Barriers to Providing Adequate Oral Healthcare in the Residential Care Setting

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Recommended: Oral care for cognitively impaired patient

It is well known that oral healthcare in nursing homes is substandard(1). There are several reasons that this is the case. From the dentists’ standpoint, the nursing home setting is not conducive for a proper oral examination and treatment. Many dentists cite a lack of portable dental equipment that can be taken into the residential facilities(2). As a consequence, many dentists who are willing to invest in the oral health of these residents would like for the patients to come to the office so that proper standard of care can be provided. However, nursing staff members and administrators find that the practicality of transporting residents from the nursing home to the dental office for treatment is “almost impossible(2).” This stems from the difficulty of caring for the cognitively impaired. Indeed, Chalmers and Pearson claim that the biggest barrier to providing oral care in these facilities stems from the residents’ cognitive, functional, and communication impairment(3). In a 2008 study, researches found that about 68% of nursing home residents were cognitively impaired(4). Approximately 40% of those residents were categorized as having severe mental impairment(4).
According to Chalmers, assessment of oral health is generally dependent upon the ability of the resident to self identify problems with their oral health and their ability to cooperate and communicate with the nursing staff(3). This illustrates a problem with those patients who do not have the cognitive ability to self identify dental problems and then effectively communicate those problems to professionals. This is extremely common with patients who suffer from dementia.
One suggested barrier to residents receiving adequate oral healthcare is the possible negative...

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... JM, Pearson A. A systematic review of oral health assessment by nurses and carers for residents with dementia in residential care facilities. Spec Care Dentist. 2005;25(5):227-33.
3. Chalmers J, Pearson A. Oral hygiene care for residents with dementia: a literature review. J Adv Nurs. 2005;52(4):410-9.
4. Chen X, Clark JJ, Naorungroj S. Oral health in nursing home residents with different cognitive statuses. Gerodontology. 2013;30(1):49-60.
5. Forsell M, Sjogren P, Kullberg E, Johansson O, Wedel P, Herbst B, et al. Attitudes and perceptions towards oral hygiene tasks among geriatric nursing home staff. Int J Dent Hyg. 2011;9(3):199-203.
6. Isaksson R, Paulsson G, Fridlund B, Nederfors T. Evaluation of an oral health education program for nursing personnel in special housing facilities for the elderly. Part II: Clinical aspects. Spec Care Dentist. 2000;20(3):109-13.

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