“Swelling, pain, infection, pneumonia”: The heartbreaking toll of dental care neglect in aged care

Elderly woman ashamed of her teeth

“Despite the royal commission recommendations, oral health is still not considered part of general health care for our elderly,” she wrote. 

The situation is “heartbreaking”, she added.

HelloCare reached out to Wallace after seeing her post, and in a follow-up series of emails, Wallace told us “our frail and elderly deserve better”. 

Poor dental care can cost vulnerable older people their lives, she said.

When dental health is neglected, residents can experience “swelling, pain, infection, or – as a result of bacteria on their teeth and in their mouths – they may get aspiration pneumonia [when bacteria is inhaled into their airways],” Wallace explained. 

Community Home Australia’s Managing Director, Dr Rodney Jilek, told HelloCare that poor dental care has significant ramifications for aged care residents, “from pain through to a complete inability to eat”. 

Dr Jilek continued, “This often results in poor nutritional intake, which then results in poor health outcomes, weight loss, lack of energy and poor wound healing.”

In recognition of the seriousness of the issue, the royal commission made two recommendations in relation to dental care. 

Recommendation 38 related to the inclusion of allied health, including an oral health practitioner in residential aged care to provide care “appropriate to each person’s needs”.

Recommendation 65 related to the establishment of a new ‘Senior Dental Benefits Scheme’, which would allow Pension Concession Card holders over the age of 65 and Commonwealth Seniors Card holders access to subsidised public or private dental treatment every two years.  

Oral health practitioners in every home

Recommendation 38, which required that aged care providers engage at least one oral health practitioner in every aged care home, would involve “integrating oral health into general health care for the residents,” said Wallace. 

An on-site oral health practitioner would help residents and staff with daily oral hygiene care. Their role would be to provide oral health risk assessments, develop oral health care plans, provide education and guidance, and to set up referrals for local practitioners for timely dental care. 

“It would also mean that oral health/dental problems can be identified quickly and that the residents can be referred for necessary dental treatment in a timely manner, rather than when it becomes an emergency.” 

This model is based on the Senior Smiles program, which was presented to the royal commission, and is behind the oral health component of the royal commission’s allied health recommendation. 

A trial of Senior Smiles found that regular assessment of residents and the development of care plans led to a significant reduction in general health care costs.

“Funding for this model … would integrate oral health into general health care for our residents,” said Wallace.

Ongoing, regular assessment

The SDBS could be used to pay for assessments prior to entering residential aged care facilities and then on a regular basis thereafter, Wallace said. 

The funding would enable private dental practitioners to provide dental care to these concession card holders, and enable older people to access public dental services. 

“It would share the load and ensure our most vulnerable can access dental care when needed. 

“I totally support [the SDBS],” Wallace wrote.

Dental practitioners in aged care homes

Wallace, who herself worked in public dental services for years, said the public system treats emergencies well, but general dental treatment usually involves a waitlist. The ideal situation is for dental practitioners to have their consultations within the aged care home.

“Having the dental practitioner visit the RACF to provide on-site treatment is a really good option, the SDBS would enable this service,” she said.

“With a SDBS, our aged care residents would have access to dental treatment regularly, without having to wait until an emergency situation developed.”

Wallace added “leaving the RACF for some residents can be challenging” due to physical challenges, cognitive impairment and transport.

Dr Jilek said staffing levels in traditional aged care homes simply do not allow for individual staff to take a resident to the dentist one-on-one.

Oral health and dementia

Dementia poses a particular challenge to dental care in residential aged care. 

It’s estimated that 54% of aged care residents are living with dementia, however, the real figure is likely to be higher as many residents are never officially diagnosed with the condition. 

“Managing daily oral hygiene care is challenging [in residential aged care], especially for residents with cognitive impairment,” said Wallace.

Aged care residents living with dementia may be unable to verbalise oral or dental pain or other symptoms, said Wallace. 

For aged care residents unable to communicate if they have a toothache or dry mouth, their quality of life is “detrimentally affected”.

Prevention is the key

Leading Age Services Australia CEO, Sean Rooney, also “strongly supports” the establishment of a SDBS and outreach programs by oral health practitioners into residential aged care “as a priority”.

 “There is a range of research which establishes that good oral health is a key indicator of general health,” he told HelloCare.

Older people living in residential aged care are particularly vulnerable because they have higher oral health needs and limited access to dental care, Rooney said.

“Preventative oral health treatment will enable many older Australians in residential care to keep their own teeth for longer, to have access to a variety of nutritious foods, and to have an overall improved quality of life,” he said.

Oral health care is an essential part of care, “not an add-on luxury,” says Wallace. 

Every resident should – at least – have access to the medical and dental care they were able to access before entering residential aged care, she believes. 

“Anything less, in my opinion, is unacceptable.”

The Department of Health issued a statement saying the federal government “acknowledges the issue of oral health care for older Australians is a complex and important issue”. 

It said it is “taking the necessary time to consider the matter in full”.  

“The delivery of adult public dental services is currently a state and territory responsibility,” the statement said.

The government funds the Federation Funding Agreement, which enables states and territories to provide services to 180,000 public dental patients, funds dental care through hospitals, emergency departments, and community health settings, and through private health insurance rebates.

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  1. Oral and dental care and hygiene is important, but it can be very difficult to have a dentist visit a facility, not all residents can be taken out to a dental surgery, difficult access, cognitive decline and long waiting lists for government provided services all play a part. Good dental care needs to start in childhood – school dental services seem to have disappeared in my area and dental visits are expensive.
    I have felt strongly that basic dental care should be added to Medicare so everyone could access annual dental checks and preventative management. It is proven that poor dental health causes heart disease as well as the conditions listed in the article.

  2. This is not only an issue for Aged Care Residents. it is an issue for many aged people still living in the community who may not be able to afford to attend a dentist.
    Despite the Government spending money on running courses for Aged Care Staff /Carers on the importance of oral hygiene and the need sometimes for follow up care by a dentist a few years ago, there seems to be few choices for people who do need dental care. and are on a limited income. The public system is totally inadequate. I lived in a council area where as part of their community health they provided dental care, and although there was a waiting list in the case of severe dental problems they always kept an appointment blank daily for emergencies. I now live in a different area and here the community health services do not include any dental care.

  3. The basic problem is that dental care is too expensive and it has become a luxury for the few rather than a basic right for all Australians. Dental care should be funded under Medicare and more funding has to go into public dentistry. There is actually an over supply of Dentists in the cities and an under supply in regional areas. Something needs to be done to fix this problem because vulnerable groups in general live in poorer areas and this is exactly where care is needed the most.

  4. It amazes me how our federal government can find millions of dollars for businesses to give them a kick start and billions for Emissions Targets and so much more but cannot fund enough physios and dentists who specialize in people who are elderly. They have alot of behavior issues as well so some dentists would probably stay far away especially when someone has dementia. Even after hr doctors are almost impossible to get when you need them some often never turn up! I have seen the worst cases of bad oral hygiene and will gently clean my resident’s teeth and around their gums and finish up with a sponge tip applicator. You have to be careful incase they bit you and the toothbrush. Sad state of affairs. We live in an ageist world where we segregate our elderly from society in places that are like jails and not hardly enough staff to take them out or spend ti.e walking them but since there are only tiny footpaths with gates at both ends it is a travesty of no thought to how they design residential facilities.

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