The silent epidemic of oral disease in older adults.

Oral health among nursing home residents remains a significantly overlooked aspect of long-term care, despite its proven connection to systemic health and quality of life. In the article "Oral Health in Nursing Homes: What We Know and What We Need to Know," Sifuentes and Lapane (2020) present a comprehensive overview of the oral health crisis affecting elderly populations in nursing facilities and call for urgent systemic change.

Older adults residing in nursing homes experience some of the poorest oral health outcomes in the United States. On average, residents develop one new cavity per year. However, there is a lack of recent national data, especially for adults over the age of 75. Existing evidence suggests that oral diseases disproportionately affect racial minorities, those with lower socioeconomic status, and rural populations—yet these groups are consistently underrepresented in oral health research.

Poor oral hygiene is not merely a dental issue, it is a public health concern. Consequences of neglected oral care include pain, impaired chewing and swallowing, malnutrition, and diminished quality of life. More alarmingly, poor oral health has been linked to serious systemic conditions such as cardiovascular disease, diabetes, respiratory infections, and cognitive decline. Despite this, oral hygiene is often neglected in long-term care facilities. Research shows that only 16% of nursing home residents receive any form of oral care, and the average time spent brushing teeth is approximately 1.25 minutes—far below the recommended six minutes necessary for effective oral hygiene.

Multiple barriers contribute to this neglect. Residents may be unable to perform oral care due to physical or cognitive impairments. Caregivers, often overburdened and inadequately trained, lack the time, tools, and confidence to provide consistent oral care. High staff turnover and the absence of formal oral care protocols further hinder effective practice.

Federal regulations, specifically CMS's 42 CFR §483.20, mandate that oral health assessments be conducted upon admission and periodically thereafter. Facilities are also required to help residents access dental services, provide transportation, and assist with costs if covered by Medicaid. Yet compliance with these mandates is inconsistent, largely due to the lack of standardized procedures and staff education.

There is also a noticeable gap in evidence-based interventions. One study in Korea demonstrated that biweekly professional care from dental hygienists led to marked improvements in plaque levels, gingival health, and saliva production. Similarly, Sweden's Senior Alert registry and the Revised Oral Assessment Guide–Jönköping (ROAG-J) model offer an example of how structured protocols, staff involvement, and interdisciplinary coordination can dramatically improve oral care outcomes.

Sifuentes and Lapane argue that the U.S. must adopt similar strategies, including the integration of dental professionals into long-term care teams, enhanced training for nursing staff, and development of scalable intervention models. Policymakers, administrators, and public health advocates must work collaboratively to close this gap, enforce existing regulations, and prioritize oral health as an essential component of comprehensive elder care.

To bridge this critical gap, OralNexus offers a practical, compliant solution by educating nursing home staff through specialized oral health trainings and on-site assessments. Our programs empower caregivers to recognize early signs of oral disease, implement effective hygiene protocols, and integrate oral health into the broader care plan, ensuring residents receive the comprehensive, preventive care they deserve. With regulatory compliance, improved health outcomes, and staff empowerment at its core, OralNexus supports facilities in transforming oral care from a neglected task into a standard of excellence.

Reference

Sifuentes, A. M. F., & Lapane, K. L. (2020). Oral health in nursing homes: What we know and what we need to know. Journal of Nursing Home Research Sciences, 6(1), 1–5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286629/