Aged Care Oral Health in Australia: A Comprehensive Analysis

This report provides a comprehensive analysis of aged care oral health in Australia, addressing key issues such as the increasing elderly population and the rise in dental problems. It explores challenges like edentulousness, periodontal disease, xerostomia, oral cancer, and tooth wear, which lead to difficulties in chewing, avoidance of certain foods, and social challenges. The report also examines special needs dentistry, highlighting the role of clinical health workers, community health initiatives, prosthodontics, and the pharmacological burden on aging patients. It discusses the impact of dental problems on the overall health of the elderly, the preference for private health facilities, and the importance of cost subsidy in public institutions. The report also covers special needs dentistry, the role of clinical health workers in community health, and the challenges faced by aged individuals with special needs, including the lack of mobility, funds, and information. Finally, the report touches on the pharmacological burden on the elderly and the importance of balancing the risks and benefits of medication.

Running head: Aged care oral health in Australia 1
Aged Care Oral Health in Australia
Student’s name
Institutional affiliation

Aged care oral health in Australia 2
According to Lewis, et al (2015) the number of elderly people in the population of
Australia has been on the increase. Significantly, problems of oral health and special needs
dentistry hasproblems of oral health and special needs dentistry have been on the increase too.
However, the overall oral health has improved in terms of comparison between dentate and
edentulous old people whereby the dentate has a significant increase. The increase in the number
of dentate elderly people has necessitated an increased concern in general oral health of the
elderly. This paper focuses on the key issues for aged dental care, the role of clinical health
workers in community health, prosthodontics management and pharmacological burden of the
aging patient, special needs dentistry and dental public health in Australia.
Stewart, & Wild, (2017) the main dental care challenges among the elderly in Australia
range from edentulous individuals, periodontal disease, having a dry mouth which is also known
as xerostomia, oral cancer and tooth wear. These has caused occasional oral health problems
such as difficulties in chewing, avoidance of several foods, development of sores in the mouth
and increased dryness. Avoidance of several foods may cause challenges of malnutrition or
under nutrition which also makes it difficult for healing of the dental related problems. Teeth
related problems also affects interpersonal relationships as elderly edentulous people have
complained of challenges when communicating and stomatitis which refers to the inflammation
of the oral mucosa that also heightens the difficulties.
The prevalence and risk of infection of dental diseases among the elderly increase as they
age which rather insinuates that the condition is accumulative as opposed to susceptibility with
age. Research has also proven that in overall health care data, the number of people whose teeth
needs to be extracted due to dental diseases increases with age which also indicates that the
problem increases with time. This can be proven by the fact that as people age, they have

Aged care oral health in Australia 3
deteriorating efforts to maintain their teeth which requires more attention with ages due to wear
and tear. Carelessness in handling teeth and continuous drug use such as alcohol and smoking
has also increased susceptibility of teeth related infections. Prevalence of lifestyle diseases such
as diabetes and other chronic illnesses among the elderly also sums up to the difficulties that old
people encounter in maintaining dental hygiene.
Dental related problems have profound impacts in the health and lives of aging
Australians. These challenges and difficulties in eating communication are more in the
edentulous that in the dentate individuals. Oral ulcers and fractured femurs are also some of the
impacts that result from poor dental care. These challenges impact in the overall health of the
elderly especially as they become choose on foods due to dry mouths conditions and difficulties
in chewing and swallowing of food. They may opt to consume more fibers and vegetables as
opposed to proteins and fruits.
Smylie, et al (2016) has confirmed that more elderly people have visited the private
health facilities as opposed to government facilities. This has shifted the focus of the Australian
government into focusing more on the service delivery in the private facilities and also increased
knowledge on the various dental related problems and ways of handling the dental problems.
Improving the quality of services in the government facilities is also being observed to see to it
that more individuals are able to access care in the government facilities which are considerably
cheaper as opposed to the private institutions.
Pradhan & Gryst, (2016) aged Australians have shown preference to private institutions
whatsoever due to the increased mobility of service delivery. It is possible and much easier for
private institutions to deliver services to the people’s homes and work places as opposed to
government health officers. This they have said helps them conserve more time they spend on

