Tackling the Dental Hygiene Crisis Among America’s Elderly

September 2, 2013

Dental Healthcare

Dental hygiene

Dental hygiene

America’s elderly are facing a growing health crisis in the form of an appalling lack of oral health care. There’s no national standard for assessing the quality of dental care and oral hygiene in nursing facilities, but numerous states have conducted independent evaluations of the quality of dental care their nursing home residents receive.

Results show that a substantial majority of these residents aren’t receiving adequate care. Many have untreated oral health problems. The reasons for the lack of oral health care among nursing home residents are many. Nursing staff may not have time to give adequate care to residents who can’t manage it themselves. Other residents resist having someone else brush and floss their teeth.

Access to oral health care is another significant obstacle. Medicare doesn’t cover dental costs and Medicaid covers only some dental costs, because until recently, dental care wasn’t considered medically necessary.

For this same reason, nursing home staff members often don’t understand that poor oral hygiene can compromise an elderly resident’s health and even prove deadly. Education, as well as improvements in oral care access and access to oral hygiene tools, is necessary to combat this epidemic of oral disease among America’s elderly.

The Oral Health Crisis As It Stands

In the past two years, seven states have evaluated the quality of the oral health care their elderly nursing home residents receive, using standards established by the Association of State and Territorial Dental Directors. The results revealed a shocking lack of oral health care among elderly residents of nursing homes.

In Wisconsin, evaluators found that 35 percent of those surveyed displayed “substantial oral debris,” the dental plaque and residue normally removed by brushing. Thirty-one percent had teeth broken off to the gums.

In Kansas, more than one-third of those surveyed suffered from untreated tooth decay, while 30 percent showed evidence of oral debris from not brushing. In New York, evaluators found that only 16 percent of nursing home residents get any oral health care at all, and that even those who do get their teeth brushed have them brushed for an average of 16 seconds. The American Dental Association recommends brushing for two minutes.

Causes of the Oral Health Crisis

A 2005 report by the TRECS Institute found that many elderly people stop receiving needed dental care after they retire because they lose dental insurance when they go on Medicare. As a result, many people enter nursing homes already in need of dental health services. According to this report, as many as 80 to 96 percent of people in nursing homes have unmet dental health needs.

Members of previous generations had typically lost all of their teeth before they reached an age at which they required nursing care, but more of today’s elderly enter nursing care with some or all of their natural teeth. Nursing staff are unprepared to deal with the consequently increased demand for oral care. Today’s nursing students or future students who enroll in online nursing masters programs (check this site) should expect to be faced with the dental dilemma of the elderly.

The TRECS Institute report also cited ageism as a cause for lack of adequate oral care in nursing homes. Nursing staff, and even residents and their families, may not understand why the elderly need the same level of oral care that younger people do. They may even feel that tooth decay and oral diseases should be expected in the elderly.

Even when nursing staff are prepared to offer oral care to patients who can’t manage it themselves, those patients may not want it. It can be impossible to administer oral care to patients who refuse or resist it.

Fighting the Oral Disease Epidemic in America’s Nursing Homes

What can be done to treat oral disease in nursing home residents and provide these people with the oral care they need? We can start by educating nursing home staff, residents and their families on the need for oral care even for the elderly.

Decayed and broken teeth are excruciatingly painful, but they’re also a serious health risk. Tooth decay has been linked to heart disease and diabetes. It’s also linked to pneumonia in the elderly — one in 10 pneumonia deaths among nursing home residents could be prevented by proper oral hygiene. Even residents without teeth need care to reduce the chances of oral lesions and remove dangerous bacteria from the mouth.

When nurses, residents and families understand the need for oral hygiene, it will be more likely to be attended to. Nursing home administrators also need to be proactive in partnering with dentists and dental hygienists to get patients the care they need. Nurses should be trained in how to administer oral care and how to deal with a recalcitrant resident.

Residents can be equipped with tools that make caring for their own teeth easier. These include long-handled toothbrushes that are easier to grip and magnifying mirrors to use during brushing.

Tackling the Dental Hygiene Crisis Among America’s Elderly


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Dental Hygiene

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