Digity With A Smile: Oral Healthcare for Elders in Residential Care

 Published in Denturism Canada
Summer 2011
The full article can be accessed here

Editor’s note: the following is excerpted from a report for the Federal Dental Advisory Committee 2008. The full report, including references, can be viewed at http://www.fptdwg.ca/English/ e-documents.html.


At the request of the Federal Dental Care Advisory Committee (FDCAC), a sub- group of members agreed to tackle one of the serious oral health concerns that is more than just an access-to-care issue. They began by identifying questions raised within the committee. This is the final list of questions addressed in this report.

1. What oral health problems are found among elders in residential care in Canada; and how are they related to other disabilities and disorders?

• Oral problems are diverse and prevalent.

• Oral problems are associated with other systemic disabilities and disorders (e.g., diabetes, cardiovascular diseases).

2. Can oral healthcare be managed effectively in residential facilities?

3. Who manages the oral health of elders in residential facilities?

4. Can oral health be assessed competently by non-dental personnel?

• A role for non-dental personnel in assessing oral health.

5. How can the quality of oral health-related services in residential care be assessed?

• Assessing quality of services.

6. What policies, legislation and standards regulate oral care in residential facilities?

• Setting policies, legislation and standards of oral care in facilities.

7. How can policies for managing oral healthcare be translated to an acceptable standard of care in this multidisciplinary environment?

• Translating policies to an acceptable standard in a multidisciplinary environment.

8. How can the apparent widespread neglect of oral health in residential care facilities be placed on the agenda of the federal/provincial health ministers?

• Sensitizing health ministers to oral healthcare for frail elders.

The sub-group then addressed each of these eight questions, identifying the information available to address the question and what further information, strategies, and recom- mendations were required. These recommen- dations were listed and then categorized into five overarching themes. These themes are:

• Oral health care is integral to residential care

• Management of oral healthcare in residential care

• Education

• Assessing oral health

• Policies, legislation and standards


The summary of solutions, strategies and recommendations are as follows:


1. Recognize oral health as an integral part of general health.

2. Research agencies must support at reasonable and sustainable levels research on oral health for frail elders.

3. Regulatory bodies must enforce responsibility of all professional groups to care for oral health at an appropriate standard.

4. Promote collaboration between oral healthcare and other healthcare providers.

5. Investigate contractual agreements between facilities and oral healthcare providers.

6. Heighten sensitivity to risks associated with sugar, alcohol, tobacco, and poor hygiene.

7. Advise pharmaceutical companies and residential care managers to eliminate sugar as a medium for delivering medications.

8. Advise health authorities to discourage continuous snacking on sugar and other refined carbohydrates.

9. Promote professional collaboration on oral health to combat anorexia and social isolation among frail elders.



10. Identify oral hygiene as part of all care plans.

11. Implement regulations for appropriate daily oral hygiene support in all facilities.

12. Support placement of certified dental assistants (CDAs) and dental hygienists (DHs) on salary in every facility to co-ordinate oral healthcare.

13. Explore the possibility of CDAs as primary promoters of oral healthcare in facilities.

14. Acknowledge that institutional structure and culture influences oral health as much as surgical or medical interventions.



15. Develop inter-professional education to promote teamwork.

16. Ask professional accreditation boards to establish educational objectives for oral healthcare appropriate to the scope of practice of each professional group.

17. Implement basic and continuing oral health-related programs for all health professionals.

18. Encourage continuing educational programs for all care staff to highlight associations between sugar, obesity, diabetes, cardiovascular disease, and oral diseases.

19. Expand professional development initiatives for all healthcare providers to enhance oral healthcare.



20. Develop guidelines for assessing programs of oral healthcare in residential care facilities.

21. Define the role of oral health professionals in assessing oral health status and need for care.

22. Develop clinical and psychometric instruments for non-dental healthcare providers to assess the oral status and propensity for oral care.




23. Identify financial, physical, and psychological barriers, including inter-professional rivalries that impede effective oral healthcare for frail elders.

24. Promote best practice guidelines on oral healthcare and oral hygiene.

25. Ask all regulatory authorities in Canada to increase compliance with existing oral health guidelines.

26. Encourage development of health promotion strategies to increase appreciation for oral health in old age.

27. Rethink the hierarchy of healthcare providers in residential care.