clinical focus
Protecting the pearly whites
How has oral health fallen behind
toenail and hair cutting for older
Australians?
By Kathleen Matthews
G
ood oral health is an intrinsic part
of overall wellbeing for people
of all ages, but it’s particularly
important for Australia’s elderly population.
Poor oral health can impact quality of
life and contribute to life-threatening
conditions such as malnutrition and
pneumonia. This is distressing for families
and contributes to an avoidable drain on
Australian health resources.
Many older adults, particularly those in
care homes, have increased vulnerability to
oral diseases. Factors contributing to this
include multiple medications, significant
limitations in mobility, marked diet changes
and limits in ability to perform personal
hygiene measures.
In Australian residential aged care
homes (RACFs) there is no priority to clean
residents’ teeth or offer access to dental
treatment. It’s commonplace for residents
to go days and even weeks without
34 agedcareinsite.com.au
having their teeth or dentures cleaned.
Medicare rightly funds a person having
professional foot care four times a year
to aid mobility and reduce the risk of falls,
but there is nothing for dental professional
assessment or care.
In some RACFs providing access to
dental healthcare, dental practitioners line
up behind podiatrists and hairdressers.
Cutting toenails and hair styling has
become a higher priority than oral health.
The problem is also exacerbated by
the current uncoordinated approach to
providing daily dental care and regular
access to professional oral treatment
for residents in RACFs and frail elderly
residents on home care packages. Tooth
brushing and denture cleaning should be
mandated for inclusion in daily care plans
for residents.
Many aged care staff and carers do a
wonderful job looking after our ageing
Australians. They cannot, however, be
expected to know the signs of dental
disease and infection. This lack of
specialised knowledge, time demands
and poor staffing ratios give carers huge
barriers to providing the necessary oral
health support for older Australians. Throw
in the lack of timely assessments, lack of
ongoing structured oral care education for
RACF staff and lack of access to qualified
dental professionals and the situation is
worsened further.
So what’s the solution?
As the Australian Dental Association’s
(NSW branch) recent submission to the
Royal Commission into Aged Care Safety
and Quality highlighted, elderly Australians
must be given patient-centred, timely oral
healthcare that forms part of their overall
integrated healthcare plan.
Several other peak professional
organisations, including the Australian
Dental Prosthetists Association, the Dental
Hygienists Association of Australia, the
Australian Dental and Oral Health Therapist
Association (NSW branch) and the NSW
Council of Social Services collaborated
with ADA NSW to develop the submission
and outline solutions.
Older adults entering residential care
must have an oral health assessment and
care plan provided by a qualified dental
practitioner. This will identify individual
dental health problems immediately and
support their ongoing oral health needs.
People on all levels of home care packages
must have access to a government
supported oral health assessment and care
planning by a registered dental practitioner
either within their community or if needed
within their home. Family members and
carers must also have access to education
and oral care plans.
Furthermore, RACFs with more than 50
residents must be strongly encouraged to
employ a registered dental practitioner to
provide training, oral health assessments
and oral care plans. This would enable
a professional coordinated approach to
residents’ oral health, staff education and
preventive dental services.
An oral health advocate and expert
should be embedded within the facility
to provide support and enhance access
to specialised dental health services
for people with complex illnesses and
conditions such as dementia. Provision
must also be made to ensure that access
to culturally appropriate oral healthcare
services for older Indigenous adults is
available. These objectives are essential in
caring for our older Australians.
In NSW there are currently models of
care and workforce capability that can be
scaled up to achieve these goals within
the near future.
It is not a privilege but a basic human
right that these vulnerable members of our
society have access to the oral healthcare
they require in order to provide the best
possible quality of life. ADA NSW believes
oral health must be made a priority for our
elderly Australians. ■
Dr Kathleen Matthews is ADA NSW
vice-president and is a practising dentist
based in Wagga Wagga, NSW.