ADA NSW President Dr Neil Peppitt comments on the need for improvement in aged care dentistry. “The oral health of older Australians is being overlooked in many ways,” he says. “The health of a society is gauged by how we look after those who can’t look after themselves, and we can certainly improve how we approach oral health for elderly people - especially those who are living in aged-care facilities.” 

Bite article published 17 December 2018:

Aged-care dentistry - improvement needed

As a new royal commission investigates the aged-care industry, dental experts are warning of a potential ‘dental Armageddon’ for Australia’s ageing population. Shane Conroy reports.

Dr Peter Foltyn is a consulting dentist at St Vincent’s Hospital and a passionate advocate for oral healthcare for the elderly. He tells the story of an 81-year-old dementia patient who spent 27 days in hospital recovering from surgery to treat a life-threatening dental infection that should have been picked up in a routine oral health assessment.

“The gentleman was suffering delirium from the anaesthetic and went from living in his own home to needing to enter an aged-care facility as a result,” says Dr Foltyn. “However, if a full dental examination had been provided to him at some point in the past three to four years, any dentist would have picked up on examination that he had an abscess and would have recommended removing that tooth to prevent the infection ever taking hold.”

Such is the state of dental care for many of Australia’s elderly people. Dr Foltyn contends that this is not an uncommon story as the country’s ageing population increasingly falls victim to a health system that is neglecting their oral health in what he has termed a potential ‘dental Armageddon’. 

An inconvenient truth

Dr Neil Peppitt, president of the NSW branch of the Australian Dental Association (ADA), agrees that the situation has become dire. 

“The oral health of older Australians is being overlooked in many ways,” he says. “The health of a society is gauged by how we look after those who can’t look after themselves, and we can certainly improve how we approach oral health for elderly people—especially those who are living in aged-care facilities.”  

Dr Peppitt explains that there is no oral health component in GP medical health assessments for people aged 75 years and older, and Aged Care Assessment Teams are not required to consider a patient’s dental health before they engage in a home care program or enter a residential aged-care facility.

“Put simply, nobody is looking in their mouths,” he says. “The result is a situation where older people—some of whom may not be able to care for themselves or even communicate that they are experiencing oral pain—are being left vulnerable to preventable dental problems that can contribute to a range of serious associated health issues.” 

Oral pain that contributes to an inability to eat can result in malnutrition, “which is associated with an increased risk of infection, falls and fractures”, says Dr Peppitt.

“Every patient you see likely has an older family member, so take the opportunity to speak with them about the importance of oral healthcare for their elderly relatives.” 
Dr Peter Foltyn, consulting dentist, St Vincent’s Hospital

Patients with untreated oral disease can also be at increased risk of contracting life-threatening conditions including pneumonia and heart disease. Gum disease may also exacerbate diabetes, and oral pain can negatively affect sleep quality and even the patient’s ability to communicate.   

A preventive approach

Dr Foltyn believes the crux of the problem is that many people are entering aged-care facilities with undiagnosed oral health issues that are likely to flare up into larger medical problems in the proceeding years. 

“Most of the data is saying that the average length of time a person spends in an aged-care facility is about three and a half years. So it’s not necessarily about doing fancy fillings and crowns, but rather ensuring that good oral health can be maintained at a level that is not going to cause symptomatic problems or interfere with a person’s quality of life while they are residing in an aged-care facility.

“To do that, we need to go back to the future to improve the level of oral health before the person ends up in an aged-care facility. Medical practitioners need to ensure that any patients with suspect or borderline teeth that are likely to blow up in the next couple of years are referred to a dentist who may consider extraction as the sensible option rather than complex treatment that could be difficult to maintain if the resident has poor fine motor skills or inadequate oral care is provided by the aged-care facility. That way we can be confident that the patient isn’t going to experience any major dental issues over their next three to four years in an aged-care facility, and therefore will have a better quality of life.” 

At the same time, Dr Peppitt and the ADA remain committed to improving dental care standards in aged-care facilities and will be calling on the Royal Commission into Aged Care Quality and Safety to make the oral health of elderly Australians a priority.  

When the royal commission findings are released in 2019, Dr Peppitt would like to see “an acknowledgement that oral health is important in aged care, along with a requirement that people undergo an oral assessment before they enter an aged-care facility”.

Keeping seniors smiling

While hopes are high, Dr Peppitt and the ADA are not relying solely on the royal commission to come to the rescue and are supporting several initiatives to improve the standard of oral care in aged-care facilities. 
Among them is Senior Smiles—a preventive program developed by Associate Professor Janet Wallace and oral health researchers from the University of Newcastle—that places qualified oral health practitioners in residential aged-care facilities to provide patients with risk assessments, care plans and referral pathways for dental treatment. The program also aims to deliver oral health instruction and education to families, carers and staff at aged-care facilities.       

“Our program means the team is able to provide a preventive oral health focus, gain the trust of residents in order to proactively identify issues in their oral health and fast-track their treatment for specialist attention before problems become severe,” says Dr Wallace.
Senior Smiles is already running in Sydney, Newcastle and on the NSW Central Coast, and plans are underway to expand to Brisbane. 

Dr Foltyn also calls on all dentists to engage with the issue in their local communities and sees opportunities for dentists to improve outcomes for elderly people while also building their practices. 

“Every patient you see likely has an older family member, so take the opportunity to speak with them about the importance of oral healthcare for their elderly relatives,” he says. “You can also talk to your local aged-care facilities about coming in to provide oral health assessments, then communicate your findings with the centre staff and the patients’ families to come up with an appropriate treatment plan.

“If you can bring older patients into your practice, you’ll probably find their younger family members will come as well. That kind of relationship building is going to lead to practice growth.”