As a hospital dentist it’s always a heart sink moment when you get the referral from the ward that reads, “Mrs X has lost her dentures, please could you replace them”. If only it was that easy…
Mrs X has not only lost her dentures, but also the ability to eat her meals, communicate clearly, smile at her family and potentially, her dignity.
It is normally a similar story. Mrs X had fallen asleep and her dentures weren’t there when she woke up, she had wrapped them in some tissue to keep them clean, safe or left them on her meal tray. One way or another they were accidentally mistaken for rubbish and disposed of. She had been in hospital for days yet no one had asked if she had dentures and therefore she wasn’t provided with a denture pot to keep them clean.
Patients who have lost dentures are often sad and their families are often very angry. There is no quick fix. Losing dentures is not like losing hearing aids or glasses; they cannot be replaced in a few days with a prescription. Making dentures is a technical process that involves four or five appointments with a dentist to take moulds and measurements, and between each appointment the work is sent to a technician who makes the individual dentures. This process takes, on average, 6 weeks. Dentures are like a good pair of shoes – they take time to get used to and often older people find it difficult, or are unable, to adapt to a new set.
In a very few hospitals there is a dental department or pathways via which re-making of dentures can be organised, but in many hospitals they do not exist. The result is patients waiting until they are discharged, which could take several months.
For a dentist, making dentures for hospitalised patients can be challenging. Patients are often not well enough to cooperate and you know deep down, that despite your best efforts you will inevitably be making a substandard set of teeth.
Last week my saddest denture loss case was a lady who was so upset that her dentures had been lost she could not bear to see her family and asked them not to visit her until they were remade.
This week I would say my saddest case is a lady who woke up in hospital one day to find that her dentures had gone. A letter came to the dental department asking for the dentures to be remade but also mentioned that the patient was on a palliative care unit. Speaking with the ward sister, I explained that we would remake them as soon as possible but it would still take at least 4 weeks. The sister explained it was likely that the patient would have died by then. After speaking to the patient it was clear that she was preparing for her last days with her family. She wanted a dignified death, the opportunity to say good-bye to all her loved ones and it upset her deeply that she had no teeth. She pleaded, as did her husband, for us to somehow make her some dentures within a week.
So how do you solve this problem of denture loss? A problem that costs the NHS millions each year? A problem that is hardly ever incident reported?
A good start is ensuring that staff check with patients on admission whether they have dentures and advising that they are kept in a labelled denture pot when not in the mouth. Maybe a discreet sunflower sign behind a patient’s bed as a reminder to check trays and the bed-space for dentures? Patients and their family should be advised that when they are not wearing their dentures, they should be kept in a denture pot. Ward staff all ought to be reminded about the importance of checking trays and bed linen for dentures.
Hopefully these measures will make a difference and with time, perseverance and a one-team approach, we will see less of the sad cases above.