Managing medical complexity in the dental chair | BDJ Team

BDJ Team volume 12, pages 245–246 (2025)Cite this article

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Emma Slade-Jones unveils new British Society of Dental Hygiene and Therapy (BSDHT) guidance to help oral healthcare teams respond to the clinical challenges of medically complex patients.

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From cancer treatment and antibiotic prophylaxis to managing anticoagulants, pacemakers, and even cold sores, medical conditions frequently influence decisions around personal care planning. Recognising these varied and often complex scenarios, the British Society of Dental Hygiene and Therapy's new guidance, ‘Medical Conditions That May Impact Dental Appointments', brings together essential considerations in one accessible resource.

It aims to support clinicians with clear, practical advice across common areas of uncertainty, while encouraging a holistic, individualised approach to care. The guidance also reinforces the importance of interprofessional communication, thorough documentation, and proactive patient education, all of which contribute to safe and effective personalised care planning.

Among the topics covered, the guidance explores how cancer treatment can affect oral health and dental care planning. Dental professionals are encouraged to work closely with oncology teams to understand the timing and effects of therapies such as chemotherapy or radiotherapy, which may influence whether and when oral and dental care can proceed.

Clear guidance from oncology teams about appropriate timings for dental treatment can help bridge the gap between secondary and primary care, ensuring that oral healthcare teams are well-informed and aligned. Assessment appointments should be prioritised post-diagnosis and before treatment begins to ensure patients do not miss opportunities for preventive care.

Personal experience has shown how easily oral health advice from medical teams can differ from dental recommendations. When my mum was undergoing breast cancer treatment, she was advised to drink squash regularly for dry mouth and use chlorhexidine mouthwash twice a day. As a dental hygienist, I found this surprising and offered alternative guidance.

While communication between disciplines has certainly improved in recent years, the experience highlighted for me just how important it is that patients receive consistent, evidence-based advice. It also reinforced the value of dental professionals contributing confidently to those wider conversations.

Cancer care is just one example of how wider health issues can shape oral health outcomes and influence day-to-day hygiene routines. Medical conditions do not always directly contraindicate dental treatment, but they can significantly affect a patient's ability to maintain oral hygiene.

Stroke is one example that can result in long-term challenges with swallowing, speech, and manual dexterity, all of which make routine hygiene more difficult to manage independently. This issue becomes even more apparent in supported living or residential care settings, where competing care needs can lead to oral health being deprioritised.

In one family experience, oral hygiene was clearly included in a stroke survivor's care plan, yet daily toothbrushing was often missed. It is a scenario that reflects a wider systemic challenge and highlights the need for improved integration between dental guidance and day-to-day care delivery.

Medication adds another layer of complexity. For patients taking anticoagulants such as warfarin, apixaban or rivaroxaban, careful planning is essential. Blood INR (international normalised ratio) levels must be checked for those on warfarin. Other anticoagulants require risk assessment based on current clinical guidelines. The Scottish Dental Clinical Effectiveness Programme (SDCEP) is highlighted as a helpful reference point for managing these decisions.

Closely related is the issue of antibiotic prophylaxis, which remains a challenging area for many clinicians. The BSDHT's guidance offers a practical framework that considers the invasiveness of the planned treatment, such as extractions or subgingival periodontal therapy, the patient's medical history, including immunosuppression or previous endocarditis, and the latest recommendations from the National Institute for Health and Care Excellence (NICE). In all cases, shared decision-making and thorough documentation are key.

A brief conversation, some oral hygiene advice, or simply showing care and presence can make a meaningful difference, particularly for those going through challenging health circumstances.

Another area where oral healthcare teams may face pressure to make quick decisions is in managing patients with active cold sores. While strict infection control is routine, guidance states that elective treatment should still be deferred until lesions are fully healed to prevent discomfort and reduce the risk of viral spread. The BSDHT encourages dental professionals to exercise their judgement while keeping health risks front of mind, recognising that while cancellations may be inconvenient, the wellbeing of both patients and the oral healthcare team must come first.

Preventive communication can ease much of this complexity. The guidance includes a clinic poster to help patients and caregivers understand how their health may affect dental treatment. Whether it is avoiding appointments during cold sore outbreaks or ensuring INR levels are checked beforehand, giving patients this knowledge upfront supports smoother planning.

Even when treatment is postponed, these moments can be turned into positive interactions. A brief conversation, some oral hygiene advice, or simply showing care and presence can make a meaningful difference, particularly for those going through challenging health circumstances.

This guidance represents a collaborative effort, shaped by contributions from experienced professionals across the sector. Special thanks go to Joss Harding for her insight into cancer care pathways.

As new questions arise and evidence evolves, the resource will be updated, but its purpose remains the same - to support oral healthcare teams in managing medical complexity with clarity, confidence and compassion.

For practical guidance and resources to support your clinical decision-making, visit https://members.bsdht.org.uk/resources/83/medical-conditions-that-may-impact-dental-appointments.

Emma Slade-Jones is a dental hygienist, accredited coach, and author of the newly published BSDHT Guidance Sheet, ‘Medical Conditions That May Impact Dental Appointments'. With experience across clinical, academic, and quality assurance roles, she has a special interest in career development, wellbeing, and work-life balance for dental professionals.

Dental hygienist, Accredited coach, UK

Emma Slade-Jones

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Slade-Jones, E. Managing medical complexity in the dental chair. BDJ Team 12, 245–246 (2025). https://doi.org/10.1038/s41407-025-2995-x

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Published: 16 May 2025

Issue Date: 16 May 2025

DOI: https://doi.org/10.1038/s41407-025-2995-x

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