After discovering her mother had lost two front teeth, a Wellington woman says she was shocked to learn rest homes aren't required to provide oral care for their residents.
Caroline said she visited her elderly mother last week and found she had two missing front teeth which had gone unnoticed by staff.
She said her mother, who is in her late eighties, has dementia and can't remember how she lost her teeth or when.
"Well I was just talking to her and I'd noticed a gap in her mouth and I thought 'Well, that's a bit odd'. And I knew she'd had a broken tooth before some years ago and I thought maybe it's just broken off again. So I asked her to open her mouth and there was just a gap there," Caroline said.
"So I toddled off to the nurses station and I said, 'Oh, what's this about mum's got some broken teeth? What's the story?' And they kind of looked at me blankly and they obviously didn't know anything."
Caroline visits her elderly mother at her rest home every week and whilst she says staff take good care of her, they were unaware of her missing teeth.
She said she asked rest home staff to follow it up but eight days later, she still hadn't received a response.
"I emailed the nursing manager who rang me and they've checked and they didn't know that she'd lost the teeth. They weren't aware of it at all. So I've made an appointment just for her to see my dentist," said Caroline.
Caroline said so far her mother has been happy with the care she's received in the rest home she's been living at for almost a year. But she's surprised that no one had noticed her mother had lost her front teeth during the week.
"It was the little stumps where the teeth would've been just sitting there. I thought it might have just been the one that she had previously had broken but I lifted up her gums and there were two teeth gone. And I thought "Oh my god." I mean, obviously you know, she's got dementia. So she's not going to be aware of those things because of the lack of awareness she has," said Caroline.
"So I can only assume that the teeth have come away, I don't know when, and she swallowed them."
The experience has been eye-opening for Caroline who had no idea that nurses weren't required to check on the oral hygiene of their elderly residents.
"It wasn't even something that I'd even thought about. It seems to be quite a grey area because there's obviously no dentists in the rest home. Most rest homes only have qualified nurses and of course nurses aren't qualified on dental matters," she said.
"It's more frustrating that that wasn't clarified in the beginning. I guess that could be clearer."
Dental care is specifically excluded from the Ministry of Health's Age Related Residential Care contract between district health boards and rest homes and hospitals.
According to the contract, care facilities aren't required to have oral care policies or provide oral care plans for their residents.
Professor Murray Thompson, who is an experienced dental researcher and specialist in dental public health, said Caroline's story comes as no surprise.
"Throughout adulthood, the average person experiences one new surface of tooth decay every year. Once you enter the nursing home sector, that doubles. And if the person has dementia as well - that doubles again," he said.
"So you've got a group of people who are in this sector who have a very high decay rate for a number of reasons."
According to Dr Thompson those reasons include residents taking medications that can dry the mouth, rest home diets tending to be high in sugar and the act of chewing and cleaning teeth regularly becoming harder for the elderly as they age which leaves more bacteria on their teeth during the day.
It's an issue he said needs urgent addressing with New Zealand's ageing population.
Currently just over 15 percent of New Zealanders are aged 65 and over and that's expected to rise to around 23 percent within two decades.
Dr Thompson is part of a team of researchers who are working to improve policies for better dental care for the elderly.
"Oral health care has never been at the top of people's priorities in the health care system and in geriatrics it is what we call a 'Cinderella service'. It's an area where if people are getting dental care, it's tended to be up to their families or themselves to get themselves to it so it's a tremendously complex problem."
Caroline doesn't drive so she has had to arrange transport to help take her mother to see the nearest dentist outside the rest home. The trip will mean she'll be taking half a day off work.
She is now urging others to regularly check on the oral hygiene of their elderly relatives who are living in aged care facilities.
"I would hate to see someone else's loved ones end up with a mouthful of rotten teeth because they weren't looked after," she said.
"You know I'm fortunate there doesn't seem to be any sign of infection but you know, if you've got a loved one in a rest home at the other end of the country - how would you know?"