The annual nationwide oral health campaign is just around the corner, so it’s a good time to look at the long overdue changes needed to improve oral healthcare for older Australians in aged care facilities, writes Dr Mark Hutton.

The Royal Commission into Aged Care Quality and Safety when it met a few years ago, provided an expansive stage for the Australian public to hear about the frightening oral health neglect in the nation’s many aged care homes.

With a new government in Canberra the Australian Dental Association is quietly confident that this neglect and disorder will finally get addressed.

The commission heard stories of teeth and dentures not being cleaned for weeks, ulcerated mouths, pus in gums, cracked and broken teeth and people suffering in terrible pain, rendering them unable to eat or speak.

The inquiry put into sharp focus the urgent need to address how we tackle the health needs of our senior citizens, whether independent or no longer living at home – and this is only going to get more pressing with Aussies living longer.

Between now and 2050 the number of Australians aged 65 to 84 years is expected to more than double, while the number of Australians aged 85 years and over is expected to more than quadruple to 1.8 million by 2050.

As people age, they have poorer mobility and more complicated multifactorial medical issues requiring more complex care, coupled with more people keeping their natural teeth for longer but needing complex restorations to keep those teeth, as well as a much higher risk of degenerative problems like decay and fracture.

Add in almost non-existent provision of oral care for those in aged care coupled with long waiting lists in the public dental system and poor value for money for private health insurance cover for dental work and you have a perfect storm for rotten dental health for this rapidly expanding cohort.

We made several recommendations to the aged care inquiry and central to this is the need to tackle the oral healthcare of seniors not only within aged care, but in the years before they enter the system. Yet the health assessments done by GPs for the over 75s don’t currently include oral health.

Many older people enter aged care with poor oral health for several reasons. They may only go to the dentist when in pain, or they have reduced manual dexterity from arthritis making brushing and flossing challenging, or perhaps dementia is a contributory factor and they’re not aware brushing is a necessity.

Add to this the many complex health conditions older people suffer and associated medications that can result in reduced saliva flow, increasing the risk of dental caries and gum disease. In fact, Australian Institute of Health and Welfare statistics show that over half of the over 65s have gum disease.

Addressing and preventing these problems requires careful daily attention to oral hygiene, as well as regular reviews by a dentist. Under the current aged care system, none of this happens.

Some of the consequences of this are borne out in studies showing that high levels of plaque accumulate on residents’ natural teeth and dentures, which places them at high risk for developing aspiration pneumonia, a condition which can be fatal and demands transfer an acute care facility.

Several reviews found that daily brushing of nursing home residents’ teeth or dentures could dramatically reduce that pneumonia risk – in one study by almost 40 per cent for pneumonia and almost 60 per cent for fatal pneumonia.

Knowing what a difference even basic oral hygiene steps can make is one of many incentives to resolve this issue of understaffed residential homes, where care worker have not received appropriate training.

In our royal commission submission, we recommended setting up the ‘seniors dental benefits schedule’, a national funding model to make dentistry accessible to older Australians in both the public and private sectors. The royal commissioners agreed and included it in their set of recommendations.

The ADA estimates this would cost $95 million a year to administer based on a 100 per cent uptake of the scheme – a small figure in comparison to the overall annual health budget of $80 billion a year.

Other urgent measures we are advocating for to fix the broken system include the Certificate III Aged Care qualification to include oral care as one of its core units of study for workers in that sector, and for GPs to include oral health in their assessments for over 75s.

It remains to be seen if the royal commission recommendations to ensure there are enough nursing staff and personal care workers for appropriate care, given there is already a national shortage of nurses and aged care workers are notoriously underpaid.

Lack of an appropriate type of dental chairs, x-ray facilities and other dental equipment at aged care homes are also barriers to good care provision.

A multi-purpose room used by dentists and other healthcare professionals would have significant cost benefits to the health system and enable allied health services to support aged care residents in their day-to-day healthcare needs and ensure that all healthcare professionals effectively and safely perform their work when needed.

If these facilities were incorporated into the design of new aged care homes, more complex cases could be treated on site rather than off-site with all the transport complexities that brings.

There’s much to do to improve the oral care of aged care residents but with the new Labor Government working with peak health bodies like the ADA as well as significant changes to funding models, staffing levels and training, those much needed improvements could well be within our sights.

Dr Mark Hutton is president of the Australian Dental Association, and a dentist in South Australia.

Dental Health Week runs from 1 to 7 August

Main image: Dr Mark Hutton

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