Prioritize Dental Hygiene for Nursing Home Residents

nursing home resident

Target: U.S. Department of Health and Human Services Secretary Kathleen Sebelius

Goal: Make proper dental hygiene a priority in nursing homes and improve nurses’ training for dealing with residents suffering from dementia

Nursing homes nationwide are experiencing an “epidemic” of cavities, gum disease, and cracked teeth due to poor routine dental hygiene. Nursing home employees must deal with myriad responsibilities in taking care of their residents, often relegating dental care to the bottom of an ever-mounting daily task list. Employees actually available are often inadequately prepared to provide dental care to residents who “now require more dental care in the past.”

Quoted in the Times, Dr. Sarah J. Dirks, a San Antonio dentist who cares for nursing home residents, says dental hygiene in such facilities is ‘almost universally overlooked.’ Indeed, there are currently no national assessments of dental hygiene in nursing homes. Some states have conducted evaluations since 2011 using surveys from the Association of State and Dental Directors. One Kansas survey reports that the occasional filling notwithstanding, nearly 1/3 of 540 residents in 20 long-term care facilities exhibit untreated tooth decay.

Of particular concern is the lack of routine dental hygiene like cleanings and exams, which face the added barrier of non-coverage by Medicare and limited coverage by Medicaid. According to dental hygienist Shirley Gutkowski, who educates nursing home staff in Wisconsin, nursing home medical directors often fail to see the value in keeping a dentist or even a hygienist on staff.

The consequences for residents with inadequate routine dental hygiene include experiencing incredible pain and discomfort. According to new studies, residents might also face increased risk of pneumonia, a common killer of nursing home residents.

Not to be dismissed, the very intimate nature of having one’s mouth handled makes improved training for nursing home employees essential in order to accommodate the over two thirds of nursing home residents with dementia (not to mention other brain-damaging conditions such as stroke) who may feel uncomfortable with procedures they’re unable to understand and who may clamp their jaws shut or even hit their aides.

The National Institute of Health is researching ways to improve dental hygiene for care-resistant residents suffering from dementia. Please sign the petition below to voice concern over this epidemic and to spur its prioritization in the form of more research and improved training for nursing home staff.


Dear U.S. Department of Health and Human Services Secretary Kathleen Sebelius,

I write urging you to consider the dire epidemic of dental ill health in nursing home residents nationwide. Cavities, cracked teeth, and gum disease abound, a consequence of nursing home staff being overrun with other responsibilities and relegating routine dental hygiene to the back of an ever-mounting daily task list. Nursing home employees who are available too often lack the training to help care-resistant residents suffering from dementia.

Nearly 2/3 of nursing home residents suffer from dementia and other brain-damaging chronic diseases like stroke which, combined with prescription medications, can dry the mouth and pose a risk to oral health. Furthermore, according to new studies, improper dental hygiene puts residents at higher risk of pneumonia, an often fatal disease among long-term care residents. With Medicare’s non-coverage and Medicaid’s limited coverage of routine dental hygiene, this health disparity requires immediate oversight to encourage its prioritization among long-term care facilities.

Various organizations such as the American Health Care Association and the American Dental Hygienists Association recognize the severity of this epidemic. With the former being a trade group representing 2/3 of nursing homes nationwide, these groups hold potential to enact improvement in residents’ dental hygiene. Finally, we must change the nursing home culture itself. Many nursing home medical directors still fail to see the value in having a dentist or even a hygienist on staff. Tackling this barrier, along with improving training for staff in efficiency and in care-resistant resident interaction, must be priorities.

Please help in laying the groundwork for these changes and leading the way in eliminating these communities’ health disparity.


[Your Name Here]

Photo Credit: Ulrich Joho via Flickr

Sign the Petition

  • Only your name will be displayed. By signing, you accept our terms and may receive updates on this and related causes.
FacebookCare2 NewsTwitterEmailShare


  1. Lynn Stedman, RDH, BS, MEd, MA says:

    Thisis a critical problem that could be solved by employing a Registered Dental Hygienist in every nursing facility — a professional who is trained to provide daily oral health care and assessment of patient needs and to provide dental hygiene services to all residents of these facilities.

    Please expand your thinking of quality of life care to include the oral cavity and get professionals in these locations to take the burden off already overworked RN’s and CNA’s, staff and volunteers who are not equipped to deal with the mouth.

  2. Lori Jackson says:

    Not to mention oral cancer screenings!!! Info on Oral Systemic links are everywhere…Dental Hygienists provide services that affect one’s WHOLE health!

  3. Pnemonia, heart disease and other infections can be spread by poor oral hygiene and lack of preventive treatment

  4. Judith Corbin says:

    Many areas in the mouth are chronic and acute wounds in the entry to the digestive system and can be controlled by daily oral infection control therapy (debridement and medication of oral structures) done by carestaff.
    Dental hygienists are a readily available workforce who can train staff and supervise the delivery of this medically essential service as well as provide other preventive and therapeutic oral health care.
    Folks, we are all in danger of oral MELTDOWN when we can no longer provide this care for ourselves.

