Oral care matters even more in a pandemic, say experts

Nurses play a critical role in preventing oral disease and COVID-related complications, writes Vandana Bhagat.

COVID-19 has uncovered the many deficiencies that exist in the Australian health system, particularly regarding the oral health of older people in residential care.

Dental professionals were required to limit dental care to urgent and emergency procedures due to infection risks associated with several aerosol-generated dental procedures and the shortage of personal protective equipment. But out of such challenges come opportunities and recognition of the important role of nurses. 

Oral health is essential to healthy ageing and nurses can take a proactive and leading role in oral health promotion in residential aged care as well as community and hospital settings. Nurses build trust through their dedicated and courageous service, especially in the uncertain times we all are witnessing in this pandemic.

Nurses can help in aligning oral health delivery as part of general health services. Nurses can screen oral health and assess the need for referral to a dental professional. Nurses can educate family members and caregivers in providing routine oral health care. Nurses can facilitate tele-dentistry to enable remote dental counselling for older people who are unable to attend an oral health facility and evaluate the need for emergency dental treatment.

Nurses understand the pain that many older people who have cognitive impairment, dementia or hearing or visual difficulties experience and may not be able to communicate, especially when such pain is related to oral health.

Aged care communities have become hotspots for COVID-19. Aged care residents are the highest risk group because of their frequent chronic health conditions, multi-morbidities, and weakened immune system.

Many older people are prescribed multiple medications and such needed medications can decrease saliva, drying the mouth and increasing the risk of oral disease, triggering further nutritional and general health problems. The potential oral side-effects of complex pharmacology used to manage complications arising from COVID-19 cannot be underestimated.

While COVID-19 has a viral origin, many older people with COVID-19 have developed complications due to bacterial superinfections. Poor oral health increases the risk of transferring these pathogenic bacteria to the lungs, compounding the risk of respiratory infections and potential post-viral bacterial complications.

Nurses’ leadership in promoting and maintaining older adults’ oral health may decrease the observed viral shedding period and prevent lengthy hospitalisation. Current evidence supports oral mucosa breakdown as an initial site of entry for the COVID-19 virus and oral symptoms, such as decreased saliva and taste sensation, oral ulcers and related pain might be early symptoms of COVID-19.

These complications are also consequences of needed ventilation and effective daily oral care is essential to prevent the accumulation of pathogenic bacteria in the mouth.

As on-site services by dentists and oral health therapists are rare in residential care, nurses have a leading role in maintaining residents’ oral health. Nurses can ensure effective daily oral care and ongoing collaboration with dental, medical, and allied health professionals.

There is concern by some that toothbrushing is an aerosolising activity and therefore should be stopped during a virus pandemic such as COVID-19. This is not true. Older people must have their teeth and dentures cleaned effectively at least once a day. 

Oral health care remains an under-recognised priority by residential aged care policymakers in Australia, possibly due to underestimation of the importance of oral health in primary and preventive health care.

The COVID-19 pandemic has identified the urgent need to design effective and affordable oral health services integrated into general health programs to improve the quality of life of older people. Nurses need to be at the forefront in facilitating effective preventive, interprofessional and holistic care to maintain the oral and general health of aged care residents.    

Now, more than ever, oral care matters to prevent oral disease and COVID-19 complications among aged care residents. There is a need to ensure that preventive oral health care reaches all older Australians and to recognise the vital role nurses can play.

Vandana Bhagat is a PhD candidate at the Centre for Rural Health at University of Tasmania. Her supervisors Associate Professor Lynette Goldberg, Dr Ha Hoang and Adjunct Professor Leonard Crocombe contributed to this article.

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