Long-Term Care Patients Refuse Dental Treatment

Dentistry Today


Nearly 90% of patients at long-term care facilities don’t take advantage of dental services, even when they’re free, according to the University of Buffalo (UB). The research also found that the longer patients stayed at a nursing home or an assisted living facility, the more likely they were to use dental services. But even among those patients who had stayed at the facility for years, only 55% used the services. 

Still, the researchers point out that the low utilization of these services reflects overall attitudes toward oral healthcare. Based on data from 2014, the Centers for Disease Control and Prevention report that nearly 4 in 10 American adults don’t visit the dentist.

“There is a problem within the population as a whole toward appreciation for dental care. The perception is that if you don’t have pain, you don’t have a problem,” said Frank A. Scannapieco, DMD, PhD, lead investigator of the study and chair of the Department of Oral Biology at the UB School of Dental Medicine.

The study examined the dental and medical records of more than 2,500 residents at the Brothers of Mercy Nursing and Rehabilitation Center in Clarence, NY, who were discharged between 2008 and 2012. Among the group, only 10% received a dental exam at least once during their stay.

The average length of stay at the facility was 2 years, with nearly half of the patients staying less than a month. Usage rates of dental services ranged from 7% for patients who stayed less than a month to 30% for those who stayed between a month and 2 years. Usage rates increased to 55% among those who stayed beyond 2 years.

Age also was a factor, as patients aged 76 years and older were twice as likely to use dental services as younger residents. Patients with endocrine, nutritional, metabolic, immunity, mental, and circulatory system disorders and diseases were more likely to receive dental services as well.

Scannapieco suggested that medical treatment took priority over dental services for patients who stayed less than a month, often for short-term rehabilitation. These patients also were likely to have their own dentists outside of the facility. But he said he was surprised to find that the usage of dental services remained low among the rest of the patients.

The New York State Department of Health requires all patients newly admitted to long-term care facilities be offered dental services upon admission and annually afterwards. The patients are saying no. Scannapieco said that financial barriers are a common deterrent for patients in need of dental care.

While Medicare does cover dental exams, it does not cover many procedures, and oral healthcare is seen as less of a priority than other medical needs, Scannapieco said. Improving this attitude toward dental care may lie in connecting oral health with overall health and quality of life, Scannapieco said.

“We need to do the research that answers if excellent dental health translates into prolonged life, health, and perceptions of quality of life,” said Scannapieco. “That is one of the major questions around dental care that is still unanswered: Does optimal dental care prevent medical diseases?”

The study, “Factors Associated with Utilization of Dental Services in a Long-Term Care Facility: A Descriptive Cross-Sectional Study,” was published by Special Care in Dentistry.  

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