Poor oral health in aged care – a national disgrace.
We cannot let another generation of Australians suffer the indignity of poor oral health as they age. It’s time to stop the rot.
The pandemic has exposed serious cracks across our healthcare system, from hospitals and GPs to ambulances and mental health. Public health is under-resourced and staff are exhausted, burnt out and struggling to cope. This is impacting on patient access to care and health outcome. We are reaching a tipping point, and nowhere is this more apparent than the dental sector.
I was recently contacted by a friend who wanted to share her story. Her father had early onset dementia and lost the ability to care for his teeth as his condition progressed. Despite enjoying good oral health for most of his life, things deteriorated rapidly in aged care. It was difficult to get find a dentist to visit the nursing home. As a result, many teeth had decayed causing him significant pain and difficulty eating. They finally managed to arrange a dentist to visit and remove 11 teeth while her father lay in his bed. My friend felt guilt and shame, yet this story is all too common in families across Australia.
Poor oral health is one of the strongest indicators of inequality in Australia, with people more likely to suffer dental problems if they are unemployed, uninsured, have a lower income, live in rural and regional areas, are indigenous or have a lower level of education. With an ageing population and improvements in oral health over the past 60 years, we now see more people retaining their own teeth with more complex dental needs. Older Australians carry a large burden of these dental problems due to the chronic and cumulative nature of dental disease.
One in five Australians aged 75 years have no natural teeth, half have an inadequate dentition to function properly, 25 per cent have untreated tooth decay and 70 per cent have moderate to severe gum disease. There is significant deterioration in oral health in the period before people move into residential aged care as they become more dependent on others for care.
We are regularly reminded that our universal healthcare system is the envy of the world, yet that doesn’t even remotely extend to the provision of dental care. Around half of Australians don’t seek dental care on a regular basis, and cost is a significant barrier to care. Governments pay around 80 per cent of hospital and medical care and 90 per cent of subsidised medication, but only 22 per cent of dental care, leading to long waiting times for poorly funded public dental services. Nowhere is this problem more apparent than in residential aged care.
Case Study
Stannos* had been living in residential aged care for more than five years. The oral health assessment and care plan developed by the nursing staff indicated that he had his own teeth and needed assistance with his oral hygiene. However on examination I discovered that Stannos actually had a partial denture, which the staff had completely missed in their assessment. As a consequence, the denture had not been removed in the entire time that he had been living in residential care, and calculus (tartar) had built up over the denture due to lack to daily cleaning. This meant that it could not be physically taken out of his mouth without a professional clean to remove the calculus that had formed over the denture. This was probably one of the most extreme cases that I had seen, but unfortunately, this level of neglect is not an isolated one.
This is not meant to blame the staff in residential care, who have a difficult job at the best of times. The blame rests with the government in not adequately funding basic dental care for these residents, so that residents like Stannos can access appropriate professional services.
Aged Care Royal Commission
The Aged Care Royal Commission heard many harrowing stories, like the one above, of dental neglect of residents who were suffering pain and discomfort. There are more than 220,000 Australians living in residential aged care, and many more living in various in-home care arrangements. We have an abundance of research that shows limited access to dental care and a high burden of disease for aged care residents.
Care staff are overworked, and not adequately trained to manage the daily oral hygiene requirements for their residents. Many of them will rate oral care as the worst of the tasks that they have to perform. It’s not surprising then to routinely see residents with significant levels of plaque, which not only contribute to dental disease, but also pose a significant risk for aspiration pneumonia - one of the leading causes of hospitalisation of aged care residents.
Senior Dental Benefits Scheme
A Senior Dental Benefits Scheme was a key recommendation from the Aged Care Royal Commission. Cost is regularly reported to be a major barrier to accessing dental care, and this is particularly so for many older Australians who are reliant on underfunded public dental services. A Senior Dental Benefits Schedule would provide a sustainable funding mechanism for people living in residential aged care or who live in the community and receive the aged pension or qualify for the Commonwealth Seniors Health Card. It would ensure that residents and seniors in the community would be able to access dental care in either the public or private dental system and would encourage outreach models of care to ensure that people who may not be able to travel can have care provided in their home or place of residence. Dental services would focus on prevention and treatment necessary to maintain function and dignity. We know that a large amount of the deterioration in oral health occurs in the years immediately prior to entering residential care, so it is important that this scheme extend to older Australians living in the community and not just focus on those already in aged care. It would also allow people the choice of continuing to see their regular dental care provider, which we know is important for quality health care outcomes.
We cannot let another generation of Australians suffer the indignity of poor oral health as they age. It’s time to stop the rot.
The Royal Commission final report was published in 2021, and very quickly the conversation appears to have moved on. Despite our best efforts, a Senior Dental Benefits Schedule didn’t get on the radar during the federal election in 2022, and it is unlikely to feature in the upcoming Federal Budget. For the sake of our older Australians, we cannot continue to stay silent. We don’t accept this for any other area of health, and we shouldn’t accept it for oral health. It is past time for the federal government to get serious about oral health and extend Medicare to older Australians to stop this neglect.
[* Not his real name]
This week in dental research
An interesting article in the Journal of Dental Research caught my eye this week. Nonpublication and Selective Outcome Reporting of Oral Health Trials highlighted that a large number of oral health trials did not get published, and in fact less than one quarter were publicly registered before commencement. Academics (and journals) are often focused on publishing ‘results’, and we forget that sometimes ‘no result’ is also an important research finding.
Next week: April 25 is ANZAC Day, so next week will be a little history lesson on the role of dentists in the Army.
Last week: If you missed, last week, you can go back and read my thoughts on the Indigenous Voice to Parliament.