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Saskatchewan Seniors Oral Health and Long Term Care Strategy

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Oct 24th 2016

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Saskatchewan Seniors Oral Health and Long Term Care Strategy

  1. 1. Saskatchewan Seniors’ Oral Health and Long Term Care Strategy Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan Saskatchewan Oral Health Coalition October 24, 2016
  2. 2. A clean, healthy, pain-free mouth contributes greatly to: • chewing and being able to enjoy a variety of nutritious foods • clear speech and communication • sleeping well • overall health • general comfort and a higher quality of life • a more attractive personal appearance, positive self-esteem and satisfying social interactions Our Goal: Health and Wellness Better Oral Health in Long Term Care
  3. 3. Status of Oral Health among older adults in Long Term Care (LTC) homes in Saskatchewan Better Oral Health in Long Term Care
  4. 4. Approximately 72% of residents in long term homes reported that routine oral hygiene is their greatest single need. (findings from University of Saskatchewan - College of Dentistry pilot study) Better Oral Health in Long Term Care
  5. 5. • LTC residents often suffer from some form of dementia, and most have physical and medical challenges too. • These fragile elderly are at an especially high risk for a number of serious conditions because they: • Often forget to brush their teeth or are unable to do it without help • May resist or refuse assistance • May have problems recognizing and reporting pain and discomfort in the mouth Better Oral Health in Long Term Care Resident Challenges
  6. 6. So if these are the facts… • Increasing population and associated high prevalence of chronic diseases • Population of older adults will experience “doubling phenomena” • Population over age 65 will double by 2030 • Older adults are retaining more teeth • Retention of natural teeth puts them at risk for dental and oral diseases such as caries and periodontal diseases Better Oral Health in Long Term Care
  7. 7. Better Health and Wellness • If the mouth is being cared for like the rest of the body, diseases manifesting in the mouth like diabetes and cancer can be spotted sooner. • If there is regular daily care and prevention, there will be less oral disease and less systemic disease – heart disease, diabetes, stroke, aspiration pneumonia. = Less health care dollars being spent, while achieving a better quality of life for our people Better Oral Health in Long Term Care
  8. 8. Proportion of Seniors: • In 2015, 14.6% of the residents of Saskatchewan were seniors. (Statistics Canada, 2015) • By 2036, 23.3% of Saskatchewan residents are expected to be seniors. (Statistics Canada, 2010) 16.10% 18.40% 18.60% 18.90% 19% 17.60% 16% 14.80% 14.60% 11.60% 17.50% 10.90% 6.80% 3.70% 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00% 20.00% Canada Newfounland and Labrador Prince Edward Isaland Novo Scotia New Bruswick Quebec Ontario Manitoba Saskatchewan Alberta British Columbia Yukon Northwest Territories Nunavut Proportion of Population ≥ 65 years old Better Oral Health in Long Term Care
  9. 9. Aging Population and Long Term Care Homes: • In 2011, the percentage of Canadians seniors living in Special Care Homes increased with age. ( Census 2011) 0 5 10 15 20 25 30 35 40 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 years and over PercentageofCanadiansLivingin SpecialCareHomes Age Group Men Women Total *Special care homes refers to nursing homes, chronic care or long-term care hospitals and residences for senior citizens Better Oral Health in Long Term Care
  10. 10. Aging Population and Long Term Care Homes: • In 2014, there were 111 Residential Care Homes in Saskatchewan with 9,024 residents. The average age was 79 years. 55.7% of the residents were ≥ 85. (Continuing Care Reporting System 2014-2015) • In 2014, 49.7% of residents of Residential Care in Saskatchewan had dementia (6.1% Alzheimer's disease, dementia other than Alzheimer's disease 46%) (Continuing Care Reporting System 2014-2015) Better Oral Health in Long Term Care
  11. 11. Aging Population and Oral Health Problems: •Dental Caries •Edentulism (tooth loss) •Oral Candidiasis •Oral Pre-cancerous/cancerous Lesions •Periodontal Disease • Xerostomia (dry mouth) Better Oral Health in Long Term Care
  12. 12. Dental Caries Coronal Caries: • Canadians 60–79 years had the highest average DMFT (15.7) (Canadian Health Measures Survey 2007-2009) • In 39 Long Term Care (LTC) hospitals in Vancouver area, on average, 50.4% had coronal caries; and the average DMFT was 26.6 (Wyatt CC, 2002) Better Oral Health in Long Term Care
