saskatchewan oral health professions (sohp) seniors oral health and long term care strategy

Saskatchewan Oral Health Professions (SOHP)

Seniors Oral Health and Long Term Care Strategy

In The Past

• Twenty years ago most residents entered long term care with upper and lower denture…

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Today• Clients entering care have their own teeth• They often have sophisticated dentistry

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Status of Oral Health among older Adults in LTC facilities in Saskatchewan

Seniors are one of the fastest growing demographics; optimal oral health is integral to overall health. The co-founder of the famous Mayo Clinic, Dr. Charles Mayo stated, “People who keep their teeth live an average of 10 years longer than people who lose their teeth.”

Factors Responsible for Poor Oral Health

• Increasing population and associated high prevalence of chronic diseases.

• Population of older individuals will experience “doubling phenomena” population over age 65 will double by 2030

population over age 85 will double by 2030

• Seniors are retaining more teeth

For example, 48% of individuals aged 65 years and over without natural teeth in 1990 and 30 % of seniors were edentulous in 2003.

• Retention of natural teeth put them at risk for dental and oral diseases such as caries and periodontal diseases.

LTC Residents - ConsiderationsThese fragile elderly are at an especially high risk for a number of serious conditions because they:•Often suffer from some form of dementia and most have physical and medical challenges too • Bedridden: care needs to be brought bedside• Frailty/Dexterity Issues: increases the need for regular

oral assessment•Often forget to brush their teeth or are unable to do it without help • May resist or refuse assistance •May have problems recognizing and reporting pain and discomfort in the mouth

• Dental decay• Gum disease

• Denture issues• Oral sores• Candidiasis

Oral HealthThe US Surgeon General’s 2000 report on oral health described oral health of older individuals as “silent epidemic of profound and consequential dental problems”.

Oral disease particularly gum (periodontal disease) is associated with:

cardiovascular diseases ischemic stroke respiratory infections (aspiration pneumonia) diabetes mellitus nutritional deficiencies and weight loss

More than 100 systemic illnesses have oral manifestations.

Oral conditions and dysfunctions are extremely painful and can devastate the quality of life of an individual

Aspiration Pneumonia

Proper oral hygiene reduces the risk of aspiration pneumonia andimproves cognitive status and alertness.Almost one in 10 cases of death can be prevented in the residents of LTC facility by improving their oral hygiene.

Gum Disease

Next to the common cold .......

•Gum/Periodontal disease is the most preventable disease in North America today• 4 out of 5 adults will develop it

• 1 million adults currently have it •1/3 of those are in danger of loosing their teeth because of it•INFLAMMATION due to plaque and bacteria around the teeth and gums

Inflammation

Periodontal infection was reported to be one of the top five causes of chronic systemic inflammation by Anne St Charles PhD in Inflammation: Causes, Prevention and Control. Chronic inflammation is believed to be the underlying cause of the many “age- related” diseases (heart disease being #1)

Inflammation

Another potential way for bacteria to enter the bloodstream is through activities of daily living: tooth brushing, eating, etc. Inflammatory chemicals and bacteria can leak from the periodontal area into your bloodstream and cause havoc in far away areas. It takes 23 seconds for the blood to circulate throughout your body.

“If there is inflammation anywhere, it can show up everywhere.”

Dr. U Phillip Odiatu BA, DMD. NSCA Certified Personal Trainer Personal Training Specialist Can Fit Pro Certified Holistic Lifestyle Coach Certified Nutrition and Wellness Specialist

Plaque growth occurs within hours and must be completely removed within 24 hours to

prevent inflammation.

A clean, healthy, pain-free mouth contributes greatly to:

•Chewing and being able to enjoy a variety of nutritious foods

• Clear speech and communication

• Sleeping well

• Overall health

• General comfort and a higher quality of life

•A more attractive personal appearance, positive self- esteem and satisfying social interactions

Approximately 72% of residents of long term facilities reported that routine oral hygiene is their greatest single need.

Oral health does not appear to be a priority of the governments.

• Various Canadian surveys show strong support for publicly funded oral health program

• For example, in a survey of 24 nursing homes, more than 90% of nursing homes were interested: in an oral health care program provided by the public health department of the health region and were willing to offer support for such publicly funded dental health program

Many LTC facilities have physical, occupational department and hair salons but no provision of space for dental treatment.

Dental Equipment

Equipment

Long Term Care Team

Why is oral care not provided to all residents as the “standard of care”?

Together we can make a difference

Saskatchewan Oral Health Professions

Recommendations

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Vision

The Saskatchewan Oral Health Professions (SOHP) collaboratively

envision a future where seniors and long term care residents have access to oral

health professionals as part of their primary health care team to provide oral

health care services based on best practice to strive for optimal oral and

overall health for the people of Saskatchewan.

Recommendations

1. Establish legislative Oral Health Care Policies/Standards for Long Term Care and Personal Care Homes. Policies should ensure that every resident has access to oral health care services that include:1. An individualized oral health care plan2. Daily oral hygiene 3. Professional dental services 4. Dental recommendations/orders are followed

Note: As per Section 23 of the current Personal Care Home Regulation, each resident receive a dental examination, as necessary.

Recommendations

2. An Oral Health Coordinator (OHC)(s), who is a licensed oral health professional, should be employed in each health region to facilitate the delivery of initial oral assessments, dental examinations and treatment, daily oral hygiene for residents and oral health education. The Oral Health Coordinator will work collaboratively with the long term care, multi-disciplinary team to improve the oral and overall health of residents.

Recommendations3. Upon entry into a Long-Term Care (LTC) facility, an

initial oral assessment must be completed by a licensed oral health professional, through the general/medical consent provided by the long term care facility.

1. Oral assessments should be routinely performed every 6 months thereafter. They may be performed by an oral health professional or a health care professional trained in oral health.

2. Non-oral health professionals performing the assessment will be trained to conduct the oral assessment using an Oral Health Assessment Tool (OHAT) and will receive Professional Portfolio Training.

3. All Portfolio Training (Professional, Staff and Facilitator) will be provided by oral health professionals.

Recommendations4. The initial oral assessment may trigger a referral to a dentist for a

full dental examination to include:

1. Personal client record, including consent for dental examination

2. Review of medical and dental history

3. Complete examination of the oral cavity, to include:1.Assessment of hard and soft tissues2.Assessment of oral hygiene care3.Oral cancer screening4.Denture Assessment

4. Treatment plan/progress notes

5. Estimate/Consent for financial responsibility

6. Consent for treatment

Recommendations

5.Treatment needs based on the dental examination, may be provided by dentists, denturists, dental hygienists, dental therapists and/or dental assistants. Residents may access dental services through their personal oral health professional or through dental services as available through the long term care facility.

Recommendations

6.Establish a safety net program for low income residents (similar to Ministry of Health Supplementary Health/Family Health Benefits or Alberta’s Dental Assistance for Seniors Program through which low income seniors are eligible for up to $5000 every 5 years).

Questions/Discussion

Please discuss the questions on each table and complete the surveys individually