Healthcare Minute: Lacking Dental Care in Skilled Nursing Facilities

a nurse and an old woman in a wheelchair.

According to a New York Times article published in August 2013, nursing homes were shown to have a lack of appropriate dental care for their residents, even when including those with dental insurance. Besides already being a challenging environment to provide care, medical professionals in these facilities are simply overwhelmed. “Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.” (NYT.com) Residents may also be resistant to receiving care because they may lack the cognitive ability to understand why dental care is so important.

In addition to residents not getting their teeth brushed or mouths cleaned enough, there are other considerations that contribute to their overall health showing us why it is so important. “Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth. Without daily oral care, older people taking such drugs are especially prone to “a relatively rapid deterioration,” said Dr. Ira Lamster, a dentist and a professor of health policy at the Mailman School of Public Health at Columbia.” (NYT.com) However, it’s not just rotting teeth or teeth falling out that we should be concerned about. Pneumonia, one of the most common and deadly illnesses among the elderly, has been found to be linked to poor dental hygiene due to the bacteria building up in the mouth. The Mayo Clinic also identified other diseases linked to poor dental health including:

  • Cardiovascular disease: In a nutshell, this means heart disease. The bacteria from inflammation of the gums and periodontal disease can enter your bloodstream and travel to the arteries in the heart and cause atherosclerosis (hardening of the arteries). Atherosclerosis causes plaque to develop on the inner walls of arteries which thicken and this decreases or may block blood flow through the body. This can cause an increased risk of heart attack or stroke. The inner lining of the heart can also become infected and inflamed — a condition known as endocarditis.
  • Dementia: The bacteria from gingivitis may enter the brain through either nerve channels in the head or through the bloodstream, that might even lead to the development of Alzheimer’s disease.
  • Respiratory infections: The Journal of Periodontology warns that gum disease could cause you to get infections in your lungs, including pneumonia. While the connection might not be completely obvious at first, think of what might happen from breathing in bacteria from infected teeth and gums over a long period of time.
  • Diabetic complications: Inflammation of the gum tissue and periodontal disease can make it harder to control your blood sugar and make your diabetes symptoms worse. Diabetes sufferers are also more susceptible to periodontal disease, making proper dental care even more important for those with this disease.

(Excerpt from Colgate.com)

 “A study by Frenkel and colleagues found that 72% to 94% of LTC residents have difficulty providing their own oral hygiene care or cleaning their own dentures, yet residents often receive little or no help with these practices. In one study, only 5% of residents in LTC facilities who requested assistance with oral hygiene ever received help.” (annalsoflongtermcare.com) According to this same source, caregivers observed have challenges with time but also lack training and education to be able to provide the services needed. Investigators completing an observational study on the subject stated that “adherence to standards was low; teeth were brushed and rinsed with water in only 16% of resident observations, and when help was given, the staff brushed the teeth on average for 16.2 seconds, instead of the 2 minutes that is commonly recommended by dentists. Furthermore, the investigators cited a disturbing lack of appropriate infection control, with none of the CNAs wearing clean gloves to provide oral care and some not even changing gloves after cleaning the perineal area or changing soiled garments.” (annalsoflongtermcare.com)

While staff not having time to complete dental care is a reality and while you cannot make time, you can re-educate staff and re-prioritize to affect change. Some changes that can be made include:

  • Providing information to all staff and residents/families regarding the importance of dental health and how to complete basic dental care.
  • Creating a curriculum in conjunction with a dental professional for front line staff who primarily handle the dental care of residents.
  • After staff “graduate” from the educational program created, bring in a Registered Dental Hygienist (RDH) to show staff the proper way to use the basic dental tools on residents for optimal dental care.

With these changes in mind, the long-term care industry can begin to recover from a problem that has been in place for many years. Improving the care of residents in a way that directly effects their health will allow them to have a better quality of life. For more in depth information on the studies and information presented, please see the resources listed below.

Resources:

http://well.blogs.nytimes.com/2013/08/04/in-nursing-homes-an-epidemic-of-poor-dental-hygiene/?_r=0

http://www.colgate.com/en/us/oc/oral-health/conditions/gum-disease/article/sw-281474979066921

http://www.annalsoflongtermcare.com/article/meeting-oral-health-challenges-long-term-care-facilities#sthash.Et9qAy4Y.dpuf

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