  13. 13. Dental Caries Root Caries: • 11% of Canadians 60–79 had untreated root caries (Canadian Health Measures Survey 2007-2009) • In Vancouver, the proportion of LTC hospital residents with root caries was 68.8% (Wyatt CC, 2002) Better Oral Health in Long Term Care
  14. 14. Edentulism and Denture Stomatitis: • Canadians 60–79 years had the highest rate of edentulism (22%) (Canadian Health Measures Survey 2007-2009) • In Nova Scotia, among LTC residents, 41% were edentulous; 41% had some mucosal abnormality. Most of the dentures in lower jaw were non-retentive (59%) and almost half were unstable (49%) (Matthews DC, et al 2012) Better Oral Health in Long Term Care
  15. 15. Oral Pre-cancerous/cancerous Lesions • In Canada, more deaths occur from oral cancer than from melanoma or cervical cancer. (Canadian Cancer Statistics 2015 ). • The five-year survival rate for oral cancer is much lower (68% and 61% in female and male respectively) than the most common cancers, that is breast cancer and prostate cancer (Canadian Cancer Statistics 2015 ). Better Oral Health in Long Term Care
  16. 16. Periodontal Disease (gingivitis and periodontitis) • In Nova Scotia, among LTC dentate residents, 67% had Loss of Attachment (LOA) of ≥ 4 mm at one or more site (Matthews DC, et al 2012) Better Oral Health in Long Term Care
  17. 17. Xerostomia (Dry Mouth) • In a survey in LTC residents of Nova Scotia, the most common (36%) problem was xerostomia (Matthews DC, et al 2012) Photo courtesy Peri-Products UK Better Oral Health in Long Term Care
  18. 18. Importance of Prevention/Detection of Oral Problems in the Elderly • Daily removal of plaque is an important factor for the maintenance of dental, gingival and periodontal health ( Arora V et al 2014) • Brushing twice a day is the least expensive and most effective physical method to remove and control dental plaque (South Australian Dental Service 2009) Better Oral Health in Long Term Care
  19. 19. Importance of Prevention/Detection of Oral Problems in the Elderly • A recent two year follow-up study showed, using fluoride toothpaste in elderly people slowed down the rates of progression of both coronal and root caries (Wyatt CC et al, 2014). Better Oral Health in Long Term Care
  20. 20. Importance of Prevention/Detection of Oral Problems in the Elderly • Antibacterial agents such cetylpyridinium chloride (Perivex) provides protection against dental plaque and gingivitis. Perivex is non-fluoridated, alcohol free antibacterial mouth cleaning gel and is highly recommended for the residents at risk of choking. (Silva MF et al 2009) • Brushing with mild soap and water is an effective way to clean dentures (South Australian Dental Service 2009) Better Oral Health in Long Term Care
  21. 21. Impacts of Poor Oral Health • Major health, social, psychological consequences • Economic impacts • The total cost of poor oral health in older Australians is estimated to be more than $750 million per year (Social Development Committee Parliament of South Australia, 2010) • Employment of an “oral care specialist” such as a dental assistant, could result in net cost saving of more than $300 million annually (Stein PS, 2009) Better Oral Health in Long Term Care
  22. 22. Limited Access to Dental Services • It is difficult for LTC residents to access oral care because dental services are mostly limited to emergency care within Canadian LTC homes. (Wyatt CC, 2009). • Many LTC homes lack space for a dental unit. • Not all private dental clinics are wheelchair accessible, or do not meet the demands of providing oral care to patients with dementia. (Yao Cs et al 2014) Better Oral Health in Long Term Care
  23. 23. Daily oral care and basic professional dental services can: •Enhance the overall health and quality of life (Dyck D et al, 2012) •Improve the success of treatment (BC Dental Association, 2011 ) •Reduce dental plaque (Dyck D et al, 2012 ) •Reduce the need for emergency care (BC Dental Association, 2011 ) •Reduce the need for invasive/complex treatment (BC Dental Association, 2011 ) •Reduce the overall cost of care (Wyatt CC et al 1997, BC Dental Association, 2011 ) •Reduce the progression of oral disease (BC Dental Association, 2011 ) Better Oral Health in Long Term Care
  24. 24. Programs/Services in Canadian Provinces • British Columbia: The Geriatric Dentistry Program (2002): The program now offers services to the residents of several intermediate and extended care hospitals. Oral examinations and basic oral care are provided at the bedside using mobile dental equipment, while complex treatment is provided at University of British Columbia dental clinic, or at clinic within the hospital. Better Oral Health in Long Term Care
