Dr Greg Miller founded the South Australian Dental Outreach program as a way of dealing with that state’s crisis in gerodontics. By Clara Pirani
Claire McLoughlin believes it’s entirely possible that a dentist saved her mother’s life.
Wheelchair-bound and suffering dementia, 83-year-old Marjorie McLoughlin needed urgent dental treatment to remove several rotting teeth.
However, Marjorie, who lives in an aged-care facility in Eastwood, Adelaide, had become too frail to travel to a dental surgery. “I used to take her to the dentist when I was able to get her in and out of the wheelchair, but now she also has back problems, and it’s impossible to get her there,” says her daughter, Claire.
“I had noticed that some of her teeth were disappearing and I think they either fell out, or she may have even swallowed them. It was really concerning and it was affecting her overall health, but there are hardly any dentists who will go into a nursing home.
“So the only option was to somehow get her to hospital but the doctors would not recommend a general anaesthetic, as it was too dangerous in her condition, and it would be too distressing for her to have her teeth removed in hospital without a general anaesthetic.”
Not sure where else to turn, Claire sought advice from the nursing home’s director of care, who suggested she get in touch with Dr Greg Miller, founder of the Dental Outreach program in South Australia. The program offers a mobile dental clinic to more than 100 aged-care facilities around the state.
“Greg started treating Mum and now he’s been seeing her every six months for about two years,” Claire says. “He’s taken several rotting teeth. It’s really hard for someone with dementia to cope with that, but he’s been fantastic. The visits always go really well. Without Greg, I don’t know what I would have done. I think it saved her life.”
Dr Miller launched the outreach program five years ago after he became aware that many aged-care facilities were unable to offer dental care to residents who were too ill or frail to visit their own dentists. “I was treating elderly patients, many of whom were moving into nursing homes and aged-care facilities. Their families were contacting me and asking me to visit them, and it was happening over and over again,” Dr Miller says.
“One day I was visiting a lady in a nursing home and, while I was there, I was approached by several other visitors. They stated that they were surprised there was a dentist in a nursing home and asked if I could also treat their relatives [who lived at the same facility]. That’s how it started and it’s been a snowball effect ever since.”
Four dentists, including Dr Miller and a team of auxiliary staff, visit the sites, offering a full range of treatment, including exams, screening and restorative work.
“We travel all over Australia, including to some very remote places,” Dr Miller says. Providing oral care to people with dementia—especially those living in nursing homes—presents a considerable challenge to healthcare providers. Patients often can’t provide consent or describe where or how they are experiencing pain or discomfort. Those living in aged-care facilities are often unable to travel to receive medical treatment. More than 300,000 Australians have dementia and the Australian Institute of Health and Welfare (AIHW) predicts that number will treble by 2050. The AIHW’s 2012 report—‘Australia’s Health’—claims that 20 per cent of people over 65 avoided eating some foods because of problems with the teeth, mouth or dentures.
In addition to treating residents, the Dental Outreach program trains nursing home staff and family members in the best way to care for elderly people with oral health problems and maintain oral hygiene. “We find that some of the entrenched urban myths about elderly people with dentures not needing dental care still exist at some facilities which have led some of these residents to be left under-treated,” Dr Miller says.
The Australian Dental Association Foundation’s (ADAF) vice-chair Dr Shane Fryer says older Australians who are no longer able to stay in their homes face a higher risk of poor health due to an inability to maintain self-care and a reduced ability to access the care of dental providers. He says there is a growing need for mobile dental services.
“By taking the dental services to the aged-care facilities, we believe that we will positively impact on the older patients’ overall health, reduce the need for further treatment by taking a preventive approach and potentially reduce the incidence of transfer to an already overly burdened acute health care system,” Dr Fryer says.
The outreach program has about 30 staff based in its Adelaide centre and much of the outreach work is voluntary.
“The service is not cheap to run and it’s certainly not a money-making venture,” Dr Miller says. However the program received a significant and unexpected financial boost in August this year. The ADAF and Wrigley Company Foundation community service grants awarded $US82,000 to 13 volunteer organisations in Australia, including a new $US10,000 “principles in action” grant given to the Dental Outreach program. The program won the grant for “providing high-quality dental care to 800 elderly patients in aged-care facilities within the Yorke and Mid North LGA region in South Australia”.
The outreach program also receives funding from dental product supplier, Henry Schein Hallas, NAB Health, Colgate and private individuals.
Dr Miller, who also works in several dental practices in Adelaide, says running the program is time-consuming but immensely rewarding. “The relief of pain for patients who are non-communicative has immeasurably improved their quality of life. Some people have expensive cars but I have lots of old people with nice teeth, and I know which I would rather have.”