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Mouldy toothbrushes: Poor oral health in aged care can have fatal risks

9 June 2019   
The Sydney Morning Herald
Author: Julie Power 

Kevin Fearnside had always prided himself on being nicely turned out in a shirt and tie, with gleaming teeth. Within months, though, of being admitted to a nursing home with dementia, his family discovered Mr Fearnside's toothbrush black with mould and neglect.

"[His teeth] deteriorated so quickly," said Jenine Bradburn, his stepdaughter.

"One staff member said it was an occupational health and safety risk to 'brush your dad's teeth' because he might bite him."

The Royal Commission on Aged Care Safety and Quality heard evidence in May that poor oral care can have fatal results, leading to aspiration pneumonia.

Experts report rotten teeth, painful abscesses and undiagnosed cancers in the mouth in residents with dementia, or those unable to use a toothbrush, in aged care facilities because of the absence of any oral care.

The federal and NSW branch of the Australian Dental Association is calling for an oral health assessment of every person entering a nursing home.

Until Mr Fearnside died in 2017, his widow Florence Fearnside would visit the nursing home in western Sydney every day to clean his teeth and make sure he was bathed and wearing clean clothes.

But when Mrs Fearnside had to go away, and Ms Bradburn was unable to visit, they returned to find his toothbrush mouldy. "The toothbrush was disgusting. They obviously weren't cleaning his teeth at all," said Ms Bradburn, the national president of Australian Dental Prosthetist Association (ADPA), who found it professionally distressing.

Unable to tell staff what was the matter, Mr Fearnside was clapping his hands and yelling all the time, said his widow Mrs Fearnside.

"He had an abscess ... he was in a very bad way. They had no idea why he was screaming all the time," she said.

The president of the NSW branch of the ADA Dr Neil Peppitt said there was no requirement to clean residents’ teeth or even offer access to dental treatment in aged care facilities.

In those facilities that do provide care, "dental practitioners line up behind podiatrists and hairdressers".

Ms Bradburn said when she visits nursing homes to fix broken dentures, she has to treat patients in the hairdressers' or other spaces because of a lack of dedicated spaces.

Dental specialist Dr Peter Foltyn told the royal commission in May that families routinely said that aged care staff claimed to clean teeth and dentures regularly. "Yet the toothbrush is in the same location day after day and dentures in some cases are not removed for days on end," he said.
Residents were at risk of aspiration pneumonia if their teeth and dentures weren't cleaned, and the failure of staff to clean them was putting "the lives of their residents at risk."

Dr Foltyn cited a case where an aged resident refused to eat. When a care worker looked in his mouth, she discovered an ulcer. It was a large invasive cancer "which would have been causing severe pain and taken several months to progress to that size".

Mrs Fearnside and her daughter said they didn't blame the staff, who were overworked and underqualified, and said they believed the nursing home was better than most.

The ADA is also lobbying for the introduction of a Commonwealth Dental Scheme for Older Australians to provide $1000 in free treatment every two years, said the national president Dr Carmelo Bonanno.

Read The Sydney Morning Herald article

Read the ADA NSW Submission to the Royal Commission into Aged Care Quality and Safety

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