Intergrated dental care in nursing homes

Abstract

The thesis deals with integrated dental care in nursing homes. First, the dental treatment needs were ascertained of 432 residents in three Dutch nursing homes that offer integrated dental care. Dentist researchers intra-orally examined the residents and found that 72% required dental treatment. However, the percentage differed strongly between the homes: 44%, 91% and 90% respectively. This difference is related to differences between the homes in the amount of working hours of the dental team, the attitude of the institution dentist towards surgical and prosthetic treatments in elderly residents, the average age of the residents and the indication for admission. The percentage of (partly) dentate residents is also important, as virtually all residents with natural teeth needed dental treatment. Next, the dental treatment needs are compared between a nursing home offering integrated dental care and a home offering incidental care. In the home offering integrated dental care, less residents needed treatment (44% vs. 87%), the costs per resident for the dental team and laboratory were higher (per year 229€+143€ vs. 15€+20€) and more edentulous residents were wearing dentures (90% vs. 68%). Soft tissue pathology was found about twice as often in the home offering incidental care. The main cause for these differences must lie in the different ways in which dental care is offered in the nursing homes. In the third part of the study, primary care nurses in the three homes offering integrated dental care were interviewed about the oral health of the residents in their ward. The nurses generally judged the oral health of the residents as good (8,3 on a scale of 0-10) with only 9% of the residents requiring dental treatment. This contrasts starkly with the findings of the dentists, who found that 72% of the residents needed dental treatment. The difference is explained by the differences in education and method of evaluation. The nurses base their evaluation on daily observations of function during eating, speaking, personal hygienic care and possibly remarks from the resident on oral pain or discomfort. Apparently a nursing home resident can be perceived in good functional oral health, even when intra-oral examination by a dentist reveals a need for dental treatment. Furthermore, dentists may focus more on prevention of possible dental problems. Finally, the effect of integrated dental care is described on the oral treatment needs in elderly residents (70+) during prolonged stay in the nursing home. Residents who had stayed shorter than 6 months were compared with those who had stayed longer than 6 months. In most subgroups of residents the specific treatment needs seemed reduced in the long-stay residents. However, a statistically significant reduction could only be shown in edentulous residents, especially those with a psycho-geriatric indication for stay. One reason for this may be that residents with a psycho-geriatric indication, on average, have a longer duration of stay. Another factor may be that prosthetic treatment is reversible and forms a relatively light burden for the resident.