In a small aged care facility on the New South Wales Central Coast, more and more residents are finding a reason to smile.
That's because for more than a decade, a highly successful program has helped them improve their dental health.
Senior Smiles was created by Doctor Janet Wallace from the University of Newcastle after years of researching the importance of dental care in aged care facilities.
She's now a professor of oral health at the University of Sydney.
"Senior Smiles is unique in the fact that it puts an oral health practitioner in the facility so that the practitioner can build a relationship with the staff and residents and dentists in the private and public sector," she said.
A lack of dental care for elderly residents can cause extreme pain, difficulties swallowing and speaking, disrupted sleep, depression and even early death.
A recent report found a quarter of Australians over 75 have teeth affected by decay, while 20 per cent have complete tooth loss.
Professor Wallace said that dental care in Australia's aged care system was, at best, ad-hoc.
"Currently residents in aged care facilities are treated for oral health conditions when it becomes an emergency and that's really not good enough," she added.
How does it work?
The Senior Smiles program was established with a grant across five residential aged care facilities on the NSW central coast.
It provides an oral health practitioner who works on-site, regular dental checks, the creation of individual dental care plans, and referral pathways to dentists.
Senior Smiles team member Kay Franks said oral health had long been neglected in aged care.
"Staff are very busy and oral health tends to get put on the back burner, but now having an oral health practitioner… [the residents] can get used to someone that negotiates 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 health care in residential aged care, $2.40 in benefits was delivered to the healthcare system and an additional $3.18 in social benefits.
Those benefits included improved nutrition, a lower risk of pneumonia, fewer hospital admissions and visits to doctors, decreased prescription costs and fewer deaths.
Some participating facilities are now planning on expanding to include a dental surgery on site.
The program is endorsed by all of Australia's dental health professional associations.
Decay a pneumonia risk
Dr Kathleen Matthews, from the Australian Dental Association, gave evidence to the Aged Care Royal Commission about the need for programs like Senior Smiles.
It was really important to remember, she said, that aged care facilities already had other specialists, such as podiatrists, come in to provide care.
"I also think that most of the residential aged care facilities that I've gone into have a hairdressing salon, which is wonderful because I love having my hair done," she said.
"But I think it's not right when only certain parts of the body get access and this is 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 cause-of-death you will often see aspiration pneumonia. I think there's a strong link between poor oral health and having aspiration pneumonia."
The royal commission ultimately recommended every resident entering a facility should have an oral health assessment, regular dental care and referrals for any treatment.
"The majority of people within an aged care setting don't get a dental assessment as part of their in-boarding… and then they have a number of huge barriers to overcome to go and get dental care," Dr Matthews said.
"The hard thing is when you see someone who can't communicate well, their cognitive decline means their ability to communicate has been impacted and so potentially they're grumpy, out of sorts and an unhappy person and sometimes the reason for that is a toothache."