Aged care oral health in Australia 4
appointments and checkups for other personal work. This has been more effective for people
who have other difficulties in mobility due to being handicapped, bedridden or other difficulties
in accessing health care services in public institutions.
Some people have blamed poor weather and other obstructions to accessibility of public
dental services as an explanation as to why they opt private health services that have increased
mobility. Cost subsidy in public institutions have been efficient as more people with insurance
cover are able to access these dental services without having to encounter a lot of cost. However
dental care is still expensive for people with low social economic status. Lowering the cost in the
public institutions has its disadvantages too in that too many people try to access it which ends
up resulting in congestion in the health facilities.
Congestion in the public health facilities is very unsuitable for the aged and worse when
it is full of bureaucracy and chronic queues for patients wishing to access services if there are no
specialized care centers specifically for the aged. For people with low socioeconomic status in
the society, neglect of dental care services is evident even amidst cost subsidy. Visschere, et al
(2015). confirms that on average, people with low social economic status attend the dental clinics
for specific problems and not frequent checkups. However enough sensitization needs to be done
to make the people aware that dental health does not necessarily infer to lack of a disease but
regular checkup is necessary to also prevent possible infections.
Special dentistry
Masoe, et al (2015) special needs dentistry also known as special care dentistry is a field
that is generally concerned in delivery of dental care services to people living with special denta
problems. The Australian society of special care dentistry has coupled efforts with government

Aged care oral health in Australia 5
and other care takers of people with special needs to provide specialized oral health to people
with special needs. However, the complex work needed to cater for the special needs patients
and the insufficient number of available health workers is a continuing menace to the aged
people with special needs some of whom do not have immediate caretakers.
Yap, Parashos, & Borromeo, (2015) outlines some of the challenges that aged people
with special needs face as the inability to move to the health facilities to access oral health
services, insufficient funds to care for the complex health care needs, lack of information on their
needs and services they require, insufficient care and support from their families to enable them
pursue the required dental care services. All these challenges summed up with the inability of the
individual to take care of their personal hygiene really complicates the oral health of the aged
people with special needs.
The complex conditions of special needs dentistry according to Ahmad, Razak, &
Borromeo, (2015) range from extreme phobia related issues to autism and misdiagnosis of the
illnesses. The very complex conditions includes patients with conditions such as cystic fibrosis
patients undergoing a lung transplant whereby they are examined for oral infections. Cancer
treatment techniques such as radiotherapy and chemotherapy leaves some conditions that are
alarming if not well taken care of such as dryness of the mouth due to effect to the salivary
glands, these patients are thus referred to the special dental unit for specialized care (Brown,
Ford, & Symons, 2017).
A major challenge facing special needs dentistry is the longer hours spent at the heath
facility which amounts to more costs. This has seen an even greater challenge due to financial
constraints on the aged. Poor and politicized government funding facilities sum up together with
insufficient special needs dentistry centers to make it an even greater challenge for these aged

Aged care oral health in Australia 6
people to access special care dentistry. amidst all these challenges, The Australian Society of
Special Care in Dentistry which ensures that relevant information is provided to people with
special needs and that they are accorded relevant help to overcome these challenges.
The role of the clinical health workers in community health
Tan, et al (2015) defines community health as a collection of health related services that
revolve around early disease detection, preventive measures such as vaccination, assessing the
health needs, modes of treating the illnesses and the maintenance of the overall health of the
community. In community health, both the social and clinical directives are identifies and dealt
with in order to provide a freer society from disease and control environmental causatives of
disease. Dental care as part of community health is no different. It encompasses all the dental
care services of prevention of disease, maintenance of hygiene, continued care to prevent
worsening of already complex conditions and curing already existing diseases.
The community addressed health care and provision of service has for decades been
considered as a very cheap way and affordable by many individuals. It is cost efficient and
effective at the same time as opposed to hospitalized care since it favors the persistent long term
and recurrent conditions that are not suitably offered in the hospitals. Community based care has
however not been at the Centre post of dental service delivery since it has lacked support from
the concerned stakeholders. The society also tends to undermine the community based
dismissing it as lacking efficiency as opposed to hospital based health care.
Kisely, et al (2015) suggests that the role of clinical health team in community health
among the aged revolves around demystifying the idea of viewing the aged are an economic
social burden. This has been achieved through the enactment of policies favoring the aged such