  25. 25. Programs/Services in Canadian Provinces • Ontario: Halton, Ontario Oral Health Outreach Program Oral health assessments for individuals entering a LTC home, or clients living in the community who may require oral health services is completed. At the time of the oral health assessment, financial assistance is offered to qualifying individuals to cover the cost of dental treatment. In addition, the program maintains a data base of oral health professionals willing to provide services to clients in their offices or other settings. Better Oral Health in Long Term Care
  26. 26. Programs/Services in Canadian Provinces • Alberta: Alberta Health Services – Calgary Zone Better Oral Health in Long Term Care
  27. 27. Programs/Services in Canadian Provinces • Alberta: Alberta Health Services – Calgary Zone Better Oral Health in Long Term Care
  28. 28. Programs/Services in Canadian Provinces • Alberta: Alberta Health Services – Calgary Zone Better Oral Health in Long Term Care
  29. 29. Programs/Services in Canadian Provinces • Alberta: Alberta Health Services – Calgary Zone Better Oral Health in Long Term Care
  30. 30. Programs/Services in Canadian Provinces • Alberta: Alberta Health Services – Calgary Zone Better Oral Health in Long Term Care
  31. 31. Programs/Services in Canadian Provinces • Alberta: Alberta Health Services – Calgary Zone Better Oral Health in Long Term Care
  32. 32. Programs/Services in Canadian Provinces • Alberta: Alberta Health Services – Calgary Zone Better Oral Health in Long Term Care
  33. 33. Programs/Services in Canadian Provinces • Alberta: Alberta Health Services – Calgary Zone Better Oral Health in Long Term Care
  34. 34. Saskatchewan Projects Background: During 2007-2008, pilot projects began in Saskatoon and Regina to provide clinical oral health services to the residents at LTC homes • Regina: Santa Maria Senior Citizens Home • Full dental operatory • Dr. Maureen Lefebvre • Saskatoon: St. Ann’s Home and Saskatoon Convalescent Home • Portable dental equipment • Dr. Raj Bhargava Better Oral Health in Long Term Care
  35. 35. Regina Pilot: • The College of Dentistry (U of S) partnered with Santa Maria Senior Citizens Home to provide support for: o administration o human resources (dental assistant) o oral health status/data o treatment needs Better Oral Health in Long Term Care
  36. 36. • College of Dentistry, (U of S) partnered with St. Ann’s Nursing Home/Saskatoon Convalescent Home • Residents and their families were surveyed on basic oral health information. • Saskatoon Health Region – Population and Public Health, Dental Health Educators provided education to long term care staff at two long term care homes. Better Oral Health in Long Term Care Saskatoon Pilot:
  37. 37. Survey Results: A 2007 Saskatoon Health Region survey of staff, residents, and residents’ families showed that: • 35% of residents were experiencing problems with their teeth/gums; • 69% of residents only accessed oral care when there were problems (mobility was the main reason); • 64% of residents perform their own daily care; and • the main reasons LTC staff do not provide daily care to residents is uncooperative residents, and not enough time. Better Oral Health in Long Term Care
  38. 38. Regina and Saskatoon Data: • Average age 86 (n = 200) • Male 29%; Female 71% • Residents requiring dental care: 67% • Residents with decay: 55% with decay • Residents with nerve involvement pain and/or infection): 15%
  39. 39. Regina and Saskatoon Data: • Residents with own teeth: 50% • Residents with no teeth: 50% • Residents with faulty dentures: 46% • Dentures with no identification: 71.5% • Average treatment cost* per resident: $137.00 *Included oral hygiene services, treatment (fillings and extractions) and denture repair
  40. 40. • Staff understanding of oral health issues increased significantly between pre and post surveys. • Staff indicated most challenging aspects of providing mouth care were: • uncooperative residents • not enough time • not enough/any appropriate supplies Regina and Saskatoon Data: Better Oral Health in Long Term Care
  41. 41. Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan Since 2011, the Saskatchewan Oral Health Professions (SOHP) and Saskatchewan Oral Health Coalition have been collaborating to develop a model for oral health care in LTC: • conducted best practice literature review • developed policies and procedures • continued data collection • informed and include other health regions and providers.
