Teeth Matter: Dental Health in the Elderly

The population 65 and older is anticipated to double in the next 40 years due to the aging of the baby boomer generation.1 The major growth of this population will affect the amount of elderly residents needing long-term care in nursing homes and other facilities. According to the National Institute of Dental and Craniofacial Research (NIDCR), the elderly residents of nursing homes are a group of individuals with significant health disparities in the area of oral health. 2

Research has shown that there is a correlation between oral health and systemic health, and that poor oral conditions can increase the risk of developing conditions such as heart disease, stroke, and diabetes. 3,4 Studies have demonstrated that there are high rates of caries, poor oral hygiene, gingivitis, periodontal disease, and dry mouth in the elderly residing in long-term care facilities. 5

The purpose of this study was to identify possible barriers and propose solutions to influence the conduct of oral health care in care facilities where the elderly reside.

Study Methods and Results
Participants were selected from three long-term care facilities within Southern California, which shared similar characteristics. The study consisted of twelve individual interviews with the different staff members of the facilities including three administrators, three nursing directors, one registered nurse, and five nursing aides. Participants were asked the same general, semi-structured, open-ended questions regarding their perceived barriers to providing oral care to the older adult residents and perceived solutions to overcome these barriers for the residents of the long-term care facilities. Interview items were generated based on the literature. Approval was granted by the University Human Subjects Committee.

Administrators of three long-term care facilities were contacted and asked for consent to conduct the study with staff members of their facility. The facilities were small to medium facilities that had less than 100 beds each. Facilities included a nursing center facility, a memory care facility, and an assisted living facility. Each interview took place at the staff member’s facility of employment. Each participant received a letter explaining the study in detail and what was to be expected. Participants had to be employed for at least three months in the long-term care facility. Each participant had the option of discontinuing the study at any time for any reason. Informed consents were signed before interviews were conducted. Each interview was audio recorded and transcribed at a later time by an outside source. Most interviews were conducted within a fifteen-minute time frame to accommodate the schedules of the participants. Several participants completed follow-up questions at a later time to obtain more detailed information to improve the study.elderly man brushes teeth

Data analysis involved identifying themes from the audio recordings.6 Analysis involved reading through the transcripts several times and identifying patterns and themes expressed by the participants.

A total of twelve staff members of long-term care facilities were interviewed. After transcription and analysis of responses, several main themes emerged: the oral health of residents, oral care provided to residents, barriers to care, and solutions to improving oral care.

Barriers to Care
The majority of staff members interviewed felt there were some barriers faced when providing oral hygiene assistance to the residents of the long-term care facilities. While interviewing the staff members on the oral health of the residents, varying opinions emerged. The administrator of the nursing center facility stated: “I guess it depends on the resident. It depends, good or bad depending on the kind of diagnosis they have. It really affects their teeth.”

The nursing director of the nursing facility stated: “Sometimes we run into behavioral changes with the disease process. Residents with Alzheimer’s or dementia may be more likely to be combative, especially if you’re trying to brush their teeth during mealtimes or at the end of a meal”. The nursing aides indicated that patients that are not so alert pose the greatest challenge and are more difficult with whom to work.

The administrator of the assisted living facility pointed out that residents can be forgetful: “They basically have to be reminded several times or [we] actually physically put the toothbrush in their hands.”

Solutions to Improving Care
The director of nursing at assisted living facility felt that the: “Caregivers are very good at making sure that things are done. Also if the resident isn’t good at doing it themselves, then our med techs check on them to make sure they are doing it right”

Further, a nursing aide from the nursing care facility stated: “We always want every person to brush their teeth of course. It is very important.”

The nurse of this facility stated: “We all assist. We offer. We assist. We do the best we can. If we run into a difficult resident, then we notify the family and get them involved so they’re aware of what’s going on.”

Most aides and administrators reported that a patient and gentle approach made the most difference when providing care and assistance to the residents. One aide stated: “A kind and caring approach works best and that 90% is approach, 10% is actual task. Getting to know them, gaining their trust, talking to them and letting them know what you are doing helped when gaining compliance.”

toothbrushThe nursing aide at the memory care facility stated: “You have to have a lot of patience and do what you can to help the residents do as much as they can on their own.” She felt that everyone at the facility had a role to try to help the residents.

SEE ALSO: Earn CE: Patient Education for Older Adults

The nurse at the memory care facility stated: “We all want to have clean teeth. We work in a building where it’s really hard because it’s Alzheimer’s and dementia, so it’s pretty hard, but you have to manage on how you do [provide oral care]. The approach is what really counts.” Several other solutions to improving oral care identified by the interviewees were flossing more, providing better oral hygiene supplies, having a mobile dentist come to the facility, and having more dental professionals participating with the facility to provide oral care to the residents.

Findings emerged that required the attention of nurses, oral health professionals, administrators, and caregivers of long-term care facilities. None of the interviewees indicated that oral assessments occurred on a regular basis. Finkleman, Lawrence, and Glogauer4 stated that many residents enter long-term care facilities with active dental needs, so it is important for oral screenings to be completed upon their entrance into the facility. Limitations existed for this study. The study was confined to three facilities in one state. Given these limitations, results cannot be generalized to all long-term care facilities.

The majority of elderly residents residing in assisted living and long-term care facilities need assistance with oral care and hygiene, yet findings of this study showed that providing adequate oral hygiene is challenging. Improvement in the oral health of elderly residents in assisted living and long-term care facilities requires the efforts of all caregivers, administrators, and oral health professionals.


1. Vincent GK, Velkoff VA. The next four decades: The older population in the United States: 2010 to 2050. [Internet]. 2010 [cited 2014 July 26]. Available from: http://www.consensus.gov-/prod/2010pubs/p25-1138.pdf

2. Porter J, Ntouva A, Read A, Murdoch M, Ola D, Tsakos G. The impact of oral health on the quality of life of nursing home residents. Health & Quality Of Life Outcomes . July 2015;13(1):1-8.

3. Wintch P, Johnson T, Gurenlian J, Neil K. Executive Director’ Perceptions of Oral Health Care of Aging Adults in Long-Term Care Settings. Journal Of Dental Hygiene. October 2014;88(5):302-308 7p.

4. Finkleman G I, Lawrence H P, Glogauer M. The impact of dental services on oral health in long-term care: qualitiative analysis. Gerodontology. 2012; 29 (2): 77-82.

5. Coker E, Ploeg J, Kaasalainen S, Fisher A. A concept analysis of oral hygiene care in dependent older adults. Journal of Advanced Nursing. 2013;69(10):2360-2371.

6. Richards L, Morse J. Readme First For A User’s Guide To Qualitative Methods. Los Angeles: Sage; 2013.

Karissa A. Harper, practices at Cherry Valley Family Dental, JoAnn R. Gurenlian, RDH, MS, PhD is professor and graduate program director, Department of Dental Hygiene, Idaho State University, and Mary A. Nies is director of Nursing Research and Professor Division of Health Sciences, Idaho State University.

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