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Lack of dental care sees nursing home patients needing up to 20 teeth extracted at once

One of country’s senior dentists reveals some nursing homes neglecting duty of care to elderly.
Feb 12th 2017, 9:30 AM 11,960 16

ONE OF THE country’s most senior dentists has warned that the lack of appropriate dental care for the elderly is causing “untold damage” to the oral health of thousands of nursing home patients.

A diet high in sugar and the lack of a suitable oral health programme is exacerbating the situation, according to Irish Dental Association vice president Dr Anne Twomey.

“Patients who’ve kept their own teeth into old age can lose them in as little as three months,” Twomey said. “Very often the situation has reached crisis proportions by the time I’m called in and I have to take out 15 to 20 teeth over a short period of time.”

She accused the HSE of “reneging on its duty of care to some 27,000 nursing home patients” by failing to meet their dental needs, and said that both the HSE and HIQA needed to step up to its obligations for older people.

Twomey cited the case of Frank – not his real name – a 71-year-old who had spent four months in hospital following a stroke. When he was admitted to a nursing home, he was visited by Twomey and told her that he had noticed his teeth turning black.

Many of these began to break off, and the dentist diagnosed rampant tooth decay. He wasn’t able to brush his teeth, due to his stroke, and was also being fed sugary food and drinks to build back up his weight.

The majority of his teeth needed to be taken out, and Twomey said this case was typical of stroke patients.

She also cited the case of Bridget – also not her real name – who was a very frail 75-year-old who had Parkinson’s disease and mild dementia.

She refused to let anyone near her mouth, until Twomey diagnosed overwhelming halitosis.

Nursing staff revealed the lady’s mouth was cleaned twice daily with a sponge but nothing in the way of effective tooth brushing had been carried out in the two years since her admission to the nursing home. Sadly her grandchildren were refusing to visit her or hug her because of the infection.

Phased extractions of most of her teeth was the only option, but Bridget now has an electric toothbrush that her care assistants have been shown to use to take care of her teeth properly.

She also cited cases where some patients needed 20 teeth out at once.

Twomey said: “As the case studies highlight, this situation cannot be allowed to continue. Training programmes for healthcare assistants in oral care should be mandatory and meaningful.

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“A written oral care plan should be created with these patients where family and carers are involved.

Dentists need to be involved when doctors prescribe a high-sugar food supplements or when a chronic debilitating condition is first diagnosed or when a patient is at high risk of inhalation pneumonia.

In response, HIQA said in a statement: “HIQA agrees that a greater emphasis should be placed on good oral hygiene and the provision of dental care in nursing homes.

“The team responsible for inspecting designated centres for older people are aware of the issues identified by the IDA.

It is the providers responsibility to ensure that resident’s health care needs are assessed and met (including dental and oral care).

“Inspectors continue to review the health and social care provided to residents under the Heath Act 2007.”

Read: More people are being hospitalised because of problems with their teeth

Read: Scared of the dentist? It’s in your genes

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Sean Murray

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