Oral health in Long Term Care Facilities: Why it matters

April 13, 2017

When I decided to make dentistry my career many years ago, I looked forward to having my own business that could utilize skills I would learn and develop over time.

What I didn’t appreciate then was that I was embarking on a long-term journey with my patients’ lives. I would get to know individuals and families over decades, watching them grow from youth to middle age, and from middle to old age. It was a privilege to be a part of their team of health care providers, and to get to know them through their transitions.

senior-oral-careAs my patients aged, some of them began to lose the ability to adequately take care of their oral hygiene needs.

For some, their lack of manual dexterity inhibited effective tooth brushing and flossing. They were sometimes on multiple medications that gave them dry mouths and this lack of saliva, besides being uncomfortable, caused a rapid increase in cavities.

The change in the bacterial population in their mouths due to these changes made them susceptible to infections, loose teeth, tooth loss, and a host of other problems. In general, with some extra measures, these expected changes with aging can be limited and controlled.

But what I was not prepared for was the dramatic downturn in their oral health that too often occurred when my patients entered long term care facilities (LTCF). Patients would come to my office for their appointments, accompanied by their adult children or other caregivers, and I would be disheartened to see many loose teeth, multiple deep cavities, fungal infections, and dental appliances that clearly had not been cleaned or even removed for weeks. Why was this happening?

The answer, I have found, is that the oral care of older adults and other residents in LTCF is often inadequate.

The reasons are many:

  • Many older adults lose or have a reduced ability to self-care.
  • There is no real standard of care for oral care in LTCF.
  • Each resident requires a personalized program for their individual oral care. Most LTCF, however, do not have certified nursing assistants (CNAs) adequately trained to provide this care.
  • Family members are not educated in the oral care needs of their relatives. Because of this lack of education or awareness, they can’t recognize problems or effectively monitor the care that is given.

In truth, oral care has long been an underappreciated component of older adults’ general health.

The challenges of decreasing mental and physical abilities, along with a lack of understanding and education, create a situation for neglect.

The results can include:

  • An increase in the likelihood of aspiration pneumonia.
  • An increase in the incidence of diabetes.
  • Mouth pain.
  • Weight loss due to an inability to properly chew food, and the accompanying digestive problems.
  • A decrease in socializing due to appearance, mouth odors, etc.

As has been abundantly reported, the population of older adults is continuing to increase as a percentage of our nation’s population. In addition, we are living longer. This is good news, especially if our attitudes on maintaining our capabilities evolve with these realities.

Thankfully, there is an emerging recognition of this in the dental profession. The American Dental Association, dental schools, nursing schools, governmental agencies, and others are developing standards of care and are conducting oral care programs in LTCF. These efforts are just getting off the ground, and public awareness is an important component of success.

Since my retirement last year, I have been a member of the District of Columbia Dental Society Foundation. We are developing training programs for the LTCF in DC. Our goal is to educate these facilities in the best practice standards of oral care for their residents and work with them to develop programs that will work for them. We also want to provide families and caregivers the information and tools to partner with their LTCF in caring for their loved ones.

Visit Iona’s blog again for a future post on oral care advice for family members and caregivers.

By Sal Selvaggio, DDS

Sal Selvaggio received his Doctor of Dental Surgery (DDS) degree from Georgetown University and completed a General Practice Residency at Providence Hospital in DC. He had a private practice in general dentistry for 36 years. He has been a volunteer dentist at Catholic Charities’ Spanish Catholic Center for 32 years and currently chairs a committee for the District of Columbia Dental Society Foundation exploring ways to improve the oral health of our aging population.

2 thoughts on “Oral health in Long Term Care Facilities: Why it matters”

  1. I spent about a week at Sibley Hospital and about 3 weeks at Sibley Rehabilitation in December 2015. I found that in the hospital when I was confined to bed it was difficult to get someone to bring me what was needed ( mostly a tray to spit in – it had to be brought and removed) so that I could brush my teeth even 1 time a day. The staff was so busy. There was no dental floss and finally a friend brought me some. I thought my mouth and teeth had declined due to that experience.

    I had to have 2 fillings a few months after that experience. I cannot say whether it was
    due to my hospital stay or my problem of eating too many sweets. I have infrequently needed fillings in the past.

    1. Dear Ms. Buckberg:.
      Thank you for your comments responding to my blog posting. Unfortunately, it is sometimes true that patients can have difficulty receiving the help they require. As you noted, the aids and nurses can get pretty busy, and your request for some dental supplies didn’t get attended to.

      It has been my experience that most of the CNAs (certified nurse assistants) and caregivers in long-term care facilities and other settings are dedicated and try their best to help the residents there. My blog posting really was meant to raise the awareness of patients, their family members, and caregivers of the importance of daily individualized oral care. Luckily you have the ability and understanding that you needed to maintain your oral hygiene while recuperating. There are many residents of long-term care facilities, who don’t have that ability, and that is when their oral health can take a dramatic downturn.The District Of Columbia Dental Society Foundation is working to get the message out, and hopefully, we can have an impact on the quality of care.

      By the way, the cavities you needed to have filled probably had little to do with your month stay. Generally, it takes longer for tooth decay to occur, and also existing fillings have a lifespan and need replacing periodically.

      Sal Selvaggio DDS

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