Exploring Long-Term Care and the Gap in Oral Health

Most long-term care facilities do not include (or consistently administer) oral health services within their daily care delivery. Patients who want or need dental care or treatment can arrange for a visit from a dentist or a hygienist, but they or their families are typically on the hook for the cost. 

According to a recent report from the Canadian Association for Long Term Care (CALTC), Canada’s population of seniors age 65 and older will rise by about 25% by the year 2036. From 2011 to 2036, the number of seniors age 80 and over is predicted to double. According to the report, Canada is already facing an increased demand for care and services for seniors in long-term care facilities and many dental professionals and advocates are calling for dental care to be included.

Today, many seniors are entering (or will soon enter) long-term care facilities where oral health services are limited, varied, and often not included in their service costs. In Ontario, oral health professionals are not included in the Long-Term Care Homes Act, meaning it’s up to staff, whatever their ability, to manage it according to individual facility protocols which can be limited to teeth brushing and checking a box.

CDA’s position on Oral Health in Long-term Care

Given the particular oral health challenges faced by seniors in care facilities and the importance of oral health to overall health, the following should be the minimum oral care requirements for all residents in long-term care in Canada:

• Oral health assessment by an appropriately trained and licensed/registered health professional upon admission and annually thereafter;
• Beginning as soon as possible after admission, a referral process to a dentist for examination, diagnosis and treatment planning;
• A daily mouth care plan that is implemented by appropriately trained staff;
• Suitable infrastructure to support the appropriate delivery of needed care by the oral health care team.

Oral Health Status of Long-Term Care Residents

For seniors, poor oral health and hygiene can lead to other health conditions, including stroke and cardiovascular disease. Because many seniors arrive at long-term care living facilities with their own teeth, care providers must adapt and equip themselves to manage oral health as well as monitor things like implants, bridges, crowns. 

A study to establish the oral health status of residents in 32 long-term care facilities in Alberta, Manitoba, Ontario, and New Brunswick found that most dentate residents had moderate or severe inflammation in at least one tooth.

The study found that:

• 60% of residents wore dentures;
• 43% of edentulous residents had poor hygiene of their dentures;
• 9% of residents needed urgent dental treatment for infection, severe decay, ulcers and broken teeth.

Overall, the prevalence of oral health problems was high enough to indicate that improvement in oral health care is needed and future strategies to optimise oral health for longer care residents is required.

Is the Gap in Oral Healthcare Being Filled?

Research, focused on determining BC dentists’ perceptions about their decision to provide treatment in long-term care facilities and to compare attitudes to treating elderly patients among dentists, found perceptions had shifted substantially from 1985 to 2008:

• Dentists who did not provide care for residents of long-term care facilities in 2008 seemed more likely to be deterred by administrative difficulties and financial costs than those not providing such care in 1985.
• Fewer dentists had appropriate training in geriatrics.
• Continuing education, working with a dental team and payment on a fee-for-service basis were important factors for dentists who were providing care in such facilities.
• Dentists who had stopped treating patients in long-term care facilities reported their perception that treating elderly people is financially unrewarding and professionally unsatisfying.
• Dentists responding to the 2008 survey who had never provided services in long-term care facilities were more likely to perceive administrative difficulties and a lack of financial reward as barriers than those surveyed in 1985. 

While the CALTC’s report does not make a recommendation toward including oral health services in long-term care facilities, hygienists and nurses across Canada are advocating to fill the gap. Representatives of the Canadian Dental Hygienist Association (CDHA) recently met with Senators and MPs in Ottawa to address oral health issues affecting seniors and remind government that bacteria in the mouth can spread and contribute to other serious health conditions.

Lynda McKeown, a dental hygienist based in Thunder Bay, says that improving oral health care in long-term care facilities is critical. In 2010 and 2011, she conducted a study that found “discrepancies in oral dental documentation.” She says, “There are some healthy mouths — but in many cases, they are not. So, the evidence does not match the documentation. I see this consistently.”

To help care providers more consistently and effectively monitor residents’ oral health The Registered Nurses’ Association of Ontario has created the Long-Term Care Best-Practice Toolkit.

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Until next time!

CDA Oasis Team