As the population of older adults rapidly increases, many of them face barriers when it comes to accessing regular preventive dental hygiene services, especially those living in long-term care facilities.
Oral health is essential to overall health and well-being. Research shows links between gum (periodontal) disease and other health conditions, including diabetes, heart disease, stroke and pneumonia.
Bedridden or compromised individuals are at greater risk for pneumonia caused by breathing in bacteria from the mouth to their lungs. Elders are also at increased risk for dry mouth, abscesses, tooth loss, fungal infections and oral lesions.
As people age, the gingival margins (gums) of teeth often recede and roots are exposed which are softer and more susceptible to dental decay than the crown of the tooth.
About 50 percent of people over age 75 have root caries affecting at least one tooth in their mouth. Without routine oral hygiene, the roots of these teeth decay to the point of breaking off at the gum line. One director of nursing told me, “Our No. 1 dental problem here is residents breaking off teeth and swallowing them.”
People are also reading…
To compound the situation, as we age the area that houses our nerves and blood supply slowly diminishes, which means that an individual can have broken, decayed and abscessed teeth and have no pain.
Proper nutrition, including increased protein and fiber, is very important for health maintenance and prevention of chronic diseases. While having lunch at one facility, I noticed residents near me were missing quite a few teeth. Unfortunately, they only ate a few bites of the nutritious main course, but ate all of their soft dessert.
Today’s older adults keep their natural teeth much longer than elders in past generations. I see many who have gold crowns, porcelain bridgework and titanium implants. They have spent their entire lives investing in their oral care and now must depend on others to help maintain their teeth.
Unfortunately, once a person enters a long-term care facility, little dental hygiene care is available. Hard-working personal care staff at facilities cannot be faulted – they typically do not have time, training or proper supplies to perform effective daily oral care for their residents.
In addition, performing proper dental hygiene care on someone who is compromised, has dementia or may be combative can be extremely difficult and requires a trained professional.
The good news is that poor oral health is largely preventable by having regular care by a dentist and dental hygienist.
Since 2003, Montana dental hygienists have been able to practice in residential facilities with a Limited Access Permit endorsement. I have been providing dental hygiene services two days a week in 16 different long-term care facilities in Missoula, Mineral and Ravalli counties for several years.
Advanced technology makes it possible for me and other dental hygienists to do this for residents in their beds, wheelchairs and recliners.
My vision is for every long-term care facility to hire dental providers to work alongside other health professionals to ensure the best possible health outcome for each resident.
This past September, the U.S. Senate unanimously approved the reauthorization of the Older Americans Act, with the insertion of “oral health.” Hopefully, this amendment will open the door for state and area agencies on aging to use funds to improve the oral health of older adults.
Under this bill, oral health screenings, related disease prevention and health promotion activities could be paid for with OAA funds. The Center for Oral Health will continue to monitor House negotiations to see if the oral health provisions are included in their version of the bill.
For residents who have no voice, it is important that family and friends advocate for their dental care. Talk with the facility staff and insist that oral care becomes a part of the overall care plan. It’s critical that it be provided to all residents to maintain their general health, dignity and quality of life.
For me, the rewards of taking care of elders’ teeth have been great. I was forewarned about a resident who might be combative, bite and hit. After spending an hour with him and getting to know him, he asked when I was coming back for his next visit!
If you would like to learn more, please email me at firstname.lastname@example.org.
Heidi Halverson, Montana Dental Hygienists' Association president, works at Dr. Ike Heaphy’s office in Missoula and also provides dental hygiene services in long-term care facilities through her business, Dental Hygiene at Home.