Dental Care in Long Term Care Homes

Sephora Djomo Ngwamou, Taylor Gowans, Manisha Sharvananthan

Project Smile Global

10 September 2025

Long term care (LTC) homes provide a wide variety of services for older adults who cannot live alone (Hamel et al. 1-26).  It has been observed worldwide that older adults living in LTC homes are at higher risk of poor oral health outcomes compared to older adults who do not (Laurence 177-84). In general, the residents living within LTC homes are more susceptible to other health complications (Haumschild 667-71). There has been evidence-based research that highlights how chronic oral complications are linked with poor health outcomes for residents in LTC homes (Haumschild 667-71). Seniors living in LTC homes are often dependent on the care of staff for assistance with activities, which includes oral care (Yoon et al. 359-64). Frail residents are particularly expected to experience worse oral health outcomes as they usually require more assistance (Yoon et al. 359-64). The interconnected relationship between body and oral health emphasizes that close monitoring of dental care among residents is needed to understand the root cause of the disparities observed to devise effective intervention plans (Haumschild 667-71).

The oral health issues experienced by seniors living in LTC homes were accentuated in a national study on Canadian LTC homes by Marusiak et al. (180-190). Residents in Marusiak et al.’s study were found to have lip problems (69.8%), edentulism (42.4%), angular cheilitis (5.1%), denture stomatitis (8.5%), denture-induced hyperplasia (2%), tooth pain, periodontal disease or inflammation (79.6%) and more (180-190).  These issues observed within Canadian LTC homes are not unique, as similar problems have been reported in the U.S. and the U.K. Systematic reviews have found that oral health care in U.S. LTC homes is often neglected, leading to unmet oral health needs among residents (MacEntee et al. 41-52). In Wales, a study found that three-quarters of residents living in LTC had tooth decay (Karki et al. 331-34). The widespread oral health disparities among LTC residents across countries emphasize that poor dental hygiene and limited access to treatment are not confined to a single national border. In general, oral health issues within LTC homes are linked with worse quality of life (Marusiak et al. 180-190). For example, residents with oral health conditions can have challenges with food intake, speech, facial aesthetics and social interaction. Moreover, LTC residents with poor oral health, particularly periodontal disease, face a higher risk of conditions such as aspiration pneumonia and systemic diseases (Haumschild 667-71). These trends in health suggest that there is a need for revised evidence-based interventions that better address the oral health needs of those living in LTC homes.

Health care professionals, such as nurses, social workers, physical therapists, physicians, and pharmacists play a key role in maintaining the health of LTC home residents (Crittenden 334-39). However, it has been observed that they often receive limited training on older adult oral health care (Crittenden 334-39). Additionally, health care professionals often face time constraints, staff shortages, or resident resistance to care, all of which can contribute to a decline in overall oral health (Crittenden 334-39). In LTC homes, nurses frequently carry primary responsibility for residents’ oral hygiene, such as performing toothbrushing and ensuring proper care of dental prostheses (Crittenden 334-39). Nevertheless, the absence of a clear or consistent routine for providing oral care to the residents prevents the staff at LTC homes from  properly providing these services (Laurence 177-84). Hence, more in-depth training in oral health for nurses in LTC homes could lead to improved outcomes (Crittenden 334-39). The training provided regarding oral health care could be extended to workers beyond direct care staff and nurses, so that there is a collaborative spirit to change oral health practices for the better.

To improve the oral health outcomes of older adults living in LTC homes, a daily checklist specific to oral care with random inspections by a nurse on duty could improve oral hygiene (Laurence et al. 177-84). A research article by Laurence et al. investigated whether this intervention would reduce residents’ plaque levels and overall improve their oral hygiene. (177-84). The checklist required nursing staff to brush residents’ teeth twice daily and clean their dentures when applicable (Laurence et al. 177-84).  The study found that these measures improved residents’ oral hygiene, significantly lowering plaque levels (Laurence et al. 177-84). However, the researchers acknowledged that the small sample size limited the study’s ability to draw general conclusions. Despite this, the findings showed promising results, and many LTC homes could benefit from implementing such an intervention. Another strategy that LTC homes could consider investing in is to provide regular dental hygienist services, such as biannual professional cleanings, which are known to reduce plaque buildup and prevent the progression of oral complications (Needleman et al. 12-35). Given financial constraints, LTC homes could encourage residents’ families to arrange private hygiene services and schedule dental visits. Combining a structured checklist with regular hygiene care could help narrow the gap in oral health outcomes between LTC residents and older adults living in the general population.

Overall, residents living in LTC homes are often at greater risk of poor oral health that leads to additional health complications. Evidence-based research demonstrates strong links between chronic oral health problems and broader health outcomes. As LTC residents typically rely on staff for daily care, targeted interventions are necessary to reduce these disparities. An intervention is needed to minimize these gaps in health between populations. Closer monitoring of dental care through checklists, combined with regular cleanings by dental hygienists, may represent an important step toward improving oral health and overall well-being in this population.

Works Cited

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Hamel, Candyce, et al. “Models of Provider Care in Long-Term Care: A Rapid Scoping Review.” PLOS ONE, vol. 16, no. 7, 2021, pp. 1-26, https://doi.org/10.1371/journal.pone.0254527.

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Laurence, Brian, et al. “Reducing Dental Plaque Scores in Long-Term Care Facilities Using a Checklist and Random Inspections: A Pilot Study.” The Bulletin of Tokyo Dental College, vol. 60, no. 3, 2019, pp. 177–84, https://doi.org/10.2209/tdcpublication.2018 0056.

Karki, Monaghan, et al. “Oral Health Status of Older People Living in Care Homes in Wales.” British Dental Journal, vol. 219, no. 7, 2015, pp. 331–34, https://doi.org/10.1038/sj.bdj.2015.756.

Marusiak, Michelle J., et al. “Professional oral health care prevents mouth-lung infection in long-term care homes: a systematic review.” Canadian Journal of Dental Hygiene, vol. 57, no. 3, 2023, pp. 180-190. 

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Needleman, Ian, et al. “Professional Mechanical Plaque Removal for Prevention of Periodontal Diseases in Adults - Systematic Review Update.” Journal of Clinical Periodontology, vol. 42, 2015, pp. S12–35, https://doi.org/10.1111/jcpe.12341.

‌Yoon, Minn N., et al. “Oral Health Status of Long‐Term Care Residents in Canada: Results of a National Cross‐Sectional Study.” Gerodontology, vol. 35, no. 4, 2018, pp. 359–64, https://doi.org/10.1111/ger.12356.