Metropolitan Digital

The Conversation

  • Written by Frank Scannapieco, Professor and Chair of Oral Biology, University at Buffalo, The State University of New York

Elderly people in nursing homes often go without a good toothbrushing.

While it might be icky to imagine the horrible way that feels to the oldsters, there are consequences worse than grossness. The mouth and other parts of the oral cavity are a gateway into the body, allowing bacteria inside our bodies that can cause serious disease.

This lack of basic care is big issue for seniors in nursing homes, who number about 1.3 million[1]. It is an example of serious challenges that these facilities face in keeping people healthy. One recent study published in Special Care in Dentistry in 2017 found that only 10.3% of patients [2] admitted to a nursing home over a five-year period utilized dental services within the home at least once during their stay.

A recent investigation by The New York Times into a fatal fungus[3] in nursing homes highlighted one specific difficulty of patients in nursing homes, bringing their plight to the forefront. Even so, it’s not exactly captured the attention of the presidential candidates.

I am a dentist and periodontist also trained in microbiology. About 30 years ago, I began to investigate how bacteria in the mouth could affect overall health. My colleagues and I determined, for example, that bacteria that cause pneumonia likely first stick to teeth before being aspirated, or inhaled, into the lungs, especially in vulnerable patients such as those who are intubated in intensive care units or who reside in nursing homes. In one study, we found that the bacteria cultured from the lungs of hospitalized patients with diagnosed pneumonia were identical to those cultured[4] from the teeth of the same patients.

No one’s ideal residence

There is good documentation that oral hygiene in hospitalized and nursing home patients is often overlooked, deficient and sometimes ignored[5]. The lack of care, including toothbrushing, has been ignored for years, in part because basic Medicare does not cover dental care.

Thousands of people a day who are in nursing homes often go without their teeth being brushed[6]. The bacteria that arise as a result of the poor care often are resistant to antibiotics[7], and contribute to infections that which are commonly found in these places[8].

And, there is considerable evidence[9] and general agreement that microbes that cause pneumonia in health care facilities can enter the lungs through the mouth to cause severe lung infections.

This problem will certainly worsen as the the population ages and more people will require nursing home care.

Of oral biofilms and pneumonia

Lack of toothbrushing for seniors in nursing homes may sound gross, but it's a serious health risk Good oral hygiene might be one of the best ways to prevent pneumonia. bbernard/[10]

One of the best-documented connections between the oral cavity, which includes the teeth, tongue and gums, and overall health is pneumonia. A substantial body of evidence suggests that attention to oral hygiene can reduce the risk[11] for pneumonia. This is especially well documented in the case of hospital- and nursing home-acquired pneumonia[12], both common forms of pneumonia which kill many people and have a large economic impact. Bacteria first make a home in the mouth and then can be aspirated, or inhaled, into the lungs to cause serious infections.

The bacteria that normally reside in the mouth grow as dental plaque, a biofilm[13] that firmly attaches to teeth and oral surfaces such as the tongue. Dental plaque is difficult to remove, and the bacteria within them are more resistant[14] to anti-microbial rinses.

While toothbrushing and flossing help, the best way to remove biofilm like dental plaque is for a professional such as a dentist or hygienist to remove it with sharp instruments or ultrasonic scalers[15]. This mostly does not happen since payment for such services are mostly not covered[16] by medical insurance. Various interventions have been explored and show promise, including nurse-assisted toothbrushing, oral rinses such as chlorhexidine[17] and betadine[18] and topical antibiotics.

Lack of toothbrushing for seniors in nursing homes may sound gross, but it's a serious health risk Plaque build up could house bacteria that can cause pneumonia. YAKOBCHUK VIACHESLAV/[19]

For toothbrushing and flossing to work, they must be performed meticulously several times a day.

Older patients are often too sick to do this themselves, or they may not do it well enough. While nurses and nursing aids can perform this task, they are often overwhelmed doing other things, and they themselves may not be sufficiently practiced to this task well. Performing effective oral hygiene is quite difficult and time consuming. It is also often unpleasant due to the fact that oral biofilms often produce unpleasant odors, and may contain food debris.

As a result, oral hygiene is at best performed mostly inadequately for these patients, and at worst, not performed at all.

As a practitioner and researcher, I find it frustrating that proposals to study more effective methods to improve hygiene in older people are almost always passed over by granting agencies. The reasons for this are not clear, but I wonder if there is bias from medical researchers against the idea that dental care is worth the cost in this setting?

