Oral Health Facts in Nursing Homes | Delmarva Dental Services

Oral Health Facts in Nursing Homes

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Five percent of all Americans or 1.75 million people are in long term health care facilities or nursing homes. Ninety-one percent of nursing home residents are 65 years of age or older, and 46% are 85 years of age or older.A recent study showed 79.6% of the residents had teeth, and all had calcified plaque (tartar) on their tooth surfaces. One-third of the residents had calculus (tartar) that covered two-thirds or more of the tooth surface. Another study found the greatest single need was for routine oral hygiene (72%), denture adjustment of loose dentures was (46.4%). Periodontal (gum) problems were 43% and root cavities 36% . The conclusion was that a high proportion of elderly nursing home residents suffer from lack of oral hygiene and oral health neglect.High levels of oral bacteria affect the rest of the body. It is associated with coronary artery disease, diabetes, and pneumonia. Serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes. Bacteria present on the teeth, oral soft tissue, and dentures enter the throat and lungs and cause pneumonia. Four million cases of nursing home acquired pneumonia (NHAP) occur a year. It is the most common infection in chronic care facilities. It is the leading cause of hospitalizations and death. One study found patients with poor oral care were three times more likely to contract pneumonia than patients with good oral hygiene and twice as likely to die from the pneumonia. The primary cause for this oral health crisis is that oral hygiene is not considered a priority. Nursing assistants receive very little training in oral hygiene. Assistance in bathing and eating is a higher priority and oral care sometimes is omitted. One study found the following that only 16% of residents received oral care. When patients brushed their own teeth they were stopped by the nursing assistant before 2 minutes. A toothbrush was available only 27% of the time. No patient received a mouthwash and it was present only 18% of the time. And when the patient was supervised cleaning their own teeth none received oral care encouragement, praise, or even a smile during oral care. Many nursing home residents are resistant to the attempts of nursing assistants to provide oral care. One study found 63% of patients were resistant to oral hygiene attempts. Another study where 90% of patients were diagnosed with dementia; all needed significant help with dressing and bathing, and 94% required assistance with personal hygiene, including mouth care. Only 28% received any type of mouth care; of that number, the average time for received mouth care was 1 minute and 12 seconds. In a study of 187 nursing home residents, researchers noted associations between persons with highly compromised dentition (no teeth, teeth with 1 full-denture plate, or 6 or fewer teeth) and weight loss. In another study that examined relationships between oral health status and weight in persons newly admitted to a nursing home, researchers found an association between low body mass and poor oral health. Nearly one-third of all older adults experience xerostomia, or dry mouth. The average NH resident takes eight medications daily. Anticholinergics, antihypertensives, antidepressants, diuretics, anxiolytics, and antihistamines all diminish salivary production and alter the ability of the oral environment to fight the effects of harmful microbes. Professional dental care is limited for nursing home residents. Seventy percent of persons age 65 years and older lacked any dental insurance, as compared to 34% of persons age 45-64. When dental coverage for older adults was examined according to age strata, 64.6% of older adults age 65-74 lacked dental insurance and 75.7% of adults age 75 and older lacked dental insurance. Medicare does not cover routine dental care; Medicaid coverage varies between states but either does not cover dental care or compensates dentists so poorly that no one will accept it.