Assisting With Oral Care – One of the Least Liked Tasks

Yesterday my friend rang me asking if I knew of any subsidised dental service her father could access.  He had difficulty eating his meals and didn’t want people seeing his condition so was feeling isolated. He could not afford to pay for private dental treatment and feared he would lose his independence.

Coincidentally, this month’s The Lantern Project meeting was focussed on oral health and the implications for residents and older people with poor oral health.

Dr Archana Pradhan from University of Queensland spoke at the meeting.  She has been providing dental care to people with special needs since 2004 and her research projects include older adults.  She pointed out that if people have ill-fitting dentures, mouth ulceration, painful gums, teeth issues, dry mouth, oral cancer, etc they will have difficulty eating their meals.   Dr Pradhan also pointed out that jaws and face (maxillofacial) fractures are the 3^rd most common trauma after femur and upper limb fractures and can lead to challenges in eating and getting adequate nutrition.

If residents cannot eat their meals properly, there is a risk of malnutrition, pneumonia, hospitalisation and even death.  There is also an association between periodontal disease & diabetes and tooth loss & nutrition.

Causes of oral health issues include:

• Poor oral hygiene
• Use of drugs
• Multiple dietary sugar exposures each day
• Drugs sweetened with sugar or taken with sugary thickened fluids such as honey, yoghurt, jam

Many older Australians are slipping through the dental cracks.  A small review of residents in 2 residential care facilities revealed 63% of poorly nourished residents required dental treatment as well as 33% of those who were considered well nourished.  It was pointed out that many came into a facility with pre-existing oral health issues, which may have impacted on their overall health resulting in earlier transition to residential care than anticipated.  As a consequence, some residents have their diet texture modified rather than have their oral health issues sorted.  This significantly impacts their quality of life.

Some conclusions from Dr Pradham

• Dentists have not had the training in aged care and dementia.
• Students require practical experience to break the stigma of aged care.
• Increase collaboration between dentists, dietitians and speech pathologists.
• A multidisciplinary approach would benefit, to break the silos and treat the person as a whole.
• Include oral health in accreditation standards.
• Lobby to increase access to visiting dental services to our older community where they live.
• Retired and part time “Dental Volunteers” could be trained to go into residential care facilities and just clean the teeth of residents.

When asked what could be done on an everyday basis to improve the quality of life for residents, it was suggested that staff ensured residents had their teeth and mouth cleaned daily including after medication.

This would require support from management and incorporated into the culture of care. Dr Pradhan told the Lantern Project meeting that some staff considered oral health tasks the least liked – even below showering and toileting.  There was also a correlation between value towards their own oral health and the value of others.

The Lantern Project will continue to research the issue of oral health in residential aged care.

Do you have an effective solution/strategy/system/method for improving and maintaining the oral health of your residents? We would love to hear more.