From toothache to hospital bed: Preventing the next aged care health crisis

Aged care has a dental care problem.

In many ways, it is a problem linked to oral health in the broader society where education and awareness or proper dental hygiene can be lacking and the high cost of living forces Australians to skip important dentist trips.

Key points: 

• According to the Australian Dental Association (ADA), 16,000 people aged 65 and over were admitted to hospital for urgent dental treatment in 2022-23
• That figure is expected to increase by 42% within three years
• Around 37% of older people only see a dentist every 2-5 years, while 23% visit just once every five years
• Affordability is the main barrier, even though one in two older adults report debilitating symptoms like tooth or gum pain, swelling, or infections
• Modern aged care recipients, particularly baby boomers, tend to have more complex dental needs, with crowns, bridges and implants requiring ongoing maintenance and care.

The ramifications are serious. Dr Mark Wotherspoon, a seasoned dental practitioner and educator, explained to Hello Leaders that neglecting oral health can lead to other health conditions, yet many people fail to realise this. 

“It’s about oral health related quality of life. To have that we need three things: 20 teeth to smile with dignity, talk clearly and chew food properly; a clean mouth to taste food and boost appetite; and support for a dry mouth which can be caused by medication,” Dr Wotherspoon said.

“Research tells us that germs and disease in the mouth can travel throughout the body and affect almost every organ, including the lungs, and there is even a link to dementia and Alzheimer’s disease.

“A lot of people enter aged care and they want to be left alone and you can’t force help on someone. But when you finally look in their mouth, it’s a nightmare,” he added. 

Bringing dental care to the resident’s door

Frailty, illness, and lack of transport make it difficult for older people in residential care to access dentists. One missed appointment can easily turn into two or three, increasing the risk of tooth decay, infection or a preventable hospitalisation. 

Dr Wotherspoon believes every dental practice should offer out-of-office care to overcome these barriers. He uses a portable dental unit that fits on a trolley and can be set up within 90 seconds.

Avoiding procedures that require anaesthesia, he focuses on diagnostics, preventive care, and maintenance, which he says make up 95% of treatments.

“There’s zero compromise on the standard of care. Everything that occurs before and after  the appointment is the same as if you were going into a dental clinic,” he explained.

By visiting residents on-site — as well as people living in the community — Dr Wotherspoon is promoting comfort and personalisation as part of an individually tailored service. 

The missing link: Enhancing staff knowledge

There is untapped potential with staff often lacking the education that would help them identify early warning signs of decay or inflammation, or better support residents with cleaning and care. 

Associate Professor Angie Nilsson, Clinical Director at the Northern NSW LHD Oral Health Services, says that oral health must be embedded into relevant educational pathways.

“Unfortunately, the barriers to provision of care in residential facilities or homes means there are large disparities in accessing care for older Australians,” A/Prof Nilsson said. 

“The oral health literacy of care workers also needs to be supported; including oral health as a core component of education for health workers is essential.”

SA Dental, palliAGED and Altura Learning provide relevant courses and educational materials for aged care. Additionally, industry peak body Ageing Australia held a masterclass on the topic in February.

Dementia is not a barrier to dental care

Dementia and cognitive decline can turn a simple task such as brushing teeth into a complex one. Dr Wotherspoon shared the following practical advice to help with difficult scenarios:

• Establish positive routines early so residents are comfortable and confident with looking after their own teeth, and are more likely to accept help later on.
• Recognise their routines, e.g. if someone has always brushed their teeth after breakfast and before bed, don’t force them to change.
• Utilise distractions such as a cloth, pillow or comfort item that a resident can hold to reduce sensitivity while brushing their teeth or inspecting their mouth. 
• Use gentle encouragement, such as brushing their cheek and saying ‘open wide’.
• Support residents to brush their own teeth where possible as this can help with ongoing independence and ability.

If a resident refuses care, Dr Wotherspoon advises a considered approach. For example, ask a different carer or family member to help establish a good brushing routine, or simply try again at a different time of day. 

“If that decision is made, we need to make good clinical notes in the care plan so everybody understands what the situation is. Then we can revisit it a week later and continue doing that. It should never be a permanent decision,” he added. 

Affordability is the long-term solution 

With affordability one of the greatest barriers to ongoing dental care, many older adults are going without essential support. The ADA continues to advocate for a government-funded Seniors’ Dental Benefits Schedule (SDBS) that would benefit everyone aged over 65.

Modelling the SDBS on the Child Dental Benefits Schedule (CDBS) would provide $1,100 of annual dental care, helping build up greater awareness of good oral hygiene in the process.

“It is all about preventative care. If people are using their entitlement every year, their own health will be a lot better. They won’t be a burden on the system and it might mean by the time they enter residential aged care, their oral health is far better than if they hadn’t been supported by the entitlement,” A spokesperson for the ADA told Hello Leaders. 

Government funding is critical, however, with A/Prof Nilsson urging the Australian Government to invest in oral healthcare. 

“The sad thing is that none of the advocacy on older people’s oral health has been ‘under the radar’; there has been huge advocacy efforts for decades, but nothing has been happening other than the problem exponentially growing,” she said.

“Oral health has such a huge impact on the quality of life for people; to continue to socialise, eat, talk, smile… it’s immeasurable.”