November, around Armistice Day is an appropriate time to remember those that have died, so it is timely that the GDC has finally produced its report into deaths that have occurred during fitness to practise investigations GDC publishes report on causes of death during fitness to practise investigations .

As the prevalence of dementia in the UK increases, and researchers struggle to find concrete evidence for the possible causes of the disease, controversial studies have emerged hypothesising that dental X-rays could be the source of the infamous disorder. With no evidence to support this claim, however, and no indication that research can actually be conducted to prove such a theory, it would, perhaps, be more pertinent for professionals to reverse their concerns and focus instead on the effects diagnostic imaging can have on people currently living with dementia.

Presently, there is next to no research on how the experience of undergoing an X-ray can affect dementia patients both emotionally and psychologically, apart from one study funded by the Clinical Research Fellowship titled “Exploring the experiences of diagnostic imaging for people with dementia”, which has not yet published its findings.[i] The project hopes to improve understanding through interviews with patients and their carers as well as develop recommendations for practice change.

As it stands, there are advice pathways in place to steer professionals in the right direction – including Nice guidelines (CG42)[ii] and recommendations from the Society of Radiographers –[iii] with some consideration placed on support and intervention methods. However, it is also important to examine ways in which distress, confusion and discomfort can be minimised within the dental practice.  

To do so, it is necessary to consider how the patient might feel before, during and after the process. Before the X-ray is taken, for instance, the patient is required to remove all jewellery, dentures, eyewear and any other metal objects or clothing that might interfere with the images, which can be an ordeal in itself for someone living with dementia. Indeed, depending on the level of their understanding, they might not be able to comprehend why you are removing their wedding ring, or why they aren’t allowed to have their glasses, without which, they cannot see.

That’s not to mention the confusion the patient might feel when the machine is positioned close to the body. Plus, if the equipment is big, bulky or intimidating in appearance, there is a possibility that the experience could induce anxiety or fear.

Emotional and psychological distress could occur during the process too, especially if the patient is unable to keep still and the images need to be retaken. Not only could this induce further feelings of anxiety in a situation that is already stressful for the patient, but it also puts the patient at risk of increased radiation exposure.

It is important to take into consideration the waiting time that is required after the examination is complete to check if all the necessary images have been obtained. If the equipment does not enable the user to view the images immediately, there is a chance that the patient could become impatient or agitated, which could lead to challenging behaviour. 

To minimise such risks and create an experience that is as positive and comfortable as possible, there are several measures that could be implemented within the dental practice. One potential strategy could be to alter protocol and develop a specialist system specifically for patients with dementia – a service that is already being developed within innovative hospitals and clinical commissioning groups (CCGs). The Mid Essex CCG, for instance, funds a service affiliated with the national charity Carers Trust, which has developed a pathway that enables patients with dementia who require an X-ray to have direct access to radiology services.[iv] If practices were to implement a similar protocol and allow patients to bypass the waiting room, it could help the patient to feel more relaxed and minimise the likelihood of agitation and distress from occurring.

A clinician’s understanding and attitude towards the disease could also affect patients’ overall X-ray experience. Indeed, one study found that the approach of participating radiographers towards people with dementia was largely of a negative nature, especially from staff with fewer than 10 years’ work experience.[v] With better training, and an increased awareness of the affects of dementia, clinicians could help minimise agitation and behavioural symptoms during the X-ray process.[vi]

Lastly, the machine itself can have a huge impact on the outcome of the appointment and the patient’s experience. By using an X-ray unit such as the RXDC Hypersphere+ from RPA Dental, that provides a larger source-to-skin distance, generates consistently sharp images and reduces the irradiated surface area – and therefore exposure – practices could improve negative elements of the experience.

While it is clear that evidence is needed to discover more on how an X-ray could affect patients with dementia both emotionally and psychologically, there are practical solutions that practices can implement that could help make a difference. Nobody can know for sure what the cause of dementia is, nor can they reverse its effects, but it’s not too late to change the way patients live with it.

For more information, contact RPA Dental on 08000 933 975 or visit the website www.dental-equipment.co.uk