There are some glimmers of hope. A number of scientific studies have been published to document how implementation of oral care strategies can reduce the level of serious infections such as pneumonia. One recent study[20] found that enhanced oral care before surgery and on the units, along with other tasks such as enhanced management of tubes inserted into the trachea, and appropriate stress ulcer medication, statistically reduced pneumonia rates over a four-year period. Such outcomes require widespread attention not only by caregivers such as nurses, but also by attending physicians, managers and ultimately insurance providers.

[ Deep knowledge, daily. Sign up for The Conversation’s newsletter[21]. ]


  1. ^ 1.3 million (
  2. ^ 10.3% of patients (
  3. ^ fatal fungus (
  4. ^ identical to those cultured (
  5. ^ often overlooked, deficient and sometimes ignored (
  6. ^ go without their teeth being brushed (
  7. ^ resistant to antibiotics (
  8. ^ commonly found in these places (
  9. ^ evidence (
  10. ^ bbernard/ (
  11. ^ attention to oral hygiene can reduce the risk (
  12. ^ hospital- and nursing home-acquired pneumonia (
  13. ^ biofilm (
  14. ^ more resistant (
  15. ^ ultrasonic scalers (
  16. ^ mostly not covered (
  17. ^ chlorhexidine (
  18. ^ betadine (
  20. ^ recent study (
  21. ^ Sign up for The Conversation’s newsletter (

Authors: Frank Scannapieco, Professor and Chair of Oral Biology, University at Buffalo, The State University of New York

Read more

Metropolitan republishes selected articles from The Conversation USA with permission

Visit The Conversation to see more

Entertainment News

Phish’s 2018 Fall Tour to Conclude with Four Performances at MGM Grand Garden Arena

LAS VEGAS (May 15, 2018) – Phish, the American rock band known worldwide for its dedicated fan base, recently announced a 14-date Fall tour which will conclude in Las Vegas with four performances at...

Blane Ferguson - avatar Blane Ferguson

Dave Damiani and The No Vacancy Orchestra are “Bending The Standard”

Tina Sinatra, Dave Damiani & Landau Murphy Jr. celebrate 100 years of Frank Sinatra in Los Angeles There have been stories about independent filmmakers, but how about the independent big band...

Tom Estey - avatar Tom Estey

Billboard Chart-Topping Saxophonist VANDELL ANDREW Returns With New Single

From the vantage point of 30, his age and the name of his infectious, sensually grooving new full length album, Vandell continues to be fueled by the impressive roar of accolades and achievements th...

Metropolitan Digital - avatar Metropolitan Digital

Metropolitan Business News

Office Cleaner Takes Ownership of the Neglected Dishwasher

In an office that a dishwasher is being used communally, it is pretty difficult to set rules on how a certain appliance needs to be taken cared of. A dishwasher is a responsibility of no one until you...

News Company - avatar News Company

Amazing tips to become a successful trader

Everyone is working very hard to secure their financial freedom. Most of the people find it hard to support their family even after having a 9-5 day job. For this very reason, people often look for ...

News Company - avatar News Company

Best Practice For Young Professionals Working Through HR Internships

The industry of human relations is vitally important to the health and prosperity of a business.   Whether they are operating in textile manufacturing, accounting, sports, IT development or hospit...

News Company - avatar News Company

4 Easy Steps To Gaining SEO Momentum For Your Business

SEO (search engine optimisation) does not have to be a tiresome and overbearing exercise that diverts attention away from the core functions of a business.   SEO Shark affirms this as a smart and ...

News Company - avatar News Company

How to Manage An SEO Project On Limited Funds

SEO operators don’t need thousands upon thousands of dollars to become successful.   What SEO practitioners needs more than ever is the skills and diligence to identify problems that are acting a...

News Company - avatar News Company

An Introduction To Coworking For Australian Business Owners

Advancing technology is bringing with it great advantages in communications and networking, and to survive in business you need to keep up. With the rate at which everything changes these days, that...

News Company - avatar News Company


New Baggage Regulations to Help Aussie Parents Travel with Infants

Travelling around the globe has never been easy, especially when infants tag along for the trip. One of the main issues that parents often have to deal with is the need to bring extra item...

News Company - avatar News Company

Maya Beach Opens to Tourists

Despite recent reports that Southern Thailand's famous Maya Beach will close for three months this year, in fact no decision to this effect has been made by Thai authorities. Phi Phi Nati...

Maevadi Rosenfeldt - avatar Maevadi Rosenfeldt


SKYN®, Australia’s best-selling condom*, today launches its very first SKYN® Places of Intimacy Guide.   Curated in partnership with GQ Magazine and Conde Nast, the Guide features 30 lux...

SKYN - avatar SKYN