The journey with my elderly patients is filled with joy and sorrow. It is difficult to realize that in some situations all attempted interventions for maintaining a healthy mouth can and do fail. When this happens, it is usually due to quick decline in a client’s health or lack of collaboration on the part of the staff, the medical community and, even the dental community.

As a Dental Hygienist, I was often frustrated at the oral health situation nursing home residents presented with at the dental office. I also admit that, before I started working as an Independent Oral Care Specialist, I wrote notes criticizing the oral care provided in nursing homes. Today, this type of a note waited for me at a facility where I see a resident to perform oral care…

The note from the hygienist said, “Patient’s mouth is atrocious. There is a complete lack of effort to improve her oral hygiene. Her teeth have to be brushed 2 times a day, flossed 2 times a day, and rinsed with mouthwash 3 times a day”. For the first time, I understood what my previous notes did to the care teams who attempt to provide the best care they can.

My initial thoughts were, “Really, dental hygienist? If it were that easy, her mouth would not look as it does.”  There are several reasons this woman’s mouth is not as healthy as we wish it was. She has swallowing issues. That prevents her from using mouthwash. She has severe medication-induced dry mouth. That can’t be reversed because she needs the medications. She has Parkinson’s disease. This makes it impossible for her to brush or floss her own teeth. She has dementia. This makes her cooperation with oral care nonexistent. Putting fingers in her mouth to floss puts the caregiver at risk of being bitten, so the recommendation of flossing cannot be accomplished. Most days she does not even allow a toothbrush in her mouth. Other items are contributing to her lack of oral health as well. It is frustrating to everyone who cares for her and yet we attempt to do the best we can, day in and day out. Sometimes we must succumb to the reality there is nothing more that can be done.

Here is what I have considered sending in response to the dental hygienist: “Dear Dental Hygienist. Thank you so much for taking the time to write to me and let me know that I failed miserably to provide adequate oral hygiene for XXXX. I would like to improve my skills and invite you to visit XXXX with me. I am excited to learn from you. Before we visit together with XXXX please review XXXX’s medical history. I believe it will be helpful for you as you create an effective oral care regimen for her. Please contact me to set up a time to join me. I look forward to hearing from you.

I have not sent my response yet. I wanted to take a bit of time to think about what the lesson in all of this is. Here are my take aways:

  • This was a good reminder of how I reacted to the bleeding and plaque in my elderly patients before I was trained as an Oral Care Specialist, Caregiver and Certified Dementia Practitioner.
  • Hygienists working in clinical hygiene do not have enough training and education to fully understand how hard it is to provide ideal hygiene to special needs patients.
  • The dental hygienists who work in non-traditional settings can be a resource for those who work in traditional settings, so they can understand the challenges faced in nontraditional settings.
  • This Hygienist was very concerned about my client.
  • Remember that support and understanding of what people attempt to do and an offering of assistance can stimulate collaboration.
  • Collaboration is what will serve our clients/patients in the best way possible.

Teresa Ciejka RDH, OCS
Certified Caregiver
Certified Dementia Practitioner