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.

As 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.