  42. 42. Background: • In 2011, the Saskatchewan Oral Health Professions (SOHP) and Saskatchewan Oral Health Coalition (SOHC) endorsed the use and adaptation of the Australian Better Oral Health in Residential Care • Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan program was focus tested in Saskatoon Health Region at Parkridge Centre, in two of their neighborhoods, in early 2014. Better Oral Health in Long Term Care
  43. 43. • Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan is a train-the-trainer model teaching the best practices to provide daily oral care.
  44. 44. • The Parkridge Centre pilot was used as the model for full implementation in other LTC homes in Saskatoon Health Region. • Saskatoon Health Region Population and Public Health Dental Health Educators provided pre- assessments, facilitator training, and monitored implementation.
  45. 45. Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan Portfolios: Educators’, Professional, Staff) Educators’ Portfolio Professional Portfolio Staff Portfolio Better Oral Health in Long Term Care
  46. 46. Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan Posters and Pamphlets Better Oral Health in Long Term Care
  47. 47. Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan Oral Health Assessment Tool (OHAT) Better Oral Health in Long Term Care
  48. 48. Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan Oral Health Care Plan (OHCP) Better Oral Health in Long Term Care
  49. 49. Better Oral Health in Long Term Care The oral care costs are included in the $20.25/month charged to each resident for personal care items. (Pilot program at Parkridge Centre in Saskatoon ) Residents with Natural Dentition Not Requiring Assistance: •Fluoridated toothpaste ($0.72) •Toothbrushes GUM ($0.52) •End-Tuft toothbrushes GUM ($0.50) Residents Needing Assistance or Having Swallowing or Expectorating Difficulties: • Perivex ($1.67) • Toothbrushes GUM ($0.52) • End-Tuft toothbrushes GUM ($0.50) Residents that are edentulous: •Perivex ($1.67) •Toothbrushes GUM ($0.52) •Polident Tablet ($0.11) Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan Basic Oral Hygiene Supplies
  50. 50. Long Term Care Smiles: The Journey of Implementing an Oral Health Program at Parkridge Centre, Saskatoon
  51. 51. 2011 – Yearly treatments Better Oral Health in Long Term Care
  52. 52. November 2012 Why re-invent the wheel? Better Oral Health in Long Term Care
  53. 53. • The oral health kit is based on the model used @ Deer Lodge Centre in Winnipeg. Equipment Better Oral Health in Long Term Care • Meetings with Material Management to bring products into our Stores inventory.
  54. 54. MAY 2014 Better Oral Health in Long Term Care
  55. 55. Better Oral Health in Long Term Care Clinical Nurse Educators used a mannequin with teeth and tongue to educate the staff and champions of each Neighborhood/Unit.
