This was the title of a piece1 I wrote for JCDA in 1998. In my first 10 years or so in practice, I had developed a concern for the elderly and in particular for folks living in long-term care (LTC) facilities. Even at that time, “looming” was an understatement. The last 20 years have shown that the problem of geriatric dental care is here with a vengeance. The sad thing is that very little has changed in a practical manner to address the situation since that article was published. Over the course of my career, I have attended at least 4 national conferences on the topic, with all attendees agreeing on possible solutions. Yet nothing is forthcoming to address the nightmare that is forming, as well over 60% of residents in LTC will have teeth and require care.
Access to care was always one of the biggest action points from these conferences. The hope was that positive change could be affected through various initiatives such as the provision of dental facilities in institutions, the development of affordable portable equipment and even an expansion of scope of practice for hygienists. Unfortunately, this has not been the case and I believe it comes down to the willingness of dentists and dental hygienists to be available to do the work.
Please don’t get me wrong or be offended—this is very difficult dentistry performed under some of the worst circumstances possible. It takes very special providers to be willing to treat patients that are often medically and psychologically compromised in less than ideal situations—sometimes in an environment where it seems that the only concerned people are the dentists and family members of the patient. My hat goes off to those who do the work. I feel they are underpaid for the most part, for simply trying to maintain patient comfort.
On the other hand, we have to be careful what we wish for. There are seemingly saintly providers that go into LTC facilities and provide amazing services. The services are, of course, only offered to those with enough money or coverage to pay what the providers feel they deserve. To that end, the provision of fixed bridges and 20 units of scaling per year to people with an average life expectancy of 18 months after admission to the facility seems a little over the top.
So, all things considered, the answer for appropriate care for these folks probably doesn’t lie with dental professionals. As with any underserviced or underfunded group in need of dental care, the answer is prevention. The staff and family members of people living in LTC have to be educated on how best to care for their patients and relatives. Measures such as daily oral brushing and the provision of fluoride and chlorhexedine (if appropriate) should be employed. Nutritionists in LTC facilities have to be educated about the benefits of low-sugar diets to help combat tooth decay. Governments have to be made aware of the costs to the health care system of aspiration pneumonia and chronic infections.
There is a fine line between advocating for people in LTC and appearing to abrogate responsibility for their direct care. But the ideal profession is one that strives to eliminate the need for its services and here is a way we can do just that.
- Barrett B. The looming geriatric dental care crisis. J Can Dent Assoc.1998;64(9):623-4.