It is preferable to deliver care in a dental surgery setting, where possible, and domiciliary visits should be undertaken only in cases of genuine patient need rather than dictated solely by convenience.
Risk assess every potential episode of domiciliary care to determine whether it is necessary and, if so, how any risk should be mitigated [1]. Assign a risk category (see below) taking into account:
- The nature of the dental care and the experience of the practitioner. Some dental procedures such as examinations and the construction of dentures are essentially non-invasive and will carry a much lower risk.
- The patient’s medical history and any possible/likely causes of collapse or reaction to treatment (e.g. depending on severity - cardiac or respiratory disease, peripheral vascular disease, neurodegenerative conditions leading to impaired swallowing, epilepsy, extreme dental anxiety).
- The physical environment and any possible risks related to this. Note that some nursing or care homes might have resuscitation equipment and emergency drugs.
The risk assessment might require an initial visit, depending on knowledge of the patient’s dental and medical condition and other factors.
Record the outcomes of the risk assessment (see Domiciliary Care Risk Assessment Record template).
Risk categories
Risk categories are described in Emergency drugs and equipment in primary dental care [1] as follows:
Low risk: If it is thought that the dental care presents a low risk to the patient then emergency drugs and equipment might not be required for the domiciliary visit. Consequently, for non-invasive dental treatment including dental examinations, oral health assessments and providing dentures, dental teams would not necessarily be expected to take the full range of resuscitation equipment.
Moderate Risk: Where the care provided is deemed to be of moderate risk, the following recommended emergency drugs and equipment must be available to the dental team in the domiciliary setting.
- Emergency drugs kit, single-use sterile syringes and needles.
- Portable oxygen with flowmeter, tubing and a face mask capable of delivering high concentrations of oxygen (see Transport of Medical Oxygen Cylinders).
- Oro-pharyngeal airways and bag-valve-mask.
- Portable independently powered suction machine with appropriate tips and tubing.
- Spacer device for inhaled bronchodilators.
Significant risk: If the risk assessment determines that there would be a significant risk of patient collapse or reaction to the dental procedure in a domiciliary setting, the dental team should refer the patient to the Public Dental Service or local hospital dental department as appropriate, including the risk assessment with the referral.