The second process in helping to improve an older person's oral health is oral health care planning.

The outcome of the oral health assessment will help to inform the care planning process.

A healthy or changes assessment can be managed by using the Oral Health Care Planning Guidelines (897KB PDF). An unhealthy assessment indicates the need for a dental referral.

• It is recommended that an appropriate health professional such as registered nurse or doctor perform an oral health assessment using the Oral Health Assessment Tool (OHAT) (7MB PDF) on admission and repeat as required.
• A ‘healthy’ or ‘changes’ assessment can be managed using the Oral Health Care Planning Guidelines.
• An ‘unhealthy’ assessment indicates a referral to a dental professional is recommended. As most referrals are likely to be of a non-urgent nature, this information should be included in discharge planning advice and correspondence.

1. The risk of poor oral health increases when older people become less able to self-manage due to issues of functional dependence, physical frailty, medical co-morbidity, polypharmacy and cognitive impairment.
2. Increasing numbers of older people are retaining at least some of their natural teeth. As their ability to self-manage oral hygiene decreases, their risk of oral disease and infection increases.
3. Oral disease impacts other areas of health and quality of life.
4. Oral Health Assessment on admission to the hospital is essential for the identification of issues and implementation of management strategies.
5. Simple oral health strategies involving a multi-disciplinary approach can assist with promoting and maintaining good oral health.

As the ageing population is increasingly retaining their natural teeth, their need for optimal oral health care also increases.

Older peoples’ mouths are prone to oral disease and those with natural teeth are more likely to have advanced gum disease (gingivitis or periodontitis). Oral health care for older people is often further complicated by a past dental history including crown and bridgework, partial dentures and implants.

Oral health is linked to general health, and oral conditions involving teeth, gums and dentures can significantly affect overall well-being and the ability to age positively.

For example:

• Oral pain and difficulty with eating can affect nutritional intake and body weight and therefore skin integrity, strength and mobility, and continence.
• Oral pain may also affect mood and behaviour, especially for people with dementia who find it difficult to self-report their pain and discomfort.
• Poor oral health is linked to increased risk of cardiovascular disease, stroke and aspiration pneumonia. Aspiration pneumonia is a major cause of morbidity and mortality for hospitalised and institutionalised frail older people.
• Chronic oral infection can complicate the medical management of general illnesses such as diabetes, chronic heart failure and respiratory diseases.
• Poor oral health results in bad breath and affects people’s ability to speak, socialise and feel happy with their appearance.
• Medications taken by older people often cause dry mouth (xerostomia) which affects speaking, eating and also increases the levels of oral bacteria and infection.

Oral health care may be overlooked by community-living patients with decreasing levels of cognition, health and mobility. Cost and transport is also a factor affecting older people and their decisions around accessing dental treatment services.

As people age, they tend to interact with a range of health workers more frequently than they do a dentist. For older people admitted to acute hospitals, oral health assessment and oral health care should be considered as an integral component of patient-centred care and a valuable opportunity to address these health issues.

Older people may have a range of health problems or disabilities that impact their ability to care for their own oral health and may need assistance during their hospital stay as well as follow up care on discharge. This may be related to issues associated with cognitive impairment or functional limitations such as hand and upper limb function due to poor dexterity, pain and strength. It may also involve functional problems with mouth and tongue movements and swallowing.