Oral Care in the US needs to be incorporated into services normally offered at health facilities. Poor oral hygiene can result in oral disease. We are learning more and more about how the mouth and the body relate to each other and affect each other. There is a profound correlation between the two. Oral disease has the potential to create other health problems, including aspiration pneumonia, ventilator associated pneumonia, increased risk for heart disease, and stroke which can all lead to death. Individuals with poor oral health are more likely to develop diabetes than those with good oral health and those with diabetes are more likely to develop periodontal (gum) disease.
from Reuters Health – Preventative dental care provided in the early stages of dementia could help limit major tooth problems later, researchers say. “Dementia is associated with a change in health habits, including two major ones – diet and teeth cleaning,” said Robert Emanuel of Sussex Community NHS Foundation Trust in Sussex in the UK< a specialty care dentist who is often consulted to help patients with the late-stage dementia. Sometimes teeth are nearly untreatable.
Health facilities and clinics are ideal locations to perform nutritional status screenings as they can identify patients who may not regularly visit a primary care provider and who may be at risk for malnutrition. They are also ideal places for patients to be screened for needed dental care and there is the ability to give preventative care also to avoid the potential health problems listed above.
https://www.sciencedaily.com/releases/2018/10/181025141018.htm
Evidence shows that oral care for the elderly is at risk. For example, dependent elders have many health challenges. Keeping their mouths healthy can keep some of these challenges at bay. Oral care is on the list of Activities of Daily Living (ADL’s) that nursing assistants are to help residents with. However, oral care is one of the most frequently neglected tasks. There is good reason for this. Nursing assistants are busy taking care of things other than oral care. When they don’t have time to complete everything, oral care is easily left undone. No one can really tell if it has been completed and often times the mouth goes unchecked by supervisors. Nursing assistants also have limited education on how to deliver effective oral care, which leads to them not wanting to brush and floss residents teeth. Nursing assistants also get bitten by residents when they attempt to brush and floss their teeth. This also makes the nursing assistant hesitant to deliver oral care.
Another problem for the elderly is that Medicare doesn’t cover routine dental care or dental procedures, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. These services typically need to be paid for by the resident or their families. This is another reason many residents go without dental/dental hygiene services. This contributes to why the nursing home population has extensive oral disease and poor oral hygiene. This group suffers the worst oral health of any population. Patient’s also in these facilities are unable to come to the dental office. Their problems are often critical due to xerostomia and diabetes. Co management of patients with diabetes (for example) and periodontal disease will promote better dental and medical care for patients.
Dental hygienists who promote disease prevention and oral health care fit perfectly into an interprofessional model to provide comprehensive health care to all. Many states do not allow dental hygienists to work without a dentist present supervising. This then affects the amount of people that can access care because there is less available and it is most likely more expensive. Some states though allow hygienists to work independently in many ways. In 2016 there were 39 states that allow hygienists to provide direct access (without dentist on site). Without supervision of a dentist the hygienist could provide services like cleanings, xrays, periodontal therapy, and sealants. The dental practice could benefit the health care systems, schools, primary care clinics, pediatric offices , prison system, free clinics, long term care facilities, Head Start programs, rehab centers and senior homes. Diminishing the progression of disease can really help the patient and if we control periodontal disease we could prolong the life of the patient.
The hygienist could address preventative oral care and education at health care centers and also be able to use tele-dentistry and have the hygienist be able to work independently. The hygienist could collaborate with the other medical professionals making a plan to make the patient as healthy as possible. The patient that presents with a dental problem could be referred out or there would be a dentist on staff, but they would also get the collaborative care they need, whether it be information about diabetes, periodontal disease and so on.
Are you were aware of the legislation in IL called Illinois 2015 225 ILCS 25/18.1 Public Health Dental Hygienist? It basically states that a hygienist can work without a DDS being present or doing an exam if working on patients that are Medicaid-eligible.
Illinois 2015 225 ILCS 25/18.1 Public Health Dental Hygienist : A dental hygienist may treat patients in specified public health settings without a dentist first examining the patient and being present during treatment, who are Medicaid-eligible or uninsured and with household incomes not greater that 200% of the federal poverty level. Requirements: A licensed dental hygienist must have 2 years of full-time clinical experience or an equivalent of 4,000 hours of clinical experience and have completed 42 hours of additional course work in areas specific to public health dentistry. The dental hygienist must also practice pursuant to a written public health supervision agreement with a dentist. Revised June 2017 www.adha.org Provider Services: Dental hygienist may provide prophylactic cleanings, apply fluoride place sealants, and take radiographs. Additional services may be prescribed by the Illinois Department of Financial and Professional Regulation.
