Not for a second was I, a second-year dental student, overly nervous prior to, or during, my quaint little presentation to the rows of elderly seated before me. Through my personal experiences, I’ve always had a positive outlook on the elderly, so I was certain they would remain quiet, respectful and wouldn’t giggle at my strange Maltese dialect throughout the outreach programme.
Truly, my expectations would be fulfilled. Owing to the head nurse at the residential home fielding attentive individuals for this exercise, pairs of eyes tracked me as my feet paced to and fro, while my little clipboard nudged my conversation forward. Yet, regardless of all this mutual respect, the presentation on oral health was suddenly halted, and not in an expected manner.
Specifically, to demonstrate the benefits of planting restored teeth into hard food substances, an illustration of an elderly couple diving into some corn was presented as an example. Ergo, a polite question inquiring as to the Maltese translation of what was being eaten flew my way.
Naturally, I had no idea with regards to the translation of the word, and hence commotion broke out in the ranks of elderly, enthralled by this surprising puzzle. Standing there patiently, it occurred to me that I hadn’t expected any questions, just several nodding heads and a few keen smiles.
Anyways, the remainder of my presentation proceeded undisturbed, after the elderly excused themselves thoroughly while chuckling at their momentary giddiness.
However, as soon as the final phrases danced out of my mouth, there was an onslaught of questioning. All at once, legions of hands took to the sky, beckoning our band of dental students forward to discuss their oral situation while encouraging the residents to interact with the samples of oral hygiene aids at hand.
Regardless of their specific situation, mutual mannerisms were shared across the board. Looking deep in the eyes of greyed heads − eyes which were now expectant on hearing some form of hope, some form of help for their neglected oral condition, eyes which were exhausted at looking down onto soft meals, eyes reluctant to acknowledge the reflection of themselves in the mirror, eyes which demonstrated a cathartic sense of relief, eyes which trusted me – it moved me, how could it not?
Lacking oral health has been linked to dementia and Alzheimer’s disease
Certainly, the importance of oral health among the elderly population cannot be overstated. Empowering the individual with the ability to smile, speak, eat and function with full confidence and enjoy improved brain function is very beneficial.
As emphasised by the World Health Organisation, oral health is a key indicator of overall health, well-being and quality of life. Furthermore, poor oral health places the old and frail person at a higher medical risk for cardiovascular disease, pulmonary disease, diabetes, rheumatoid arthritis and cancer. As aforementioned with regards to brain function, lacking oral health has been linked to dementia and Alzheimer’s disease.
In the context of the Maltese islands, local studies conducted by the Faculty of Dental Surgery have identified that institutionalised older adults suffer from a poorer oral health status, similar to the rest of Europe, compared to independent older adults in the same community. For example, in Malta, only 65 per cent of persons over 60 feel that they may obtain dental treatment when needed. Conducive to this finding are a number of present barriers which deny such individuals from accessing and receiving treatment.
Correspondingly, these barriers were identified during the 27th Annual Congress of the European College of Gerodontology, which was hosted in Malta in 2017. Present in macro and micro forms, examples include workforce shortages, media coverage of oral health and the elderly, and clinical barriers. In this context, for the past two years, the novel COVID-19 pandemic has presented as a clinical barrier.
Gerodontology, defined as the specialised area of dentistry dealing with the management of dental conditions related to the elderly, aims to address and overcome these barriers, in order to improve the quality of life of these individuals.
This includes addressing the psychological stresses the elderly face, with more than two-thirds (67.3 per cent) of residents in Malta’s homes expressing sentiments of depression linked to feelings of isolation.
This was further revealed to me when I asked if this resident, an elderly lady, felt integrated into society. No, she didn’t. Yes, her kids tend to visit every now and then, providing the essential needs. However, she addressed the elephant in the room by admitting that life hasn’t been the same since the onset of the ongoing pandemic.
Addressing her experience of having to quarantine, she admitted to mentally checking out during this episode of loneliness. Regardless, she was adamant in explaining that optimism is something which keeps her going. Spontaneous relationships with other home-dwellers and carers, which she developed thanks to her outgoing personality, have supported an impressive mental state. Granted the importance of oral health to quality of life, there are already a number of measures and policies in place to safeguard oral health. These include government initiatives and oral health policies, the provision of dental services by the University of Malta Dental Faculty at St Vincent De Paul since 2015, and the implementation of gerodontology within the training of dental students.
Furthermore, the Mobile Dental Clinic, set up and launched by the Faculty of Dental Surgery in 2015, is in itself a form of domiciliary dentistry which travels across the entire island – a service which reaches out to those who cannot reach such a service themselves.
Following two years of challenges presented by the pandemic, the elderly have suffered in more ways than one, including as regards oral health. Bearing this in mind, the fact that the residential home in particular for this outreach experience was very enthusiastic about inviting us dental students over is very encouraging for the future.
Such a sentiment is further supported by the response of the elderly residents encountered, as they voiced their appreciation for addressing the taboo behind edentulism (the state of being without natural teeth), demonstrated a yearning desire to learn more and religiously thanked us dental students for the samples provided.
And that poses the question – what is gerodontology? Is it a field? Is it a study unit? In my opinion, it’s a movement. It’s a movement to reignite a change in society, one which will rekindle a love for the elderly as a growing proportion of modern civilisation. Indeed, a change which will likely involve a key principle, one which was celebrated by the likes of Pope John Paul II – solidarność.
Through the means mentioned and through future initiatives, we can continue to bridge this gap… this dearth in oral health policy in, but not exclusive to, our residential homes. Certainly, the act of simply trying to raise the bar, to push the limits with regards to the standards of healthcare for these individuals, will potentially improve the level of healthcare I’ll receive when I’m frail and old.
The article has been reviewed by Nikolai Attard, dean of the Faculty of Dental Surgery and head of the Department of Oral Rehabilitation and Community Care, and Alexander Schembri, visiting lecturer at the Faculty of Dental Surgery, Department of Oral Rehabilitation and Community Care, Gerodontology coordinator.