By: Dr. Grace Liu and Dr. Lewis Yu
We make sure that our children and ourselves brush teeth everyday and get dental check ups twice a year. What about our geriatric parents living in nursing homes? Senior citizens in the nursing home setting have traditionally been an underserved segment of our population in terms of oral health care. We would like to use this opportunity to highlight some of the challenges that our seniors are facing and some possible solutions.
Our elderly parents face unique challenges in maintaining proper oral hygiene due to physical and/or mental disabilities that often come with old age. Reduced dexterity and hand-eye coordination translate directly to a lower state of oral health.  On top of these physical obstacles, human emotions (such as pride, embarrassment, guilt) make it so much more difficult for our elderly parents to accept help in brushing teeth. The same set of emotions also prevents us, the caregivers, from readily offering help in these mundane tasks and doing them with extreme care. For those senior citizens who live with their immediate families, they are more likely to enjoy a higher level of care from their loved ones. It is a different story for the ones who live in institutional settings.
Most of the nursing home population is frail and are medically compromised and who would require more care than their family can give. Nursing home staffs have the underappreciated job of taking care of a large number of residents with tight budget and resource constraints.  Under these circumstances, lower priority care items might be ignored.  Oral health care often falls into this category. Is it really a lower priority item?
Overall health starts at the mouth.  Oral health and medical health are very much interrelated. Here are some examples:  Proper digestion of food is not possible without good teeth.  Gum disease is an infection that can lower the immune system’s ability to fight other sickness. Bacteria in gum infections has been linked to heart disease. Illness in other parts of the body may show signs in oral cavity.  Imbalance of the bite (such as broken denture) may cause headache, neck pain, dizziness, and hormonal imbalance, ear ringing. (see the article “TMD the Great Imposter”)   This list goes on and on; however, there is one single most important factor in deciding how important oral health is. That factor is QUALITY OF LIFE. Of course it is important for our body to function properly, but what about our mental state? Would we be happier eating a juicy steak or drinking Ensure milkshake through a straw? Depression is common among the geriatric population. Imagine how difficult it is for our elderly parents to slowly lose their independence. Under these circumstances, the simple pleasure of eating and tasting food has a great impact in lifting their spirit.

What Can We Do? Education
Our team at All About Smiles has conducted many onsite training sessions for nursing home staff.  Our goals are to share with the staff techniques in assisting residents with oral hygiene procedures and in identifying signs of oral pathology and infections. We have been received with great enthusiasm from the staff.  It has been very gratifying to see these health professionals willing to learn so they can elevate the level of care.

Bring Dental Office into Nursing Home
Transportation is a common problem for home residents to receive dental care. With the advent of portal dental equipments, it is possible to perform some of the dental procedures in the nursing home. Procedures such as denture fabrication and repair, teeth cleaning are within possibility. A dentist can perform regular check up onsite and can contribute in the development of the comprehensive care plan of each of the individual resident.
As the population in the United States ages, the number of nursing home residents can only increase.  Care for our elderly citizens will continue to be a hot debate topic. Oral health care issue really should be raised in this discussion as a distinct topic, not as a secondary issue after medical care. After all, we are all going to get old.
Note: Caring for the elders is one of our team All About Smiles’ passion.  If you would like us to speak with your group about geriatric care or any other dental related subjects, we would very happy to do so.

Dr. Lewis Yu earned his degree from the University of Pennsylvania School of Dentistry in 1996. He received two years of advanced post-graduate oral surgery training in both the New York City Hospital System and the Hospital of the University of Pennsylvania.
He continues his education through extensive training at the prestigious Las Vegas Institute for Advanced Studies and the Pankey Institute. He has practiced in Philadelphia and Newark, DE before joining All About Smiles, P.A. He is a member of the Delaware State Dental Society, American Dental Association, and the Academy of General Dentistry.

Dr. Grace Liu has been practicing dentistry since 1996 having earned her degree from the New York University School of Dentistry. She continued her education through post-graduate studies at Columbia University, the Las Vegas Institute for Advanced Studies in Nevada, and the Academy of General Dentistry. She is a member of the Delaware State Dental Society, American Dental Association, the Academy of General Dentistry, and the International Association of Comprehensive Aesthetics.

Dr. Grace Liu and Dr. Lewis Yu are married and have two children.

Publisher’s Note:
You will not find a more friendly practice than All About Smiles. On my last visit I overheard another patient say “This is more like going to the spa than being at a dentist’s office.” They manage to combine the latest technology, with an extremely pleasant staff that will leave you confident you are receiving the best dental treatment possible.