Oral care a concern for older adults About this story
In 2014, 1.4 million Americans lived in a long-term care facility, according to the Centers for Disease Control and Prevention.
Long-term care is a growing business, and families who rely on that care, often assume that every need is being met. Most of the time, it is. However, there are a few cracks in the system.
Kirsten Roling is a dentist with Smiles by Delivery, a mobile dentistry service that crisscrosses the Phoenix area providing oral care to residents in long-term care and skilled nursing. On this day, she and her dental hygienist are visiting an assisted-living facility in Glendale. A 97year-old woman with a broken crown is sitting in the portable dental clinic.
“So the issue now these teeth are 60, 70, 80, 90, sometimes 100 years old,” Roling said. “We’ve had crowns, implants, and then we hit a bump in the road, right? We hit dementia, Alzheimer’s, COPD — and we’re not able to care for the dentistry we’ve invested in.”
She said oral health care, or the lack of it, specifically in these facilities, is a public health issue. And the reasons why means solutions are tough to come by.
But it often starts when a person turns 65.
“There’s not dental benefit built into Medicare. So many people who were Baby Boomers who had good dental benefits in connection to their employment” may go without, unless they choose a Medicare Advantage plan or supplemental dental insurance, said Kevin Earle, the executive director of the Arizona Dental Association.
Dentistry is also very expensive and low reimbursement rates means dentists may not want to work with this population. Then there’s the dentistry itself; think implants and crowns, without regular care.
“Patients that have entered a facility where within a year, their dentistry has been completely wiped out, often by dry mouth,” Roling said.
Dry mouth can affect older adults taking certain medications. But some residents take multiple medications that cause dry mouth, and Roling said it can cause tooth decay very quickly.
And that bacteria can be inhaled and lead to aspiration pneumonia, it can also This story was produced by KJZZ and appears here through a collaboration between The Arizona Republic/azcentral.com and KJZZ. To hear the original story, go to kjzz.org. exacerbate conditions like diabetes. Nursing staff are supposed to brush teeth and remove and clean dentures daily, but Roling and others don’t think that’s always happening.
Ann Ross is a dental hygienist and the owner of Mobile Dentistry of Arizona. She says tooth loss, decay and abscesses are common in this population, and she has seen it first hand.
“Our dentist removed (a woman’s) upper denture and lower partial and my dental assistant whisked it away to get it cleaned,” said Ross. “What we saw was pretty horrific. Her dentures for the most part were black. They were covered in black mold, you know the stuff you scrub away with a toothbrush along the shower.”
Ross said she talked to the nurse and some of the caregivers about the woman’s situation.
“They did not know that she had a denture or a lower partial,” Ross said. “She had lived at this community for over six years.”
Residents who move into a facility that accepts Medicare or Medicaid are supposed to get a federally mandated assessment by a nurse or an oral health professional, but that may not be happening.
“My understanding is that screening is rather cursory and often not performed by an oral health professional, either a dental hygienist or dentist. So a nurse my not readily identify things that are potential problems,” Earle said.
Both Roling and Ross agree: the assessments aren’t adequate.
“So, for instance, we’ll see, ‘Patient’s teeth look fine.’ That’s the assessment and they really have dentures. They have natural teeth so we know a dentist probably didn’t do that assessment,” Roling said.
Ross has even created half sheet assessment for staff, which includes questions like, “when was the last time a patient visited the dentist?”