Nursing homes neglect teeth
Article by: CATHERINE SAINT LOUIS NEW YORK TIMES Updated: August 10, 2013 – 5:46 PM
A widespread disregard of dental hygiene in assisted-living facilities is leading to pnemonia, studies suggest.
Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush. His teeth, she found, had not been recently brushed, so she began doing it herself after their lunches together.
But after he complained of a severe, unrelenting headache, she said, she badgered the staff to make an appointment with his dentist. The dentist found that a tooth had broken in two, and he showed Ford the part that had lodged in the roof of her father’s mouth.
“I was livid,” said Ford, 57, a court reporter. “I’m there every day, pointing out he’s in pain — and he had dental insurance. So there’s no reason this wasn’t addressed.”
In nursing homes across the country, residents suffer from cavities, gum disease and cracked teeth, in part because their mouths are not kept clean. While residents now require more dental care than in the past, nursing home employees are rarely prepared to provide it.
“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, head of the department of general dentistry at Boston University.
The neglect can lead to terrible pain for the residents. Worse, new studies suggest that this problem might be contributing to another: pneumonia, a leading killer of the institutionalized elderly.
The lack of daily oral care in nursing facilities is “an epidemic that’s almost universally overlooked,” said Dr. Sarah J. Dirks, a dentist who treats nursing home residents in San Antonio.
Gauging the problem
There are no current national assessments of oral health in nursing homes, but since 2011, at least seven states have evaluated residents using a survey developed by the Association of State and Territorial Dental Directors. One was Kansas, where dental hygienists examined 540 elderly residents in 20 long-term care facilities. Nearly 30 percent of the residents had “substantial oral debris on at least two-thirds of their teeth,” according to a report issued by the Kansas Bureau of Oral Health. More than a third had untreated decay.
The screeners saw plenty of fillings and crowns but concluded that “regular dental care has become a thing of the past” for many of the elderly residents.
In Wisconsin, nearly 1,100 residents from 24 homes were examined. About 31 percent had teeth broken to the gums, with visible roots; 35 percent had substantial oral debris from meals past.
The problem has been graphically documented in state and federal inspections of nursing homes. A 2006 study of five facilities in upstate New York found only 16 percent of residents received any oral care at all. Among those who did, average brushing time was 16 seconds. Supplies like toothbrushes were scarce, the report said.
Nearly two-thirds of those who stay in a facility long-term have dementia, and many resist oral care, clenching their mouth shut or even trying to hit aides.
Many prescription drugs — including some antidepressants, medications for high blood pressure, and anti-seizure medications — can reduce saliva and dry out the mouth. Without daily oral care, elderly people taking such drugs are especially prone to “a relatively rapid deterioration,” said Dr. Ira Lamster, a dentist and a professor of health policy at the Mailman School of Public Health at Columbia University in New York.
The consequences are not limited to cavities and gum disease. Since 2004, when researchers first linked oral bacteria to the occurrence of hospital-acquired pneumonia in the elderly, a series of studies have shown that oral care — from regular brushing to professional dental care — might reduce the risk. Roughly one in 10 cases of death from pneumonia in nursing home residents could be prevented by improving oral hygiene, according to a 2008 systematic review published in the Journal of the American Geriatrics Society.
Some companies are offering new solutions. Apple Tree Dental, a nonprofit practice in Minnesota that serves about 100 nursing homes, provides routine cleanings by dental hygienists for residents. More than 30 states allow for dental hygienists to provide some treatment without specific authorization from a dentist, according to the American Dental Hygienists Association