What is expected in a nursing home regarding dental hygiene?

Every state has its own rules regarding this. When I worked for our dental division of the State Dept. Of Health, a law was passed to insure that nursing homes had to do dental hygiene procedures daily. Now the other issue is how well are they trained. As a dental hygienist I will tell you a lot of people are grossed out by caring for the mouth so I’m sure there are staff who will barely do it. The bad breath, bleeds ng gums are from bacteria causing periodontal disease. Dental caries at the gum line are due to plaque and food being left there long enough to break down the enamel. Two places you can call to find out what regulations the nursing home is to follow. Your dental division of The State (not county) department of health or the Board of Dentistry in your state. Hopefully you will find out. But from a hygiene point of view a mouthwash doesn’t do anything...just a bandaid. Dental plaque which is full of bacteria needs to be removed from all tooth surfaces once a day. Flossing should be once a day to prevent gum disease and cavities between teeth. You will not find aides flossing but they should brush. This is neglect if your mother is unable to do this herself. The nursing home should have a dentist who is affiliated with them. Ask who it is and get them to come and check her.

I think places handle it in a variety of ways and I suspect that the rules and regulations of many facilities may not even address it.

We were trying to keep my LO's teeth (she has severe dementia and is in MC unit. Unable to do any dental hygiene.) and gums as healthy as possible, to avoid losing them all and to avoid invasive procedures. She had 3 extractions and then regular cleanings. Her dentists PRESCRIBED that the facility brush her teeth twice a day and that she rinse with ACT. With the prescription, they HAVE to abide by that regimen. It there is no dentist order, I don't think they do anything regarding their dental care. That's my take on it. And, her teeth and gums look so much better. She had let her dental care go when she got dementia, but, now, she seems to be stable.

Thank goodness for a great dentist who works with dementia patients.

This is something I posted about not too long ago. My mom only has 6 of her own teeth left and she needs them to anchor her lower dentures, yet after 6 months in facilities I was shocked to discover her gums bled profusely when I brushed her teeth. Everyone assured me that they do oral care and seemed to accept that bleeding gums were normal. No, they are NOT!! I imagine that aside from to possibility of losing her teeth mom's mouth must have been painful.
I managed to get a dentist to advise on prescription mouthwash which the nurses had to administer which did heal mom's gums, but they tried to get mom to swoosh and spit despite being told to use a swab, needless to say she mostly swallowed instead of spitting.🙄 Now I clean mom's teeth myself once or twice a week with a drop or two of peroxide on her brush and proxabrush just to make sure.

Rather late in the day, I discovered that if you made enough piteous phone calls along the chain of command you would eventually be put through to the community dental team and they would appear miraculously at your home to see to your mother.

Better still, the "team" comprised a dentist and dental nurse who were lovely, and brilliant with my mother, and who told me not to be tentative - just get right in there with a small-headed electric toothbrush, my fears that I might dislodge something were groundless, and even ninety year old roots were a lot tougher than I might expect.

Now, admittedly this was through the NHS which in your case you do not have. But it still proves that house-calling dentists are a thing, and I will put money on it that if you keep digging you will find one.

My expectations of care settings on this point had already taken a dive when my mother's post-stroke rehab team started treating her for thrush having failed to read "partial denture" on her notes. They don't look. They evidently don't assist; and they certainly don't do it for the person. So with the routine care it comes down to "if you want a job done properly, you have to do it yourself." Get busy.

If you can't or anyway don't visit often enough for this to be practical, I should start by asking the NH what is supposed to happen with support for personal care and see what is said about dental hygiene. I mean, it should be obvious, it should be routine, but it's just possible they're operating some kind of daft exclusion clause - and if they're not, then you have a valid complaint which the NH needs to resolve.

And don't swallow mouthwash. Have you read the ingredients label???

Dental hygiene in the nursing home where my husband is a resident does not exist. They simply do not, never have, brushed his teeth or given any mouth rinse. I try and visit my husband at least 5-6 times a week. Part of our routine is brushing teeth. He spits out blood, his teeth are not the best, but I feel an accomplishment knowing when I leave the nursing home for the day, oral hygiene has been done to the best to my ability. There are no visiting dentists. Also, please check your mom's fingernails and toenails. This is another big concern of mine. The nursing home does not do it, nor do they have a doctor come in that does. All-in-all, the best advise I could give anyone who has a loved one in a nursing home is please be observant. I have even turned down my husband's bed spread to discover there were no sheets on his bed. Another time my husband apparently had thrown-up. Instead of changing the pillowcase, one of the aides turned the pillow upside down! So, please be vigilant. Nursing homes will cut any corner they can to avoid hiring adequate staff or to keep an adequate supply of products available. I have seen aides use unwashed towels and wash clothes on several patients, personal wipes bought by family members taken out of resident's drawers to use on other residents simply to save money. Personally, I have taken several boxes of extra soft wipes---a total of 120 wipes in all. In 2 days both boxes were used up! In 2 days! When I ask the aides where all the supplies went as there should have been enough for several weeks, I get a dumb look. Nursing homes are not the best, but they are the best we can do for a loved one. You may wish to check with your mother's PCP and ask her doctor what he/she would suggest. There are also finger tooth brushes. If you brushed your mother's teeth very gently, I don't see any ripping up of the gums. Flossing is probably out, but you may like to try either a finger tooth brush or a extra soft regular toothbrush. Start out very slow and gentle at first even if you only accomplish one or two teeth being brushed. Once your mother becomes accustomed to brushing, she may be able to tolerate a more thorough procedure. Good luck.

