Dentist skill and setting to address dental treatment needs of care home residents in Wales.

OBJECTIVE: To explore the relationship between treatment plans, complexity anticipated in delivering those plans, and the special care dental skills and settings identified as appropriate.
BACKGROUND: In older adults, many factors may complicate dental treatment including health and disability problems. Assessment of dental treatment needs amongst care home residents provides information about clinical care required and clinical experience needed for this population.
MATERIAL AND METHODS: Analysis of dental data collected in a 2010 Welsh survey. Data analysed included treatment plan information, complexity assessment and dental expertise and settings required to deliver the treatment plans.
RESULTS: The majority of participating residents needed simple dentistry, that is examinations, oral hygiene instruction, scaling of teeth, fillings, new dentures and fluoride application. Additional time was the commonest complexity factor. A large proportion of participants required dental treatment within a domiciliary setting. A similar proportion required care within a primary care setting (typically with care from a general dental practitioner) or a special care clinic (typically with care from a dentist with special care experience). Treatment plans involving specialists were more likely to be associated with poor general health, higher levels of interventional treatment and greater complexity.
CONCLUSION: Most treatment need in care homes is basic restorative, periodontal and preventive care. Half of this could be managed by general dentists, some on a domiciliary basis and the rest in primary care dental clinics. The commonest complexity was additional time. More complex treatments were associated with care in clinics, skills in special care dentistry and multidisciplinary care.