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Table 3 Vignettes (based on observation data)

From: Domiciliary dentistry clinics: a multiple case study in the province of Quebec, Canada

Vignette 1

The dentist had a follow-up appointment with a 94-year-old patient with Alzheimer’s who resided in a LTCF. From previous encounters, the dentist was aware of the patient’s tendency for aggressive behavior (ex. biting). The patient’s daughter booked the appointment directly with the mobile clinic’s manager; the latter then called the residence staff to relay the dentist’s instruction to give the patient a small dose of tranquilizer prior to the scheduled visita. The patient’s daughter was not present at this appointment. Under medication, the patient was unable to engage verbally with the dentist and appeared in a light sleep. The dentist used non-verbal sensory stimulation to communicate certain commands (for example, applying slight pressure behind the corners of the lips to ask her to open the mouth). After completing the appointment, the dentist called the patient’s daughter to give her an update. He also wrote an update in the patient’s file at the center and then sent an electronic update to his clinic’s manager.

Vignette 2

Another patient in a LTCF was refusing to interact with the dental team. She turned her head away every time the dentist tried to approach and explain that the appointment was planned by her son. “My son did not tell me about this” the patient exclaimed repeatedly. The dentist tried to comfort her and asked if she would like to speak to her son to confirm that he had scheduled the appointment. The dentist used her own cell-phone and put the son on speaker to comfort his mother. The patient, relieved by hearing her son’s voice asked him repeatedly to “stay” with her. The dentist placed the phone near the patient’s bed and assured the patient that her son could stay with them for the entire session. Hearing the voice of her son comforted this person and allowed the dentist to perform the treatment (dental filling).

  1. aNote: some dentists in this study were not in favor of medicating patients and preferred them to remain aware of their presence and what they were doing. When attempts to gain patient’s collaboration fail, they preferred to stop and to reschedule the appointment for a different day.