During his speech at the “Opening Ceremony of the International Dental Exhibition and Meeting” in April 2016, Health Minister Gan Kim Yong mentioned three ways where the ministry is addressing the dental needs of the elderly. The three measures taken were infrastructure, manpower and provision of affordable healthcare.

With regards to infrastructure, Mr Gan highlighted the set-up of Geriatric and Special Needs Dentistry clinic in September 2015, which provides specialised dental services for the elderly. He also mentioned the ministry’s efforts to make accessible dental services for patients who were less ambulant, such as those residing in nursing homes.

These measures were taken in light of the rapid ageing population situation in Singapore, where 1 in 8 Singaporeans are currently aged 65 and above. Here we look at the studies that have been conducted and the efforts taken to provide dental healthcare to the ambulant elderly residing in nursing homes.

The importance of making dental care services available to the elderly

Several studies conducted on the oral health of elderly residents in the nursing homes accentuate the importance of making accessible dental care services for this group, which in 2011, formed about 3% of the Singaporean elderly. One of the studies was a pilot project conducted by National University Hospital (NUH) in 2007 to assess the dental awareness of nursing home staff in Singapore.

The study revealed that while nursing home staff demonstrated positive knowledge of periodontal disease and denture care, their knowledge of dental caries revealed substantial room for improvement, and concluded with the suggestion for future staff training and development on dental caries.

Two years later in 2009, the Annals Academy of Medicine published a letter to the editor, on the “Oral health status and complete denture status of independent-living Singaporean elderly residing in a community home”. The report mentions two findings: One was the 2006 oral health assessment conducted by a team of 3 dentists for the residents of a “270-bedded local nursing home” and second was a more recent oral health assessment held by the NUH dentistry team on a “convenient sample of residents” at a nursing home.

Both the findings revealed that dental and oral hygiene were generally poor while untreated dental conditions were still common at nursing homes. Similar to the 2007 study, the 2009 report recommended the support of dental practitioners at nursing homes and for the “staff and residents (to) be empowered with training in tooth brushing and denture cleaning”.

What the health ministry has done to meet the dental care needs of the elderly

Based on the above findings, targetted efforts by the health ministry to make accessible dental services for residents of nursing home is a positive move to address their dental condition needs. In fact, in 2014, some measures in the form of governance has been implemented by the Health Ministry, when its workgroup (comprising of representatives and clinical and policy experts) instituted dental healthcare as one of the sub-domains under the enhanced nursing home standards (ENHS).

Meanwhile, some of the major initiative to provide dental services to the elderly at nursing homes was the collaboration between National University Health System (NUHS) and three of the nursing homes within its regional health system – Orange Valley Nursing Home, Jamiyah Nursing Home and Econ-Sunnyville Nursing Home in 2015.

As part of this collaboration, NUHS conducted a comprehensive oral health promotion programme where the care staff of nursing homes would be equipped with the necessary knowledge and skills to help their residents maintain good oral hygiene. This programme would enable the care staff to carry out simple oral health checks and identity oral conditions for referral and treatment.

As of August 2015, NUHS reported that 30 care staff in nursing homes had participated in the programme. Another initiative was the Memorandum of Understanding (MOU) between Tzu Chi Singapore and Ren Ci Nursing Home in 2016. This partnership enables dental professionals from the Tzu Chi International Medical Association to provide two years of free monthly dental services at Ren Ci. Both these initiatives illustrate the ways where dental healthcare was reaching the elderly of nursing homes: through the nursing homes’ care staff (who had now received dental training) and through the support of general dental practitioners.

With findings from studies reporting the need for better provision of dental healthcare, the latest initiatives by the healthcare and dental community in collaboration with nursing homes is a positive sign that more elderly in nursing homes would now have access to basic and competent dental healthcare and services.

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