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Lack of Oral Care may Lead to Pneumonia Deaths

Nursing home negligence lawyers at Pintas & Mullins highlight a recent article by the New York Times which gives attention to the ignored issue of oral care in skilled nursing facilities. Residents may go extended periods of time without dental attention, leading to the obvious dental problems but also to extreme weight loss and, recent studies suggest, often-fatal episodes of pneumonia.

As for-profit nursing home chains proliferate throughout the country, more and more facilities are becoming chronically understaffed, and the staff they do retain are overworked, stressed, and overwhelmed with tasks. Nurses are often assigned dozens of patients, even whole wings, per shift, barely giving them enough time to change sheets and administer medications, much less provide adequate dental care.

As a result, gum disease, cracked teeth, cavities, and other oral-related disease plague nursing homes, leading to terrible pain for the residents. Not only is this lack of dental care painful (and disgusting) for the residents, but it is incredibly dangerous as well. Several new studies have found that this problem is contributing to the high prevalence of pneumonia in nursing homes, which is the leading cause of death for elders in institutions such as nursing homes.

One of the studies, published in The Journal of the American Dental Association, concluded that there is significant evidence that mechanical hygiene practices reduce the occurrence and progression of respiratory diseases in elderly residents of nursing homes and hospitals. Further, mechanical oral hygiene practices may even prevent death in about one of every ten nursing home residents from pneumonia.

Even in nursing homes that are adequately staffed and maintained, employees may not be trained to deal with the increasing numbers of residents with dementia who resist daily dental hygiene. There is currently no law or regulation regarding oral health in nursing homes, so if a resident resists having their teeth brushed and flossed, a nurses’ aide will more often than not comply with the resident.

In 2011, however, seven states began evaluating residents using a survey created by the Association of State and Territorial Dental Directors. For the survey, dental hygienists in Kansas examined 540 elder residents in 20 skilled nursing facilities, and nearly 30% of them had substantial oral debris on at least two-thirds of their teeth. Over one-third had untreated oral decay.

Wisconsin dental hygienists examined over 1,000 residents from 24 facilities and found, again, over a third of those residents had teeth broken all the way to the gums, with the roots visible. Another 35% had significant oral debris. In Texas, investigators reported on one dementia patient who was in so much pain she could not eat, and inspectors found her gums red and swollen and lower teeth packed with food debris.

Unfortunately, this issue is ignored and almost completely overlooked: a 2006 survey of five skilled nursing facilities in New York State found that a mere 16% of residents received any oral attention whatsoever, and supplies like toothbrushes were meager.

Researchers first linked oral bacteria to hospital-acquired pneumonia in senior citizens in 2004. Even if families know their loved one is not receiving adequate dental care, however, paying for improved services can be difficult, if not impossible for some. Medicare does not pay for routine dental care, such as cleanings and fillings, and Medicaid does only rarely.

Nursing homes are allowed to employ a dental hygienist to perform some treatments without authorization of any kind from a dentist, however, most do not. Amid devastating slashes to budgets and the previously mentioned move toward for-profit facilities, medical directors at nursing homes do not see the value of employing a full- or even part-time hygienists.

Elder neglect lawyers at Pintas & Mullins affirm that dental health is a critical part of one’s overall well-being, just as dental disease is a primary threat to one’s overall health. If you or a loved one was hospitalized for pneumonia while residing in a nursing home, you may have the right to obtain compensation for past and future medical bills through a lawsuit against the facility, and should contact a skilled nursing home lawyer as soon as possible.