Word of mouth – the changing face of dentistry

When Bev was called on to attend her father-in-law’s 80th birthday party it was with some trepidation.

Having suffered problems with her teeth since long sessions of anaesthetic for heart surgery to repair a valve damaged in her childhood with rheumatic fever, she had pegs and three temporary glued-in top teeth while awaiting crowns.

Her worst fears were realised during the festivities when she bit into a scone and one of her teeth ended up in the cream and jam and she was left looking like a pirate.

“I’ve never been so embarrassed,” she says. “I just had this peg sticking down in front, but on the upside I’m pleased I didn’t swallow the tooth.”

Teeth have often been the bane of the Baby Boomer generation who didn’t have access to the knowledge and practices of modern dentistry, and usually have a mouth full of amalgam fillings – if they are lucky.

Many others just suffer the trials and tribulations of dentures – partial or full mouth – and the dread of eating out in public in case they come loose, or the discomfort of getting bits of food grating between the dental plate and gums.

Often the fear of being seen “toothless” is all consuming and Bev recalls her own mother – who, like Bev’s dad, ended up having all teeth extracted and replaced with dentures when they were in their 20s – refusing to ever be seen without her teeth.

While her dad didn’t care and always took his out at night to soak in a glass beside the bed, her mum was intensely private about teeth issues.

Bev remembers finding her mum unconscious after a mini-stroke, with her teeth fallen out on the floor.

“I was waiting for the ambulance and all I could think of was trying to put her teeth back in because I knew she hated being seen without them,” she says.

It almost sounds funny, but for a generation that didn’t grow up with fluoride in the water supply, white fillings, affordable crowns and veneers as well as implants and all the trappings of today’s modern dentistry, dealing with teeth problems can affect quality of life.

Bev eventually had to have all her teeth out when she was 60 and with no substantial bone left in her jaws for implants, the only option was dentures top and bottom. All very well, but getting them to fit properly without pain or discomfort is a whole other ball game as anyone with dentures will attest.

In Bev’s case she often ended up avoiding certain foods – or eating at all – and lost weight as well as the confidence to eat in public places.

After many trips to the dentist, she is now coping OK but is envious of her friend Vera who had a full set of implants some time ago and seems to breeze through all the situations that can cause potential embarrassment.

Dentistry has transformed greatly since we sat in the dentist’s chairs as youngsters – often given a dab of mercury to play with in a dish – while the dreaded drill roared and hefty amalgam fillings were forced into every cavity.

In the very, very early days cocaine was sometimes used as an anaesthetic.

Ronald Leach a retired dentist with 42-years’ experience writes that perhaps one of the biggest ways dentistry has changed has been in infection control.

It wasn’t that long ago that masks weren’t used and instruments were cold disinfected. Over time, blood-borne pathogens increased in the general population and things changed dramatically. Instruments were properly sterilised, gloves and masks became the norm and easily contaminated surfaces were covered with disposable materials.

Dental records have also changed with electronic entries showing complete details of fillings, cavities, diagnosis and treatment plans.

Filling materials which were once basic with silver and gold or porcelain, are now composite or acrylic with exact shadings, and implants are common.

Even X-rays have changed from hand-developed silver emulsion celluloid film to today’s rapid digitisation and these days you get more radiation walking past a brick building than a dental X-ray.

The arrival of dental insurance also changed the landscape, although it can be stressful finding out just what procedures are and are not covered by your particular level of cover.

Cosmetically, the chance to have a better smile has never been easier with porcelain laminate veneers effecting an instant transformation by simply removing a small amount of enamel, rather than other long-term procedures.

Tooth whitening, which began with chemical and rubber dams and lights that caused discomfort, can be carried out at home. There’s rapid laser whitening and over-the counter products.

In fact, new technologies such as laser dentistry, cone beam radiology, digital X-rays, diagnostic imaging and intra-oral cameras have virtually created a new profession, so the real challenge for dentists is deciding which technologies to buy and how to afford them.

Dental hygienists have also changed the landscape, with regular appointments concentrating on prevention rather than cure.

But a growing proportion of elderly Australians now living in residential aged care facilities, is dependent on others for daily oral hygiene care and they often have high levels of plaque and dental calculus, or teeth tartar.

