An evaluation of 328 studies reported between 1996 and 2007 that appeared in the September 2010 edition of The Journal of the American Dental Association addressed the question, “Does better oral hygiene prevent health care–associated pneumonia or lower the rate of respiratory infections among elderly people in nursing homes and hospitals?” The 2010 study concluded, “There is good evidence that mechanical oral hygiene practices reduce the progression or occurrence of respiratory diseases in high-risk elderly people in nursing homes or hospitals. Mechanical oral hygiene practices may prevent the death of about one in 10 elderly residents of nursing homes from health care–associated pneumonia.”
Inasmuch as 2.8% of nursing home residents were diagnosed as having pneumonia in 1999 (source), and the 30-day mortality rates for nursing home residents with pneumonia ranged between 10% and 30% (source), the provision of good dental hygiene for nursing home residents is critical to their overall health and well-being.
The lack of daily oral care in nursing homes is rampant. The results of a study reported in the January 2006 edition of the Journal of the American Geriatric Society described the actual daily oral care provided by certified nursing assistants (CNAs) for elderly nursing home residents who required assistance with oral care in five non-randomly selected nursing homes in upstate New York. The study found that the CNAs brushed the teeth and rinsed the mouths with water in 16% of resident observations. Furthermore, the CNAs did not brush residents’ teeth for at least 2 minutes, did not floss, did not do an oral assessment, did not rinse residents’ mouths with mouthwash, and did not wear gloves while providing oral care. It was also observed that 63% of the nursing home residents were resistive to the CNAs’ oral care assistance. Source
In the summer of 2012, the Kansas Bureau of Oral Health and Oral Health Kansas conducted an oral health survey of 540 Kansas elders living in 20 nursing facilities. The questionnaire asked the resident (or their guardian if necessary) about their daily oral care, access to dental treatment, and insurance status. The key findings of the survey were: one-third of nursing facility residents have lost all of their natural teeth (compared to 17.4% of seniors living independently in the community who have lost all of their natural teeth); over one-third of nursing facility residents had untreated dental decay (a large number had past access and investment in professional dental care as indicated by past dental work (crowns, bridges, partial dentures) in the residents’ mouths); and, nursing facility residents had poor oral hygiene as indicated by 26% of surveyed residents having severe gingival inflammation (the gums were swollen, bleeding, and/or painful), 29% having substantial oral debris on at least two-thirds of their teeth, and 15% having natural teeth that were loose, suggesting that many nursing facility residents are not removing the plaque and bacteria from their teeth on a regular basis. Source
One possible reason for poor dental care in nursing homes is that Medicare does not cover preventive and restorative professional dental services or dentures although many state Medicaid programs provide very limited dental benefits. Another plausible explanation for the lack of proper oral care for residents in nursing homes is that nursing home care-givers are over-burdened by addressing other important needs of residents such as cleaning and bathing, dressing, turning and repositioning, feeding, and other assistive requirements so that time to provide proper dental hygiene is lacking because nursing homes are understaffed or caregivers are over-worked.
Whatever the reasons or causes of poor dental hygiene in nursing homes in the U.S., it is clear that the issue must be properly, timely, and effectively addressed so that nursing home residents do not continue to suffer unnecessary harms due to poor dental hygiene and the lack of dental care in nursing homes.
If you or a loved one suffered injuries or other significant harms due to nursing home neglect, nursing home abuse, or nursing home negligence, you should promptly seek the legal advice of a local nursing home claim attorney in your U.S. state who can investigate the cause of the harms you suffered and represent you or your loved one in a nursing home claim, if appropriate.
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