Oral Treatment Intention and Realistic Oral Treatment Need for Patients in Long-term Care in Sweden, 2003

Abstract: A new regulation within the Swedish National Dental Health Care Insurance was introduced in 1999. It stipulates increased economic support for dental care to persons, who, due to disease or handicap, are depending on the aid from nursing personnel for their daily activities. The support is intended for those receiving long term care either living in nursing homes/homes for the elderly (NH) or those enlisted in municipal care in their own dwellings, home care (HC), with extensive and permanent assistance from mobile nursing personnel. Being enrolled in such care to a great extent entitles the care receivers to get an annual, free-of-charge, oral health examination on a voluntary basis. This population group is also entitled to receive what is considered necessary dental treatment on the same economic terms as medical treatment, with a set, low fee. There were two aims of this thesis. The first aim was to evaluate the clinical oral health outcome in care receivers, by using an oral health screening protocol, after the caregivers had undergone a one-session, four-hour oral health education program. The second aim was to evaluate the realistic oral treatment need, taking into consideration the treatment intention. The first study was performed at a smaller scale; 170 subjects enrolled in municipal long term care were included, available for examination both before and 3-4 months after education to the caregivers. The second study was performed at a larger scale; a sample, of 866 persons was selected to be examined; i.e. every third person included in long term care in three municipalities. The results showed that a limited oral health education, offered to caregivers within longterm care facilities, had a positive impact on residents´ oral health status. Further, it showed that the realistic oral treatment need, guided by the examiners´estimation of the appropriate treatment intention, was quite modest in this population, as 61% not only had a need for an oral health evaluation but also a need for additional oral/dental treatment, 31% to be accomplished by prophylactics and 30% by reparative/urgent measures. Of the latter group, about half were judged as needing prophylactics beside dentist´s treatment. Only one per cent were estimated to be in urgent need. In conclusion, the first study indicates that a limited oral health education of the caregivers combined with screening and prophylactic measures, will benefit the care-receivers in long term care.The second study indicates that when considering the treatment intention, the realistic treatment need among patients in long term care is quite modest, but prophylactic measures are important. The different levels of intention do not always aim at achieving complete oral health, but rather at facilitating a realistic oral treatment and an acceptable oral comfort.