Mouthcare matters at the bedside
Dental teams from The Royal London Hospital have been using their skills to look after the mouth and teeth of patients critically ill with Covid-19 on The Queen Elizabeth Unit.
Since the beginning of the pandemic much of the team’s routine dental work has been put on hold, but they continue to use their expertise to support staff by conducting mouth care rounds on intensive care wards.
We caught up with clinical director, Joe McQuillan (JM) and Joanna Dick (JD), specialty registrar in special care dentistry, about their team’s work in critical care and beyond.
How did your mouth care rounds begin?
JM: “Our dental nurses were redeployed to support critical care and the wards during the first and second wave of the pandemic. Their response to the call for help was incredible and inspired all the Dental Hospital. Our dental core trainees were redeployed to healthcare support worker roles on The Queen Elizabeth Unit and have been amazing in taking this step.
“Our dental consultants and registrars were also keen to help and were due to support the critical care units as healthcare support workers. However, as dentists, they were also aware of the oral problem’s patients may develop whilst in critical care.
“Whilst on ventilators, there is the risk that patients may acquire pneumonia from bacteria build up in the mouth, if not cleaned regularly. So, we thought who better to provide dental care than the dental team?”
JD: “During the second wave, dental consultants and registrars stepped up to support critical care and this is when the mouth care rounds started. We were put in contact with Leanne McCarthy and Lynne Barrass, a senior sister and a consultant from ACCU, and we started to work together.
“As dentists we are used to looking inside the mouth of patients, however our patients are usually awake and relatively fit and healthy – unlike those being treated in intensive care. Sister Leanne was fantastic in helping us to understand the equipment used in critical care, tubes we should be mindful of and issues we should raise with the nurses if we were concerned. It was a great a collaboration between both of our teams.”
JM: “Joanna and Leanne were instrumental in starting these mouth care rounds; they created a care trolley, disseminated training and took the lead when troubleshooting – thank you from all of us.”
Take us through what happens on a daily mouth care round.
JD: “Firstly, we check the status of the patient and if they have a difficult airway. It is important we know how the patient is doing before we begin.
“Once the initial checks are complete, we begin brushing and suctioning around the mouth and teeth. We also use sponges, antibacterial mouthwash and suction the back of the throat; all of this helps prevent the build-up of bacteria.
“Many of the patients we look after were critically ill with Covid-19 and acquiring an additional respiratory infection could result in further complications. The work we do helps to prevent this.”
JM: “Dental disease is quite prevalent in our community and some of our patients present with poor dental care, but since our rounds have begun, we have seen an improvement in dental health. As we’re cleaning and examining a patient’s mouth each day, we’re picking up fewer dental problems, and if we do spot any issues, we can treat them earlier.”
What other things have the dental team done to support the pandemic response?
JM: “During the first wave of the pandemic dentistry nationally was paused and we were only treating emergency patients so many of our team were redeployed across The Royal London – supporting maternity services, stores, wards, critical care, A&E and many others.
“Our dental nurses have been working 12 hour shifts as healthcare support workers on the intensive care units. The jump from outpatient dental nurse to working on critical care is huge, the team have really stepped up to the plate and we are really proud of them. They have been incredible.”
JD: “Our support doesn’t stop at brushing teeth; if patients on critical care require any teeth extracting, this is something we help with too.
“We also care for patients on high flow oxygen. It is nice to see patients who were previously intubated on critical care, awake and getting better. We help them brush their teeth and educate them on dental care once they have left hospital.”
JM: “We also opened up a dental clinic for Barts Health staff. Our staff are working really hard, and we wanted to do something to help with their self-care. In the first weekend we received nearly 90 appointment requests.”
And finally, how were your experiences of working in intensive care?
JM: “At times, we did feel out of our depth, but personally seeing the intensive care nurses’ work was incredible – I can’t speak more highly of them. They are so calm, supportive, welcoming, and they were very appreciative of our help. Knowing that we are contributing in a small way, means a lot to us.”
JD: “In the first and second wave all we wanted to do was help, and we could see that the situation was deteriorating on the news. Our dental work takes one job away from an intensive care nurse, that’s more time that can be spent looking after the more specialist needs of a patient.”
JM: “There was a big moral call from all of us – stepping up to critical care was the right thing to do. Caring for patients is the centre of everything we do in the NHS, regardless of specialty.”
