The age-old issue: Dentistry and an older population

6 September 2019

Melbourne Special Needs Dentist Dr Kerri Punshon has worked with aged care patients for over 30 years. "I still remember back then nurses saying to me, 'What does it matter if we never clean their teeth or never look into their mouths?'" Dr Punshon recalls.

"These days, nobody says anything like that. They might tell you it’s difficult and challenging, but now nobody would ever say they don’t think it matters. That’s been one of the positive outcomes of all the activity in recent years."

As a result of this activity – the dedicated promotion of the issue – there’s been a shift in the recognition of how dentistry plays a key role in the health outcomes of Australia’s ageing population.

In 2015, the Federal Government released Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2015-2024. The following year, the ADA in partnership with Dementia Australia released the Partnership in Practicing Care: Quality Dental Care For People With Dementia, an online training program to inform dentists about best practice procedures for the treatment of patients with dementia.

Also, in 2016 came the Successful Ageing and Oral Health report by ANU and UWA, exploring how to incorporate dental professionals into aged care facilities. Last year, a study titled Older Australia at a glance was issued by Australian Institute of Health and Welfare (AIHW), which included a specific section about the importance of oral health in reducing disease throughout the body.

In more recent times, there’s been the Royal Commission into Aged Care Quality and Safety, which included a session about oral health treatment in aged care. An interim report is due on 31 October.

Making progress
Professor Linda Slack-Smith of the University of Western Australia (UWA) was one of the leaders of the Successful Ageing and Oral Health report, which concluded, "There is a need for greater collaboration across dental health services, dental professionals, dental associations, pharmaceutical agencies and dental technician industries to enhance the promotion of better oral health in residential aged care facilities (RACFs). Studies support a shift from a service delivery oriented model of oral care to a more collaborative, team-based, interprofessional approach."

It also found, dental care for older adults in various types of residential aged care in Australia is often conducted on an ad hoc basis with little structure to such services. Many aged care residents do not receive adequate oral hygiene or any dental services.

Three years on, Professor Slack-Smith believes there has been a definite change in the approach to dentistry.

"I feel optimistic we are making progress and things seem to be moving forward, but I also feel we are making it slowly," Professor Slack-Smith says. "We have graduates who are interested in aged care and dentistry, and there’s increasing collaborations between the different dental areas and other medical professions. I also think we’re sharing more information and boundaries are breaking down.

"But there are many people in aged care who are just not getting adequate dental care. A lot of the time, we all know the solutions, but it is a matter of changing the systems to make it work in terms of structure, awareness, funding and support. The more this is discussed, however, the better for everyone."

The ageing population
According to the Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2015-2024 report, it’s expected that by 2056, one in four people living in Australia will be over the age of 65 and 1.8 million people will be over the age of 85. It also states an increasing number of older people are retaining their natural teeth and by 2021 only three per cent of the population will have complete tooth loss.

The Successful Ageing and Oral Health report offered a similar statistical portrait, including the number of permanent aged care residents increased from 1999–2011 by 25 per cent and the number of residents aged 85 years and over rose by 45 per cent.

In particular, the number of patients living with dementia has increased, with the AIHW estimating that by 2020, over 400,000 Australians will be living with dementia.

"With that comes a complexity for the dentist," Dr Punshon says. "Some will be relatively straightforward, while others might be sickly, frail, have dementia and are confused. In the later stages of dementia patients can get easily agitated or they might be very quiet and bedridden and dealing with swallowing problems. Most are on a number of different medications, which can have side effects."

You can read the rest of this article at News Bulletin Online (September 2019 issue)