Scottish Dental

A personalised approach to care

Allowing you to achieve care outcomes that really matter to people

11 February, 2025 / indepth
 Christopher Yule and Deborah Gray*  

Evidence suggests that people who feel they have been listened to in medical consultations are more likely to adhere to treatment and are less likely to regret their treatment choices¹. A personalised approach to dentistry places people at the centre of their care, balancing clinical expertise with patient preference. It is achieved through meaningful conversations and aligns with other pillars of Realistic Dentistry, such as Shared Decision Making². 

The foundations of personalised care

As well as clinical decisions, personalised care requires a deep understanding of each patient’s unique circumstances³. Tools such as ACCESS can allow practitioners to understand patient preferences. They can also be used at various stages in the patient’s journey, acting as prompts before important decisions about their care. The previous article on Shared Decision Making covers the use of the BRAN framework for shared decision making and is useful suggested reading.

Here we describe how the ACCESS tool – Access, Communication, Consent, Education and Special Considerations – can provide a structured framework for understanding each patient’s circumstances⁴.

Access

A vital part of personalised care is recognising and addressing barriers to access. This may be the ability to physically reach a dental clinic or the challenges posed by accessing the patient’s mouth itself. These barriers can stem from physical disabilities, mental illness, cognitive impairment or logistical limitations, such as employment or care commitments. Domiciliary care can be a lifeline for those who are housebound owing to multiple factors. Short and simple appointments and flexible approaches to appointments and treatment planning can make care more manageable.  

Communication and Consent

Patient consent is not merely a legal requirement but an opportunity to build trust and empower individuals to take control of their oral health. Having meaningful discussions with patients and relevant others (in the case of those who may lack capacity for certain decisions) is paramount⁵. The BRAN framework is a crucial tool for these discussions (AOMRC, 2024)⁶. 

Educating patients: setting realistic expectations

Education is a key aspect of personalised dental care. It enables patients to understand their dental condition and encourages ownership of their oral health. This can guide patients towards realistic expectations of what is achievable and appropriate for their individual circumstances⁷. Patient circumstances are likely to change over time, which is why regular assessment and discussion is crucial in delivering the most appropriate care. 

Special considerations for complex patients

Patients who are critically ill, bed-bound, severely frail or those with multiple comorbidities often require tailored dental care that prioritises maintenance and quality of life over extensive intervention. Where the risk of treatment is either too great, or if there is doubt of a patient being able to tolerate invasive work, palliative dentistry and preventing pain may be the main aim. Personalised approaches to care and shared decision making facilitate pragmatic care, ensuring comfort and function where idealistic care planning is not achievable. By integrating these considerations into the treatment planning process, dentistry becomes a collaborative, person-centred practice which can lead to improved clinical outcomes⁸.

The following case studies explore what personalised care can look like in two patient scenarios, using the approaches described above: 

1. Case discussion: accepting retained roots

A 95-year-old lady who was housebound with multiple co-morbidities presented with upper left central and lateral incisor  retained roots. The roots were asymptomatic and demonstrated no clinical or radiographic evidence of infection. The patient was clear that she did not wish any dental extractions. A detailed discussion explained the potential risks of retaining the roots, such as infection or further fracture, alongside the benefits of minimal intervention in light of her frailty and limited access to dental services. Respecting her autonomy and priorities, we agreed on a treatment plan that balanced clinical pragmatism with her personal wishes. An over-denture was constructed to meet her functional and aesthetic needs while aligning with the patient’s wishes and was complemented by tailored prevention.

2. Case discussion: balancing ideal care and patient priorities

A 33-year-old patient presented with symptoms of irreversible pulpitis originating from a lower right premolar. Although clinical and radiographic assessments indicated the tooth could be restored with root canal treatment and extra-coronal restoration, the patient was unwilling to commit to multiple appointments. Citing a busy job, family responsibilities and social constraints, he preferred a quicker solution. 

Applying a patient-centred approach, the BRAN framework was used to ensure he fully understood the benefits and drawbacks of each option and the tooth was extracted. 

Conclusion

Taking a personalised approach to care allows us to achieve outcomes that really matter to people. By understanding patients’ perspectives, we can make more informed clinical decisions. Providing care that patients value can also reduce harmful waste and helps patients to take ownership of their oral care. By embracing each patient’s unique circumstances, dentistry develops beyond standard protocols and becomes person-centred. In doing so, we respect not only the profession’s commitment to excellence, but also the patient’s right to comfort, autonomy and dignity.

*In association with The Realistic Dentistry Group. Christopher Yule is a Specialty Registrar in Special Care Dentistry, NHS Greater Glasgow and Clyde, and Deborah Gray is a Specialist in Special Care Dentistry, NHS Greater Glasgow and Clyde.

Categories: Feature / Magazine