When Mary Farrar first saw that her husband had a gap in his lower front teeth, it was a major breakthrough.
She was mystified; the only thing that could be explained was the size of the area. Everyone was completely in the dark about the whereabouts of the object; no one knew where it had gone. She shares her home with her husband, Ed, who is a former geophysicist and now lives in a secured mental ward at Kingston General Hospital. Because he is confined to a wheelchair, his dementia makes conversation difficult.
Everyone thought his teeth were OK, but they were coming out; he couldn’t tell them. It seemed as if Mary Farrar had convinced herself that it was acid reflux whenever he moved his lips. All in all, maybe the dentist was right. Perhaps he had chronic pain all these time and it was not tooth decay that was causing his discomfort. She believes no one ever glanced at his mouth, much alone sent him to the hospital’s dental specialist. When she realized there was a problem, she went to ask for aid. Ed Farrar had only lost eight teeth; he had not lost a single one. Because of the decay on the right side of his mouth, they could only be seen if the decay had left tooth marks in his gums. Not only did no one notice that he was in discomfort as he moved his jaws and cheeks often, but everyone thought he was satisfied with his condition. It was impossible for him to advocate for himself or speak for himself or to state that he was in agony.
“I don’t blame anybody here,” she stated, saying that the problem included administrators above her husband’s care providers. His practice has appeared in every part of the province, but this time, it was him. His experience is one that is all too familiar: food becomes tangled around the gum line, strangling the tooth and leaving it to fade away. He and other patients in long-term care were provided with dental treatment and personal hygiene throughout the whole of their lives, which supported their lifelong habits of caring for their mouths. All of a sudden, their cognitive and physical abilities evaporated. Then they no longer had the ability to care for themselves, tooth decay became a problem.
For a long-term care patient, the process of treatment takes just a short time. To be known as Apple-core decay, teeth must have a tartar buildup along the gum line that wears away at the tooth enamel until it forms an hourglass shape, after which it gets the label of Apple core decay. There is often not enough attention paid to the patient’s lips, which are tightly closed, and it’s difficult to recognize when the process starts. According to Cindy McQueen, who is a local dental hygienist, this is part of the issue. To make the image she describes more vivid, think about walking into a nursing home and almost all of the residents had an open sore on their wrist.
McQueen said registered nurses and personal care aides perform an enormous amount of work with their caseload and so shouldn’t be held responsible. However, according to the director, “oral care — and I assume it’s unintentional — barely cracks the bottom of the rankings. Her theory is that, in some cases, patients are only given 30 seconds to brush their teeth.
The generational change is partially responsible for the current state of things, according to Dr. Aaron Burry, who is the Canadian Dental Association’s Associate Director of Professional Affairs. This is now the case: most people in long-term care join the facility with their own teeth whereas the vast majority had dentures in the past. Because this next older, frailer generation of long-term care patients requires dental care in a new way, these patients are distinct from those who are only concerned with caring for their dentures.
Based on Dr. Burry’s research, the dental health of the patients improved, which enabled many of them to maintain their teeth. The main difficulty is that many older facilities were never built with appropriate dentistry space in mind. Rather than seeking to take advantage of the existing state of affairs, you’re actually simply attempting to preserve the current state of affairs, he stated concerning dental treatment for long-term patients. “As of now, we don’t place a big focus on dental care in long-term care,” he said.
Just like with medically assisted tooth extractions, if the patient requires this done, the procedure may be done in the hospital’s operating room. Due to a shortage of time and/or equipment, the patient will be placed on a lengthy waiting list, bearing the burden of limited time the room has committed to dental treatments. McQueen said that when someone is in a life-threatening medical situation, they may go to the emergency department, where they will be informed of the condition and provided an antibiotic for the discomfort. But therapy can only be given once the patient is ready. As a result, the oral surgeon is only able to do a certain number of procedures in a day, and will be able to use the operating room a handful of times per year. Even if they may need it tomorrow, they put themselves on the waiting list. It is impossible to get access to that waiting list right now, she added. On the other hand, they will not be able to provide the medical services to those who have an acute need.