I never thought I would see a mouth like that of Harold Smith*. Harold is a current resident of an assisted living facility in the Portland Metro area. When his family first called, they knew Harold required professional dental/oral care and were at a loss as what to do since his limited mobility prevented him from getting into the dental office. They were so glad to have found my name and said they just “want Dad to be comfortable.” The first time I visited Harold it was apparent he needed extensive dental hygiene care. He had suffered a stroke the prior year and had not been able to rinse or spit since that day. All his liquids were thickened so he was also an aspiration risk. Due to paralysis on his right side, he could not close his mouth and consequently the saliva flow was constant. His teeth had the appearance of not being brushed for a long time. The calcium deposits on his teeth were more than I had seen in 35 years of clinical dental hygiene practice. These deposits were so heavy you could not distinguish his teeth. With the use of portable suction, lighting equipment, and a cavitron, I managed to remove much of the accumulation and knew his mouth and tissues were in a much healthier condition. I saw Harold again for more treatment and indeed his oral condition was greatly improved. He continues to be a patient of mine, who would otherwise not receive routine dental hygiene care.

In September of 2000, the Department of Health and Human Services produced the first ever report from the Surgeon General, Oral Health in America. The intent of this publication is to alert Americans to the full meaning of oral health and its importance to general health and well-being. It states that “the terms oral health and general health should not be interpreted as separate entities. Oral health is integral to general health; this report provides important reminders that oral health means more than healthy teeth and that you cannot be healthy without oral hea1th.”** The report outlines the connection between chronic oral infections and diabetes, heart disease, lung disease, stroke and a myriad of other health concerns. The Department has released the Healthy People 2010 program, which emphasizes the broad aims of improving quality of life and eliminating health disparities.

Since 1997 a Limited Access Permit (LAP) has been granted to those licensed Dental Hygienists in Oregon who have completed the following key requirements:

1. Completed 5,000 hours of dental hygiene services in the past five years,

2. 36 hours of continuing education every two years,

3. Keep a current CPR license and

4. Maintain adequate liability insurance.

This permit is specifically designed to allow the hygienist to go into assisted living, Alzheimer’s care facilities, foster care, nursing homes and a host of other facilities, as fully explained in OR 680.205. Note that once a year, according to OR818-035-0100: “The LAP dental hygienist shall refer each patient to a dentist who is available to treat the patient or resident and note in the chart that the patient has been referred.”

Often the role of the hygienist in facilities is for palliative treatment to keep a resident out of pain and reduce discomfort. By default, medications and poor oral care, especially among the elderly, often create a landscape of rampant caries and periodontal disease. Broken teeth and plaque accumulation are more common than most dental health care professionals can imagine. Discussions with others in the Oregon health community recognize that oral care is often a low priority Dental hygiene is soon to be a major issue that the consumer will look at when making a choice of a facility for their loved one. Currently several states are including additional requirements revolving around daily oral care and will be included in their surveys.

Smiles All Around began in the fall of 2000, and the mission has been to deliver routine dental hygiene care to individuals in care facilities. A smile from someone who can no longer speak swells the heart and I know that I am helping. Harold smiles every time he sees me, and his family continues to be very grateful for the dental hy­giene care that he was previously unable to receive. Everyone deserves a healthy smile!

Sandy Nelson from Smiles All Around can be reached at:
(503) 631-7994,
fax (503) 631-7924 or
e-mail: cowgirlrising@msn.com

* Fictitious Name
** Surgeon General: Oral Health in America, message from Donna E. Shalala, pg. iii. (A free copy is available online from the Department of Health and Human Services)