Ben NelsonAn 84-year-old nursing home resident was becoming increasingly verbally and physically aggressive toward his caregivers. He was suffering from the advanced stages of Alzheimer’s disease, and his ongoing medical conditions also included diabetes, hypertension, and chronic kidney disease. He was unable to express detail about any pain or symptoms and eventually began attempting to bite those caring for him. This coincided with biting of his silverware during meals.

Over the subsequent months, he began spitting and hitting caregivers, as well as biting his own hand, causing significant lacerations.

Physicians continued to work to resolve whatever condition was causing his behavioral problems. As the biting worsened, an appointment with a dentist was arranged. Three cavities were discovered. After these were extracted, the biting and other antisocial behavior stopped immediately. According to the paper that details the case, years after the extractions, the patient “remains a pleasant patient,” according to authors Akimichi Inaba et. al, writing for

Dental Health Supports Overall Health

This case illustrates the risk patients and facilities face when regular dental care is overlooked or postponed. Indeed, a recent statement released by the American Dental Association (ADA) says, “Dental care is essential health care. Regular dental visits are important because treatment, as well as prevention of dental disease, helps keep people healthy.”

The postponement of all but emergency oral health care during the pandemic may have been necessary during the first weeks as the Centers for Disease Control and Prevention (CDC) and ADA examined existing research and considered infection control.

However, both organizations have recently issued statements indicating further delay is not only unnecessary but puts people’s health at risk.

Presenting his organization’s guidelines, ADA President Chad Gehani, DDS, said, “The longer patients go without preventative care and treatment for early forms of dental disease, the more likely their untreated disease will progress.” He also emphasized that “the safety of patients, dentists, and dental team members has been and always will be ADA’s utmost concern.”

Care Guidance During COVID

Guidelines issued by ADA are in close alignment with recommendations issued by CDC and include:

  • Masks for patients;
  • N95 masks and additional personal protective equipment (PPE) as needed for dental staff;
  • Limiting the number of people who accompany a patient;
  • Temperature checks;
  • Social distancing; and
  • Regular use of hand sanitizer.

CDC and ADA policies provide the details medical directors, nursing directors, and nursing home administrators need to create guidelines and reference points for a standard of care as it applies to oral health care in a pandemic, regardless of the place of service. Additional details are available on ADA’s website at

Preventable Risks for Skilled Nursing Facility Patients

Chronic diseases, including diabetes, heart disease, and stroke, have been linked to poor oral health, according to, and for those over 65, additional risks lurk. Complications from dysphagia, including pneumonia, malnutrition, and dehydration, in addition to bacterial infections such as non-pneumococcal pneumonia, according to the site, are among the conditions that can be exacerbated by neglecting regular dental care.

In a study detailed in the July/August 2019 issue of Special Care in Dentistry, authors Man Hung et. al. found “strong empirical evidence that oral health is directly associated with different disease conditions and contributes largely to an individual’s general health, particularly in the elderly.”

Without this care during the pandemic, skilled nursing facility residents are likely to be more vulnerable to the effects of comorbidities related to undetected oral health deficiencies. Every facility must weigh these risks against those of dental care that follows CDC and ADA guidelines. In the vast majority of cases, they are likely to find that not attending to their residents’ oral health is the bigger risk.

“Millions of patients have safely visited their dentists in the past few months for the full range of dental services,” Gehani said in an ADA press release. “With appropriate PPE, dental care should continue to be delivered during global pandemics or other disaster situations.”

Ben Nelson is vice president of operations with Aria Care Partners, a leading provider of onsite ancillary medical services for skilled nursing facilities. Connect with him on LinkedIn.​