The impact of oral health on a person’s overall health and well-being is so significant that the National Dental Centre Singapore (NDCS) is focusing efforts on training non-dental healthcare professionals and nursing home staff about managing oral care for patients.

Poor oral hygiene causes more than bad breath and caries – it is linked to diabetes and can put the sick and the elderly at risk of life-threatening diseases. Severely ill patients and those who suffer from a stroke or dementia and require help with daily tasks are particularly at risk of poor oral health.

So NDCS has started to train healthcare professionals outside the dental discipline to raise awareness of the importance of good oral hygiene for patients and impart skills and tools to enable them to better manage patients’ oral health care as part of their overall care.

Sister Noor Asiah A Aman, Nurse Clinician, Medical High Dependency and Stroke Unit, Changi General Hospital (CGH), was among the first batch of nurses to attend the NDCS Basic Oral Health Education Programme (OHEP) workshop in October 2018.

“I have had some prior information about basic oral care for my patients and have been managing this aspect of care for them since I started my nursing career nearly 40 years ago. Still, this course was an eye-opener for me! Poor oral hygiene can cause bacteria to enter the lungs leading to medical conditions such as pneumonia and it can also worsen diabetes. This brought home the importance of oral care and how I need to pay attention so that I can protect my patients from developing complications especially when they are already very sick,” said Sister Noor Asiah.

OHEP training curriculum includes training of non-dental healthcare professionals to gain knowledge on recognising and preventing common oral conditions and performing a simple oral health assessment.  In addition, a comprehensive oral hygiene care in normal adults and those with special medical conditions will be taught. 

“Ward nurses already carry out basic oral hygiene for their patients, so they are ideally placed to conduct a simple oral health assessment. Should the nurses identify inflammation, abscess, oral swellings or tumors, they would be empowered to refer the patients for the appropriate care and follow-up,” said Clinical Associate Professor Teoh Khim Hean, Deputy Director, Clinical & Regional Health, NDCS, whose team member, Dr Yang Jingrong developed the OHEP training curriculum.

So far, Sister Noor Asiah has identified patients to receive dental services for severe caries and gum disease. For stroke patients who still require help with daily care activities when they get discharged, it was important to also teach family members and caregivers about the importance of paying attention to the patients’ oral hygiene. “Our priority at the stroke unit is to stabilise patients as their condition can deteriorate very quickly. I advise family members about oral hygiene but at this stage of the recovery journey, it is often not their priority. When patients are transferred to other wards for rehabilitation, we now include oral hygiene in the handover so the receiving ward can follow up on the caregiver training,” said Sister Noor Asiah.

The OHEP training included CGH nurses from the high dependency and stroke unit, intensive care unit, rehabilitation and geriatrics wards as well as nurses from Bright Vision Hospital (BVH). As a follow up, training materials are being developed so more healthcare professionals can be trained across the hospitals about the importance of good oral hygiene for patients.

This workshop was particularly important for healthcare professionals in BVH, as residents in intermediate and long-term care are often at high risk of oral health problems because of their other chronic and sometimes, complicated existing conditions.

“Community hospital patients and nursing home residents with severe stroke or advanced dementia are unable to look after their own oral hygiene and have difficulty in swallowing. Many suffer from dry mouth and poor oral health but if they are unable to speak, they cannot ask for help if they are in pain or uncomfortable,” said Assoc Prof Teoh. “It is therefore imperative that we bring the knowledge and awareness to non-dental healthcare professionals at intermediate care facilities such as community hospitals and nursing homes so that our most frail patients can get the care they need in a timely manner.”

NDCS has been reaching out to the seniors in the community through functional screening carried out in school dental clinics but it is only available during weekends and school holidays. This does not reach the frail and institutionalized elders in the nursing homes. To bring more timely care to elderly and frail patients, NDCS is raising funds to build a dental bus that can be fitted with the necessary facilities to bring dental care to the door step of Singaporeans, especially the elderly and to those who need it. 

For more information about supporting the Oral Health Education Programme or the dental bus, please contact: NDCS Development,