  5. Pamela Tinnell says:

    I have been saying this for 15 yrs. Dentists in Ga. hear the plea of everyone in a nursing home that has no access to care. A dental hygienist is needed to visit and provide education, denture/partial cleaning and examination,including prophies!!

    • Suzanne Newkirk, RDH says:

      I agree that the lack of oral health care in nursing homes is dire. To help this situation many states are expanding dental hygiene practice acts to allow hygienists to provide services in nontraditional dental settings, such as clinics, nursing homes, hospitals, and facilities that treat people with developmental disabilities. This common sense solution not only improves the oral health of the underserved, but increases employment opportunities for an already licensed oral healthcare workforce.

      Unfortunately Georgia’s restrictive practice acts make it illegal for dental hygienists to provide dental hygiene services to the public without the direct supervision of a dentist much, to the detriment of our citizens, especially nursing home residents!!

      Instead of collaborating with public health officials, the state dental hygiene association (GDHA), policymakers, consumer advocates, and oral health coalitions on improving access to oral health care our citizens, Georgia’s state dental association (GDA) put together a “packet” to SELL to nursing home administrators on how to teach (already burdened) nursing assistants how to provide oral health care. Which makes me wonder how many “packets” GDA has sold to nursing home administrators?

      At GDA’s “Mission of Mercy” one of their stated goals was to impart the importance of dental hygiene education… and yet GDA fiercely restricts access to dental hygienists to the public without direct supervision of a dentist; which makes one wonder whose interests are served by GDA’s stranglehold on access to dental care?

      A combined, consistent effort is urgently needed in Georgia and the rest of the nation to improve oral health care for the underserved. By signing this petition and passing it on to friends and family members, I have to believe that eventually consumer advocates and oral health coalitions will urge policymakers to make changes for the good of the public.

  6. Marcia Bryan says:

    I am sooooo happy to see this petition. I have been in my current practice for the last thirteen years and it BREAKS my heart to see the decline(oral health in particular)over the years. As is the natural progression of events,these folks get older and are no longer able to live independently. The more fortunate ones may have an option to live with family members but the majority are in assisted living or nursing homes. The ones that are able to come in for continuing care or restorative treatment exhibit many, many signs of poor or “barely there” homecare. Sometimes manual deterity is a problem or inadequate supervision from the nursing staff.

    I sincerely hope that with ALL of us dental professionals, family members, friends, loved ones, and health care givers acting together we will effect CHANGE.

  7. Kathleen Endres says:

    In order for this to be effective you would also need to teach dental hygienist how to work with those with dementia. I say this because I have a husband with Alzheimer’s and neither my nurses training or my dental hygiene training has prepared me to work with someone with dementia. There is an occupational therapist, Teepa Snow, who’s lectures I have attended that has provided me with the knowledge to know how to brush the teeth of someone with dementia.

  8. Suzanne Newkirk, RDH says:

    Both of my in-laws (my father in-law especially) had Alzheimer’s… living in GA they had NO ORAL HEALTCARE WHATSOEVER.
    “Oral health” (daily brushing and the cleaning the teeth) falls under the category of “grooming” and as a result there is no designated oral health professional on staff (there are plenty of doctors, but no dentists or hygienists).
    The law must change! There is a ton of press about the oral-systemic link, but as long as taking care of resident’s oral health is considered “Grooming” there will be no emphasis for having an “oral health care professional” provide preventive care for this population.

  9. Laura DeHennis RDH, PHDHP says:

    We are lucky to have the Public Health Dental Hygiene Practitioner in PA. We are able to go into designated sites and work without supervision. We are now trying to get reimbursement from Medicaid as we can only get paid fee for service now. It is definitely on the strategic plan and gaining access to these populations is a win for everyone! Keep trying…

  10. Everyone should be able to access oral care and be able to benefit from it, the nursing home should not be excluded. Preventive care allows the patient to be aware of preventing oral disease and enjoy food at all age. We are willing to go to them and make it convenient for them. People in nursing home are the parent of others and they deserve to be taken care of because they took care of this generation and we should take care of them, it’s only fair to pay them back for them.

  11. Access to care is a critical component of any healthcare system. The dental hygiene community is ready and willing, we only need the State legislatures to step in and allow us to serve those who desperately need it.

Leave a Reply

Your email address will not be published. Required fields are marked *


Facebook Comments


707 Signatures

  • jeff hopkins
  • Hermann Kastner
  • James Thrailkill
  • Mal Gaff
  • Holly Hall
  • Terrie Phenicie
  • Nancy Petersen
  • Alexander Dolowitz
  • Melanie waleski
  • Marianne Oelman
1 of 71123...71
Skip to toolbar