Oral health care among nursing home residents in Avon Heather Frenkel', Ian Harvey^ and Robert G. Newcombe-' ' Department of Oral and Dental Science, University of Bristol Dental Hospital, Bristol BSI 2LY, UK • Population Health and Primary Cure Group. School of Healtli Policy and Practice, University ol hast Anglia, Norwich, NK4 77 J, UK 'Department of Medical Computing and Statistics. University of Wales College of Medicine, Cardiff, CFI4 4XN, UK. Abstract Objective: To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention. Design: Descriptive survey, interview and clinical data. Setting: 22 randomly selected nursing homes in the Bristol area. Method: 412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries. Results: Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects. Conchisions: Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned. Key words: dental care for the aged, nursing home residents, oral health, denture hygiene, denture stomatitis, oral hygiene, dental caries. Introduction As longevity in industrialised countries is increasing, edentulousness levels are falling. Successive cohorts of elderly people are retaining more natural teeth well into old age. Oral health maintenance for people with ageing dentitions will increasingly present problems for the dental profession. In comparison with their high use of medical services, older adults' use of dental services tends to diminish with increasing age and decreasing mobility'^ Elderly people are frequently prevented from achieving good dental and denture hygiene due to lack of information", failing eyesight and impaired dexterity^'^. Individuals with compromised independence may, while a degree of self-care is still possible, elect to live in a residential home. However, severely functionally dep)endent elderly individuals may require nursing as well as personal care. Many individuals in this latter category are admitted to nursing homes where all their care needs are assumed to be met. However, studies have indicated that nursing home residents' oral health is worse than that of similarly aged community dwellers, and that an emergency rather than a routine dental check is the usual reason for requesting a dentist's services for a resident*"**. Dental diseases do not exclusively affect the mouth but also impact on physical health'"'^ and on psychological and social well-being'^ '\ Conversely, systemic disease and medication can markedly affect the health of the tnouth''*'^'^. Oral health is therefore an important factor in Volunne 17, No. 1