Many residents of long-term care facilities have undetected oral health problems and staff feel inadequate to help with oral hygiene, according to a recent UBC study.
A team of three researchers from the oral health sciences, nursing and health services and policy research areas evaluated the oral health programs of care facilities in the Lower Mainland to determine what makes a program successful and to find out what dental services are required.
"We didn't know too much about the environment of long-term care facilities," says team member Michael MacEntee, professor of Oral Health Sciences. "Learning about needs for this population can help dentists target resources for residential facilities."
The research team interviewed facility management, staff, dentists and residents.
They found that facility workers have trouble squeezing oral hygiene into an already demanding routine of changing bed linen and clothing, assisting residents to the bathroom and bathing. Lack of training for aides and resistance from some residents, including biting, contribute to inattention to oral hygiene.
The provincial government requires dental services be available to all facility residents. These services may include mobile clinics or an on-site clinic.
These minimal standards of oral health care are not widely enforced, MacEntee says.
Four of the facilities studied made no provision for dental treatment on site; three had a fully equipped dental clinic; and the remainder had mobile dental equipment, a dental chair or access to a dentist with mobile equipment.
Researchers found that no one model of care was superior. Oral hygiene, diagnostic assessment and dental treatment all need to be in place for a successful program.
But services alone don't guarantee effective oral health care, the team discovered.
"We found that organizational factors such as budget, management style and training were secondary and that individual influence was more significant," says research team member Arminée Kazanjian, associate director of the Centre for Health Services and Policy Research. "This points to a policy vacuum which needs to be addressed by the Ministry of Health."
Fellow researcher Sally Thorne agrees that the philosophy and people skills of the facility management were key factors.
"Engaging the staff to pull together toward the same goal is critical," says Thorne, a professor in the School of Nursing. "This study suggests that the values people hold are just as important as any other aspect of health care delivery."
The researchers hope to include training on dental care outside dental facilities as part of undergraduate and continuing dental education.