26
|
Volume1 Issue3
I
ssues and
P
eople
from thisprincipleof distributive
justice.
47
With thecurrent system—
whereemployment-sponsored
dental insurance is terminatedupon
retirement—most people lose their
premiumcontributions, aswell as the
potential gains frompreventiveoral
care. Although thebenefitsof periodic
recall examinations areunclear,
48
we
believe that regular examinations
wouldbenefit older people, especially
when theygrow frail and increasingly
moredependent onothers.
OvercomingBehavioural
Barriers
HealthPromotionandSkill
Development
Educational anddental publichealth
programshelp to increaseawareness
about oral careandcanalleviate the
anxietyassociatedwithdentistry.
49,50
Althoughnurses incare facilities are
oftenoverwhelmedbycompeting
priorities, theycan bemotivated to
convey their ownpersonal hygiene
values to their patients.
51
Safe
techniques for renderingoral care to
confusedor defensivelyaggressive
elderlypatients arechallengingand
shouldbemade familiar toall care
providers incare facilities.
52
Specially
traineddental auxiliaries, suchas
dental assistants and therapists, could
helpchampionoral care routines.
53
Educatingcaregivers, including family
members, inoral carecan improve
thegeneral healthof frail peopleand
reducehospital admissions andhealth
careexpenses.
54,55
Oneconservative
estimate indicated that engagingone
dental assistant tooffer anoral care
program ineach long-termcare facility
in theUnitedStates would savea
total of about $300millionannuallyby
reducing the incidenceof aspiration
pneumoniaby10%.
56
A similar program
could lead toameaningful reduction in
Canada’shealthcarecosts.
QualityAssurance
Continuous commitment toquality
assuranceanda regular audit of
interventions incare facilities are
needed to reduce inconsistencies
inoral care, evenwhen staffare
well trained.
57-60
Awell-run facility
shouldengageall of its staff toview
“quality” broadly, providequantitative
andqualitativeevidenceof itsoral
healthpromotionactivities toassure
continuousmaintenanceof care.
58
We
believe that anoral careprotocol in
everycare facility inCanadawouldgo
a longway toward translatingdidactic
knowledge intodailypractice.
61
ProfessionalTraining
Somedentists feel ill-preparedand
overwhelmedwhenconfrontedwith
themedical and social problems
associatedwith frailty, and they
strugglewith themoral considerations
of benevolenceandnonmaleficence
in treatment plans.
62,63
Frequently,
dental treatment performedon frail
elderlypatients is littlemore thana
“patchwork” effort toward symptomatic
relief.
64
Questions about choiceof
restorativematerials, preservationof
natural teethand level of oral hygiene
can raise largeethical dilemmas for
which there ismuchuncertainty
.65,66
Geriatrics is taught inalmost all dental
schools inNorthAmerica, although
principallyas adidactic rather than
aclinical subject.
67,68
Obstacles
to teachingdental geriatrics in
undergraduateeducation include
overcrowded syllabuses, compounded
by lackof fundingandpersonnel. Only
about one-thirdof thedental schools
in theUnitedStates andhalf of those
inCanadaoffer their students clinical
exposure togeriatricpatients.
67,68
Moreover, therearevery few formal
programs (fellowshipor specialty)
availableworldwide for postgraduate
clinical and research training ingeriatric
dentistry.
67
Similarly, advanced training
5Strategies toReduce Inequity inOral Care
➊
Encourage a government-administered universal dental plan
supported financially by redirecting the premiums currently paid for private
dental insurance in each province and territory
❷
Promote oral health care
widely to increase awareness and enhance the
skills of care providers responsible for older people
➌
Establish official guidelines for standards
of oral care within all care
facilities to reduce complications from oral diseases and improve quality of
life among residents living in the facilities
➍
Develop and expand educational programs
in dental geriatrics for dental
professionals interested in expanding their scope of practice in the care of
people who are elderly and frail
➎
Review the admission criteria for dental and dental hygiene programs
to promote the selection of applicants withmature social and humanistic values
suitable for managing chronic disease and disability in an aging population
Thecomplete "Inequity in
OralHealthCare forElderly
Canadians"seriesavailable:
Part 1. Oral health status.
Part 2. Causes andethical considerations.
Part 3. Reducingbarriers tooral care.
Visit
jcda.ca
