The residential aged care environment is like no other, residents enter requiring assistance with their daily care needs and that often includes daily oral hygiene care.
That sounds simple enough, grab a toothbrush and toothpaste, hand it to the resident and that jobs done.
However, many residents have a cognitive impairment, Alzheimer’s Disease or Dementia and lose the ability to manage tasks like toothbrushing, tasks that most of us consider second nature.
Many of us are not great at cleaning our own teeth, imagine how difficult it can be to brush someone else’s teeth, especially if their cognitive state is declining.
A lack of regular oral hygiene care can very quickly result in pain, infection, swelling, aspirational pneumonia; and at times, can contribute to hospitalisation.
What is needed is a change in the way oral hygiene care and dental care is viewed, it must be part of general health care and is as important for residents as showering, eating, toileting.
The residents deserve a ‘quality of life’ that includes the ability to eat, drink, speak, smile without pain or discomfort and they deserve services to manage dental issues in a timely and appropriate way, both on-site in the facilities and if they are able; access to safe and supportive dental practices that are close to their facility.
Community involvement from the dental profession is important to ensure the residents can access dental treatment regularly and quickly and so it’s very important for the Facilities to build relationships with dental practitioners nearby.
There are two important and necessary parts to improving and managing oral health in Residential Aged Care Facilities (RACF), they are daily preventive oral health care and then clinical dental access and treatment care.
To ensure the residents have regular oral hygiene care, the care staff need to be educated to manage daily oral hygiene care routines, including tooth brushing, denture cleaning and the ability to recognise dental issues, before they become dental emergencies.
An on-site dental practitioner (such as an oral health therapist or dental hygiene) can provide education sessions for staff and can assist in conducting oral health risk assessments, developing oral health care plans for all residents and can establishing referral pathways from the RACF to local dentists and dental prosthetists to ensure complex dental needs are managed quickly.
In a perfect world, all RACF would have a dental practitioner visiting regularly and working with the RACF multidisciplinary team to ensure oral health is considered holistically in the resident’s daily care.
Having a small dental surgery on-site to encourage all dental practitioners to provide care at the RACF, is the stuff that dental professionals dream of, if we have hairdressing salons, surely, we can manage a small dental surgery.
Currently, in RACF, residents will manage their own daily oral hygiene until they can’t, RACF staff will try to assist when they can, and when that becomes impossible, residents become uncomfortable with mouths that will have plaque, food debris, ulcers, thrush, dental decay and dental pathology that is often unseen until it becomes an emergency.
These are the existing gaps in the RACF system as far as oral hygiene care and dental care is concerned.
The recommendations from the Royal Commission into Aged Care are out this week, it’s timely to again re-visit the need to included dental practitioners as part of holistic care for our fragile and elderly.
Without funding and a paradigm shift to include dental professionals in this environment, nothing will change.
The recommendations will be many, many are needed to improve the RACF environment, lets hope dental care has been included.
Care workers have a multitude of tasks that must be completed daily, most of these cares are documented, like feeding, showering, toileting, but not so for oral hygiene care.
To ensure daily oral hygiene care is managed care staff can link oral hygiene care with other tasks, such as showering, to ensure it’s not forgotten.
Making sure residents have access to soft, clean toothbrushes that are stored in a place where they can dry and where no one else can use them, fluoride toothpaste, products for dry mouths and a ‘watchful eye’ to see if residents have difficulty swallowing, chewing or biting food, which may result in medical complications and poor quality of life.
Difficulties assisting residents with oral hygiene care should be investigated. if the resident is resisting the toothbrush, there may be a very good reason, if in doubt contact a dental practitioner.
Check out this website for some helpful oral health education tools www.seniorsmiles.org.au
The dental team consists of various dental practitioners with various skill sets, knowledge, and expertise to be able to provide all aspects of care in the RACF environment.
These include dental specialists, dentists, oral health therapists, dental prosthetists, dental therapists, dental hygienists, and dental nurses.
It takes a dental team to care for the complex dental needs of our frail and elderly in RACF, and this teamwork will see better oral health and better quality of life for the residents and they deserve that!
Great article Dr Wallace.
Very timely