Aged care oral health in Australia 7
as the Living Longer Living Better reforms which brings together health care providers and the
community to looking at the aged as an important resource of social and economic prowess. This
has increased the attention of the community to focusing on dental health for the aging as a
priority. Advanced technology, learning and increased social mobility of Australians have
continued to ensure penetration of dental health services into the communities and it has also
seen increased people seeking these health services.
The oral health for older people have however continued to be considered as insufficient.
This is because service delivery has been inhibited by several barriers deterring the efficient
delivery of services to the aged people in the communities. (McKechnie, & McKechnie, 2017)
rural ageing being one of the contributing factors which forms a basis of neglect. This is also
associated with rural-urban migration, brain drain and lack of collaboration between health care
providers and policy makers. This presents the clinical health team with a challenge of stretching
themselves beyond their limit in order to accommodate specific needs of the aged by adopting a
palliative and long term care for the elderly who are sometimes living with several chronic
conditions.
HealthInfoNet, (2014) reports has proven that one of the root causes of adverse clinical
outcomes results as a results of use and misuse of sedative and anticholinergic drugs. The drug
burden index-a method formulated and developed to assess continued exposure to such
medications and impact in the cognitive and body’s physical and physiological functioning-has
been effective in explaining impacts of drugs and research on continued use of drugs, their
advantages, disadvantages and limitations on the elderly unlike other pharmacologically devised
ways of measuring the dangers associated with long term and high risk drug usage.

Aged care oral health in Australia 8
The pharmacological burden has made drug prescription and management for older
individuals quite challenging. This is due to increased threats to their health. On average, 40
percent of Australians who are above sixty five years of age uses about three different types of
drugs weekly for various health conditions and 35 percent are living with chronic illnesses
(HealthInfoNet, (2014). These factors have increased polypharmacy. Use of many drugs exhibit
different reactions as some drugs react with other drugs while others trigger different reactions in
the body. Drug administration for older patients becomes even quite challenging due to the
summation of all these factors.
Murray (2014) explains that establishing a balance between the risks and benefits of
medication is important in determining the choice of medication among the aged.
Anticholinergic drugs which are commonly administered to adults have increased deterioration
of cognitive functioning of the individual. Other adverse effects of prolonged use of these drugs
include drying of the mouth, confusion, constipation and visual acuity problems. Sedative
medication in older adults also cause incontinence of urination, mental illness, pain disorders and
dementia among other conditions. These conditions make it difficult to treat certain condition in
the elderly due to such health risks of continued medication.
Making treatment decisions on people with various oral problems especially in such a
heterogeneous context like that of Australia has all the same proved difficult due to a number of
associated challenges and conditions which range from time available and willingness of the
patient and the social economic power of the patient which influences the choice of treatment
they seek. For instance, the level of finances may influence the patient choosing whether to fill a
cavity or to remove a tooth. Finances will also influence the choice of materials a patient opts to
use to fill the cavity (Brennan, & Teusner, 2015).

Aged care oral health in Australia 9
Walker, (2017) for the clinicians however, the choice of treatment option is influenced by
different factors such as the skills and resources to conduct the appropriate treatment. For older
adults and the aging population, factors such as the prevailing health conditions, chronic illnesses
and the effectiveness of the treatment option is still relevant in influencing the choice of
treatment plan that is considered as most appropriate. There are several paths of decision making
depending on all these factors which can be known as rational care dentistry, minimal invasive
and cost efficient. For the aged population however, the rational care dentistry has been chosen
over the rest since it is centered on the best interests of the patient.
The aging population has been said to be facing numerous challenges that range from
feebleness, poor vision which increases the risks of falls and fractures, neurocognitive delirium
and decline, compromised sleep and rest, oral and dental problems among other challenges.
Research has proven that all of these challenges if not well catered for may impact negatively on
other parts. Gerontologists’ research has shown that among all these problems, dental related
problems are the least adhered to. This has resulted the oral problems impacting negatively on
other factors such as psychosocial problems which arise as a result of projection, teeth decay and
various chronic periodontal infections.
According to Riggs, et al (2015) among the aging populations, edentulous individuals has
been on the decrease. This has followed proper care. Nevertheless, there are several challenges
that have continued to worsen amidst improved dental care which include loss of teeth,
periodontitis, dryness of the mouth, and oral cancer. These have been considered as the major
issues that relate to dentition among most elderly Australians since every six out of ten
Australians have a problem with their oral health. Edentulism being a major phenomenon can be
attributed to both poor health and cultural societal influences. Incremental loss of teeth as one

