Karen De Luca, RDH, shares her personal journey and advocates for dental hygienists to provide preventive dental therapy for people living in long term care.

I used to feel uncomfortable at the thought of visiting a nursing home and seeing residents confined to their beds or wheelchairs, with their heads hanging down and saliva dripping from their mouths. As soon as I walked in, I felt a mix of emotions – disgust, sadness, and a determination to make a difference in their lives. I may not be able to change their living situation, but I can improve their oral health, one person and one facility at a time. I have to be creative in finding ways to help.

I have heard from many dental hygienists who are frustrated and bored with working in traditional dental offices. I certainly felt this way. Many of them have expressed interest in helping people in long-term care facilities. Oral care in these facilities is either not happening or, at best, is poor, even though intentions may be good. Based on my experience, I find that administrators, nurses, and social service directors, on the whole,
have no idea about what is going on in the mouths of their residents. They are not looking in the mouth and think that if a resident does not complain, all is good! Slowly, I am educating those in charge, as well as the nursing team, about the importance of oral health as well as the unhealthy status of residents’ mouths. It is not easy to get started. Getting facilities on board might be slow, but we need to start somewhere to make a difference. Have you had the opportunity to look into the mouth of a resident living in long-term care? What about a person with special needs who is unable to go to a dental office or someone who is homebound? It is my goal to have at least one dental hygienist on staff providing education and direct dental hygiene services. Our parents, grandparents, brothers, sisters, and friends need our care.

When I worked in private practice, I had only seen a small number of special needs and dementia patients. I was shocked the first time I saw the lack of oral care in a long-term care facility. I was quick to judge (at least in my mind) about why oral care was not happening. It was far worse than I ever expected, even for people who have money. I quickly learned that people in facilities are not getting the oral care they need because care providers are overworked underpaid, and many do not feel comfortable providing oral care. Of course, there are patients/residents who are not cooperative, making oral hygiene difficult. However, most of these residents no longer have the skills to effectively clean their mouths, and those who try usually do not do a thorough job. Finding a way to educate staff without them feeling judged can go a long way in building strong relationships with care providers. These relationships build trust and open up good lines of communication. I knew I had to find a balance between educating and appreciating not to create animosity.

If you haven’t visited a nursing home, memory care facility, rehab, or assisted living facility, I recommend that you do so. I have never seen one with a dental operatory, but they all have hair salons. Looking good makes you feel good, but the importance of oral health is understated. I started by contacting the facilities and asking to speak with the administrator, director of nursing, or social services director. I asked if I could write a short blog about oral health to go into their newsletter that is sent home to family members. When I started doing this, a resident immediately contacted me with questions about dry mouth remedies. I asked if I could come to the facility and provide in-service training. This is a great way to help the staff and administrators understand
the importance of oral health. This could be done in a variety of ways. I questioned to find out what the care providers are doing now to provide oral care and how they feel about doing it. I could use that information to help formulate a presentation with PowerPoint slides that include information about the oral-systemic link, periodontal disease, and caries as a start.

I have encountered situations where facilities have given me less than an hour for my presentation, with some only allowing 20 minutes. In these cases, it’s important to prioritize the most crucial information for the staff to learn. My presentation covers working with individuals who have dementia, as well as those with an intellectual or developmental disability. However, not all facilities have these types of patients. Therefore, it’s helpful to inquire about specific patient demographics in advance. During my presentations, I always offer to demonstrate how to provide oral care to care providers, and I express gratitude for their hard work before beginning. This approach can help foster positive relationships and garner the support needed to provide dental
hygiene services

I often wonder if the assessments are being done and, if so, what treatment is being performed for oral disease, even with these guidelines. After seeing the mouths of the residents in the long term care homes, I cannot fathom that much, if any, dental treatment has taken place. I don’t know what is happening, but aside from
much-needed preventive dental hygiene services, even these minimum standards do not appear to be happening. More than 1.3 million people living in long-term care homes need our care. I am up for the challenge. It is my goal to have at least one dental hygienist on staff providing education and direct dental hygiene services in every facility in Ontario. Our parents, grandparents, brothers, sisters, and friends need our care.

There are several hurdles I have to overcome, such as identifying the power of attorney for some patients, figuring out payment procedures, and gaining access to these facilities. Care providers at these facilities are often overworked and underpaid, with limited time to engage with us. I understand that assessing the oral health of residents in long-term care homes may seem daunting. However, if no action is taken, healthcare
costs, health outcomes, and quality of life will continue to decline. Each time we educate, even without providing treatment, we are taking a step closer to providing care and building necessary relationships to collaborate and improve the lives of the many people living in these places. Us Dental Hygienists in Ontario are allowed to work independently. Getting my foot in the door is the first step in educating patients, care
providers, administrators, and families on the importance of good oral hygiene and professional dental hygiene services. My presence in doing this and providing in-service training will help bridge the gap between the medical and dental communities.

Presently I provide dental hygiene services in 11 long-term care facilities, 22 group homes, 4 retirement homes and a number of private homes. I am working on getting the local media to cover our pilot project and how we provide preventive oral care to people who have not had it for many years. I know it can be easy to talk yourself out of trying for fear of getting a door closed in your face. This just means it’s time to try a different tactic. Be persistent. New ideas and change can take time, and it may take several attempts via email, phone calls, and showing up before you get an audience. I am grateful that I get to make an impact on the lives of those living in these facilities. I try hard not to judge, even though I have assessed countless residents with multiple broken teeth, teeth broken to the gumline, unimaginable periodontal disease with many teeth hanging on by sheer will, rampant decay, and mouths laden with biofilm and food debris that has probably not moved for years. It’s so much easier to judge than not to, but when we do, our progress will be stifled, and gaining trust and acceptance will be that much tougher. Finding a way to delicately explain the situation can be difficult. For me, what has helped is taking photos and/or showing the administrator or nurse directly in a resident’s mouth, often not the first time I am there, but after a few visits when the staff knows me. Every time I have done this, there are shocked responses. I have also heard, “Wow, but they never complained!” Obviously, no one is looking! Instead of complaining or giving up, let’s take action to educate and share our expertise with long-term care facilities. This will ensure that our loved ones and those without anyone to care for them receive daily oral care and professional dental hygiene services regularly. We need to open doors to better health and dignity. Are you ready for the challenge? Let’s start laying the groundwork; the rewards are worth the hard work