What about older persons
in long-term care homes?
Commitment to their oral health
International Symposium on Dental Hygiene
Panel Discussion on
Positioning Dental Hygiene in Health Care
Friday July 20, 2007
Mary-Lou van der Horst, RN, BScN, MScN, MBA
Regional Best Practice Coordinator in LTC
Central South Region, Ontario Canada
Long-Term Care Reality… …
Deteriorating oral health starts before older persons
are admitted to LTC homes and continues to decline
Interrelationship between oral health and general
health is pronounced among older persons
The oral health issues
• Are progressive and cumulative
• Profoundly affect quality of life
• Have significant consequences
• May become more critical as more older persons
have teeth on admission to LTC
Long-Term Care Reality………
The probability is high that the majority of LTC
residents will be in a high risk group and experience
severe oral diseases at some time during their stay
• Poor oral health and plaque-related oral diseases are
• Not due to aging
• Increases risk to general health and well-being
• Similarly, systemic diseases and adverse effects of
treatments/medication can lead to increased risk for
High Risk for Oral Diseases… …
Residents who are at higher risk of developing oral diseases:
• Are cognitively impaired
• Are functionally impaired
• Require assistance with daily oral hygiene
• Are completely dependent
• Are complaining of a dry mouth
• Have medical conditions that affect their mouths
• Take medications with adverse oral side effects
• Have nutritional problems
• Have swallowing problems and/or
• History of oral health problems (periodontal pocketing, denture-
related problems, poor oral hygiene, dental caries, infections)
• Perception that oral health professionals are not interested
in the Long-Term Care sector and won’t come into LTC
homes. Where are you, can’t find you?
• Access to affordable oral health care professionals. Few
publicly funded programs for older persons. Older persons
are not priority clients.
• Lack oral health and oral care information for LTC health
care providers so it’s not a critical care issue. Oral health
assessments are about whether they do or don’t have teeth.
• Oral care low and/or conflicting priority within health care
organizations. It’s separate and not part of general health
care – mouth is not part of the body myth.
Organizations don’t show the same level of
commitment and accountability to quality oral health
care as they do to other health care issues as most
don’t have oral care standards, guidelines, policies,
• Lack of specific and measurable standards on
• Need commitment and assistance from
governments, associations, organizations,
accreditation, LTC homes
…… and oral health professionals
Oral health education for LTC staff
• LTC nurse maybe the first health professional to identify
oral hygiene care concerns
• Limited oral health continuing education and skills training
available for LTC staff
• Misinformation about interrelationship between oral health
and general health
• Use ‘dental services’ on urgent/crisis basis
Limited oral health education in health care professional
education and training programs
Limited geriatric and LTC exposure in oral health
professional education and training programs
New Opportunities… …
The WHO Oral Health Report (2003) supports cost-
effective interventions and strengthening intersectoral
collaboration that is sustainable and reduces inequities
New Opportunities . . .
• Multidisciplinary comprehensive approaches to improving
oral health care in LTC. Gap analysis on models that
work in or could be adapted to LTC – where are they?
• Shared and affordable approaches that support the
• effective use of expertise and
• efficient use of resources to maximize oral health
care benefits to LTC residents
New Opportunities… …
• Improve knowledge and awareness and move oral
care practices in LTC closer to best practice.
Create guidelines for LTC
Create education resources for LTC –paper and online
• Assist to eliminate situations in LTC that result in
needing costly and intensive crisis management
approaches to oral care
• Assist academic and training programs for health care
professionals and providers to improve oral health
knowledge, care and skills content
Enhance Quality of Life… …
For LTC residents their oral cavity is a conduit for essential
nutrition, for communicating, for social connection and self-esteem.
Ultimate Challenge to Oral Health Professionals
… … enhance residents’ quality of life
TIP from LTC:
Oral health care initiatives will be most successful when adapted
to the resident population, the long-term care setting and its
health care providers . Remember the “A’s”
• Appropriate and acceptable
• Associative approaches
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Best Practice Resources……
The Registered Nurses Association of Ontario (Summer 2007). Oral health. Nursing
assessment and interventions. Toronto, ON: Author. www.rnao.org
The Registered Nurses Association of Ontario and Halton Region Health Department (Summer
2007). Oral care for resident with dementia (DVD)Toronto, ON: Author. www.rnao.org or
phone Dir: (416) 907-7965 Fax:(416) 907-7962 $15 CDN
ML vanderHorst (April 2007). The BP Blogger. Myth busting: The mouth issue. Monthly
newsletter for LTC that dispels care myths with evidence from best practice guidelines.
Available at: www.rgpc.ca
Halton Region Health Department (2006). Dental health manual for LTC home staff. Halton oral
health outreach project. Oakville, ON: Author.
Centre for Community Oral Health- Long Term Care Fact Sheets. Nov 2006
The University of Iowa College of Nursing (2002). Oral hygiene care for functionally dependent
and cognitively impaired older adults. Evidence-based practice guideline. Iowa City, Iowa:
Author/Gerontological Nursing Interventions Research Center. www.nursing.uiowa.edu
Joanna Briggs Institute (2004). Oral hygiene care for adults with dementia in residential aged
care facilities. Best Practice, 8(4). Adelaide, Australia: Author. www.joannabriggs.edu.au
Mary-Lou van der Horst, RN, BScN, MScN, MBA
Regional Best Practice Coordinator Long-Term Care
Central South Region-Ministry of Health and Long-Term Care
Village of Wentworth Heights
1620 Upper Wentworth Street
Hamilton, ON L9B 2W3
This presentation is available for download : www.rgpc.ca