Neglected Oral Health: An Overlooked Crisis in Long-Term Care

How is your smile—and the smiles of your loved ones? Oral health is a critical yet often overlooked aspect of overall well-being, particularly for residents in long-term care facilities. In the United States, approximately 1.4 million individuals reside in nursing homes, not to mention the millions more in assisted living, memory care, and those needing care in their homes.

The number of people needing long-term care will rise as the population ages. However, studies show that only 16% of these residents receive adequate daily oral care, leading to a high prevalence of oral diseases that significantly impact their quality of life.

Families play a crucial role in ensuring the well-being of their aging loved ones, yet oral health is often overlooked in routine caregiving. Many adult children and family members focus on medical conditions, mobility, and daily living needs, inadvertently neglecting oral hygiene.

This lack of attention can lead to severe consequences, including pain, infections, and even worsening of chronic illnesses such as diabetes and cardiovascular disease.

One key indicator of overall health decline in older adults is the deterioration of oral hygiene habits. When an elderly family member stops maintaining their oral health, it may signal cognitive decline, depression, or physical limitations that require intervention.

Neglecting regular brushing, failing to seek dental care, or exhibiting difficulty eating due to dental issues should prompt families to take action and seek professional dental evaluations.

Oral health is more than just a smile—it's a window into overall well-being, especially for older adults. Family members should pay close attention, as changes in oral health can be an early warning sign of decline, from poor nutrition to cognitive issues.

Family members should take proactive steps by discussing oral health during regular check-ins, helping with brushing and flossing if needed, and ensuring their loved one has access to routine dental care.

The State of Oral Health in LTC Facilities

Research indicates that 37.9% of adults aged 75 and older have untreated coronal caries, while nearly half of those aged 65 and above suffer from periodontal disease.

These conditions cause pain and discomfort and negatively affect nutrition, communication, and overall well-being. Addressing oral health in long-term care settings is imperative to improving the lives of older adults.

Ensuring Quality Dental Care for LTC Residents

Maintaining optimal oral health is crucial for residents in long-term care facilities, as poor hygiene can lead to infections, nutritional deficiencies, and exacerbation of chronic diseases.

Optimal oral health is essential for residents in long-term care facilities, as poor hygiene can lead to infections, nutritional deficiencies, and worsen chronic conditions. Prioritizing dental care isn't just about comfort—it's about preserving overall health and quality of life.

Addressing these challenges requires selecting qualified dental care providers, understanding common oral conditions, implementing preventive measures, and ensuring continuous education for caregivers.

Finding a Qualified Dentist for Older Adults

Selecting a dentist experienced in geriatric care is essential to meet the specific oral health needs of older adults with chronic health or aging issues.

Here are steps to guide families and caregivers:

• Professional Associations: Utilize resources like the American Dental Association's "Find a Dentist" tool and the Academy of General Dentistry's "Find a Dentist" tool to locate member dentists in the U.S. and Canada.
• Healthcare Provider Recommendations: Consult with primary care physicians or specialists who can provide trusted referrals.
• Community Resources: Engage with local health departments or senior centers that offer lists of dentists specializing in elder care.

You can also use the internet to search for dentists where you or a loved one lives. For example, in Calgary, Sierra Dental offers dental services that older adults can benefit from.

Evaluating Credentials and Experience

• Specialization in Geriatric Dentistry: Ensure the dentist has experience or additional training in treating older adults.
• Continuous Education: Dentists engaged in ongoing education stay updated on best practices and emerging technologies.
• Professional Affiliations: Membership in organizations such as the American Dental Association indicates adherence to high ethical standards.

Assessing Accessibility and Services

• On-Site Services: Some dental practices offer mobile services, bringing care directly to long-term care facilities.
• Comprehensive Care: Opt for dentists who provide preventive and emergency treatments.
• Emergency Availability: Confirm the dentist's availability for urgent care.

Common Oral Conditions in LTC Residents

Residents in long-term care facilities often face significant oral health challenges due to aging, underlying medical conditions, and limited access to dental care. The most prevalent conditions include:

1. Dental Caries (Tooth Decay)

• Prevalence: Older adults develop coronal caries at a rate of approximately one new cavity per year.
• Contributing Factors: Reduced salivary flow, high-carbohydrate diets, and inadequate oral hygiene practices contribute to high incidence.

