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The provincial government has resisted pressure from the College of Registered Dental Hygienists of Alberta to set standards for oral assessments and care. The regulatory body for the hygienists sought to have such standards included when an MLA task force produced standards for continuing care health service and accommodation after hearings in 2005. When the draft standards omitted oral care, the college pleaded again in a submission to the task force, but made no headway.
Alberta’s “Continuing Care Health Service Standards” as of July 2008 merely require long-term care providers to help residents arrange for their own professional care. The document says a care facility’s “operational policies and processes shall include” oral care, but does not specify what that will be.
The document is available at www.continuingcare.gov.ab.ca. The standards apply only to publicly funded health care and personal support services provided by or funded through a contract with a regional health authority. The standards are the responsibility of Alberta Health.
THE DOCUMENT INCLUDES NO ACKNOWLEDGEMENT OF THE IMPACT OF POOR ORAL CARE ON INDIVIDUALS:
- pain and infection;
- compromised ability to meet nutritional needs;
- reduced ability to speak and communicate effectively;
- social isolation;
- and increased risk of systemic infection and disease.
Alberta Health Services did not respond to requests for comment on the lack of standards or on the future of a consumer advisory committee looking at specialized geriatrics that was struck by the former Capital Health Region.
Arlaine Monaghan, Alberta Health appointee to the board of the hygienists’ college, sits on that consumer advisory committee and was excited to see the cause of oral health taken up. She is now concerned about losing momentum under a single provincial health care overseer. “Geriatric care is an area of particular concern,” she says. “There hasn’t been a standardized protocol for oral health care. It needs to be addressed by everyone concerned — hygienists, dentists, residential management and that whole network. There’s likely an educational process that’s needed. They need to make the connection between good oral health and wider health.”
Monaghan backs the college in calling for:
- Intake assessments that include oral-health indicators such as the presence or absence of natural teeth; use of full or partial dentures; broken, loose or decayed teeth; broken, damaged or ill-fitting dentures; red, swollen or bleeding gums; abscesses, yeast infection, herpetic or other lesions; pain or other oral complaints, and self-care ability related to mouth care;
- an oral-health plan to be included in the managed care plan and discussed in a family consultation;
- daily mouth care;
- a referral process for dental care, including standards on timeliness of referrals and interventions;
- and ongoing assessment and at least annual re-evaluation of oral health.
If there is no intake assessment, caregivers may not even know whether a resident has dentures or a partial plate. “People just stop eating, but it might be they have a horrid sore under a plate,” Monaghan says. “Unless somebody’s picking that up, their health just goes downhill because their nutritional needs are not being met. Their food may be mushed up. Part of oral health is chewing. If you don’t have to chew your food, it doesn’t bode well for people with their own teeth. More than we realize, good oral health care impacts appetite as well as infection. They’re all connected to health and well-being.”
Eating only soft food rather than a mix of hard and soft foods leads to the formation of plaque. Bacteria multiply in plaque, producing acid that erodes tooth structures. As people age and have gum recession, the prevalence of root cavities (caries) increases because food packs in around the teeth and sits there for a period of time. A high sugar or carbohydrate content makes the problem worse. Epidemiological studies suggest older adults are more likely than 14-year-olds to develop dental decay, with about 70 per cent of these individuals having root caries.
There is also a concern that oral cancers will be missed without checkups. “Because there are so many players and agencies involved, it really is going to require a provincial look at protocols and what’s needed,” Monaghan says.
Both British Columbia and Ontario include the provision of basic oral health-care services in licensing requirements for continuing care facilities.
