Decaying teeth and poor oral hygiene among older people, especially those in residential care, is a major public health problem that’s only going to worsen, a leading researcher says.
Professor Murray Thomson, head of University of Otago’s oral sciences and lead author of a new study on the topic, labelled the issue a “geriatric giant”.
“Neither the aged care sector nor the dental profession, in most countries, is prepared,” he said.
“Not only do we have more and more older people every year, but more and more people are entering old age with their own teeth, rather than full dentures, as was the situations just a couple of decades ago.
“In some ways, dentistry has been a victim of its success – we have long emphasised the idea of ‘teeth for life’ without much thought to what happens towards the end of life.”
Thomson warned those with poor oral health in middle age that it was not going to improve as they grew older and said they should be talking with dentists about all options, including complete extraction.
The recent study, published in the Gerodontology journal, was based on data from a 2012 nationwide survey funded by the Ministry of Health on the oral health of older people.
It found just under half of the nationally representative sample of 987 people in aged residential care had at least one or more teeth remaining and just over one third had 21 or more teeth.
The study investigated the link between cognitive function and oral health and found those with dementia and other forms of cognitive impairment had higher levels of decay.
Aged care residents with severely impaired cognitive function had, on average, 3.2 decayed teeth, compared to 2.2 for moderately impaired people and 2 for those without impairment.
There was limited data comparing the decay rate over time for residents in aged care versus older people in the community, but an Australian study suggested it was at least twice as bad.
Thomson’s study attributed this to poor oral hygiene practices among aged care residents and greater exposure to overprocessed, sugary food and drinks.
He said carers were often too busy to deal with residents, particularly those with cognitive issues, who might refuse help to brush their teeth.
Greater rates and levels of decay could result in dental and facial infections, malnutrition and possible frailty due to difficulties eating and drinking, as well as poorer quality of life, he said.
But New Zealand Aged Care Association (NZACA) chief executive Simon Wallace denied oral healthcare was lacking in aged care facilities and said staff were trained to provide dental hygiene help where needed, as well as identify issues and refer them to health professionals.
“We do not view this as a major clinical and public health problem as many in-care residents remain responsible for their own oral health,” he said.
A national contract between district health boards and aged care facilities says the homes are responsible for providing access to services such as dentistry, while residents are responsible for costs.
Residential aged care facilities are audited for compliance with the Health and Disability Services Standards, however oral health is not a specific criteria.
Thomson described it as a “legal black hole” and said aged care facilities had little incentive to improve oral health practices as a result.
He wanted to see it included in the audit process and said the Ministry of Health’s acknowledgment of the issue in its Healthy Ageing Strategy was a promising sign. Wallace did not want it included in the audit.
Ministry quality assurance and safety group manager Emma Prestidge said a review of the standards would begin soon and new information such as Thomson’s report would help inform the process.
Since 2010, the ministry had contracted the New Zealand Dental Association to provide training workshops for carers.