Dental Hygienists Role in Extended Care Facilities

Residents of extended care facilities are often unable to seek dental care at a dental office due to mobility or transportation issues. Dental care is often left unaddressed until a resident is experiencing significant pain. Dental hygienists are specialists at prevention. They are trained to identify potential disease, educate and intervene to prevent it from becoming worse. In some states, Dental hygienists write prescriptions for high fluoride toothpaste and a mouth rinse that inhibits bacteria and inflammation, as well as refer patients to specialty offices.

These are some of the reasons why every extended care facility should be mandated to have a dental hygienist on staff, at least part-time. Dental hygienists can educate staff and residents on proper oral-care, provide some preventive treatments such as scaling and fluoride and refer residents with suspicious areas to a dentist or specialist. Administrators often balk at the idea of adding additional personnel to an already strained budget; however studies show a dental hygienist can be very cost effective for a facility and that reasonable levels of untreated decay can be achieved through intervention.

Although there are numerous studies showing relationships between the mouth and body, physicians and nurses are not educated in dental disease and how it relates to overall systemic health.

It is important for states to mandate every extended care facility to employ a dental hygienist, at least part-time because prevention is less expensive than treatment, a reasonable level of oral health can be achieved with an oral care team and oral health is directly linked to overall health.

Dental disease is less expensive than treatment. Most organizations are focused on balancing budgets. If facilities and state governments can be educated about the real cost of remediating a massive dental infection versus paying a dental hygienist to provide screenings, referrals, education and preventive treatment they would see the importance of having an integrated dental hygienist on staff. According to Gams, Shewale, Demian, Khalil, & Banki (2017 p.221-229) severe dental infections are associated with substantial morbidity and cost. Early identification and treatment of dental infections would likely decrease the number of patients admitted to the hospital, length of stay (LOS) and overall costs. Early treatment of a dental infection would likely decrease overall cost since antibiotics and tooth extractions are inexpensive when compared to the average hospital bill in this study being $48,351.

Significant improvements in oral health can be achieved through an integrated oral health team in extended care facilities. As Janssens, Vanobbergen, Petrovic, Jacquet, & Schols (6/12/18 pp. 1-13) found an integrated oral healthcare program significantly reduces the untreated dental decay (caries) rate. The untreated caries rate went from 70.5% of the population at baseline to 36.5%, as well as providing oral health stability for 53.5%. Numbers that are consistent with the general population in Western Europe where this study took place. The population in extended care facilities deserve the same rights to access oral care as the general population.

Oral health is also shown to be directly linked to overall health. As facilities and governments are informed of the negative consequences poor oral health can have on the general health of residents in extended care facilities, they will come to understand the importance of providing care. According to Otomo-Corgel, Pucher, Rethman, & Reynolds (2012 pp. 20-28) oral health is linked to many systemic diseases, such as diabetes, cardiovascular disease, pneumonia and COPD. Otomo-Corgel et al. state:

Diabetes is a risk factor for periodontal disease and periodontal disease severity may influence glycemic control as well as contribute to complications in these patients. Meta-analysis of studies published between 2003 and 2009 showed a weak but statistically significant association between cardiovascular disease and periodontal disease. Optimal or improved periodontal health would likely decrease the incidence of pneumonia and may also decrease the intensity or incidence of COPD.

Although more studies are needed, clearly oral and systemic health have bidirectional effects on each other.

Administrators may argue that it is too expensive to add a dental hygienist to an already strained budget. A dental hygienist’s salary is similar to a Registered Nurse (RN). According to the Bureau of Labor Statistics (BLS.gov) the 2017 median pay for a dental hygienist is $35.61 per hour, while an RN earns $33.65 per hour.

Another point is mentioned by some is that a dental hygienist is not treating anything medically important. Teeth are cosmetic, and staff must focus on important issues. As mentioned by Gutkowski (2011 pp.23-25) having ‘moderate’ periodontal disease is the equivalent of an open wound the size of an adult’s palm or 1% of the body surface. If a resident in an extended care facility exhibited a wound this size it would be addressed immediately by “wound care” specialists due to the high probability of bacterial infection and sepsis.

Dental disease is costly to treat and even more expensive when it becomes systemically involved. Dental hygienists are trained to identify early and refer issues that can be addressed at the least expensive point possible. Dental hygienists can also implement preventive treatments to decrease further dental disease and halt some existing disease. Requiring facilities to have a dental hygienist on staff, at least part-time, would reduce the overall cost to facilities due to late identification of dental disease, and improve oral and systemic health in this population.

References

1. Gams, K., Shewale, J., Demian, N., Khalil, K., & Banki, F. (n.d.). Characteristics, length of stay, and hospital bills associated with severe odontogenic infections in Houston, TX. Journal of The American Dental Association, 148(4), 221–229. https://doi-org.ezproxy.snhu.edu/10.1016/j.adaj.2016.11.033
2. Gutkowski, S. (2011). The biggest wound: oral health in long-term care residents. Annals of Long Term Care, 19(7), 23–25. Retrieved from http://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108247233&site=eds-live&scope=site
3. Janssens, B., Vanobbergen, J., Petrovic, M., Jacquet, W., Schols, J. M. G. A., & De Visschere, L. (n.d.). The impact of a preventive and curative oral healthcare program on the prevalence and incidence of oral health problems in nursing home residents. PLoS One, 13(6). https://doi-org.ezproxy.snhu.edu/10.1371/journal.pone.0198910
4. Otomo-Corgel, J., Pucher, J. J., Rethman, M. P., & Reynolds, M. A. (2012). Original Article: State of the Science: Chronic Periodontitis and Systemic Health. The Journal of Evidence-Based Dental Practice, 12(Supplement), 20–28. https://doi-org.ezproxy.snhu.edu/10.1016/S1532-3382(12)70006-4