Josephine was a dream dental patient. She had great insurance and paid all her copays up front. She kept every appointment on time. She had good oral hygiene and saw her hygienist three times a year for maintenance.
Over the 20-plus years she was a patient, she had upwards of $20,000 worth of restorative dental work done: crowns, bridges, and esthetic veneers on the maxillary anterior teeth. She had take-home bleaching trays and faithfully purchases refill syringes. She was proud of her beautiful smile.
After her move to long-term care
Josephine is not smiling today. Instead, she sits slumped at a table, a tray of food in front of her. A few bites of French toast, a nibble of sausage, and lukewarm coffee in a plastic mug.
Her aide cuts a piece of French toast and shovels it in her mouth. No coffee or juice to chew with. She is still chewing as she is taken to her room for a quick wash up and then to the hairdresser. The hairdresser curls and styles her thinning white hair and she is brought to the lounge for a group activity. Then lunch and a nap and up for dinner.
Meanwhile the piece of French toast has been tucked between her cheek and molars. Her dry mouth has not been able to loosen it. By evening it is mush well conformed to the teeth. Underneath the bacteria work unchecked. The decay is almost through the furcation of an abutment tooth holding in the $5500 bridge.
Where’s the dental professional?
Signs in the waiting room promise they care about their patients. Pamphlets inform readers how dental health affects general health. Since Josephine can no longer go to her dental practice, her family notices her breath has a foul odor. They complain to nursing staff. A consult with the dental care service is scheduled. Her missing tooth is noted, and a flipper is made (which disappears in a matter of weeks).
Long-term care facilities are usually not well-equipped to provide dental care, and staff is often unaware of dental needs. Some facilities do have dental equipment and pay dental professionals to provide oral care, which is a positive step. The residents need frequent oral cleaning to reduce bacteria in the mouth and the disease it creates.
What can be done?
Because dental care is separated from medical care, nursing home residents suffer. We need a paradigm shift—dental care can’t continue to be viewed as a separate need. The mouth is part of the body and inhalation pneumonia is a frequent cause for transport to a hospital among nursing home patients.
Over the last several years there have been several books, courses, and webinars to help dental professionals treat their geriatric or hospitalized patients. As licensed health-care providers, we are obligated to provide care to patients for who can’t get to a dental office. As a profession, our role is to make changes.
Numerous dental hygienists are stepping into geriatric care and are eager to support other hygienists who want to help the cause. Sonya Dunbar, the Geriatric Tooth Fairy, is a hygienist who has made it her mission to help this population. She also authored a book called The Tooth and Nothing but the Truth.
Angie Stone, author of Dying From Dirty Teeth, published her message in 2015 and has lectured on the topic of the lack of proper oral health-care in nursing homes throughout her career.