Addressing an Overlooked Need: Integrating Oral Health into Long-Term Care

Oral health among long-term care residents, including those in nursing homes and assisted living facilities, remains an underrecognized yet critical component of overall wellness. A recent commentary in Caring for the Ages emphasizes that despite federal mandates requiring oral health assessments and facilitating dental care access, the actual implementation of these standards is frequently inadequate in residential care settings (Caring for the Ages, 2024).

Federal regulations stipulate that nursing homes and similar facilities must evaluate the oral health needs of residents and assist with dental care when needed. However, the article highlights that many facilities fall short of these requirements in both assessment frequency and follow‑through on identified needs. This gap persists even as residents commonly present with multiple chronic conditions, where poor oral health can exacerbate systemic disease burden (Caring for the Ages, 2024).

Compounding the issue, elderly residents often face barriers to oral hygiene and dental care due to cognitive impairment, mobility challenges, and limited staffing support. The lack of provider training results in missed detection of oral disease, underreporting in clinical records, and insufficient preventive action. Consequently, routine issues like gum inflammation, caries, and poorly fitting dentures go unaddressed, leading to pain, malnutrition, aspiration pneumonia, and increased healthcare utilization (Caring for the Ages, 2024).

The article also underscores the disconnect between policy and practice in residential settings. Although formal requirements exist, enforcement is inconsistent. Many facilities lack structured protocols, fail to document oral assessments in compliance with Minimum Data Set (MDS) standards—especially Section L—and are ill-equipped to integrate oral care into daily routines. As a result, oral health issues are too often deprioritized during staff time-constrained care (Caring for the Ages, 2024).

To close this gap, the article advocates for a multifaceted approach:

1. Education and training for caregivers and care staff to recognize oral conditions, conduct proper screening, and carry out daily hygiene interventions.

2. Designation of an oral health champion within facilities to oversee compliance, coordinate dental referrals, and ensure assessments lead to actionable care.

3. Integration of oral health into care planning, including linking Section L findings to nutritional, pain, feeding, and swallowing care area assessments (Caring for the Ages, 2024).

Such strategies echo findings from broader research: non-dental personnel can effectively use structured screening tools (e.g. ROAG-J) to detect oral issues—but this requires routine practice, clear roles, and ongoing support (Bellander et al., 2024; BMC Geriatrics). Similarly, international reviews emphasize that oral health education programs for staff significantly reduce plaque, caries incidence, and potentially hospitalization risk among frail older adults (Cibelle et al., 2025; Poudel et al., 2024).

In sum, Caring for the Ages highlights that oral health care is a required but often neglected aspect of long-term residential care. While federal regulations establish assessment and referral obligations, practical implementation lags due to lack of training, routine protocols, and leadership engagement. Adopting structured education, designating responsibility within facilities, and embedding oral health within care plans are essential to transforming policy into improved resident outcomes (Caring for the Ages, 2024). Stronger enforcement and integration—supported by evidence-based tools and training—can help elevate oral health from an overlooked duty to a core component of resident wellness.

References

Bellander, L., Angelini, E., Andersson, P., Hägglin, C., & Wijk, H. (2024). A preventive care approach for oral health in nursing homes: a qualitative study of healthcare workers’ experiences. BMC Geriatrics, 24, 803. https://doi.org/10.1186/s12877‑024‑05396‑1

Caring for the Ages. (2024). Priority for oral health in residential facilities. Caring for the Ages. https://doi.org/10.1016/j.carage.2024.10.011

Poudel, P., Paudel, G., Acharya, R., George, A., Borgnakke, W. S., & Rawal, L. B. (2024). Oral health and healthy ageing: a scoping review. BMC Geriatrics, 24, 33. https://doi.org/10.1186/s12877‑023‑04613‑7

Cibelle Cristina Oliveira dos Santos, C. C. O., Lessa Miranda, I. M., Thuller, K., Reis Silva, K., Antunes, L. S., & Picciani, B. L. S. (2025). The impact of domiciliary dental care and oral health promotion in nursing homes of older adults: a systematic review. International Journal of Environmental Research and Public Health, 22(5), 683. https://doi.org/10.3390/ijerph22050683