Evde Diş Bakımı Hizmetlerinin Artan Önemi: İhtiyaçlar, Zorluklar ve Uygulamalar

Abstract

Dünya çapında yaşlı nüfusun hızlı artışı, ağız ve diş sağlığını geriatri alanında önemli bir halk sağlığı sorunu haline getirmiştir. İnsanlar yaşlandıkça, sistemik hastalıklara yakalanma, motor ve bilişsel işlevlerde azalma, ilaç kullanma ve bakıcılara bağımlı olma olasılıkları artar. Bu faktörler, ağız hijyenini korumayı giderek zorlaştırır ve diş çürükleri, periodontal hastalıklar, protez stomatiti, ağız kuruluğu ve beslenmeyle ilgili bozukluklar gibi klinik durumların daha yaygın görülmesine neden olur. Sonuç olarak, evde diş bakımı, önleyici ve tedavi edici stratejilerin önemli bir parçası haline gelmiştir. Bu model, ağız hijyeni eğitimi, mekanik plak kontrolü, florür uygulamaları, protez bakımı, beslenme danışmanlığı ve kişinin evinde yapılan düzenli profesyonel değerlendirmeleri içerir. Bakım verenlerin eğitimi de yaşlıların ağız sağlığı sonuçlarının iyileştirilmesinde kritik bir rol oynamaktadır. Mevcut literatür, düzenli evde bakım müdahalelerinin çürüklerin ilerlemesini yavaşlatabileceğini, periodontal sağlığı destekleyebileceğini ve yaşam kalitesini artırabileceğini göstermektedir. Ancak, erişilebilirlik engelleri, ekonomik kısıtlamalar, yetersiz sağlık okuryazarlığı ve yetersiz hizmet altyapısı gibi sınırlamalar önemli zorluklar oluşturmaya devam etmektedir. Sonuç olarak, yaşlı nüfusta ağız ve diş sağlığını korumak için bütünsel, evde bakım odaklı bir yaklaşımı oldukça önemlidir. Çok disiplinli ekip çalışması, teknoloji destekli izleme sistemleri ve toplum temelli programlar, uzun vadede yaşlıların ağız sağlığı sonuçlarını iyileştirmeye yardımcı olabilir.

Keywords

• Diş Bakımı
• Ağız Sağlığı
• Evde Bakım
• Geriatrik Diş Hekimliği

The Growing Importance of Home Dental Care Services: Needs, Challenges, and Implementation

Abstract

The rapid growth of the elderly population worldwide has made oral and dental health significant public health concerns in geriatrics. As people age, they are more likely to have systemic diseases, declines in motor and cognitive functions, and to take medications and rely on caregivers. These factors make it increasingly challenging to maintain oral hygiene and lead to a higher prevalence of clinical conditions such as dental caries, periodontal diseases, denture stomatitis, xerostomia, and nutrition-related disorders. Consequently, home-based dental care has become an essential part of preventive and therapeutic strategies. This model includes oral hygiene education, mechanical plaque control, fluoride applications, denture care, nutritional counseling, and regular professional assessments conducted in the individual's home. Educating caregivers also plays a critical role in improving oral health outcomes among older adults. Current literature indicates that regular home care interventions can slow the progression of caries, support periodontal health, and enhance quality of life. However, limitations such as accessibility barriers, economic constraints, insufficient health literacy, and inadequate service infrastructure continue to pose significant challenges. In conclusion, a holistic, home-care–centered approach is essential for preserving oral and dental health in the geriatric population. Multidisciplinary teamwork, technology-assisted monitoring systems, and community-based programs may help improve oral health outcomes for the elderly in the long term.