Aged care oral health in Australia 10
becomes older has consequences in that the remaining teeth may drift. The individual may
experience pain and problems with communication which in turn affects interpersonal
relationships of the patient. Replacement of fallen teeth with dentures is then a better way of
dealing with the challenge as it helps to solve some of these challenges associated with teeth
loss.
Lee, et al (2015) dental caries have over the years been identified as the biggest challenge
of older people in as much as oral health is concerned. These statistics have been arrived at
through comparison of younger teens and adult population. The main cause of these dental
carries have been identified as coronal carries and not necessarily root related issues. The
problem has been also identified to be high among those old people with dementia as opposed to
those who are healthy. This has in turn helped to conclude that people with dementia and other
bad health conditions such as diabetes are at a higher risk of tooth infection than normal healthy
individuals.
According to Willis, Reynolds, & Keleher, (2016) the chronic dry mouth among the aged
is an equally big threat to their oral health as it presents profound challenges to their health such
as difficulties in communication, chewing and swallowing of food. However, according to
pharmacologists, dryness in the mouth can be attributed to certain types of drugs such as
antidepressants, respiratory agents and antihypertensive drugs among other drugs. The risk of
dryness in the mouth remains comparatively higher in older individuals than the younger adults
and its effects lowers the quality of life for the aged population.
Oral mucosal lesions poses an equally great challenge as dry mouth and dental caries for
the older population. Oral pre cancer and oral cancer which refers to squamous cell carcinoma
with significant malignant transformations have profound challenges on the health of older

Aged care oral health in Australia 11
people. Cases of oral cancer have been identified to be more in the less developed countries.
Treatment of oral cancer is usually difficult since it poses serious threats to the lives of individual
patients such as the risk of drying mouth (xeristosomia), affection of other organs such as the
tongue, throat and the salivary glands and also pain caused by removal of cancerous cells and
wounds. The risk of infection is equally high among the younger people who also wear dentures
instead of natural teeth Chrisopoulos, Harford, & Ellershaw, (2016).
In conclusion, the management of oral infections and overall oral hygiene is considered a
very important objective in the life of the elderly. This is because, apart from relieving pain and
making the old people comfortable while eating, it also helps to minimize the risks and sources
of pathogens especially the blood borne pathogens that may not only infect the mouth but also
reach out to other parts of the body such as the lungs and the stomach. Prevention and control of
psychosocial and behavioral problems associated with pain in the mouth and also management of
side effects of various medication that have been found out to cause problems to the teeth.
Easing the pharmacological burden, acknowledging the special needs of the aged in dentistry and
involving the community in the health of the elderly are some of the key efforts required in
ensuring oral health of the elderly has met estimated levels of improvement.

Aged care oral health in Australia 12
REFERENCES
Ahmad, M. S., Razak, I. A., & Borromeo, G. L. (2015). Special Needs Dentistry: perception,
attitudes and educational experience of Malaysian dental students. European Journal of
Dental Education, 19(1), 44-52.
Brennan, D. S., & Teusner, D. N. (2015). Oral health impacts on self‐rated general and oral
health in a cross‐sectional study of working age adults. Community dentistry and oral
epidemiology, 43(3), 282-288.
Brown, L. F., Ford, P. J., & Symons, A. L. (2017). Periodontal disease and the special needs
patient. Periodontology 2000, 74(1), 182-193.
Chrisopoulos, S., Harford, J. E., & Ellershaw, A. (2016). Oral health and dental care in
Australia: key facts and figures 2015. Australian Institute of Health and Welfare.
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., ... & Tran, N.
(2016). Royal Australian and New Zealand College of Psychiatrists clinical practice
guidelines for the management of schizophrenia and related disorders. Australian & New
Zealand Journal of Psychiatry, 50(5), 410-472.
HealthInfoNet, A. I. (2014). Overview of Australian Indigenous health status. Perth: Edith
Cowan University.
Jin, L. J., Lamster, I. B., Greenspan, J. S., Pitts, N. B., Scully, C., & Warnakulasuriya, S. (2016).
Global burden of oral diseases: emerging concepts, management and interplay with
systemic health. Oral diseases, 22(7), 609-619.

