Special efforts need to be directed toward minimizing barriers to better meet the dental needs of nursing facility residents. These are fundamentally challenging problems that are not easily resolved.

Viable partnerships are essential in promoting oral health and disease prevention. Nurses, nurse assistants, social workers, dietitians, family members, physicians, dental professionals, and others should work together to help solve this crisis.

Report Offers Oral Care Recommendations

The following recommendations from the TRECS Institute report may be helpful regarding establishing a more fully integrated and quality-based oral care program for elders in nursing homes:
■ Develop a series of broad-based educational programs to raise the awareness and understanding of the importance of oral health care, especially for the elderly residing in nursing homes. These educational programs should be developed for each specific cohort, including residents, family, and facility staff.
■ The use of dental hygienists should be expanded within the nursing home setting by allowing collaborative relationships with dentists similar to the relationship nurse practitioners share with their collaborating physicians in many states.
■ Understand that taking the appropriate efforts to improve oral and dental care for nursing home residents could have a significant impact not only on quality of life for nursing facility residents, but also a meaningful impact on downstream medical costs for the health care system by preventing hospitalizations and deaths resulting from medical care needs arising out of poor oral and dental care.
■ Encourage the use of adaptive tools and other resident-friendly devices that will encourage and promote ongoing self-care and independence.
■ Encourage facilities to ensure that all daily oral care supplies and tools are readily available and accessible to the resident, the family members participating in oral care, and staff.
■ Long term care professionals should implement a preventive oral screening program consisting not only of entrance examinations but also routine (daily) preventive care, with special training of staff for challenging patient types.

Broad-based Programs Needed

According to the report, the broad-based educational programs (recommended above) should include the following:
■ Review and update health professional educational guidelines, including courses and inservice education to include oral health and dealing with special residents like those with dementia and those that may be combative or uncooperative.
■ Train health care professionals to perform oral screenings as part of the admissions process and through routine follow-ups.
■ Elevate the importance of daily oral care by incorporating it as a key component of the nurses’ daily flow sheet.
■ Develop specialized training programs for family and residents, again emphasizing the importance of good oral care.
■ Incorporate into all training programs for all cohorts the inappropriateness of ageism and the inaccuracy of ageist thought.