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Oral Health In The Elderly Nursing Home Population: A Widely Ignored Threat To Patient Health

dentalMost 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). 

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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.

Resources:

Dentistry.com: Oral Care in Nursing homes

A Place for Mom: Healthy Mouth, Healthy Body: Senior Dental Problems

Family Gentle Dental Care: Nursing Home Oral Health Care

Medical News Today: Case finds oral health of residents in nursing homes needs more attention, USA

TheFreeLibrary.com: Nursing-Home Patients Need Better Dental Hygiene

Academy of General Dentistry: Nursing Home Oral Health Care

Department of Health and Human Services: Oral Health U.S. Report, 2002

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  • Dental care is important for each and every human. In USA the dental check is regular for all ages as your article chart is showing and it is true that we are finding people of all ages from newly grow teeth to oledset teeth. When you are in trouble you will find the importance of it. So don’t waste your time.

  • Omer Zimmerman

    I had the problem of hard brushing. The dentist tells me that my
    gums have receeded slightly in my back teeth… it’s not a problem,
    but could be abig problem if I continued brushing hard.
    What I to do to solve this problem?

  • NJ

    It is both the Evil Governor and his henchmen who are directly responsible!! Like most insurance it’s hardly worth the paper it’s written on. And if you dare complain about the treatment (or non treatment) you will Never receive treatment. Just ask my wife who’s in a nursing facility. Frankly I hope they all have to live with teeth busted off at the gum line just like she is FORCED to do!!!!!! OPnYDe

  • This is truly too bad. Most people don’t understand just how important oral health is to the rest of the body.

  • Linda Bennett

    My mother is in a nursing home and I have spoken to the staff repeatedly about brushing her teeth. I know they have so much to do for patients but oral hygiene is so important. I find it ironic that people probably think more about cleaning their cat’s teeth than humans who cannot do it for themselves !

  • Harrell Graham

    There is no evidence that fluoride prevents dental disease and much evidence that fluoride is toxic to numerous body systems and most chewing gum contains aspartame, an ‘excitotoxin’ per Dr. Russell Blaylocik, MD (neurosurgeon, retired).
    Instead of feeding patients toxic fluoride and aspartame better to concentrate on seeing that patients are hydrated: give every patients four water bottles in A.M. and encourage them to sip from them throughout the day. This way everyone can see if they are really drinking 8 glasses per day.
    Hydrating patients will prevent much kidney disease and even septic shock and DIC.

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