A couple of years have passed and you are now more established in your private practice. Your uncle has become very ill and your aunt is unable to care for him so he enters a nursing home. Once in the nursing home, he refuses to go out of his room, is speaking less and has difficulty eating. When you visit him, he frequently complains about oral discomfort and his denture. On inquiry, the nursing home staff acknowledges that this is a common problem. Thankfully your uncle is in a nursing facility that has dental services. You ask to visit the dental office at his nursing facility and get a chance to speak with the dentist on site, Dr. Patrick. He confirms that your uncle will be seen and his pain will be addressed. During your discussion, you learn that this is a unique nursing facility in that it offers significant dental services which is not generally the case with most nursing homes. Dr. Patrick explains that dental services are limited in most facilities and it is difficult for many patients to leave a nursing home for care due to lack of mobility, dementia and lack of dental facilities that are wheelchair accessible. You further learn that a dentist can easily consult with their local nursing home and you decide to look into how you can spend some of your time treating this population.

The Nursing Home Population

Oral diseases are not being adequately addressed in the general nursing home population. They pose a particular problem among residents with dementia, as these individuals are frequently unable to care for themselves, articulate their needs or the discomfort they may feel.

According to a recent New York Times article, “In Nursing Homes, an Epidemic of Poor Dental Hygiene”, In nursing homes across the country, residents are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean. Oral hygiene is often overlooked because residents with dementia may pose many challenges, competing interests can take precedence, and/or nursing home employees are rarely prepared to provide it.

Dental neglect can lead to pain and an increased risk for pneumonia, which is a leading killer of institutionalized older adults. The lack of daily oral care in nursing facilities is “an epidemic that’s almost universally overlooked,” said Dr. Sarah J. Dirks, a dentist who treats nursing home residents in San Antonio.

Dental insurance is often lost when people retire. Medicare only pays for dental care in rare instances. Many nursing home residents cannot afford to get their needed dental care. Oral health problems affect self-esteem, can contribute to the demise of overall health, and decrease quality of life. Depending on the state Medicaid compensation rate, dentists may provide care to nursing home residents with Medicaid. Ironically, some procedures that normally would not be able to be done in a private dental office can be done in a nursing home environment due to Medicaid coverage.

Meet Gregory Bunza, DDS

Director, General Practice Residency Program
Columbia University College of Dental Medicine

Dr. Bunza has been working at the Isabella Geriatric Center for 10 years. He treats this senior population two days per week. As Director of the General Practice Residency Program, he works with his residents in treating special needs patients, developmentally disabled patients, patients with medically compromised issues, and the older population, especially those with dementia.