Keywords

• Dental Care
• Oral Health
• Home Care
• Geriatric Dentistry

References

1. Alsaadi, M. G., Alsolami, A. H., Hamed, E. M., Alshamrani, Z. K., Alharbi, H. Y., Almahyawi, H. H., Ameen, R. M., Basudan, O. A., Turkistani, R. M., Bashnaini, W. A., & Turkistani, M. A. (2022). Oral health needs of the geriatric patients and the role of mobile dentistry. International Journal of Community Medicine and Public Health, 9(12), 4710. https://doi.org/10.18203/2394-6040.ijcmph202232 35
2. Andersson, P., Renvert, S., Sjogren, P., & Zimmerman M. (2017). Dental status in nursing home residents with domiciliary dental care in Sweden. Community Dental Health, 34(4), 203–207. https://doi.org/10.19 22/CDH_4100Andersson05
3. Asiri, F. Y. I., Tennant, M., & Kruger, E. (2024). Barriers to oral health care for persons with disabilities: An overview of systematic reviews. Community Dental Health, 41(4), 256–264. https://doi.org/10.1 922/CDH_00173Asiri09
4. Aslan, Ş., Uyar, S., & Güzel, Ş. (2018). Home health care services implementation in Turkey. Journal of Social Research and Management, 1, 45–56. https://doi.org/10.35375/sayod.520957
5. Baele, E., Hoste, N., De Vleeschauwer, A., Janssens, B., Pype, P., Poppe, L., & Mertens, F. (2023). Reducing oral health inequalities for frail older people by improving access to oral care and integrated oral care. International Journal of Integrated Care, 23(S1), 446. https: //doi.org/10.5334/ijic.ICIC23163
6. Bawa, R., & Sinha, A. K. (2022). Explaining the concept of home health care services- a review. Emerging Trends in Disease and Health Research, 9, 59–69. https://doi.org/10.9734/BPI/ETDHR/V9/2977 B
7. Bilir N, (2015). Problems of aging. In Ç Güler Ç (Ed.), Fundamentals of Public Health (3rd ed., pp. 1528–1538). Ankara: Hacettepe Üniversitesi Yayınları.
8. Blasi, A. M., Vonhoegen, L., Herrler, A., Wicht, M. J., & Barbe, A. G. (2024). Older people’s preferences and expectations of preventive oral care in the home. Gerodontology, 41(2), 241–250. https:// doi.org/10.1111/ger.12698

