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Saskatchewan oral health professions (sohp) seniors oral health and long term care strategy
Saskatchewan Oral Health Professions (SOHP)
Seniors Oral Health and Long Term Care Strategy
In The Past
• Twenty years ago
most residents entered
long term care with
upper and lower
• Clients entering care have their own teeth
• They often have sophisticated dentistry
Status of Oral Health among older Adults in LTC
facilities in Saskatchewan
Seniors are one of the fastest growing
demographics; optimal oral health is integral
to overall health. The co-founder of the
famous Mayo Clinic, Dr. Charles Mayo
stated, “People who keep their teeth
live an average of 10 years longer than
people who lose their teeth.”
Factors Responsible for Poor Oral Health
• Increasing population and associated high
prevalence of chronic diseases.
• Population of older individuals will experience “doubling
population over age 65 will double by 2030
population over age 85 will double by 2030
• Seniors are retaining more teeth
For example, 48% of individuals aged 65 years and
over without natural teeth in 1990 and 30 % of
seniors were edentulous in 2003.
• Retention of natural teeth put them at risk for dental and
oral diseases such as caries and periodontal diseases.
LTC Residents - Considerations
These fragile elderly are at an especially high risk for a
number of serious conditions because they:
•Often suffer from some form of dementia and most have
physical and medical challenges too
• Bedridden: care needs to be brought bedside
• Frailty/Dexterity Issues: increases the need for regular
•Often forget to brush their teeth or are unable to do it
• May resist or refuse assistance
•May have problems recognizing and reporting pain and
discomfort in the mouth
The US Surgeon General’s 2000 report on oral health described
oral health of older individuals as “silent epidemic of profound
and consequential dental problems”.
Oral disease particularly gum (periodontal disease) is associated
respiratory infections (aspiration pneumonia)
nutritional deficiencies and weight loss
More than 100 systemic illnesses have oral manifestations.
Oral conditions and dysfunctions are extremely painful and can
devastate the quality of life of an individual
Proper oral hygiene reduces the risk of
aspiration pneumonia and
improves cognitive status and alertness.
Almost one in 10 cases of death can be
prevented in the residents of LTC facility by
improving their oral hygiene.
Next to the common cold .......
•Gum/Periodontal disease is the most preventable
disease in North America today
• 4 out of 5 adults will develop it
• 1 million adults currently have it
•1/3 of those are in danger of loosing their teeth
because of it
•INFLAMMATION due to plaque and bacteria around
the teeth and gums
Periodontal infection was reported to be one
of the top five causes of chronic systemic
inflammation by Anne St Charles PhD in
Inflammation: Causes, Prevention and
Control. Chronic inflammation is believed to
be the underlying cause of the many “agerelated” diseases (heart disease being #1)
Another potential way for bacteria to enter
the bloodstream is through activities of daily
living: tooth brushing, eating, etc.
Inflammatory chemicals and bacteria can
leak from the periodontal area into your
bloodstream and cause havoc in far away
areas. It takes 23 seconds for the blood
to circulate throughout your body.
“If there is inflammation anywhere,
it can show up everywhere.”
Dr. U Phillip Odiatu BA, DMD. NSCA Certified
Personal Trainer Personal Training Specialist
Can Fit Pro Certified Holistic Lifestyle Coach
Certified Nutrition and Wellness Specialist
Plaque growth occurs within hours and must
be completely removed within 24 hours to
A clean, healthy, pain-free mouth contributes greatly to:
•Chewing and being able to enjoy a variety of nutritious
Clear speech and communication
General comfort and a higher quality of life
•A more attractive personal appearance, positive selfesteem and satisfying social interactions
Approximately 72% of residents of long
term facilities reported that routine oral
hygiene is their greatest single need.
Oral health does not appear to be a
priority of the governments.
• Various Canadian surveys show strong support
for publicly funded oral health program
• For example, in a survey of 24 nursing homes,
more than 90% of nursing homes were
interested: in an oral health care program
provided by the public health department of the
health region and were willing to offer support
for such publicly funded dental health program
Many LTC facilities have physical, occupational
department and hair salons but no provision of
space for dental treatment.
Why is oral care not provided to all
residents as the “standard of care”?
Together we can make a difference
Saskatchewan Oral Health
The Saskatchewan Oral Health
Professions (SOHP) collaboratively
envision a future where seniors and long
term care residents have access to oral
health professionals as part of their
primary health care team to provide oral
health care services based on best
practice to strive for optimal oral and
overall health for the people of
1. Establish legislative Oral Health Care
Policies/Standards for Long Term Care and Personal
Care Homes. Policies should ensure that every
resident has access to oral health care services that
1. An individualized oral health care plan
2. Daily oral hygiene
3. Professional dental services
4. Dental recommendations/orders are followed
Note: As per Section 23 of the current Personal Care
Home Regulation, each resident receive a dental
examination, as necessary.
2. An Oral Health Coordinator (OHC)(s), who is a
licensed oral health professional, should be
employed in each health region to facilitate the
delivery of initial oral assessments, dental
examinations and treatment, daily oral hygiene for
residents and oral health education. The Oral
Health Coordinator will work collaboratively with
the long term care, multi-disciplinary team to
improve the oral and overall health of residents.
3. Upon entry into a Long-Term Care (LTC) facility, an
initial oral assessment must be completed by a
licensed oral health professional, through the
general/medical consent provided by the long term
1. Oral assessments should be routinely performed every 6
months thereafter. They may be performed by an oral
health professional or a health care professional trained
in oral health.
2. Non-oral health professionals performing the assessment
will be trained to conduct the oral assessment using an
Oral Health Assessment Tool (OHAT) and will receive
Professional Portfolio Training.
3. All Portfolio Training (Professional, Staff and Facilitator)
will be provided by oral health professionals.
The initial oral assessment may trigger a referral to a dentist for a
full dental examination to include:
1. Personal client record, including consent for dental examination
2. Review of medical and dental history
3. Complete examination of the oral cavity, to include:
1.Assessment of hard and soft tissues
2.Assessment of oral hygiene care
3.Oral cancer screening
4. Treatment plan/progress notes
5. Estimate/Consent for financial responsibility
6. Consent for treatment
5. Treatment needs based on the dental
examination, may be provided by dentists,
denturists, dental hygienists, dental therapists
and/or dental assistants. Residents may access
dental services through their personal oral
health professional or through dental services as
available through the long term care facility.
6. Establish a safety net program for low income
residents (similar to Ministry of Health
Supplementary Health/Family Health Benefits or
Alberta’s Dental Assistance for Seniors Program
through which low income seniors are eligible
for up to $5000 every 5 years).
Please discuss the questions on each table
and complete the surveys individually