In another piece of bad news for a healthcare sector that is already subject to a crisis of public confidence, it has been revealed that thousands of residents in Scotland's care homes are not receiving the dental care they need.
One survey of residents in Glasgow revealed that more than half needed dental treatment and six per cent of them needed it urgently. The proportion of residents registered with a dentist may be as low as 20 per cent.
To be fair to the care home sector, it could be that the problem has crept up on them slowly. There was a time when most pensioners would have had dentures - now we are not only living longer, but more of us are keeping our teeth into old age. That is obviously a good thing, but it does mean residents' teeth will need more care and attention than they once did and it appears care homes are not geared up to deal with that. There is a good chance residents will go into a care home with good teeth but will not keep them for very long.
A number of factors inherent to care homes may be contributing to the problem: the preponderance of sweet food, for example, daily medicines that are high in sugar, and conditions such as arthritis that make it difficult for residents to brush their own teeth. There may also be a tendency to accept deteriorating teeth as just another part of getting old.
A change in care home procedures and more training for staff in caring for their residents' teeth could go a long way to improving all of this. However, there is no point in investing in the training of staff only for them to move on to better paid jobs elsewhere. Training will help, but in the long term, poor pay and conditions of care home staff will have to be tackled too.
There are some other changes that could be made quickly and relatively cost-effectively: imposing a statutory duty on care homes to register their residents with dentists, for example - a duty that could then be monitored by the Care Inspectorate, which has proved itself an effective body. Dentists also need to be encouraged to take on work in care homes and keep in touch with their patients when they move to care homes. These, and other reforms, should be considered as a matter of urgency by Michael Matheson, the minister for public health, when he meets with Dr Robert Donald, chairman of the Scottish Dental Practice Committee, this week.
There will be costs attached to these changes even though basic dental healthcare is free on the NHS, which highlights a more fundamental problem in care homes: underfunding. Local authorities are struggling to meet the cost of care, which may explain the crisis in dental care and the host of other problems uncovered in care homes in recent months.
The vast majority of care homes in Scotland perform well, but more funding is needed to turn around the worst and make all of them better on such fundamentals as dental care. Problems with teeth should not be an inevitable part of getting older, but ensuring good dental health is just one of the problems in a sector that is going to become bigger and more expensive.
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