At a small aged care facility on the central coast of New South Wales, more and more residents are finding a reason to smile.

Indeed, for more than a decade, a very successful program has helped them improve their dental health.

Senior Smiles was created by Dr Janet Wallace of Newcastle University after years of research into the importance of dental care in aged care settings.

She is now Professor of Oral Health at the University of Sydney.

“Senior Smiles is unique in that it places an oral health practitioner in the facility so that the practitioner can build a relationship with staff, residents and dentists in the private and public sectors,” a- she declared.

A lack of dental care for elderly residents can cause extreme pain, difficulty swallowing and speaking, trouble sleeping, depression, and even premature death.

A recent report revealed that a quarter of Australians over the age of 75 have decayed teeth, while 20% have complete tooth loss.

Prof Wallace said dental care in Australia’s aged care system was ad hoc at best.

“Currently residents of aged care facilities are being treated for oral health issues when it becomes an emergency and that is really not enough,” she added.

How it works?

The Senior Smiles program was created through a grant in five aged care facilities on the central coast of New South Wales.

It provides an oral health practitioner who works on site, regular dental check-ups, the creation of individual dental care plans and referral pathways to dentists.

Kay Franks, a member of the Senior Smiles team, said oral health has long been neglected in care for the elderly.

“The staff are very busy and oral health tends to be put on the back burner, but now having an oral health practitioner… [the residents] can get used to someone negotiating with them and they start to trust them,” Professor Franks said.

The in-house oral health practitioner also trains existing staff to implement parts of the care plan.

It can be as simple as teaching residents to clean dentures with soap and water instead of toothpaste.

A model of care across the country

Professor Wallace said an independent economic analysis of the program found that for every dollar spent on preventive oral care in aged care facilities, $2.40 in benefits went to the health system and $3. $18 extra in social benefits.

These benefits included better nutrition, lower risk of pneumonia, fewer hospital admissions and doctor visits, lower prescription costs and fewer deaths.

Some participating facilities are now considering expanding to include on-site dental surgery.

The program is endorsed by all professional dental health associations in Australia.

Cavities a risk of pneumonia

Dr Kathleen Matthews of the Australian Dental Association testified before the Royal Commission on the Care of the Aged on the need for programs like Senior Smiles.

It was really important to remember, she said, that elder care facilities already had other specialists, such as podiatrists, coming in to provide care.

“I also think most of the senior residences I’ve been to have hair salons, which is wonderful because I love getting my hair done,” she said.

“But I think it’s not right when only certain parts of the body have access to it and it’s such a fundamental part of your overall health, having a healthy mouth.”

Dr Matthews said it was well known that oral health affects general health.

“So when you look at the cause of death, you’ll often see aspiration pneumonia. I think there’s a strong link between poor oral health and aspiration pneumonia.”

The royal commission eventually recommended that every resident entering a facility be given an oral health assessment, regular dental care and a referral for any treatment.

“The majority of people in an elder care facility don’t get a dental assessment as part of their onboarding…and then they have a number of huge hurdles to overcome to seek dental care,” said Dr Matthews.

“The hardest thing is when you see someone who can’t communicate well, his cognitive decline means his ability to communicate has been affected and so potentially he’s grumpy, moody and an unhappy person and sometimes the reason is a toothache.”