Oral health of nursing home patients at risk

Some face multiple tooth extractions
  • Deborah Condon

The oral health of thousands of nursing home patients nationwide is at major risk, a senior dentist has warned.

According to Dr Anne Twomey, who is vice president of the Irish Dental Association (IDA), patients who have kept their teeth into old age can lose them within three months in a nursing home.

This is due to the unregulated use of fortified high-sugar food supplements in these homes, which is causing ‘untold damage' to the teeth of many patients.

And this problem is being further compounded by the fact that many visitors choose to bring sugary sweets and soft drinks as gifts to their loved ones.

"These fortified oral nutritional supplements can be effective in increasing a patient's calorie intake, but one of the consequences of constantly sipping these high-sugar content drinks is the very negative effect they have on patients' oral health. When you add in all the gifts of sweets and soft drinks which patients receive, you have a recipe for disaster," Dr Twomey explained.

She also highlighted that dry mouth accelerates dental decay and many nursing home patients have dry mouth because of the medications they are on.

"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. Although these patients are among our most vulnerable citizens with limited control over their daily lives, they have little or no access to oral hygiene and preventive measures," Dr Twomey noted.

She said that in one case she dealt with, a 75-year-old patient with end-stage Parkinson's and mild dementia was refusing to allow anyone near her mouth. Nursing staff revealed that while her mouth was cleaned twice daily with a sponge, no effective tooth brushing had taken place in the two years since she had been admitted to the home.

She required a number of extractions as a result, but is much more comfortable now and has her remaining teeth and gums brushed with an electric toothbrush, which her care assistants have been shown how to use.

Dr Twomey emphasised that dentists are not usually included in the multidisciplinary teams that care for nursing home patients.

"Basically the HSE is reneging on its duty of care to some 27,000 nursing home patients by completely failing to meet their dental health needs. Training programmes for healthcare assistants in oral care should be mandatory and meaningful. A written oral care plan should be created with these patients where families and carers are involved," she insisted.

She added that these patients ‘did not reach old age with their original teeth on a high-sugar diet'.

"As well as carefully monitoring the intake of high-sugar food supplements, families and carers should be encouraged to provide low-sugar treats. Patients' bedrooms often resemble a sweet shop and this will require a cultural change."

Dr Twomey made her comments in the Journal of the Irish Dental Association.



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