Most people never associate dental care with with nursing homes. To be honest, I never really did either until I was contacted by a family regarding a nursing home patient who developed a horrible infection in their mouth that went untreated for months. By the time the infection was diagnosed, it had progressed to the point that the man’s jaws had become infected. Within weeks of the diagnosis, the man died from the infection.
While the above situation is certainly a case of extreme neglect, dental care of nursing home patients is an issue that deserves more attention than it currently receives.
Poor oral health and untreated dental conditions are a serious problem for nursing homes, especially because older Americans are more prone to tooth decay. Roughly 23% of adults between the ages of 65 and 74 have severe periodontal disease. Despite the high percentage of dental problems, adults aged 75 or older represent the adult age group with the lowest percentage visiting a dentist within the past year (U.S. Department of Health and Human Services – Oral Health Report 2002, Table 7.1.1).
Figure 7.1.1. Percentage of the U.S. population that visited a dentist within the past year by age group
While bad teeth might seem like a relatively minor problem when compared to the many medical issues affecting nursing home residents (including disease, illness, neglect, mental illness, and isolation), untreated dental conditions can cause residents severe pain, malnutrition, social isolation, and severe dental disease.
Furthermore, poor oral health can actually affect overall health (recent studies show a correlation between gum disease and heart disease, and periodontitis shares risk factors with several chronic degenerative diseases such as ulcerative colitis and lupus). And, some diseases have oral symptoms, so proper monitoring of oral health can provide indicators for serious diseases and conditions (while examining patients’ teeth, gums, and tongues, dentists have found evidence of heart or liver disease, eating disorders, diet deficiencies, diabetes, arthritis, osteoporosis, and some autoimmune diseases).
Oftentimes, dental disease is caused by bacteria and fungus. Nursing home staff members need to ensure that residents properly clean their teeth in order to decrease the number of bacteria and fungus. This can be accomplished by having residents brush their own teeth, using fluoride (fluorinated water, fluoride in toothpaste, or fluoride lozenges), and having residents chew gum after meals. However, chewing gum should be used with caution because many residents have difficulty swallowing and gum can create a choking hazard.
Many residents require assistance with dental care and oral hygiene because they are unable to brush their own teeth because of weakness, arthritis, limited range of motion, illness, dementia, or diminished mental capacity. Therefore, staff members must ensure that residents are able to properly and thoroughly clean their own teeth or provide the assistance necessary to achieve and maintain good oral hygiene. Nursing home staff members should assist with brushing, flossing, and checking for canker sores and abscesses.
Dry mouth is one of the most common dental problems for older people because it is a common side effect of many medications. Dry mouth, besides just causing discomfort and irritation, can also increase gum recession, which can lead to root area cavities. Dry mouth can be treated with increased liquid intake, rising the mouth out with water, using a commercially available saliva substitute, avoiding dry and salty foods, and sucking on sugarless hard candies.
Illinois (through the Illinois Department of Public Health (IDPH) Steering Committee on Illinois Oral Health in response to the 2002 U.S. Oral Health Report) has recognized that efforts need to be made to improve statewide oral health education and awareness programs for at-risk populations (including the elderly). Also, training programs for medical professionals who work with these at-risk populations need to be trained to recognize oral health disease. The resources, nursing home dental health programs, and the staff members or professionals who provide dental services must improve before any widespread improvements will be seen in dental health in nursing homes.
Many nursing homes focus on medical care to the detriment of their residents’ oral health. It is important to achieve and maintain good oral health for nursing home residents because it can improve overall health and reduce health complications. If you notice that a family member has decaying teeth, is not eating as much food, or having trouble chewing, they might be suffering from severe dental problems. It is important to ask the nursing home about what dental services are being provided in order to ensure that your family members stay healthy and receive proper care.
Thank you to Heather Keil, J.D. for her assistance with this entry.