In June, on transfer to the facility where my mom now is, I was given forms to sign, one if we wanted dental care, another other for podiatry care, and the dates when these mobile units would come visit. I signed them and figured good, that will be done and I'll probably be billed. Turns out, neither the dentist nor a podiatrist saw mom and nobody bothered to tell me. I received a letter from the mobile dentist wanting $150 up front for a complete check-up and cleaning. The dentist had been there but never looked at her since she is private pay and they do want their money first. When mom becomes Medicaid, I'm to notify the dentist's office, and I believe they will at least check her now and again, who knows. I made a copy of that bill and proof I paid and gave it to a nurse to put on mom's chart; the dental office did cash that check, and I will be checking to be sure it gets done next time the dentist comes.  (Mom does have Aetna Medicare, and I can file a claim afterward).   She does have bleeding gums, her teeth have always been a problem but I did take mom to the dentist every six months prior to her being admitted to the NH. I did buy some of those oral sponge swab sticks from Amazon and a small bottle of mouthwash and attempt to clean her teeth a bit after dinner at times, and she likes the taste of the mouthwash. I actually found the same swab sticks in one of her drawers, so somebody has attempted. I find that some of the aides are more old school than others, and some days when I come in, she sure looks better than on other days. Mom can get very nasty, so I understand the difficulty in dealing with her hygiene. This place, probably like all other care places, is always in need of more aides.

Nothing at all from the podiatrist, and I keep forgetting to ask who exactly that is. I actually check her feet myself at times when she isn't wearing the Ted hose and do what I can to trim/file the nails.  I file her fingernails and use a cream occasionally on her legs and feet; she has very dry skin.

My mother-in-law with Dementia lived with us, and she brushed her own teeth for a while. 93 years old, and she still had all her natural teeth, both upper and lowers!

However, as the Dementia progressed, she was no longer able to brush her teeth unsupervised. I caught her one day putting hand soap on her toothbrush, so that was when we began storing her toothbrush where she couldn't get to it, and had to assist her.

I brushed her teeth to knock out most of the food stuff, and then gave her the brush and told her to 'brush vigorously', which she understood. I then had her rinse with water from a glass.

We didn't have her use mouthwash because we didn't want her to get ill if she swallowed any. We also didn't attempt to floss her teeth because we figured that would have been too painful for her, so we decided it was more important to at least brush her teeth and gums.

We wanted to take her in to have her teeth cleaned, but her Dentist said they couldn't because Dementia patients often become combative in the chair. :-(

I have my mom at home, so I will add a different perspective. I have been helping Mom brother her teeth for years. We used to take her to the dentist every 3 months for cleanings, because we knew she wasn't getting great brushing. Then one day we went in (about 2 years ago) and she refused. So the dentist was finished. I continued to help her brush 2-3 times a day...but she became more and more resistant. I purchased peroxide swabs and added that to our oral routine. I will tell you that now, stage 7, I do attempt twice a day to brush her teeth... She bites the brush, clinches her teeth together, sucks the tooth paste and closes her lips most of the time. Her gums bleed everytime. No, this is not great, but it is what it is. I have asked my dentist, her dentist, a friend in another state that is a dentist... No one has any good ideas. I do try to use the swabs but have to be super careful as she will be them and then I have to deal with a choking hazzard. My mom has all her own teeth. I guess I can understand the NH having issues providing dental Care because I have trouble with it and I only have one patient.

Oh gosh yes, it is not easy, and all credit it to you for persisting.

Also, of course, one does not wish to get bitten!

Racking my brains for something that a) is chewy; b) encourages salivation and c) is edible without being a choking hazard. Does your mother have a swallowing impairment as such, or is she fine with actual food? I dimly remember 'Tomorrow's World' doing a study of foods to find which left least plaque on the teeth and peanuts (obviously a non-starter) and cheese topping the list. Would she chew on small slices of Edam or something like that?

You've probably already tried this, but while I'm teaching my grandmother to suck eggs anyway... what about giving her the brush to hold and guiding her hand? Wondering if that might trigger a muscle memory and at least get a bit of the job done.

You may want to buy mouthwash and even toothpaste online at a company called Cari Free.com. They specialize in products used for gum disease. If you do purchase from this company, their mouthwash is NOT to be swallowed. It is dentist recommended.