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IMPROVING ORAL HEALTH CARE IN AGED CARE WHY IS ORAL HYGIENE AN ISSUE FOR PEOPLE LIVING IN CARE HOMES?
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ersonal and oral hygiene’ was the third highest issue for complaints in the Aged Care Quality and Safety Commission’s Performance Report for the residential care sector from April to June 2021. It ranked higher than falls prevention, post fall management and food catering. The reasons why oral health care is an important issue for people receiving care, for their families and for registered and nonregistered staff who assist with oral hygiene, are multi-faceted. With Australians living longer and as more people are retaining their natural teeth, many persons enter a care home with years, and sometimes decades, of dental neglect. Dental practitioners recommend regular check-ups every six months to two years; for vulnerable or frail older persons, every three months may be more appropriate. And denture wearers are advised to have their dentures checked, relined or replaced every two to five years. But many older Australians delay these check-ups. Oral health care or dental treatment is not like other parts of the health system. For adults, oral health care is not part of Medicare (except for Veterans’ Affairs), aged care, home care or disability care. Most dentistry (85 per cent) is provided in the private sector in Australia and most of these services are supported through private health insurance. While there is a safety net for eligible older persons (those with a health care card, pensioner concession card, commonwealth health seniors’ card or state seniors’ card), public waiting lists have exploded to one to four years in some states and areas, largely due to disruptions caused by COVID-19.
In residential aged care, dental services are defined as a ‘restricted dental act’ whereby only registered dental practitioners can provide diagnostic, treatment and preventive services for patients. This demarcation sets up a situation where other registered and non-registered health practitioners (except for doctors) cannot diagnose tooth decay and periodontal diseases, cannot treat these conditions, and cannot prescribe and apply preventive products or medicaments. This places nurses and carers in a very difficult position as they can only provide general ‘mouthcare’ or ‘oral hygiene’ services—something that should be made clearer to residents and family members.
When there is this insight, it is usually up to a partner or family member to organise dental appointments and provide the transport to and from the private or public dental provider. However, this can also present Dental practitioners Leonie Short and April van den Elsen from Seniors Dental challenges, as it Care Australia are making a difference can be complicated in the lives of older people. and costly for adult children who live a long way away from their parent who is living in care, to make the necessary arrangements. Poor oral health affects a person’s quality of life and can lead to potentially preventable hospitalisations and deaths from aspiration pneumonia and infective endocarditis. Mouths with broken teeth, rotting teeth, infected gums and ill-fitting dentures adversely affect people in terms of lower selfesteem, less effective eating and swallowing, ability to speak, and willingness to smile. These are all reasons to reform the system. In the meantime, there are many dental practitioners who are willing and able to assist with oral health care in aged care, home care and disability care settings. They can provide oral health care training for nurses and carers; advice to recipients of care; and clinical referral pathways for dental treatment onsite, off-site or virtual. By working together for the benefit of the person receiving care, we can improve oral health care for older Australians. Leonie M. Short is Owner and Director, Seniors Dental Care Australia. For more information visit www.seniorsdentalcareaustralia.com.au
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