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With an ageing population, the importance of good dental care for those in aged care facilities has become a priority. By Lynne Testoni
There has been a huge focus on aged care in Australia recently, particularly after the Royal Commission into Aged Care Quality and Safety, but the issue of dental care for residents of aged care facilities has not always received the attention it deserves.
A paper in the Australian Dental Journal, ‘Improving the oral health of frail and functionally dependent elderly’ (Lewis et al, 2015), discusses the government endorsement of a national evidence-based oral health model when it introduced the first Nursing Home Oral and Dental Health Plan in 2010.
According to the paper, this model was called Better Oral Health in Residential Care, and promoted a multidisciplinary approach with doctors, nurses, careworkers and dental professionals sharing responsibility for the four key processes of oral health screening, oral health care planning, daily oral hygiene and access to dental treatment.
The model suggested treating frail and dependent residents onsite, encouraging an aged care/dental partnership to facilitate the use of portable dental equipment in the delivery of dental care.
Another paper in the Australian Dental Journal notes that today’s elderly often have more teeth than previous generations due to better oral health education and water fluoridation in many parts of Australia since the 1960s.
This paper comments that, “we now find many 50-year-olds who had access to fluoridated water in their formative years have had a negligible number of carious lesions and many 80- and 90-year-olds have a functional dentition”.
It’s a multidisciplinary approach towards dental care that has been adopted by the NSW-based Montefiore aged care facilities.
The Montefiore experience
Oral health therapist at Montefiore, Erin Brown, says that the importance of good oral health care cannot be underestimated. She says that it is a vital part of the quality of life experienced by all their residents for a number of reasons.
“Good oral health obviously enables the residents to be able to eat a big variety of foods,” she says, “which makes a difference to their overall health.
“It facilitates confidence as well, which is really important. If you’re feeling confident, you want to go to social activities and so on, which makes a big difference to their mental health.
“It’s also important because the bacteria in decay and gum disease can contribute to other systemic manifestations, including stroke, dementia, heart disease and pneumonia. Active infections can cause behavioral changes similar to a UTI.”
Brown works as on-staff oral health therapist at Montefiore, supported by three dentists, and one dental prosthetist.
“Basically, we manage all of the preventative treatments for the residents. So we see them for their check-ups and cleans, maintain their gum health, and go over all health and oral hygiene instruction with them,” she explains.
“And then I train the nursing staff and the assistants in nursing on oral hygiene and things such as tooth brushing instruction, and how to assist residents who may be resistant to oral care, which sometimes happens with residents with cognitive decline.
“The team of dentists come in and see residents for their exams, or if they need fillings or any of that type of work as well. The dental prosthetist visits regularly and he does dentures.”
Brown says that roles like hers at Montefiore are rare in the aged care industry, but feels it is the way of the future. “I’m onsite full time, which is lucky because at Montefiore, the majority of our allied health team are employed by Montefiore and we get that continuity of care,” she says.
“So if I want to liaise with a dietitian about something diet related, or an OT about something a resident might be struggling with, such as how to hold a toothbrush, we can modify things to help them. It’s really multidisciplinary, which is quite rare. And we have an onsite dental clinic as well.”
The Montefiore dental team has been using a treatment known as silver fluoride, as well, which Brown says is an amazing, preventative treatment for residents.
“It basically stops the decay in its tracks without having to necessarily drill,” she says.
COVID has been a challenging time in aged care and Brown says that the health team has worked hard to help residents in a holistic way.
“It’s obviously hard because we have no visitors able to come in,” she says. “We just have to make sure we’re supporting the residents and their mental health, because our aged care facilities are in lockdown, so residents are unable to see their family. But we do have an amazing staff and social work team, who have been facilitating zooms and online calls. We’ve got a specific engagement and mental health and wellbeing plan that we use to support the residents who are anxious and stressed, which is understandable.”
Brown spent seven years in private practice before joining Montefiore, and says she finds her role in an aged care facility to be incredibly rewarding.
“What I like is that because we’re going into their home, you really build meaningful connections with the residents, because you’re seeing them so often,” she explains.
“They come and say hello to you; they pop in and have a chat. And you work with their families as well. And they’re always really grateful. So you are looking out for them and helping them. Probably the most rewarding thing I find about it is the connections that you make with the residents. It feels like you’re really making a difference in their day-to-day life.”