Use Home-Visit Dental Care to Keep Eating by Mouth to the End: Notes from the Front Lines of Eating Support (2)
Written by: 五島 朋幸 (Dentist)
What is a dentist’s role in the first place? You might think, “You go to the dentist when you have bad teeth, so the role must be to fix teeth and gums.” But the purpose of dentistry is “to improve the environment of the mouth and to maintain and improve the functions of the mouth.” Of course, there are fields such as cosmetic dentistry, but the true purpose is always to look after the “environment” and the “function.”
So what does improving the environment of the mouth mean? In fact, it covers all the dental treatment you can imagine. Treating a cavity because a tooth hurts, removing tartar and treating gum disease because a tooth is loose, fitting a denture because a tooth has been lost: all of these improve the environment of the mouth. The role of dentistry is to restore the ability to eat by improving that environment.
Clinic care and home healthcare
Dental care, like medical care, is provided both at clinics and as home healthcare. I have practiced at a clinic ever since I became a dentist, and I have also provided home-based care for more than 20 years. Thanks to advances in equipment, home healthcare can now offer care that compares well with clinic care (depending on the equipment the practice has).
So is home healthcare simply “providing the same care at home or in a facility because the person can no longer come to the clinic”? In fact, it isn’t that simple.
As in medicine, the goal of clinic care is to cure disease. In dentistry, too, solving the problem in the mouth is the top priority.
On the other hand, one of the main purposes of home healthcare is to support daily life. People who receive home healthcare are in a condition that makes it hard to visit a clinic. Because they have various illnesses, surgical procedures such as tooth extractions may be difficult. Their teeth and jaws may also be badly out of position. In this context, the goal is to keep the mouth clean and make it comfortable to live with.
One aspect that is surprisingly often forgotten is cost. In home healthcare, additional fees for the visit are added to the regular treatment fees, so care costs more. The number of visits also has to be kept to the necessary minimum.
House calls and scheduled home visits
You have probably heard the terms “home healthcare,” “home visits” and “house calls.” They may all sound like a clinician leaving the office to treat patients, but each has a different definition. In Japan, “home healthcare” is the broad category, and it includes both scheduled “home visits” (hōmon shinryō) and “house calls” (ōshin).
A house call is an unscheduled visit to the patient’s home or other residence when the clinician judges it medically necessary. In dentistry, for example, it is when we get a call saying, “My father’s full denture has cracked and he can’t chew!” and visit on short notice. Put the other way around, once the denture has been properly fixed and the problem is gone, the care ends there.
A scheduled home visit, on the other hand, is care in which, for a person who has difficulty visiting a clinic because of illness or other reasons, a care plan is drawn up in advance and, with the patient’s consent, the clinician visits the home regularly. For example, we might visit someone who has difficulty eating by mouth once every two weeks to do training and to assess what they can actually eat.
In practice, house calls and scheduled home visits are not completely separate. They overlap: during a course of scheduled visits, a problem arises one day and we make a house call.
Three roles of dental home healthcare
There are three main things expected of dental home healthcare:
Dental treatment: As in a clinic, we deal with dental problems.
Oral care: Since long-term care insurance was introduced, the mouths of older people living at home have become cleaner, but oral care still can’t be called widespread. Besides providing care ourselves, we also play a role in spreading oral care in caregiving settings.
Care for dysphagia (eating and swallowing disorders): Few professions in the community can deal with it, so dentistry is expected to play the leading role.
The most common request we receive is about dentures that are causing trouble. When I started home healthcare, my patients were from the generation born between about 1907 and 1920, and even then many requests concerned denture problems, almost all with full dentures. In recent years, however, thanks in part to the 8020 Campaign (which aims for people to keep 20 of their own teeth at age 80), more people have kept their own teeth, and many use partial dentures.
That means the remaining teeth and the dentures need treatment, and the remaining teeth need oral care. And because most denture problems come down to “it’s hard to chew,” we also look at eating and swallowing function. In other words, we end up taking on all three roles for one person.
For dysphagia in the community, turn to dentistry first
Who do you think learns about the conditions that make it difficult to eat by mouth, so-called dysphagia, during their professional education? In fact, it is limited to dentistry (dentists and dental hygienists), speech-language-hearing therapists, and some doctors in otolaryngology and rehabilitation medicine.
That’s right. Even if you tell the attending physician at home that “there’s a problem with eating by mouth,” in most cases they can’t deal with it (although this is of course not true of all doctors). Because nutrition is then provided without knowledge of how to manage or care for the problem, the number of gastrostomy (PEG) tubes and similar measures increases.
Now let’s compare dentistry with speech-language-hearing therapists. Neither profession yet makes enough home visits, but in the case of speech-language-hearing therapists, the number is close to zero. In addition, assessment and rehabilitation by speech-language-hearing therapists require a doctor’s instructions, so they cannot visit unless a doctor requests it.
The biggest advantage of dentistry is that it can not only assess eating and swallowing function but also improve the environment of the mouth. Training someone to eat when they have no dentures and their teeth don’t meet will not produce sufficient results, but dentistry can look at all of this as a whole.
Of course, people in other professions have also studied dysphagia. Even so, when eating by mouth becomes difficult for someone in your community, try looking first for a dentist who makes home visits.
About the author: 五島 朋幸 (Dentist)
Born in Hiroshima in 1965. Graduated from the School of Dentistry at The Nippon Dental University in 1991 and began providing home-visit dental care in 1997. Head of Fureai Shika Goto (Fureai Dental Clinic Goto) since 2003. PhD in dentistry. His roles have included clinical associate professor in the Department of Oral Rehabilitation at The Nippon Dental University Hospital, lecturer in the Department of Dental Hygiene at The Nippon Dental University College at Tokyo, and part-time lecturer at Tokyo Medical and Dental University. Representative of the Shinjuku Eating Support Study Group. Since 2003, he has hosted the radio program “Doctor Goto’s Passionate Home-Visit Clinic.” His books (in Japanese) include Oral Care: Dos and Don’ts (Chuohoki Publishing) and Home-Visit Dentist Doctor Goto 1: The Dentist Comes to Your Home! (Osumi Shoten). (Profile as of the time of writing.)
This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.
This is an English translation of a column originally published in Japanese by Next Co., Ltd.
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