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  • Writer's pictureDr. James Main

Three things you'll enjoy until you last days

In a recent in depth review of oral health care provision from the Care Quality Commission(CQC), it found that:

The majority (52%) of care homes visited had no policy to promote or protect people’s oral health.

Nearly half(47%) of care homes were not providing any staff training to support people’s daily oral healthcare

Whilst two thirds(67%) of care homes claim residents could always or nearly always access NHS dental care, the CQC report claims there is a lack of dentists able or willing to visit care homes.

Now let me tell you about David.

David was a patient that I had been seeing for many years, his teeth had been falling apart for much of his life and he had a number of bridges and crowns that were failing. David first became my patient when he was about 75 and I had tried hard to convince David to get his teeth sorted out because I knew if David became too infirm to come in to see me or was put in a care home, his teeth could not be regularly patched up and they would fall apart and he would be unable to eat. Despite me asking David every 6 months to have something more permanent done, David’s reply was

“I will be dead before my teeth fall apart”.

Sure enough, one day David called me to let me know that had been diagnosed with terminal cancer and that he had been given 6 months to live and to not send him any reminder appointments. Obviously, I felt very sad for David and wished him luck with his cancer treatment and said that we will take him off our recall system. I then thought “David was right about him dying before his teeth gave up”.

Surprisingly, about 18 months later David called me again, I was of course delighted to hear he was alive and more delighted to hear that the cancer treatment went well for him. Except David said “All my teeth have fallen out and I cannot eat anything not even my favourite meal, Lasagne!”

By this time David was about 82 and having gone through the full raft of cancer therapy. With this in mind, my first thought was to do as little as possible to allow him to eat, so I decided to make David a full upper denture and a full lower denture that was held in by a couple of implants. I thought that this would allow David to eat whilst doing the least amount of treatment for him.

However, in less than a month David came back to let me know that he was almost no better than he was before and still could not eat his meals including Lasagne. It was then I realised that at 82, David had never had dentures in his life and that to give somebody at that stage in their lives a new prosthesis is no different to losing a leg and having to cope with a prosthetic one. At that point I realised that I had to give David fixed teeth. So at the age of 82 going onto 83 I placed 4 implants his upper jaw and another 2 implants in his lower jaw and gave David 2 fixed bridges.

The day I fitted them, David was very happy and was able to eat his food including his beloved Lasagne.

The twist in the tale is that a week after fitting his bridges David became housebound and was no longer able to attend the practice. If David had left the treatment for his fixed bridges a little later, he would have ended his last days eating mush. Instead I knew from other patients that lived near David that he was still able to eat happily, probably until the day he died as this was about 10 years ago.

What keeps me awake at night is thinking about all those Davids that are having their teeth patched up every 6 months not realising that at the time they really need them and they are in a care home or unable to get in to see a dentist like me, their quality of life will be very poor.

You see there are 3 things that you will enjoy until your last days, breathing – otherwise you will be dead, drinking – this tends to get less exciting as you get older and finally eating – this is a great pleasure enjoyed until your dying breath, BUT only if you have teeth to eat with.

If you think you could be a David or Davina you should contact me before it is too late.


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