An August 4 article in the New York Times brings to light the danger many nursing home patients face as a result of inadequate dental hygiene. It quotes Dr. Sarah J. Dirks, a San Antonio dentist who treats nursing home residents, who says that the lack of daily oral care in nursing facilities is “an epidemic that’s almost universally overlooked..
More nursing home residents require dental care than in the past, because more seniors are keeping their natural teeth due to advances in hygiene and fluoridation programs. But aides and other caregivers often fail to provide nursing home patients with dental assistance because of the many other needs of toileting, dressing, and eating which take precedence.
Poor dental hygiene can lead to a host of other physical problems, some of which can be especially dangerous in the elderly population. One such ailment is pneumonia. A study published in The Journal of the American Geriatrics Society found that about one in 10 cases of death from pneumonia in nursing homes could be prevented by improving oral hygiene. Untreated oral infections also increase the risk of diabetes mellitus, cardiovascular disease and respiratory disease, according to PrevMED Dental Case Management. Dental problems can cause weight loss and increased frailty, as well.
Brushing the teeth of residents who cannot do it themselves is such an important task that it was federally mandated in the Omnibus Budget Reconciliation Act of 1987, which set new standards for nursing homes. OBRA ’87 makes each nursing home directly responsible for providing both routine and emergency dental services.
Under federal law, facilities must help the resident make dental appointments and arrange transportation to and from dentists’ offices. They must promptly refer residents who have lost or damaged dentures to a dentist. Medicaid residents must be assisted to secure routine dental care to the extent covered by the state plan. Medicare residents may be charged extra for dental services, and the regulation clarifies that the facility is under no obligation to pay for routine dental services.
Dental care for nursing home residents in South Carolina is also covered by Regulation Number 61-17 of the Standards for Licensing Nursing Homes, promulgated by the Board of Health and Environmental Control. Section 1006 provides as follows:
(A) When a person is admitted to a nursing home, an oral assessment by a physician, dentist or registered nurse shall be conducted within two weeks to determine the consistency of diet which the resident can best manage and the condition of gums and teeth. A written report of this assessment shall be placed in the medical record.
(B) Each nursing home shall maintain names of dentists who can render emergency and other dental treatments. Residents shall be encouraged to utilize dental services of choice.
(C) Residents shall be assisted as necessary with daily dental care.
“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University, in the New York Times story. If you notice that a family member has decaying teeth, is not eating as much food, or is having trouble chewing, they might be suffering from severe dental problems. Ask the nursing home about what dental services are being provided.
Look for broken, loose or decayed teeth. Observe whether gums are inflamed or bleeding and whether food debris is found in the mouth. Listen for complaints of mouth pain or chewing problems. All of these could be signs of nursing home neglect and abuse.