  56. 56. Better Oral Health in Long Term Care Practice on each other
  57. 57. Work Standards Developed (Parkridge Centre Staff Development and Saskatoon Health Region Dental Educators) 1. Oral Care Routine Assessment: • Basic assessment process 2. Proper Oral Health in LTC: • Basic oral care for natural teeth • Basic oral care for the Edentulous resident • Oral care for a resident with dysphagia Better Oral Health in Long Term Care
  58. 58. Presently at Parkridge Centre: • Oral care has now been implemented on all neighborhoods (units), staff are practicing oral care techniques. • Products have been assigned SKU numbers and can be ordered through our Saskatoon Health Region Materials Management (Stores) by the neighborhood clerks. • A Dental Assistant visits the neighborhoods weekly to educate staff, assist with new resident assessments, conduct 6 month re-assessments and staff referrals to deal with challenges for oral care of residents. This is paid by the Saskatoon Health Region. Better Oral Health in Long Term Care
  59. 59. Daily Oral Care Supply Costs: • Included are: toothbrushes, toothpaste, Perivex non- foaming antibacterial gel, denture cups, Polident, and mouthwash. • The costs are included in the $20.25 charged monthly to each resident for personal care items at Parkridge Centre. Cost per resident Before implementation After implementation Standard Toothbrush, toothpaste, denture cups, Polident, mouthwash Toothbrushes (2 types) toothpaste, Polident, Perivex, denture cups, mouthwash Per resident/month $1.78 $2.83 Better Oral Health in Long Term Care
  60. 60. Better Oral Health in Long Term Care
  61. 61. Update: 2016 • Oct 2015 saw the transition from the pilot project as the Saskatoon Health Region OHP hired a dental assistant into the LTC OH Coordinator position. • LTC OHC has audited/refreshed staff at Parkridge and implemented Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan at Sherbrooke and Sunnyside • More LTC homes in Saskatoon Health Region interested • Saskatoon Health Region LTC Advisory Committee has the reviewed Better Oral Health in LTC strategy and is supportive. Better Oral Health in Long Term Care
  62. 62. LTC - Oral Health Coordinator Role: •Train staff to provide daily care •Provide health education and promotion •Communicate/liaise with family •Coordinate/liaise with LTC staff to expedite effective care •Coordinate consent/medical history process as required Better Oral Health in Long Term Care
  63. 63. LTC Oral Health Coordinator Oral Health Assessment Tool Kit Better Oral Health in Long Term Care
  64. 64. Thankful Residents This particular resident was having her partial dentures cleaned every day, but not her natural teeth! Notice the big smile after the care aide has completed her oral care! This particular care aide requested that I visit and help her become more comfortable doing oral care for this resident, who was new to her area of care. Better Oral Health in Long Term Care
  65. 65. Love this Smile This Residents’ body has stiffened up and he can no longer care for his own mouth on his own. A care aide assists him by guiding his hand with the hand over technique, but some days he can’t grip his toothbrush at all. They then provide full assistance. Better Oral Health in Long Term Care
  66. 66. Smiles all Around This resident is happy he is able to see the dentist in his own home, and also that I have been able visit him to help him brush and floss his own teeth more effectively. He told me “no one had ever explained to him why he should brush his teeth”. Better Oral Health in Long Term Care
  67. 67. Before assistance After assistance Better Oral Health in Long Term Care
  68. 68. Resident that has benefited with the use of an electric tooth brush Before brushing After brushing Better Oral Health in Long Term Care
  69. 69. I have been asked by residents and their families: “Why do LTC homes have spaces allotted for beauty salons and physical therapy rooms in the planning of the building development, but no Dental Clinics ?” Better Oral Health in Long Term Care
  70. 70. The SOHP and SOHC have developed and endorsed the following recommendations for consideration and action by the Saskatchewan Ministry of Health: Better Oral Health in Long Term Care
  71. 71. Recommendation #1: The Saskatchewan Government, Ministry of Health, endorse the Saskatchewan Seniors’ Oral Health and Long Term Care Strategy developed by SOHP collaboratively with SOHC and Seniors Health and Continuing Care in the Saskatoon Health Region. Better Oral Health in Long Term Care
  72. 72. Recommendation #2: An OHC, who is a registered and licensed oral health professional (minimum of one) , should be employed in each health region to facilitate the delivery of initial oral assessments, dental examinations and treatment, daily oral hygiene for residents and oral health education. The OHC will work collaboratively with the LTC, multi-disciplinary team to improve the oral and overall health of residents. Better Oral Health in Long Term Care
