Priority on residents’ oral health lacking
More oral care time plus appropriate education and skills training could help turn around the poor oral health of aged care residents, says an expert.
People working in aged care have an important role to play in improving the poor oral health of aged care residents, an aged care dentist has told Australian Ageing Agenda.
Aged care homes are required to support the daily management of a resident’s oral health as part of obligations under the aged care quality standards.
Its inclusion is one of the few recommendations of the royal commission related to improving the oral health of older people that has been implemented. But problems remain country wide.
The oral health of aged care residents across Australia in general is extremely poor, said Australian Dental Association spokesperson Dr Mark Wotherspoon.
“City, suburban, rural and remote, all locations have staggering levels of mouth diseases that impact function, such as eating and speaking, comfort and dignity, including aesthetics and bad breath,” Dr Wotherspoon told AAA.
“One Australian study found over 70 per cent of residents with natural teeth had active tooth decay and around half had moderate to severe periodontitis [gum infection]. Oral thrush was very common under dentures that were not being cleaned, sometimes ever, or stored correctly. Many residents are living for months and months without have their teeth or dentures brushed.”
Among the causes is a lack of priority on the frontline, said Dr Wotherspoon – who is raising awareness of the situation as part of Dental Health Week.
He points to a 2011 Norwegian study that found resistant behaviour is a major barrier to the prioritisation of oral health in residential aged care. The study found nurses’ education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients were important factors in overcoming the barriers.
“In my experience these same factors are relevant to Australia. I am confident that if more oral care time could be ‘found’ along with appropriate education and skills training for doctors, nurses and care staff then oral health would be prioritised similar to other aspects of personal hygiene,” said Dr Wotherspoon –who conducts hands-on skills workshops at aged care facilities and TAFE NSW.
On improving the oral health of aged care residents today, Dr Wotherspoon stressed the need to take responsibility and work as a team.
“Like so many aspects of resident care – oral health is also the responsibility of everyone who engages with and supports health and wellbeing,” he said. Residents, family members, doctors, nurses, care staff, oral health professionals and other all allied health professionals need to work together led by dentists and dental specialists, he added.
“There firstly needs to be an immediate acknowledgement that the current standard of oral health is very poor, needs to change and is impacting general health, oral health and function and therefore negatively impacting quality of life and dignity,” Dr Wotherspoon said.
“Although the proven science directly links periodontal [gum] infections and poor oral hygiene to many general health conditions such as uncontrolled diabetes, cardiovascular diseases and dementia, at the very least aged care workers need to be aware that the mouth is the gateway to the lungs and that lack of oral care has been proven to directly contribute to aspiration pneumonia and death.
“Please, at the very least, all care staff need to look in the mouth, complete a basic oral health assessment – ideally using the Oral Health Assessment Tool – and then promote and motivate residents to maintain good daily dental hygiene, assist when required – and seek the necessary training if skills are lacking – and refer any concerns to management and or a dental professional for advice or treatment.”
Resources
Free science-based resources available online include:
- SA Health’s Better Oral Health in Residential Care Staff Portfolio
- Oral Health Care for Older People in NSW:
- Aged Care Quality & Safety Commission
- Supporting daily oral health care in residential aged care: provider fact sheet and staff fact sheet
- KNOW, LOOK, ACT: Recognising and responding to oral health issues in aged care provider fact sheet and oral pain aged care staff poster.
Dr Wotherspoon reiterated the value of training.
“Hands on practical skills training for staff is also very important… and can be provided by your local dental professional.”
Dental Health Week is the Australian Dental Association’s annual oral health campaign and this year runs from August 5-11 and is focused on gum health
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