NURSING-HOME PATIENTS NEED BETTER DENTAL HYGIENE.

Byline: Linda Carroll Medical Tribune News Service

With improvements in dental care over the past several decades, increasing numbers of the elderly are keeping their teeth.

But unless nursing-home staffs begin to recognize this trend, many older people could end up with painful cavities and plaque-encrusted teeth, according to a study published recently in the journal Quality in Health Care.

Currently, nursing-home patients fare far worse in terms of dental care than elderly people living at home, British researchers reported. In a national survey, nearly a third of elderly nursing-home patients were found to have tooth decay, compared to fewer than 10 percent of those living on their own.

Beyond this, more than three-fourths of the frail and dependent elderly people living in institutions had plaque so thick that it covered most of their teeth and actually blocked the spaces between the teeth, the researchers reported.

``Historically, the dental care required by most of this population amounted to no more than occasional replacement of complete dentures,'' noted Angus Walls, a professor in the department of restorative dentistry at the University of Newcastle upon Tyne. ``For most of the population, the options were limited, the costs low, and the results predictable, though not always ideal.''

But this is changing, Walls pointed out.

In 1968, almost 90 percent of the 75-year-olds in England and Wales had no natural teeth. Based on survey data, Walls predicts that by the year 2,018, the number of toothless Britons of that age will drop to 30 percent.

With increasing numbers of elderly people keeping their teeth into very old age, care-givers need to put a greater emphasis on dental care, Walls emphasized. And they need to realize that older people have special dental needs, he added. For example, elderly patients are more likely to develop cavities in the tooth roots as receding gums leave them exposed to bacteria.

A New York dental expert said he wasn't surprised that the institutionalized elderly turned out to have higher rates of decay than those living on their own.

``It's common sense,'' said David Albert, an assistant clinical professor in the school of dental and oral surgery and the school of public health at the Columbia Presbyterian Medical Center. ``There are more people in this setting who cannot take care of their own oral hygiene.''

In America, the issue of unattended dental problems may not be limited to nursing-home patients, Albert said.

``In this country, there is rarely medical coverage for dental problems in the elderly,'' he said. ``If an older person has dental problems - if he needs dentures or restorations replaced - that comes out of pocket.''

Because of this, elderly people on fixed incomes often skip trips to the dentist, Albert said.

Another problem is with misconceptions among the elderly, he said. Often older people think that if they still have their teeth, they're lucky and they don't have to worry.

``But as you get older, you need more dental care and not less,'' Albert said.

Some simple precautionary measures can protect teeth, according to the New York expert. First, Albert recommends that elderly people see a dentist at least once a year.

Another way to protect teeth involves having a fluoride varnish painted on the exposed roots, according to Albert. ``This can help prevent cavities in patients who are not really able to take care of their own dental health,'' he said. ``Painting the varnish on the surfaces of the teeth builds up a kind of `immunity' to cavities.''