices from one region to be disseminated. However, given the high response rate, with FD trainees wanting to report on their training experience and how this could positively influence further training / experiences, and the representation of the sample regarding training from different UK dental schools, gender and age, the insights gathered from this service evaluation would be anticipated to be reflective of the current FD workforce.

The findings of this study raise questions relating to the experience of the current, younger primary dental care workforce, who may in the future become FD trainers, yet they themselves may not have received training or experience for providing dentistry to this cohort. This is particularly important over the last 5 years, where the waves of the COVID-19 pandemic have prevented access to care homes and/or residents for preventive / active dental treatment. Furthermore, it might be pertinent to undertake a broader assessment of primary care dental workforce training needs in relation to providing dental care for dependant older adults residing in care home settings, given the significant external and contextual changes over recent decades including changes in oral health profiles, life expectancies etc.

Finally, limitations on cross-sectional questionnaire should be noted. It captures data at a single point in time, which does not demonstrate changes or trends in experience and/or confidence over time. Additionally, it may be subject to response bias, as it relies on self-reported data.