Day by Day

Day by Day

Michael T. Flynn, D.D.S.*:

Minnesota is about to see a “silver tsunami” as baby boomers reach retirement age, living longer than ever before. At some point, many will reside in assisted living facilities or nursing homes. Despite state oral health care requirements in those settings, many residents find themselves facing often painful delays trying to obtain such care, for a variety of reasons. The Minnesota Dental Association’s Community Service Committee is exploring ways to address that particular dental access situation. Local solutions typically work best, so here is my story.

Not Perfect, And Yet ...
I completed work as a member of the Oral Health Practitioner Workgroup in November of 2008. It was impressed upon me that in areas of Minnesota, people are having a great deal of trouble getting dental care in our nursing homes. Karen Rau, another member of the OHP Workgroup, is a nurse from Alexandria, Minnesota. She too described the lack of dental care in the nursing homes in her area as well as throughout the state. Here in Winona County, we have 414 nursing home residents.

While we certainly do not have a perfect solution here in Winona County, for more than 30 years, area dentists have been addressing this problem. Not perfect, I admit: We dropped the ball and did not see all residents in the nursing homes last year. And yet: We have already made plans to pick it back up again this year.

How It’s Done
Here’s how it works, and how it really works. We coordinate with nursing home staff to find a convenient day for a multiple-doctor visit. We then schedule a one- to two-hour block of time across the board, either in the morning or the afternoon, strictly for care of the residents. Individualized care means learning about the patients, and one thing we learned very quickly was that exams should never be scheduled over the lunch hour. This is absolutely sacred time for the residents and the nursing home staff. I smile every time I recognize this, because it always reminds me of a classroom presentation I did a few years ago. I was speaking to my usual classroom of fourth graders as part of our activities during Dental Health Month. My chalkboard lesson was optimistically designed to engage the class concerning caries, soda pop, and anything else they would contribute to give me some impromptu direction. A boy in the back row raised his hand. Yes! Now I’m excited! I just got the least motivated kid in the class engaged!
“Yes, John,” I said. “What do you think?”

Well, with kids you’d better be ready to change expectations in mid-stream of consciousness.
“Dr. Flynn,” he said. “Just how long are you gonna take, because this is our recess time.”

Point being that lunch hours are just as important for our seniors, to the degree that while I have been known to have lunch while visiting various homes, I have never interrupted lunch. In fact, I have even joined
in on a hand or two of 500 (the
card game).

This is no small thing.

A Bigger Day
On to the next agenda item: annual exam day at the local nursing home. For this event, it is convenient to have nursing home staff set up carts consisting of tongue blades, gauze, gloves, a flashlight, antiseptic handwash, and so on. Depending upon an individual doctor’s needs, bagged mirrors, explorers, and so forth can be brought from his or her office to assist in exams and oral screening. Doctors may be assisted by dental staff or by the nursing staff with charting and any patient management issues that may arise. Standardized charting records are used with any documentation on follow-up treatment recommendations. Doctors have the choice of completing the recommended work or referring. Annual exams are usually done in the late spring, so any follow-up care can be completed during good weather if a trip needs to be planned to the office.

Only to Discover ...
When I still practiced in Winona, my office was less than a block from one of the nursing homes. It was common for us to walk over to the facility and wheel a patient back to our office for an appointment. One June afternoon, I decided it would be shorter to cut across the parking lot of a local restaurant rather than follow the sidewalk all the way around. It was, after all, the only building separating us from our destination. Regrettably, after committing ourselves a few feet into the parking lot, we found it was not as smooth a ride as I thought it would be. I didn’t want to turn around and admit making the mistake, so on we trudged. After a ride that was more like crossing a raging river, I reached the office with Gertrude, now well awake and alert for her dental appointment. Once we had actually made it across, she told me she had enjoyed her “stroll” through the parking lot. She had a great sense of humor!

I have learned that many residents do enjoy getting out for a dental visit to our office. We try to arrange for two or more resident appointments at a time, particularly if a van is required for transportation. The Golden Living Center of St. Charles, for example, will arrange late morning visits to allow for lunch at an area restaurant on the way home. This has become a weekly treat for many residents. As well, it is not uncommon for us to dine with them.

Our experience with the nursing staff has been great. I appreciate their help in caring for these patients. I also appreciate the staff’s confidence in having me as their dentist. By treating these residents, health care providers bond together for a better community for dentistry, medicine, and its community.

Do What You Do, and Do What You Can
We know it’s not perfect down here, but as a wise colleague once said, “Perfect is the enemy of good.” I know there are many dentists around Minnesota who are operating in similar programs, and that is a good thing indeed. Let us know what’s working for you, and if you need help, please don’t hesitate to call us. If we could expand these screenings to reach more people, it would be good for them and good for our profession. Please communicate with your community nursing and convalescent facilities about how you could help with their dental needs.


*Dr. Flynn is a member of the Minnesota Dental Association’s Community Service Committee and serves on the MDA Board of Trustees. He is a general dentist in private practice in Winona, Minnesota. E-mail is