Dental issues plague America's nursing home residents

Good oral health is one of the keys to healthy aging, but a sobering new study shows that many U.S. nursing home residents have significant dental issues.

Close to two in every 10 residents have missing teeth, about 8% have broken teeth/cavities and another 11% report pain while chewing, researchers found.

"Inadequate oral health has far-reaching consequences that extend beyond the mouth, profoundly affecting one's overall well-being, nutritional intake and general health," said study author Dr. Natalia Chalmers, chief dental officer at the U.S. Centers for Medicare & Medicaid Services (CMS), in Baltimore.

Poor oral health can hinder a person's ability to chew properly, which can eventually lead to malnutrition. In addition, bacteria from gum infections can enter the bloodstream, increasing the risk for heart disease and other conditions, she explained.

"This interconnected relationship between oral health and overall health underscores the importance of maintaining a healthy mouth," Chalmers said.

For the study, researchers analyzed data on the oral health of Medicare beneficiaries living in CMS-certified nursing homes in 2020. Overall, having no natural teeth or tooth fragments were the most common dental problems in seniors, followed by cavities or broken natural teeth, pain, difficulty chewing, broken dentures and inflamed gums, among other oral health issues.

There are likely many reasons that dental health declines among nursing home residents, but a main driver is likely the lack of dental coverage. Fully 51% of people who receive Medicare don't have dental coverage, Chalmers noted. That may be because traditional Medicare doesn't cover routine dental services such as exams, cleanings and X-rays, or more expensive services such as fillings, crowns or dentures, so dental insurance has to be paid for separately.

There were some striking disparities seen across racial and ethnic groups. For example, Black people were 16% more likely to have no natural teeth or tooth fragments and 5% more likely to have cavities or broken natural teeth, compared with white people. American Indian or Alaskan Native seniors were also more likely to experience dental issues than white people.

Those nursing home residents with three or more chronic health conditions were more likely to have oral health issues than seniors with no chronic conditions. What's more, people in rural nursing homes had higher odds of experiencing dental problems than people in urban nursing homes, the investigators found.

"If your family member resides in a nursing home, it's essential to establish clear communication with the facility's staff regarding their oral care routine, and preferences regarding assistance and toothbrushes and toothpaste, such as whether they prefer manual or electric toothbrushes, and what fluoridated toothpaste they use," said Chalmers. "You should ensure that the staff is well-informed about your loved one's dentist and the designated contact person in emergencies."

The findings were published online Sept. 12 in JAMA Network Open.

Dr. Bruce Dye is chair of the department of community dentistry and population health at the University of Colorado School of Dental Medicine in Aurora. He wrote an editorial accompanying the new study.

"We know oral health is associated with many chronic diseases, and with more seniors living longer with more chronic diseases, having poor oral health reduces the likelihood of many of them enjoying optimal health and well-being," Dye said.

It's time to take steps to ensure that seniors can access dental care, including making dental insurance more affordable, he added.

There are also things a loved one can do to advocate for oral health among family and friends in nursing homes, Dye suggested.

"Develop an ongoing relationship with the nursing staff caring for [your] loved one and with the director of nursing," he said. In most nursing homes, the director of nursing works directly with staff and the consulting dentist.

New York City dentist Dr. Saul Pressner agreed that more efforts are needed to improve access to dental care for folks in nursing homes. He is the president of the Academy of Biomimetic Dentistry, which is a type of tooth-conserving dentistry that focuses on preserving natural teeth.

"Having a dental benefit for all Medicare recipients would go a long way toward addressing the lack of access to good dental care in the nursing home population," said Pressner.

In addition, a dedicated dental treatment area in nursing homes would make it easier for residents to seek care. Other easy fixes can include utilizing auxiliary staff to help residents with their oral care.

"Visits by dentists to conduct oral cancer exams would help in early detection of diseases, which if caught early can prevent further systemic disease issues," he suggested. "Proper nutrition in nursing homes along with good home care instruction for oral health would immensely help in minimizing dental disease."

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