Study Finds Dental Problems Often Undetected in Nursing Home Patients with Dementia

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Pain resulting from tooth decay and other dental problems is often left undetected in nursing home residents suffering from dementia, reports a new study published in the July-August issue of the American Journal of Alzheimer’s Disease [17(4)]. The researchers believe properly identifying and treating dental pain could significantly affect the quality of life for these residents and caregivers alike.

Researches Jiska Cohen-Mansfield, Ph.D. and Steven Lipson, M.D., investigated the level of dental pain detection and evaluation in nursing home residents suffering from cognitive impairment. Previous research has shown many care facilities lack dental services, with more than 60 percent of nursing homes in the United States not having services at all, or had them only on call or off site. Despite the lack of attention in nursing homes, dental problems are known to occur and can even be life threatening as it may interfere with eating.

In the study, 21 nursing home residents (18 women 3 men) with an average age of 88 years and all diagnosed with dementia, were administered dental evaluations by nine rotating volunteer dentists and two outside geriatricians. Examinations were conducted in dental clinic rooms within the nursing home. Both dental and geriatrician assessments were standardized and entered on specific forms for this study. Geriatricians rated the level of dental or denture pain, discomfort and distress as part of a physical examination. On the standardized dental form, the dentists were asked whether patients had problems such as, broken teeth, fractured teeth, cavities, cervical caries, periodontal disease, gingivitis, dentures, or retained root tips, and whether the patients experienced pain from these conditions.

Of the 21 participants twelve (57%) had fully completed the examination, while three (14.3%) had completed a majority of the exam, three (14.3%) partially completed, and three (14.3%) could not complete the evaluation. Each person unable to complete the exam suffered from severe cognitive impairment and prevented dentists from making a thorough assessment.

The study acknowledged making dental evaluations among dementia sufferers could be difficult for patients, families and caretakers. Many patients could not understand the importance of the exam, and an inability to communicate effectively rendered patients difficult to examine. Often evaluations were impossible if the patient was not cooperative, answering questions and providing feedback about what they felt. Lengthy and uncomfortable treatments also lead to difficulty. Several of the dentists confirmed the exams were challenging, with one noting, “patient is very debilitated and can’t cooperate well, patient doesn’t communicate well.”

Of the 18 patients who were examined, dental evaluations showed 86% experienced pain from broken teeth, while 60% had pain from fractured teeth, 50% had pain from retained root tips, 33% had pain from dentures, 25% had periodontal disease, 25% cervical caries, and 14% had gingivitis. Most pain ratings were of mild to moderate levels, with only one person having severe pain. There was also only one patient who did not have any dental problems.

These findings were then compared to previous research to reveal a deficiency in the ability of nursing home staff to detected oral problems during examinations. In one previous study of 466 nursing home residents evaluated for dental pain or other conditions by nursing staff, only 0.2 % of residents were identified with mouth pain, 3 % with broken or decayed teeth, 0.9 with gingival problems, and 3.2 % with oral debris. Leading the authors to concluded, “Dental problems are underdetected and undertreated in the nursing home. Better training for non-dentists in detection of such problems and better reimbursement for dental care are needed to improve care of residents.”

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