On Tuesday, the Science section of the New York Times featured an article with the headline “Nursing Homes Neglect Teeth.” The article stopped me in my tracks. The situation is serious because nursing home residents suffer from tooth decay, gum disease, broken teeth and ill-fitting dentures.
I experienced the situation first hand with my mom, even though she was in a very highly regarded nursing home before she passed away. She wore a removable partial denture but when a tooth broke, she needed a new partial denture. The nursing home employed a part-time dentist (not common at most nursing homes) but the care was substandard. She went toothless for months while they presumably were constructing a new denture which never fit properly anyway. Finally I brought in my instruments and treated her myself.
Nursing home residents today require more dental care than in the past because more of the elderly are keeping their teeth. The nursing staff is overworked and oral hygiene falls to the bottom of the to-do list. Dentures are easier to keep clean. New studies show that lack of tooth hygiene may contribute to pneumonia among the elderly. A 2008 review stated that one in 10 nursing home deaths from pneumonia may have been prevented by improved oral hygiene.
In Wisconsin nearly 1,100 nursing home residents were examined. Over 30% had teeth that were broken to the gums and 35% had extensive plaque. A 2006 study of nursing homes in New York State found that only 16% of residents had any oral care at all. Tooth brushing of nursing home residents was federally mandated in the Budget Act of 1987 which established higher standards for nursing homes. Nevertheless, residents’ dental health is of low priority in the majority of nursing homes.
The problem is compounded because many of the elderly arrive at nursing homes with decayed and broken teeth. Nursing homes are not equipped to provide the level of care needed. On top of this, nearly 2/3 of long-term residents have dementia and may resist allowing the nursing staff to brush their teeth. Additionally, prescription drugs such as antidepressants, high blood pressure medications and anti-seizure medications may contribute to reduced saliva, dry mouth and the resulting decay.