2. Periodontal Disease (Gum Disease)

• Prevalence: Many long-term care residents exhibit signs of periodontal disease, including inflammation and bleeding gums.
• Contributing Factors: Poor oral hygiene, systemic health conditions like diabetes, and medication side effects exacerbate periodontal issues.

3. Xerostomia (Dry Mouth)

• Prevalence: Common among the elderly due to medications or systemic diseases.
• Implications: Increased risk of cavities, infections, and difficulties in chewing and swallowing.

4. Oral Candidiasis (Fungal Infections)

• Prevalence: Often affects long-term care residents with weakened immune systems or dentures.
• Contributing Factors: Prolonged denture wear, poor oral hygiene, and systemic conditions.

5. Tooth Loss and Edentulism

• Prevalence: A significant percentage of elderly long-term care residents are edentulous or have lost multiple teeth.
• Implications: Affects nutrition, speech, self-esteem, and overall health.

Finding Quality Long-Term Care Services for a Loved One

Choosing the right long-term care facility is one of the most significant decisions a family can make. It's important to ensure the facility provides not just basic care but also prioritizes oral health as part of comprehensive well-being.

Quality long-term care services do more than provide assistance—they enhance a loved one's well-being physically, mentally, and even through proper oral health care. Comprehensive care ensures comfort, dignity, and a better quality of life at every stage of aging.

A helpful resource for families navigating this process is the LTC News Caregiver Directory, which lists more than 80,000 long-term care providers nationwide. The directory allows you to search for facilities that meet specific needs, including those with dedicated dental care services.

Questions to Ask About Oral Health in Long-Term Care Facilities

Before selecting a long-term care facility for your loved one, consider asking these key questions regarding oral health care:

• How does the facility integrate oral health into daily care routines?
• Are residents given regular dental check-ups and professional cleanings?
• Do caregivers receive training on oral hygiene practices?
• Are there policies in place for managing dentures, dry mouth, or other common oral health conditions?
• Does the facility collaborate with mobile dental services or have an in-house dentist?
• What emergency dental services are available for residents?

Prioritizing these aspects ensures that your loved one receives not only the best general care but also necessary dental attention, preventing complications that can affect overall health and well-being.

Paying for Quality Care

Health insurance and Medicare only pay for short-term skilled care, not custodial long-term care, which most of us will need as we age. Medicare also pays every little for oral health unless someone purchases dental insurance.

If your loved one has Long-Term Care Insurance, the guaranteed tax-free benefits can be used to pay for either in-home care or facility care - Filing a Long-Term Care Insurance Claim.

Typically, LTC insurance is purchased before retirement as a part of retirement planning. Most people do so between ages 47 and 67; however, there are affordable LTC Insurance options for those older, depending on health. If your loved one needs extended care services now, it will be too late to obtain coverage. This is something you usually do before retirement.

An LTC Insurance specialist can advise you or a loved one on options and provide accurate quotes from all the top insurance companies that offer long-term care solutions.

Preventive Strategies for Enhancing Oral Health

To mitigate these conditions, long-term care facilities can implement several preventive measures:

Regular Oral Assessments

• Conducting routine examinations for early detection and management.
• Maintaining detailed records to monitor changes and plan interventions.

Personalized Oral Hygiene Plans

• Developing individualized care plans tailored to residents' specific needs and abilities.
• Providing assistance and supervision for residents with physical or cognitive limitations.

Denture Care

• Educating residents and caregivers on proper denture maintenance.
• Regular evaluations should be made to ensure proper fit and to avoid oral lesions and discomfort.

Nutritional Support

• Encouraging diets low in sugar and rich in nutrients that promote oral health.

Oral health is deeply connected to overall health and well-being. While it is never too late to start prioritizing oral hygiene, taking preventive measures earlier in life is always preferred.

For older family members, maintaining good oral health should be a key part of their care plan. Regular dental check-ups, proper hygiene practices, and caregiver support can prevent complications and contribute to a better quality of life.

Ensuring optimal oral health in long-term care settings requires more than daily hygiene—it demands systemic changes in how facilities prioritize dental care. Emerging technologies such as AI-driven diagnostics and teledentistry are beginning to bridge the gap in access, offering promising solutions for proactive oral health management.