Editorials
Recommended action plans for oral health in older Europeans
Anastassia E . KOSSIONI DDS , MSc , PhD
The current oral health delivery system fails to meet the oral health care needs of many population groups , including the frail and care-dependent older people . Physical and mental illness , frailty and care dependency , socioeconomic inequalities , living in nursing homes , unhealthy diet , smoking , poor oral health literacy , lack of effective oral health policies including limited public dental care coverage , and limited training of healthcare professionals in oral conditions are some of the barriers to oral health faced by older persons [ 1-3 ]. Frail older people rarely visit the dentist , but they frequently meet other healthcare providers , such as physicians , nurses , physical therapists , occupational therapists , and pharmacists . However , few of those healthcare providers are adequately trained to initially assess oral problems and offer oral hygiene advice , as , for many years general and oral health have been viewed in isolation [ 3 ]. Consequently , oral health conditions in older people often remain underdiagnosed and untreated , leading to high prevalence of tooth loss , dental decay , periodontal disease , xerostomia , denture-related conditions and oral pre-cancer and cancer [ 4,5 ]. Moreover , there is evidence of an association between oral and general disease , such as cardiovascular disease , diabetes mellitus , respiratory disease and frailty [ 4,6-8 ]. In response to these challenges , the European College of Gerodontology ( ECG ) and the European Geriatric Medicine Society ( EuGMS ) have developed policy recommendations on oral health in older Europeans [ 9 ]. This expert opinion document identified three major areas for further action : a ) educational plans for healthcare professionals , b ) health policy plans , and c ) citizens ’ empowerment and involvement . The authors highlighted the importance of training non-dental healthcare professionals in oral health assessment and promotion , and provided a list of learning objectives as a basis for a dedicated “ geriatric oral health curriculum ” [ 9 ]. Healthcare professionals should be competent to initially assess oral health , identify oral conditions , discriminate between normal and abnormal findings in the mouth , decide when to refer to the dentist , demonstrate oral hygiene measures to older people and their caregivers , assist in daily oral hygiene provision , and work collaboratively with the elders ’ healthcare team . Moreover , although more than 86 % of the European dental schools teach Gerodontology at the undergraduate level , more dental training is necessary in oral health assessment and provision in nursing homes and at home , and in collaborative practice between dentists and other healthcare professionals [ 10 ]. The ECG / EuGMS recommendations further provided a list of health policy measures with emphasis on the integration of oral health into general health care assessment , prevention , provision and funding , and development of appropriate policies and protocols for oral health prevention and promotion in institutional settings for older residents [ 9 ]. Minimum requirements for nursing homes should include oral health assessment at entry , access to emergency and routine dental care , regular training of caregivers in oral hygiene provision to residents , provision of daily dental and denture hygiene and provision of regular oral screenings [ 9,11,12 ]. Other suggested actions included removing barriers to dental care , promoting domiciliary care , and promoting
6 Stoma Edu J . 2018 ; 5 ( 1 ): 6-7 . http :// www . stomaeduj . com