9. Bradley, M. B. A., & Marko V. (2021, May 21). Projected supply of dentists in the United States, 2020 – 2040. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/re search/hpi/hpibrief_0521_1.pdf
10. Çelik Güzel, E. (2018). Home-Based health care services in Turkey. Journal of Clinical Medicine and Family Practice, 10(5), 15–19.
11. Davey, V., Healey, J., Liddle, J., Beresford, B., Allan, S., Goodman, C., Gordon, A., Killett, A., Rand, S., Spilsbury, K., Towers, A. M., & Hanratty, B. (2024, October 4). Defining home care: an exploration of its roles, challenges, and data needs. https://osf.io/preprints/socarxiv/uy8cf_v1
12. Dhiman V.K., & Chavali D. (2024). From hospital to home: analyzing the market dynamics of home health and hospital-at-home care. Open Access Research Journal of Biology and Pharmacy, 11(1), 58–65. https://doi.org/10.53022/oarjbp.2024.11.1.0024
13. Directive on the procedures and principles for the implementation of palliative care services. (2018, July, 16). https://khgmsaglikhizme tleridb.saglik.gov.tr/TR-42938/palyatif-bakim-hizmetlerinin-uygu lama-usul-ve-esaslari-hakkinda-yoner ge.html
14. Fairhall, T. J., Thomson, W. M., Kieser, J. A., Broughton, J. R., Cullinan, M. P., & Seymour, G. J. (2009). Home or away? differences between home‐ and clinic‐based dental examinations for older people. Gerodontology, 26(3), 179–186. https://doi.org/10.1111/j.1741-2358.2008.00263.x
15. Fornazari, B. A., Dos Anjos, A. L., Sá, E. F. M., Rocha, F. S. C., & Falcone, M. R. (2024, November 2). A intervenção do serviço de atenção domiciliar junto ao usuário e cuidador na rede de atenção à saúde. https:// https://submissoesrevistarcmos.com.br/rcmos/a rticle/view/732/1595
16. Genaro, L. E., Aurelio, T. G., Pereira Areias, C. M. F. G., Valsecki Júnior, A., Saliba, T. A., & Lopez Rosell, F. (2024). The role of the dentist in home care for the older people: a narrative review of the literature. The Journal of Dentists, 12, 27–32. https://doi.org/10.1 2974/2311-8695.2024.12.03
17. Genç, G. (2013). Provision of home health and care services for elderly in need of protection. Yalova Journal of Social Sciences, 5, 76–92.
18. General Directorate of Family and Social Services of the Republic of Turkiye. (2022, March 1). Statistical Bulletin on Persons with Disabilities and the Elderly. https://www.aile.gov.tr/media/46090 /bulten_en_200508.pdf
19. Hansen, C., Curl, C., & Geddis-Regan, A. (2021). Barriers to the provision of oral health care for people with disabilities. BDJ In Practice, 34(3), 30–34. https://doi.org/10.1038/s41404-021-0675-x
20. Hisar F. E. Y. (2014). Current situation of home care services in Turkiye. Journal of Health Management and Education, 2(3), 156–162.
21. Howes C. (2015, May 1). Home care: the fastest growing low-wage industry. https://nlf.sagepub.com/content/24/2/98.full.pdf
22. Kretsch, M., & Gresser, U. (2015). Visiting patients at home: reasons and efficiency of dental house calls. Advances in Aging Research, 4(6), 205–211. https://doi.org/10.4236/aar.2015.46022
23. Leung, K. C. M., & Chu, C. H. (2022). Dental care for older adults. International Journal of Environmental Research and Public Health, 20(1), 214. https://doi.org/10.3390/ijerph20010214
24. Maç, Ç. E. (2018). Assessment of home health care services at Erfelek district state hospital. Journal of Clinical Medicine and Family Practice, 10(5), 1–6.
25. Rebuclic of Ministry of Health – General directorate of public services. (2020, January 23). 2020 table of personnel, vehicle, and team standards & team inventory for home health care services. https://khgmsaglikhizmetleridb.saglik.gov.tr/TR,53566/evde-saglik-hizmetleri-personel-arac-ve-ekip-standartlari-cetveliekip-envanter-cizelgesi-2020-yili-ocak-ayi.html
26. Official Gazette of the Republic of Turkiye. (2023, June 21). Official Gazette Regulation No. 32209, June 2, 2023. https://www.r esmigazete.gov.tr/eskiler/2023/06/20230602-1.htm
27. Permatasari, L. I., Ramadan, A., Amelia, D., Hoirunnisa, H., Meilizha, N., Nurliana, N., Juliyanti, S., & Kunaena, U. (2024). Home care post femur fracture surgery on MR. a In The watubelah area, cirebon regency, in 2024. Jurnal Abdisci, 2(1), 17–25. https://doi.org/10.6 2885/ABDISCI.V2I1.526
28. Public Hospitals of the Ministry of Health. (2017, December 30). 2017 Statistical Report of Public Hospitals. https://dosyamerkez.saglik. gov.tr/Eklenti/21853/0/kamu-hastaneleri-istatistik-raporu--2017pdf.pdf.
29. Republic of Turkiye Ministry of Health. (2020, December 30). Health Statistics Yearbook 2020. https://www.saglik.gov.tr/TR-89801/s aglik-istatistikleri-yilligi-2020-yayinlanmistir.html.
30. Sağlam, Ö. (2024). Gerontology and psychosocial intervention: case report. Aydın Journal of Health, 10(1), 87–101. https://doi.org/10. 17932/IAU.ASD.2015.007/asd_v010i1005
31. Shahidi, A., Casado, Y., & Friedman, P. K. (2008). Taking dentistry to the geriatric patient: a home visit model. Journal of the Massachuset Dental Society, 57(3), 46–48.
32. Sirait C., & Houghty G. (2024). Kualitas program layanan homecare terhadap tingkat kepuasan pasien : literature review. Protein: Jurnal Ilmu Keperawatan Dan Kebidanan, 2(4), 01–14. https://doi.org/10.61132/protein.v2i4.621
33. Statistical Bulletin on Persons with Disabilities and the Elderly. (2022, December 30). General Directorate of Family and Social Services of the Republic of Turkiye. https://www.aile.tr/eyhgm-en/yayin-kaynak/
34. Suzuki, Y., Dohmae, S., Ohyama, K., Nishino, H., Fujii, H., & Shuri, J. (2018). Demand for home medical care will continue to increase in the next decades: An analysis from the Yokohama original medical database (YoMDB). Geriatrics & Gerontology International, 18(11), 1578–1579. https://doi.org/10.1111/ggi.13533
35. The New Zealand Medical Workforce in 2022. (2022, December 30). https://www.mcnz.org.nz/assets/Archive/WorkforceSurvey/Workforce-Survey-Report-2022.pdf
36. Turkish Statistical Institute (TURKSTAT) – Central Distribution System. (2017, December 30). TÜİK. https://biruni.tuik.gov.tr/medas/?kn =149&locale=tr.
37. Uhlen-Strand, M.M., Hovden, E.A.S., & Schwendicke, F. (2023). Dental care for older adults in home health care services - practices, perceived knowledge and challenges among Norwegian dentists and dental hygienists. BMC Oral Health, 1, 222.
38. Yang J. (2024, December 30). Physicians employment in Norway. https://www.statista.com/statistics/462084/physicians-employm ent-in-norway/