RESEARCH LETTERS

Research letters

Oral health of elderly occupants in residential homes

D Simons, E A M Kidd, D Beighton

In March, 1994, there were 16 000 residential and nursing
homes for the elderly in the UK. By March, 1998, this
number had increased to 19 000 homes with a capacity for
453 000 people. The greatest increase was for the mentally
infirm elderly whose bed provision increased 235% from
9133 places in 1994, to 21 500 places in 1998. It has been
reported that these institutionalised elderly people have
poorer oral health than those who live independently at
home.1 We offered to assess the oral health of elderly
occupants in a random sample of 55 of the 110 residential
and nursing homes in West Hertfordshire. 48 homes
accepted. We recorded participants’ age, sex, length of
time in the home, medications, number of medicines
administered as syrups, and type of dentures worn. Extraoral
and intraoral soft tissues, denture hygiene status, clinical
status of each coronal and root surface, plaque and gingival
indices were examined and recorded. A questionnaire that
covered oral health and past dental care was completed in
the form of a structured interview and was conducted with
all those residents who were able to respond.
The sample consisted of 249 men and 792 women, with a
mean age of 83·9 (SD 7·8) years, who had spent 24·9 (26·2)
months in the residential homes. 598 residents were
edentulous, 203 residents had only teeth, and 240 had teeth
and dentures. The results (table) are consistent with findings
in other institutionalised populations.2–5 All studies showed
high levels of both coronal and root caries. The plaque and
gingival indices were high in this study at 2·3 (0·7) and
1·7 (0·4), respectively, and this poor oral hygiene was
significantly related (p<0·0001) to the presence of root
caries. Plaque retention is a problem in elderly people who
have difficulty in mechanically removing plaque owing to
diminished manual dexterity, impaired vision, or illness. The
highest denture debris levels were on the fitting surface of
the upper denture, mean 1·56 (0· 85). This was significantly
related to the levels of clinically diagnosed denture stomatisis
(p<0·001) and wearing dentures at night (p<0·001). Poor
denture hygiene has been found in other studies, which
showed that dentures cleaned by staff were no cleaner than
those cleaned by residents. 5 12% of the denture wearers had
clinically diagnosed denture stomatitis, 13% angular
cheilitis, and 9% both. The incidence of oral ulceration was
3%, glossitis or sore or fissured tongue 8·5%, and 19 red or
white lesions were found: these were reviewed and one
resident was referred for further examination. The
questionnaire showed that 250 of the residents had difficulty
eating, 206 had problems with taste, and 261 found it hard
to care for their mouth. Although 343 residents preferred
assistance in cleaning their teeth and dentures, only 94
reported that the staff had helped them. 927 residents
received medications known to produce xerostomia, 396
were given syrups containing sugar and 385 residents
reported suffering with dry mouth.
The managers and deputy managers indicated that there
was no systematic approach to arranging dental care. Dental
care was sought only when residents or their relatives
complained of acute dental problems such as pain or a
broken denture. Dental assessments were not carried out
when residents were admitted, neither was a care plan
developed that included intraoral care. Only 4% of the
edentate and 20% of the dentate residents had seen a
dentist in the past 2 years. The poor oral status of the
institutionalised elderly, found in this and previous studies,
may contribute to the eating problems and low nutrient and
vitamin C levels found in this group. These results,
combined with the reduced ability of elderly people to
communicate, may cause weight loss, dehydration, and
debility. It is surely a disgrace that the mouth, one of the
most personal and intimate areas of the body, should be
neglected in such a manner.
1 Steele JG, Sheiham A, Marcenes W, Walls AWG. National diet and
nutrition survey: people aged 65 years and over. Vol 2: Report of the
oral health survey. London: Stationery Office, 1998.
2 Kiyak HA, Grayston MN, Crinean CL. Oral health problems and
needs of nursing home residents. Community Dent Oral Epidemiol
1993; 21: 49–52.
3 Budtz-Jorgensen E, Mojon P, Rentsch A, Roehrich N,
von der Muehll D, Baehni P. Caries prevalence and associated
predisposing conditions in recently hospitalised elderly persons.
Acta Odont Scand 1996; 54: 251–56.
4 Jokstrad A, Ambjornsen E, Eide KE. Oral health in institutionalised
elderly people in 1993 compared with 1980. Acta Odont Scand 1996;
54: 303–08.
5 Merelie DL, Heyman B. Dental needs of the elderly in residential care
in Newcastle-upon-Tyne and the role of formal carers. Community
Dent Oral Epidemiol 1992; 20: 106–11.
West Herts Community Dental Services, Dental Department, Principal
Health Centre, St Albans, Herts AL1 3LA, UK (D Simons); and
Departments of Conservative Dentistry and Oral Microbiology, Dental
Institute, Guy’s, King’s and St Thomas’ Schools of Medicine and
Dentistry and Biomedical Sciences, London

Hertfordshire, UK Norway 1980 (4) Norway 1993 (4) Washington, USA UK 1994/95 Geneva, Switzerland
1996/97 1991 (2) (1) 1995 (3)
Number of participants 1041 190 243 1063 274 216
Number of dentate participants 443 38 112 450 57 120
Age range (years) 65·6–101 67– 67–102 72–98 65– 69–97
Mean age (years) 83·9 — 83·2 — — 83
% 57 80 54 52·7 79 55
Edentulousness DMFT 22·2 25·7 22·9 — — —
% retained roots 29·9 — 30 23·6 — 23
%RCI 54·4 — — — 46 —
% of population with coronal decay 41 — 60 26·3 31 33
% of population with root decay 51·2 — — 36 39 54
Mean number of teeth per person 11·7 12 15·7 — 10·7 11·1
References in brackets.
Oral surveys of institutionalised elderly

THE LANCET • Vol 353 • May 22, 1999 1761