Aged care oral health in Australia 13
Kisely, S., Baghaie, H., Lalloo, R., Siskind, D., & Johnson, N. W. (2015). A systematic review
and meta-analysis of the association between poor oral health and severe mental
illness. Psychosomatic medicine, 77(1), 83-92.
Lee, K. J., Ettinger, R. L., Cowen, H. J., & Caplan, D. J. (2015). Health trends in a geriatric and
special needs clinic patient population. Special Care in Dentistry, 35(6), 303-311.
Lewis, A., Wallace, J., Deutsch, A., & King, P. (2015). Improving the oral health of frail and
functionally dependent elderly. Australian dental journal, 60(S1), 95-105.
Masoe, A. V., Blinkhorn, A. S., Taylor, J., & Blinkhorn, F. A. (2015). Factors that influence the
preventive care offered to adolescents accessing Public Oral Health services, nsW,
Australia. Adolescent health, medicine and therapeutics, 6, 101.
McKechnie, C., & McKechnie, A. (2017). Pharmacology: Sea change of indications. British
dental journal, 222(8), 563.
Murray Thomson, W. (2014). Epidemiology of oral health conditions in older
people. Gerodontology, 31(s1), 9-16.
Pradhan, A., & Gryst, M. (2016). The use of lateral oblique radiographs in dental treatment
planning for patients with special needs. Journal of Disability and Oral Health, 17(4),
154-158.
Riggs, E., Gibbs, L., Kilpatrick, N., Gussy, M., van Gemert, C., Ali, S., & Waters, E. (2015).
Breaking down the barriers: a qualitative study to understand child oral health in refugee
and migrant communities in Australia. Ethnicity & health, 20(3), 241-257.

Aged care oral health in Australia 14
Slack‐Smith, L. M., Hearn, L., Wilson, D. F., & Wright, F. A. C. (2015). Geriatric dentistry,
teaching and future directions. Australian dental journal, 60(S1), 125-130.
Smylie, J., Kirst, M., McShane, K., Firestone, M., Wolfe, S., & O'Campo, P. (2016).
Understanding the role of indigenous community participation in indigenous prenatal and
infant-toddler health promotion programs in Canada: a realist review. Social Science &
Medicine, 150, 128-143.
Stewart, B. W. K. P., & Wild, C. P. (2017). World cancer report 2014. Health.
Tan, H., Peres, K. G., & Peres, M. A. (2015). Do people with shortened dental arches have worse
oral health‐related quality of life than those with more natural teeth? A population‐based
study. Community dentistry and oral epidemiology, 43(1), 33-46.
Thomson, W. M. (2015). Dry mouth and older people. Australian dental journal, 60(S1), 54-63.
Visschere, L., Baat, C., Meyer, L., Putten, G. J., Peeters, B., Söderfelt, B., & Vanobbergen, J.
(2015). The integration of oral health care into day‐to‐day care in nursing homes: a
qualitative study. Gerodontology, 32(2), 115-122.
Walker, A. (2017). National diet and nutrition survey: young people aged 4-18 years, Vol. 2-
Report of the oral health survey. Cancer.
Willis, E., Reynolds, L., & Keleher, H. (Eds.). (2016). Understanding the Australian health care
system. Elsevier Health Sciences.
Yap, E., Parashos, P., & Borromeo, G. L. (2015). Root canal treatment and special needs
patients. International endodontic journal, 48(4), 351-361.