The Community of Dentistry and Oral Epidemiology in Australia notes that with the declining rates of full sets of dentures, periodontal disease is becoming more prevalent in the elderly. And those with just a few teeth left or with dentures are suffering mucosal conditions and often rely on their caregivers to control or prevent oral disease.

As Bev discovered, medications frequently damage oral health, especially in the aged population which is likely to be treated with multiple medicines. Dry mouth in particular leads to caries, pain, gum damage and tooth loss. Antipsychotics also can cause major adverse oral effects.

The Dental Foundation of Australia says cognitively impaired high-care residents face increased risk of dental issues and a greater need for assistance and treatment. Poor oral health has been linked with increased mortality and morbidity in nursing home residents and has a serious impact on quality of life.

The association says the social impact of poor oral health can have an ongoing effect on other aspects of seniors’ lives such as their general health, social support and communication abilities.

The Australian Dental Foundation’s aged care program strives to support the provision of professional and high quality dental treatment and related services to residents in aged care facilities and residential living complexes, to control and prevent pain, eating difficulties, communication issues and the social embarrassment caused by dental related problems.

The association’s program operates as a fully functional mobile dental team providing a wide range of services to residents such as examinations, cleans and, where required, fillings, X-rays, denture services and extractions.

The program bulk bills the Department of Veterans Affairs Gold Care card holders and participates in all government assistance schemes such as the Pensioner Denture Scheme, Emergency Dental Scheme and General Dental Scheme to reduce out-of-pocket expenses for eligible patients.

Those with private health cover may also be eligible for potential rebates once full payment has been made to the foundation.

The recent Royal Aged Care Commission included a number of key Australian Dental Association recommendations for dramatically overhauling the delivery of oral health care in its final report to the Government.

Key to the report is that the commissioners recommended the adoption of the ADA’s recommendations for the Seniors Dental Benefits Schedule (SDBS) to help make dentistry affordable to all older Australians.

The report said the scheme would fund dental services for people who live in residential aged care and older people who live in the community and receive the age pension or have a Commonwealth Seniors Health Card.

It would be limited to treatment required to maintain functional dentition as well as being an important health prevention intervention.

Federal ADA president Dr Mark Hutton said if the Government acted on this report it would mean funding dental care for older Australians as well as seeing some fundamental systems finally put in place to ensure better dental care for those in residential and home care.

“We heard consistently that oral and dental health care needs of people living in residential aged care are not treated as priorities,” he said. “Daily oral health care is not often undertaken and access to oral and dental health practitioners is limited.”

Much of what was heard by the commission about the failures in dental care focused on lack of staff time and inadequate training as well of lack of access to dental health professionals.

“But there can be no excuse for failing to brush older people’s teeth and clean their dentures daily,” he says. “The fact is Australians are living longer, often well into their 80s, and keeping their teeth for longer too, but with a longer life span comes more complex oral health needs. Rates of gum disease and dental decay are highest in the over-65s, for example.”

Coupled with this are long waiting lists in the public dental system, poor value for money for private health insurance cover for dental work, and almost non-existent provision of oral care for those in aged care.

It’s a perfect storm for rotten dental health in older Australians.

Dr Hutton said the ADA was delighted the commissioners had agreed to a number of the group’s key recommendations and it was urging the Government to implement the various schemes and processes to make these a reality.

“With coordinated thinking between agencies, providers and dental practitioners the dental needs of our seniors in aged care means they can be assessed before going into care and receive ongoing treatment and care while in aged care or on a Level 3 or 4 Home Care Package through care by the same dentist and through enhanced training in oral health for care workers,” he said.

For your best dental health:

• Brush twice a day, floss, limit sugar intake and visit the dentist once or twice a year.
• Flush out remnants of fizzy and acidic drinks.
• Don’t rinse after brushing your teeth – the toothpaste will leave a protective film
• Use straws for sugary drinks
• Don’t snack during the day
• Eat nuts and cheese for dessert to help protect enamel.
• Don’t use whitening toothpaste to excess
• Breathe through your nose
• Don’t brush too hard.