Oral Health Group

Obstacles and Solutions in Delivering Dental Care to LTC Patients

April 15, 2019
by Parmar Dental


As we age our natural teeth and gums are more susceptible to dental caries, gingival recession, demineralisation, fungal infections, and periodontal disease. Regular hygiene and dental care is important but is often neglected, especially by those who require long-term care.

1. What is LTC?

In the United Kingdom, long-term care is provided by a range of organisations, including the NHS, private and voluntary organisations as well as the local authorities. Long-term care can be residential and provided by nursing homes, or it can be care at home. Depending on the unique needs of the patient, care can range from help dressing and bathing and eating to meals on wheels and light housekeeping.

2. Who are the LTC patients?

The long-term care population is made up of senior citizens over the age of 65 who require assistance with their daily life. Some LTC patients reside in nursing homes, but a large majority live at home and have an assisted living arrangement where they are cared for by relatives or home health visitors and volunteers.

3. What are the major problems with LTC patients?

Long-term care patients typically cannot fully care for themselves because of a stroke, dementia, arthritis, deterioration of the body and cognitive abilities, blindness, spinal cord injuries, and other physical disabilities. Cognitive disabilities like dementia and Alzheimer’s disease make preventative oral care challenging for long-term care patients and their caregivers.

4. Do LTC patients get adequate dental care?

Many LTC patients do not receive adequate dental care, and an increase in systemic health conditions have been linked to poor oral hygiene for the long-term care population. This includes diabetes, pneumonia, and cardiovascular diseases.

5. Reasons behind inadequate dental care for LTC patients

The reasons for inadequate dental care for LTC patients include:

  • Many long-term care patients are medically compromised and unable to provide oral hygiene self-care. Oral hygiene is a low priority because they are often preoccupied with serious health conditions.
  • A significant number of patients with dementia and similar cognitive disabilities are unable to articulate oral discomfort. These patients also require caregivers, nurses and dentists to have more training in managing basic oral hygiene and dental treatment.
  • The older generation is less likely to seek help from a family member, caregiver or a medical professional, is more willing to conform to the decisions of authorities and is less demanding when it comes to their dental needs.
  • Disregard for LTC patients dental needs by nursing staff and other caretakers due to prioritising their basic needs such as toileting and eating.
  • Lack of training and emphasis on oral care of LTC patients for nursing staff in nursing homes. Oral hygiene training is very basic resulting in a lack of understanding about dental conditions.
  • Shortage of nurses and aides in nursing homes.
  • Absence of on-site dental facilities in nursing homes.
  • No dental insurance or funds to pay for dental care. A lack of funds to pay for dental care is the biggest barrier to LTC patients’ oral health.
  • Shortage of dentists willing to care for the LTC population. This is due to a lack of dental facilities in nursing homes, the cost to transport dental equipment to a facility, additional time required for frail patients, frustration at the apathy to oral hygiene of the caretakers of LTC patients and inadequate training in geriatric dentistry.

6. Solutions to Improve Dental Care for LTC patients

With the baby boomer generation reaching retirement age, solutions are needed to improve the dental care for LTC patients. The baby boomer generation is more demanding than their parents and expect their needs to be met, including their dental care needs. So what solutions are there to ensure this ageing population receives the dental care they need?

  • Cost of construction and dental equipment can be prohibitive, but even rudimentary on-site facilities can meet the basic oral needs of patients, including those who are bedridden.
  • Although, cumbersome and time-consuming to set up and break down, a mobile and portable makeshift dental practice can provide a way for nursing home residents to receive basic dental care.
  • Education for dentists in geriatric dentistry is essential. Understanding how to manage fragile LTC patients, especially those with cognitive issues like dementia is even more important due to the growing elderly demographic.
  • A geriatric nurse practitioner has advanced training in working with elderly patients, specifically those who are most vulnerable like Alzheimer’s patients. They can collaborate with dentists to ensure nursing home staff can care for the oral hygiene needs of their patients.
  • Transfer to a dental practice is an ideal solution for a full range of dental services, but only the most able-bodied patients can be transported.
  • Dentists who run a successful business are unlikely to participate in a program where they are not adequately compensated for their time. Advocation for funding is essential to ensure the dental needs of LTC patients are being met.

As the number of LTC patients is likely to increase, inadequate dental care needs to be addressed so staff and caregivers can fully meet the needs of this growing population.


Author Bio
Located on the Southchurch Road, Parmar Dental is a multi-award winning dentistry in Southend-On-Sea offering high standard and quality dental treatments that patients always expect. Parmar Dental provides dental care in a very relaxed and tranquil environment, where each visit would be a unique experience for their patients.

Resources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765506/
https://www.managedhealthcareconnect.com/article/biggest-wound-oral-health-long-term-care-residents