KINGSTON — By the time Mary Farrar realized her husband, Edward, had lost a tooth, it was too late.
In the summer of 2018, she says, “We found out he had actually lost eight teeth, not just one. They’d all rotted off at the gum line.”
Edward, 80, was staying in a psychiatric ward at Kingston General Hospital at the time. He has dementia and was unable to communicate that something was wrong, and staff, Farrar says, didn’t spot the problem. His remaining teeth were in such bad shape that, in December 2018, they all had to be removed. (Kingston Health Sciences Centre’s chief of staff, Michael Fitzpatrick, told TVO.org in an email that “regular dental services are not included in the scope of practice of acute care hospitals in Ontario,” adding that patients or their families can request a visit from a dentist or hygienist, although they would be responsible for covering the cost.)
Fluoridated water and better access to dental insurance and care mean that more people such as Edward are arriving at hospitals and long-term-care facilities with their own teeth. And that poses a new set of challenges for oral health — challenges that staff and caregivers aren’t always equipped to meet.
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For one thing, teeth have become a more complicated business. “They have a lot of stuff in their mouths,” says Ontario Dental Association president David Stevenson.” More and more are going into long-term care with implants, bridges, crowns. It’s a lot of dentistry.”
Then there’s the fact, he adds, that no matter how well we care for our mouths, our teeth eventually get brittle. This, combined with an aging body (less dexterity to perform routine brushing and flossing) and mind (less likely to think about oral hygiene or know that something is wrong), leads to oral-health problems.
“The lack of physical and cognitive ability — there are things we can do to counteract this, but as a general rule, seniors are needing more assistance from caregivers. And family, if it’s possible,” he says.
Lynda McKeown, a dental hygienist based in Thunder Bay, says that improving oral care in long-term care and hospitals is critical — but it won’t be easy.
“One of the main issues is that oral-health professionals are not listed as providers in the Long-Term Care Homes Act,” she says. “So if someone can’t look after their mouth, it’s up to staff to do it, regardless of their ability.”
Staff are required to keep a record of a patient’s oral assessments, she says. But that can simply involve “checking the box” indicating that they have brushed a patient’s teeth — it doesn’t necessarily mean they’ve brushed them effectively.
In 2010 and 2011, she conducted a study that found “discrepancies in oral dental documentation.” She explains: “There are some healthy mouths — but in many cases, they are not. So the evidence does not match the documentation. I see this consistently.”
Inadequate oral care, combined with a diet that McKeown thinks is too sugary, has serious consequences for seniors in long-term care: oral disease, cardiovascular disease, even pneumonia or stroke.
“We have a population that worked really hard to keep their mouths healthy,” says Stevenson. “And if all of a sudden they can’t, there’s an increase in the likelihood of acute disease.”
Farrar, for her part, took action by forming a “task force” with two other Kingston women, dental hygienist Cindy McQueen and bioethicist Hannah Kaufman, to advocate for the implementation of oral-care standards at hospitals and long-term-care facilities.
According to McQueen, Ontario’s Long-Term Care Homes Act indicates only that caregivers must brush teeth and dentures once a day. “What we want,” she says, “are specific standards of how to brush teeth.”
Their cause now has political backing. Local NDP MPP Ian Arthur plans to introduce a private member’s bill this spring to amend the act.
“Almost everyone knows someone in long-term-care or someone who has experienced the shortcomings of the system,” he says. “We hear the same stories. There needs to be a minimum standard of dental care in the act.”
McQueen hopes that changes to the act would make long-term-care homes more accountable when it comes to oral health. Ultimately, she says, it will come down to funding. More personal-support workers are needed to provide effective care, and more dental professionals are needed for assessment and treatment. That will cost money.
“Let dental professionals assess them when they arrive and assess how they’re progressing, so that you can catch the problems before they get too bad,” she says. “But you’ve got to hire them.”
Education is also an option. As the task force waits for the bill to work its way through Queen’s Park, McQueen is offering free in-service training to local hospitals and long-term-care facilities, demonstrating proper brushing and flossing strategies.
“Everybody recognizes this is a problem,” says McQueen. “I don’t think people are out to make people come in and lose their teeth. It’s endemic of a huge issue of staffing, funding, logistics, supplies. Long-term care and home care in our province is in crisis. And that’s nothing new.”
This is one in a series of stories about issues affecting eastern Ontario. It's brought to you with the assistance of Queen’s University.
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.