By Rose Hoban

For many people with dementia, care of their teeth is an afterthought. But neglecting oral health care is something that caregivers skip at a cost to their patients.

Last year, a survey by the North Carolina Assisted Living Association found that only about one in seven people living in the state’s facilities was getting regular oral care.

“Unfortunately… there was a correlation between those communities that had lower [star ratings] and the ones that had the worst answers and the worst oral care,” said Frances Messer, who heads NCALA. She explained that the data came from staff, residents and family members of people who lived in assisted living communities around the state.

“Our goal is to do better.”

woman stands infront of a room with a powerpoint slide behind her that reads" Why does oral health matter?"
Wendy Schwade explained to certified nursing assistants at Durham’s Durham Ridge dementia care facility that brushing clients’ teeth is more than just grooming, it prevents other infections. Photo credit: Rose Hoban

So Messer has thrown the weight of her organization behind an initiative led by the state Department of Health and Human Services to get more people living in assisted living centers help with their teeth.

Messer was present on Friday when two dental hygienists from DHHS’ Oral Health Branch conducted a training for about 50 certified nursing assistants at Durham Ridge, a facility that’s home for about 120 residents with dementia.

“We have gathered stats on the poor health and the poor participation by communities, so now in 2018 we want to show where we’re going,” she said.

Infection control

More people are keeping more of their teeth longer, said Wendy Schwade, one of the dental hygienists from the Oral Health Branch.

“Complete tooth loss used to be normal,” she said. “When my mother was in her 30s she lost all of her top teeth, it wasn’t abnormal, and lots of her friends lost some of their teeth. Now, people don’t do that anymore.”

But oral health care is about more than simply having a pearly white smile.

In the past decade, multiple studies have found that people – in particular aging individuals – with poor oral hygiene are more likely to contract pneumonia.

That’s because the same bacteria that often causes pneumonia is the stuff that lives in your mouth.

“The tissue that’s in your lungs and in your windpipe is the same kind of tissue that’s in your mouth,” said Debbye Krueger, another dental hygienist. “It’s warm, it’s moist, it’s dark, it grows in the mouth. If you do not get rid of those bacteria every single day… [patients] breathe those bacteria into their lungs.”


Add to the presence of bacteria the fact that many seniors are not as active as they used to be, and that perhaps their health is compromised in other ways, it’s a recipe for lung infection.

“The bacteria form little colonies in their lungs and it doesn’t take long at all until Bingo! They’ve got pneumonia,” she said.

And it’s not just the bacteria that coats teeth that can cause lung disease, researchers have found that bacteria on tongues or on dentures can be breathed in, causing lung infections.

“Studies in NY and around other parts of the country have found that just brushing the patient’s teeth can reduce the cases of aspiration and pneumonia,” Schwade said. “If you have worked in geriatric care for very long at all, you know that.”

She explained that even while Medicare, the program that provides coverage for seniors, doesn’t cover dentistry, facilities can bill for oral care as part of an infection control regimen.

Something new

At the training, Krueger and Schwade passed around bags of oral hygiene supplies and had the CNAs perform mouth care on one another. It turns out there are more types of brushes for oral care than you’d think: a skinny one for getting in between where a tooth might be missing, soft brushes for improving circulation in toothless gums and angled brushes to clean right at the margin between tooth and gum where bacteria lurks.

woman holds up bottle of Listerine without alcohol, a better product for performing oral health care than toothpaste
Debbye Krueger talks to people attending the workshop at Durham Ridge about using products without alcohol in them. Photo credit: Rose Hoban

“No matter how you’re holding it, it automatically puts the bristles at a 45-degree angle,” Krueger told the group. “[It’s] important for someone who’s not just brushing their own teeth, but someone else’s teeth multiple times a day.”

She also instructed the CNAs not to use toothpaste on dentures, because the paste gets into the crevices of the devices and can cause damage to the devices.

“That was something real big, something I have learned,” said CNA Nadean Hall, who’s been a nurses aide for nearly three decades. “I was actually doing the wrong myself. That surprised me.”

Krueger and Schwade recommended that Durham Ridge switch over from disposable toothbrushes to making up individual kits with the right brushes for each resident. They said it would be cheaper.

“That’s only five dollars if you bill it out as ‘grooming,’” Schwade said. “You can also bill as infection control, which will pay for the kit in your first 15 minutes.”

And they warned against using any products with alcohol in it, as it can damage oral tissue.

“Instead of brushing with toothpaste, you actually use the fluoride toothpaste at the end to stay on their teeth almost as a fluoride treatment,” Schwade said.

Changing practices

Durham Ridge manager Janet Moose said Messer asked to kick off their oral health education campaign at Durham Ridge, which has about 65 CNAs on staff.

“We have to have so many mandated classes,” Moose said. “The state mandates us to do training and it’s an ongoing, never-ending process of training, training, training. Sometimes it’s difficult and challenging to get the required training much less the extra stuff.”

But the DHHS training also provided Moose’s employees with two continuing education hours in addition to the information.

Moose and CNA Nadean Hall said that performing oral care during the training on their co-workers was eye-opening.

“They wanted each of us to experience what it was like for another person to brush your teeth, having their hands in your mouth,” Moose said.

And after the session, Moose said all the CNAs were requesting more tools to do a better job.

“I’ve had a number of CNAs come in and ask me about, ‘You know, I think I need this type of brush for this resident,’” Moose said. “So, we just ordered our supplies.”

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

One reply on “Oral Health Initiative Seeks to Reduce Disease Among Seniors”

  1. Thank you for covering our event at Durham Ridge. The article shows the heart and soul of our Special Dentistry Program.
    We will share the article and use it to promote our 2018 Special Dentistry Campaign to improve the oral heath status of all residents residing in the Assisted Living Communities in NC.

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