Q: I am an entry-level OTR working in a skilled nursing facility. It's evident to me that oral care is not a priority here. Is there anything I can do as an occupational therapist?

A: Many older people have destructive periodontal disease or other oral issues. Bacteria that are allowed to enter the bloodstream from deteriorating teeth or gums can damage the heart and cause bacteria to spread to other parts of the body. According the CDC, studies have found poor oral health, plaque and respiratory diseases and lung infections to be associated with bacteria found in the oral cavity.

Many older people lack dental insurance, since Medicare does not cover dental care in most cases. There are also access issues for those who have limited community mobility or are in facilities. That does not mean, however, that dental care should be ignored! Every senior citizen or resident in a nursing home should see his or her dentist every six months.

Studies of nursing home patients show that simple, mechanical tooth brushing supplemented with mouth irrigation with an iodine solution significantly reduces the rate of pneumonia. The CDC found that those residents whose teeth were regularly cleaned had fewer cases of pneumonia and were less likely to die from the infection. The investigators found that residents whose teeth were not given additional dental care were almost twice as likely to get pneumonia.

I believe OTs can play a more aggressive role with mouth hygiene. Everyone shifts the blame when, in fact, we are all guilty to some extent. Proper mouth care is an activity of daily living. Just because you are working on another goal does not mean that you have to negate other elements of care. Start noticing your residents who have ongoing and recurrent diagnoses of pneumonia and you may see a connection.

As an occupational therapist you can start by making sure that your patients receive daily mouth, dental and denture care. Mouth care is mandatory, and is a "written" part of the resident's care plan. It is your responsibility, regardless of the goals on your treatment plan, to be concerned about your resident's overall care.

All residents in nursing homes should receive good mouth care for many reasons that impact their overall function and ability to participate in meaningful occupations. Good oral care prevents diseases; allows the resident to eat more easily; improves the resident's taste perception; improves the resident's quality of life and self esteem; and allows greater socialization without embarrassment.

Poor dental hygiene, on the other hand, can lead to many problems. It can increase the risk of undetected periodontal (gum) disease, pneumonia and other respiratory complications including chronic obstructive pulmonary disease. The resident may have a coating or lesions on his or her tongue that can affect taste and eating; bleeding and pain in the mouth can also interfere with chewing, biting and swallowing. If poor mouth health affects the resident's eating it can lead to weight loss and malnutrition.

Here are some tips for applying your resident's dentures correctly:

• Be sure to clean dentures after every meal because plaque can form on them and food can become impacted under them.

• Remove the dentures every evening to allow the gums to rest and heal.

• Use a scrubbing solution, even toothpaste if it's not too abrasive.

• Dentures should be cleaned at least twice a day. Do not use hot water. Soak overnight.

• If they are cracked or chipped, take them to the dentist.

• Ensure the dentures fit correctly; poor-fitting dentures can cause mouth ulcers.

Here are tips for brushing the teeth of older people:

• Use an electric toothbrush because it has a larger handle and can be better for someone who has arthritis.

• Replace a toothbrush every three months. Use only a small amount of toothpaste.

• Brush both gums and teeth. Leave the toothbrush uncovered to air dry and kill germs.

If the residents in your facility are not receiving proper dental care, be sure to notify the supervisor of the person responsible for the care, as well as the director of nursing. Review the daily checklist of care to be sure mouth care was completed for your residents. Raise awareness by organizing ongoing in-services on this topic.

Clarissa Fells Smith, PhD, OTR/L, has a doctorate in health services administration with a specialty in gerontology/geriatrics. She has worked as a manager and clinical education specialist and is currently an independent contractor, trainer, consultant and workshop leader in geriatric rehabilitation. Readers may contact her at clarissafsmith@aol.com.