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"...In late 1997, a working group of Australian and international dental professionals, coordinated by the Federal ADA, assisted the Australian Commonwealth Government with advice concerning the standard and guidelines for 'oral and dental care'.
This working group recommended that residents should have a dental examination conducted by a dental professional upon admission to an aged care facility and at regular intervals. However, this recommendation was not incorporated into the 1998 Australian Aged Care Standards..."
(Australian Dental Journal)
Australian residential care:
- currently there are over 140,000 places in Australian residential aged care facilities that house approximately 7–8% of older Australians aged 70+ years (approximately 11,000 of these places are in Adelaide, South Australia);
- the likelihood of the future need for use of residential care is high, with a probability of 0.3 that an older adult 65+years will require permanent placement in residential care at some point in the future and a probability of 0.6 that an older adult 85+years will require permanent placement;
- a 65 year old female can expect to live 1.9 of her 20 years of life expectancy in residential care and an 80 year old female can expect to live 2.2 of her remaining 9 years of life expectancy in residential care.
(Further information about Australian residential care can be found in: Australian Institute of Health and Welfare, Australia’s Welfare: Services and Assistance. 1997 and 1999. Australian Institute of Health and Welfare, Residential Aged Care Facilities in Australia 1998-99: a statistical overview. 2000).
Provision of dental care for Adelaide nursing homes:
- Adelaide dentists’ interest in nursing home dentistry was low—26% were not interested and another 31% were only somewhat interested in providing dental care for nursing home residents;
- dental service provision for nursing home residents was low—only 29.5% of dentists had provided care at nursing home premises in the previous 12 months, and they spent on average less than 2 hours per month doing so;
- less than 20% of dental practices had provided any educational assistance for nursing home staff about residents’ oral care in the previous 12 months;
- use of dental hygienists in nursing homes was low—only 6% of dental practices had a dental hygienist who had provided dental care for nursing home residents in the previous 12 months;
- Dentists and Directors of Nursing identified 3 specific groups of problems associated with dental care provision in nursing homes:
- the lack of portable dental equipment, transportation problems to dental practices, and nursing home issues, such as staffing and time constraints
- residents’ issues such as their cognitive status and behavioural problems
- dental practice-related issues, such as increased time needed and no suitable area to provide dental care at nursing homes.
The oral health of nursing home residents:
- the great majority of residents had dementia (~80% had dementia testing scores indicative of cognitive impairment, with 55% having scores in the severe dementia range);
- the residents with dementia, especially those with more severe dementia, presented very complex behavioural challenges to both carers and dental professionals, with approximately half of the residents giving carers difficulties with oral hygiene care. The most common difficulties were:
- 29% of residents refused oral hygiene care,
- 25% of residents not opening their mouth,
- 24% of residents not understanding directions from carers, and
- 19% of residents kicking or hitting out at carers;
- large accumulations of plaque, tartar (calculus) and food debris were present on many residents’ natural teeth and dentures;
- the prevalence of edentulism (having no natural teeth remaining) was 63%, but that percentage had greatly decreased from over 80% reported in studies conducted in the 1970s and the 1980s;
- a mean of 11.6 teeth (out of a possible 32 teeth) were present in those residents who still had some natural teeth remaining;
- a high experience of untreated decay on tooth crowns and roots (dental caries) among those with natural teeth (a mean number of 1.7 decayed crown surfaces and 1.3 decayed root surfaces per resident—this is many times greater than the decay found in community-dwelling older adults in the 1990s);
- many residents had broken tooth roots at the start of the study and one-quarter of residents developed more broken roots over the following year, but fewer than 10% of residents had any of the broken roots extracted during that time period;
- there were very few differences for general health and other characteristics between existing residents and residents who were new to the nursing home since the first baseline dental examination;
- there were no differences for levels of tooth decay between existing residents and those who were new to the nursing home, but new residents did have more teeth present, more fillings in their teeth, and fewer decayed broken tooth roots;
- over the one-year period, 64% of residents developed new decay on the crowns of their teeth and 49% developed decay on the roots of their teeth;
- the amount of new tooth decay that residents developed over the year on their tooth crowns and roots was high, especially in residents who could chew few food types, and those who had lost body weight since admission. These high decay levels were many times greater than those reported for community-dwelling older adults in the 1990s—5 times greater for tooth crowns and 2.5 times greater for tooth roots);
- new residents to the nursing homes were being admitted with untreated decay on their tooth crowns and roots, and developed further oral problems within several months of their admittance;
- residents’ oral diseases, especially decay on their tooth crowns and roots, rapidly progressed during their stay in residential care.
Note: Photographs are available on the AIHW Dental Statistics and Research Unit website http://www.adelaide.edu.au/
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