  73. 73. Recommendation #3: Upon entry into a LTC home, an initial oral assessment must be completed by a registered and licensed oral health professional, through the general and medical consent provided by the LTC home. i. Oral assessments should be routinely performed every 6 months thereafter, by an oral health professional or a health care professional trained in oral health assessments. ii. Non-oral health professionals performing oral health assessments or care will receive appropriate training developed by the Saskatchewan Oral Health Professions. iii. Training will be provided by oral health professionals. Better Oral Health in Long Term Care
  74. 74. Recommendation #4: Initial oral assessments will include: i. Personal client record*, including consent for dental examination ii. Review of medical and dental history iii. Complete examination of the oral cavity, which includes: • Assessment of hard and soft tissues • Assessment of oral hygiene care • Oral cancer screening • Denture assessment *Note: Implementation of a Saskatchewan electronic health record should include an oral health record. Better Oral Health in Long Term Care
  75. 75. Recommendation #5: Oral Health Care Policies and Procedures for LTC and Personal Care Homes* are standardized and implemented based on best practice for optimal oral and overall health for residents in LTC in Saskatchewan. Policies should ensure that every LTC resident has the right and access to the following oral health care services: i. An individualized oral health care plan ii. Basic oral hygiene supplies iii. Daily oral hygiene iv. Access to professional oral health services v. Oral health record included within the health record vi. Dental recommendations/orders are followed *Note: As per Section 23 of the current Personal Care Home Regulation (1996), each resident receive a dental examination, as necessary. Better Oral Health in Long Term Care
  76. 76. Recommendation #6: Treatment needs based on the dental examination, may be provided by dentists, denturists, dental hygienists, dental therapists and/or dental assistants. Residents may access dental services through their personal oral health professional or through dental services as available through the LTC home. Dental examinations require: i. Consent for dental examination ii. Treatment plan and progress notes iii. Estimate and consent for financial responsibility iv. Consent for treatment Better Oral Health in Long Term Care
  77. 77. Recommendation #7: The Saskatchewan Seniors’ Oral Health and Long Term Care Strategy is incorporated into post- secondary educational health training programs, orientation, and continuing professional development (i.e. for care aides, nurses, physicians, etc.). Better Oral Health in Long Term Care
  78. 78. Recommendation #8: The standard for new LTC homes includes provision for a treatment room suitable for a variety of health professionals including access to portable dental equipment to facilitate dental treatment. Better Oral Health in Long Term Care Kitchen/ Dental Clinic!
  79. 79. Recommendation #9: Surveillance, evaluation and continuous quality improvement be performed on an ongoing basis to demonstrate improved health and oral health status outcomes. Better Oral Health in Long Term Care
  80. 80. Recommendation #10: The Saskatchewan government establish a safety net program to increase access to oral health services for low income seniors (similar to Ministry of Health Supplementary Health/Family Health Benefits or Alberta’s Dental Assistance for Seniors Program through which low income seniors are eligible for up to $5000 every 5 years for those aged 65 and older). Better Oral Health in Long Term Care
  81. 81. Our Provincial Vision for Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan • Consistent integration of oral health into policy and practice of LTC homes • A provincial framework for oral health assessment, oral health care planning and oral care treatment for residents • A multidisciplinary team approach to improve the oral health of the residents Better Oral Health in Long Term Care
  82. 82. • Improved quality of life for residents who suffer from poor oral health and nutritional deficiencies • Regular assessments and oral health treatments • Residents receiving oral health treatment in the LTC homes rather than having to face the challenges involved with travelling offsite for care Better Oral Health in Long Term Care Our Provincial Vision for Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan
  83. 83. • Decreased occurrence of systemic conditions in the residents • Decreased health care spending Better Oral Health in Long Term Care Our Provincial Vision for Better Oral Health in Long Term Care: Best Practice Standards for Saskatchewan
  84. 84. How can you support and/or move Better Oral Health in Long Term Care forward in your workplace? Better Oral Health in Long Term Care
  85. 85. Better Oral Health in Long Term Care https://youtu.be/OjISugM0Tv8
  86. 86. Thank you! Better Oral Health in Long Term Care

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