A National Dental Centre pilot programme helps seniors achieve good oral function.

 

Tooth loss impacts one’s oral function, overall health and quality of life. Research has shown that by having at least 20 teeth, a person can achieve ‘good oral function’, meaning the ability to speak, chew and swallow food well. However, a 2016 Singapore study found that only nine percent of the population aged 80 and above had at least 20 teeth left. The same study also found that 30 percent of those aged 60 and above did not have any teeth.

To encourage more Singaporeans to retain as many natural teeth as possible, the National Dental Centre Singapore (NDCS) has rolled out the Oral Health Movement (OHM) 8020. The two-year pilot programme aims to screen at least 500 Singaporeans aged 40 and above for oral frailty, or the decline of good oral function.

Dr Chan Pei Yuan, consultant, Department of Restorative Dentistry at NDCS, who leads the OHM 8020 programme, said: “Many believe that tooth loss is inevitable as we age, but this is untrue. With proper oral hygiene and regular dental screening, it is possible to retain natural teeth into old age.”

The OHM 8020 programme has three key phases – community screening, intervention and review. This programme aims to educate the public on the importance of maintaining at least 20 teeth, and the impact of oral frailty on their overall well-being. “With that understanding and knowledge, we hope more Singaporeans will be able to retain at least 20 natural teeth beyond the age of 80,” said Dr Chan.

The screening, which started in March this year, is done by community nurses from Singapore General Hospital (SGH) as part of their care for the residents living in Southeast Singapore. The nurses also conduct oral health education to encourage good oral care habits and hygiene among the seniors, introduce oral exercises for them to do at home daily, and refer them for dental/speech therapy if required, to prevent further tooth loss. If the seniors have tooth decay and require treatment, they will be given a referral to Community Health Assist Scheme (CHAS) clinics for their own follow-up, or to specialists if they have complex cases. These follow-ups will not be covered under the OHM 8020 programme.To date, the nurses have screened more than 90 residents, and about one-third is deemed orally pre-frail and frail.

Tooth loss can contribute to oral frailty and affect an individual’s choice of food. Those with extensive tooth loss without replacement, such as dentures, tend to opt for food groups that are high in carbohydrates and fats, as opposed to meat, fruits and vegetables, which are more difficult to chew. This may lead to malnutrition and poor health. Being orally pre-frail or frail also increases one’s risk of choking while eating or drinking. With age, oral frailty may only become more pronounced in those with extensive tooth loss.

The concept of the OHM 8020 programme draws reference from a 2006 Japanese study, which investigated the differences in oral conditions and health status among octogenarians with 20 or more natural teeth, versus those with less than 20 natural teeth. It found that the former group showed better oral condition and were in better health (in terms of bone mass density, grip strength, masticatory ability and duration of balance) than the latter.

“There is a general lack of awareness on the importance of oral health among the elderly residents we care for. Besides showing them proper tooth brushing techniques and simple mouth exercises, we are now able to assess their strength for chewing, oral motor skills, teeth, and provide the necessary oral health education. The elderly residents were receptive to the additional care we provide, aided by the easy-to-understand teaching material developed by NDCS,” said Sri Ratina Wati Binte Abdul Razak, senior staff nurse, Community Nursing, SGH.

OHM 8020 participants who have been screened and identified as orally pre-frail or frail are invited to participate in an oral frailty prevention programme in NDCS. This is scheduled to start in July 2021 depending on the evolving COVID-19 situation. In addition to further assessment and learning how to improve their oral health, participants found to have oral health issues or swallowing issues will be referred to dentists or speech therapists for appropriate follow-up. These participants will be subsequently reviewed six months later to reassess their oral frailty status.

 

(** PHOTO CREDITS: Singapore General Hospital)