Nursing homes and oral healthcare
SUMMARY: The oral healthcare of patients in nursing homes across the nation is sub-par, and there isn't a lot being done about it.
Posted: August 5, 2013
As we age, our overall health begins to dwindle, and it's hard to overcome some of the challenges that are thrown our way. While there are plenty of health issues that need to be addressed in old age, sometimes we forget about the condition of our oral health. A recent post in The New York Times found that residents in nursing homes are not always cared for properly when it comes to their teeth and gums. In fact, Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University, told the publication that she can determine the quality of a nursing home by looking at people's mouths.
In 2006, a study conducted in five New York facilities found that a mere 16 percent of residents received proper oral health care. Among the patients that did receive some oral health care, the average time spent brushing teeth was 16 seconds, while the recommended time spent brushing teeth is about two to three minutes. After the Ominbus Budget Reconciliation Act of 1987, it was federally mandated that nursing homes keep up with the oral healthcare of their patients.
However, many people who come into nursing homes have poor oral health to begin with because of poor practices at home and not visiting the dentist on a regular basis. But not keeping up with brushing and flossing affects more than just the smile. Research has found an association between gum disease and tooth decay and heart disease and diabetes. Because of the accumulation of anaerobic bacteria in the mouth, researchers believe that it can enter the blood stream and attack other areas of the body.
Research conducted at the University of Bergen in Norway in 2009 looked at the long-term effects of an oral healthcare program on elderly patients in a nursing home. When the study began, 26 percent of the residents at the nursing home had an acceptable score for their oral health. By the end of the six year study period, 70 percent of the patients had an adequate score.
While some patients in nursing homes don't want to have healthcare professionals brush their teeth, it's important to start a conversation regarding the necessity of a clean mouth. Since more people are retaining their natural teeth, rather than having dentures, it's even more difficult to encourage healthy practices.
"They should be getting their care, but a lot of people don't," Dr. David Gifford, the senior vice president of quality at the American Health Care Association, told the publication. "It's a very personal thing to have someone else brush your teeth. A lot of residents don't want it, don't like it and will ask not to have it."
What can be done
Since many residents of nursing homes are on prescription medication, dry mouth can be a concern. Dry mouth is a common cause of medications, and it can trap anaerobic bacteria in the mouth. This is what causes gum disease, tooth decay and bad breath. Nurses should first encourage residents to consume an appropriate amount of fluids to decrease the effects of dry mouth.
Healthcare professionals can begin with educating the elderly patients in nursing homes about the lasting effects of poor habits. While they cannot force patients to brush or floss, they can promote visits to the dentist and daily practices. Nursing homes can provide resources such as all-natural toothpaste, toothbrushes with larger handles that will make it easier for some to hold, and magnified mirrors that make it possible for patients to see what they are doing.