The forgotten service in long-term care

“To date, Canada has the highest reported national proportion of COVID-19 deaths for LTC residents in the world, with 85 per cent of total COVID-19 deaths; the majority are women. Other comparable countries report percentages ranging from 29 (Australia) to 35 (U.S.) to 54 (England and Wales. Globally, the fatality rate for people with COVID-19 is estimated at 3.4 per cent. In Canada, it’s 7 per cent, but the fatality rate of LTC residents is as high as 29 per cent.” (A report in the Globe and Mail, June 10, 2020).

As Canada begins to examine its poor performance in long-term care, the experts will focus on infection control, improvements to the layout and organization of these institutions and to both funding and staff training. There will be little, if any discussion, about oral health as a major contributor to morbidity and mortality in long-term care. The dental associations will remain largely quiet and if they say anything at all, it will simply be that more long-term care residents need to see a dentist.

But ask an independent hygienist about long-term care and then watch the eyes roll. The hygienist will tell you their clients in the care home are commonly in very poor shape — extensive oral inflammation, extensive decay at the gum line, frequent abscesses. They will also tell you that most long-term care residents and their families will not visit a dentist.

Poor oral health is the forgotten service in long term care. It is largely forgotten because the existing delivery model is difficult and cumbersome, generates aerosols, and is expensive.

So what to suggest about oral health servies to the emerging Canadian self-reflections about the future direction of long-term care?

Two primary suggestions are: (a) begin the preventive oral healthcare service well before the final phase of long-term care, and (b) transform preventive oral healthcare into a medical model of correcting oral dysbiosis which is the cause of poor oral health. These changes would lead to much improved oral health in long-term care and in turn, would lower morbidity and perhaps, lower the mortality rates in a pandemic like COVID-19.