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The March 2011 ADJ editorial highlighting the unsuccessful efforts of an Australian dentist to address the poor dental health of a nursing home resident is a timely wake up call for the profession.1 The average age of new nursing home residents today is in the 80s whilst 40–50 years ago it was at least 10 years less. The more relevant difference, however, is that many of today’s new residents have several natural teeth present, some having complex crown and bridge and implants in place.

In late 2008, in response to revelations on the ABC 7.30 Report that the dental health of nursing home residents was in a poor state, the Commonwealth Department of Health rolled out a training programme to educate a nominated delegate from each of the 2830 Australian nursing homes in oral health. These new ‘dentally’ trained nurses were supposed to go back to their nursing home and be advocates for better oral health.

The sad reality is that due to poor wages and conditions in our nursing homes there is a high turnover of staff. Many of those who attended the in-service course on oral health have moved on, leaving many nursing homes with no oral and dental health input. The excellent Oral Health Assessment Tool (OHAT), which was in part developed by the South Australian Dental Health Service for implementation in all nursing homes, has been useful for a few. However, the majority either have little understanding of its benefit or have no idea of how to implement an oral health programme.

I am closely involved in a Sydney nursing home which has a modern, fully functional on-site dental clinic with an employed dental hygienist and a very proactive board of management committed to good oral health being integral to their residents’ well-being. Even we struggle getting the message across to all nursing staff, family and carers on the importance of a clean and healthy mouth. I am extremely concerned that our elderly are heading for a dental Armageddon. Time and time again we see new residents who have clearly had technically outstanding dental work done over the years, only to see the devastating consequences of neglect in the time leading up to the nursing home admission. Entry into a nursing home is never a planned elective course of action for a healthy elderly person. It is generally due to a decline in health or when an individual is no longer able to care for themselves. A combination of poor oral and systemic health, xerostomia, deterioration in cognition and decline in fine motor skills reduces significantly the ability of an older person to provide good oral care.

Sadly, poor oral health in the elderly is normal in Australian aged care facilities, contrary to the hope of the ADJ Editor. However, there are many factors at play, not least of which is the next of kin in some cases seeing the inheritance dwindling by embarking on dental care. Doctors and nurses can be in denial that there is a problem causing harm to the resident as any inference that poor oral and dental health is impacting on the resident’s systemic health, comfort and well-being will reflect poorly on their management.

There needs to be a commitment from our universities to send all undergraduates to nursing homes to provide oral and dental health education and our dentists need to ensure that our elderly have dentistry which can be maintained and supported should age and infirmity impact on an individual’s ability to look after their own mouth. Ensuring ‘that oral care for the aged is up to scratch’ will require significant State and Commonwealth Government support if we are to meet stated WHO objectives in improving oral health in the elderly. WHO have ‘highly recommended that countries establish oral health programmes to meet the needs of the elderly’.2 So far our elderly in Australia have been let down.

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