Making home-visit dental care work early

Myoung Hoon The author is the head of clinical services and public care center, Seoul National University Dental Hospital. An older adult colleague in the Korean Academy of Geriatric Dentistry often visits his mother in a long-term care facility, sharing meals and conversation. Drawing on his dental training, he carefully cleans her mouth using a toothbrush, toothpaste, several types of interdental brushes, floss and a tongue cleaner. For families caring for parents with limited mobility, this is a scene that is both admirable and difficult to replicate. Since March 27, home-visit medical care has been formally enabled under the Integrated Care Support Act. Previously, while the Medical Service Act did not explicitly prohibit house calls, they were largely treated as one-time visits similar to emergency calls. The new framework provides a clearer legal basis for ongoing care delivered outside hospitals, including in private homes and long-term care facilities, marking a shift toward more continuous and accessible services. As people age, many experience conditions that make daily life difficult without assistance. Some receive care at home while attending short-term care centers, while others reside in nursing facilities. Diseases such as cerebrovascular disorders or Parkinson's disease can impair hand movement, and cognitive decline, including dementia, can make basic oral hygiene tasks such as toothbrushing difficult. In these situations, family members or caregivers often step in, but without professional training, there are clear limitations. Regular visits by dental professionals are therefore essential not only for hygiene management but also for timely treatment. Oral health also has a direct connection to quality of life in later years. Few individuals wish to live in complete dependence on others. The ability to walk, eat and use the bathroom independently is closely tied to maintaining dignity. As life expectancy increases, reducing the duration of frailty and dependency has become a shared objective. Within this process, oral health occupies a central position. When appetite declines and oral function deteriorates, adequate nutrition becomes difficult. This leads to a decrease in muscle mass, which in turn reduces physical activity and further suppresses appetite. If falls or fractures occur, the cycle can accelerate, resulting in rapid physical decline. Many studies identify impaired oral function as a key gateway in this progression. For this reason, professional intervention is necessary to sustain a longer period of independent and non-frail living. Comprehensive oral care involves strengthening the muscles of the lips and tongue, improving swallowing function to reduce choking and managing dryness in the mouth. These measures play a decisive role in maintaining overall health among older adults. However, for home-visit dental care to become established, institutional preparation is essential. It is also necessary to acknowledge that such care cannot achieve the same level of completeness as treatment delivered in fully equipped clinical settings. In practice, dentists cannot transport all necessary equipment, and diagnostic tools such as radiographic imaging are often unavailable. In addition, sufficient support staff may not be present. Under these constraints, the goal inevitably shifts from achieving perfection to providing the best possible care within limitations. Understanding these realities is crucial for both providers and patients. From the perspective of patients and caregivers, it is important to approach home-visit dental care with realistic expectations. Rather than seeking complete treatment, the priority may be to relieve symptoms and improve daily comfort. Because care is delivered outside conventional medical institutions, there is also potential exposure to legal risks. To encourage greater participation by dentists, appropriate compensation must be accompanied by institutional safeguar...