Nursing Home Wordlist

One was Kansas, where dental hygienists examined 540 older residents in 20 long-term-care facilities.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

But medical directors at nursing facilities do not necessarily see the value of having a dental hygienist on contract or on staff, said Shirley Gutkowski, a dental hygienist of 27 years who educates nursing-home workers in Wisconsin.

While residents now require more dental care than in the past, nursing home employees are rarely prepared to provide it.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

Indeed, her group practice used to contract with 62 nursing homes, but now works only with 24 that make oral health a priority.

The screeners saw plenty of fillings and crowns but concluded that “regular dental care has become a thing of the past” for many of the residents.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

But after he complained of a severe, unrelenting headache, she said, she badgered the staff to make an appointment for him with his dentist.

Without daily oral care, older people taking such drugs are especially prone to “a relatively rapid deterioration,” said Dr. Ira Lamster, a dentist and a professor of health policy at the Mailman School of Public Health at Columbia.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

Without daily oral care, older people taking such drugs are especially prone to “a relatively rapid deterioration,” said Dr. Ira Lamster, a dentist and a professor of health policy at the Mailman School of Public Health at Columbia.

“Now it’s a whole different ballgame.”

Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth.

Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth.

Worse, new studies suggest that this problem may be contributing to another: pneumonia, a leading killer of institutionalized older people.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

More than one-third had untreated decay.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

“All patients receive medically necessary, high-quality care, including oral care and hygiene,” Mr. Tubbs said.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

The National Institutes of Health is financing research to address such resistance among nursing home residents with dementia.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

So important is this task that it was federally mandated in the Omnibus Budget Reconciliation Act of 1987, which set new standards for nursing homes.

Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth.

Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth.

A 2006 study of five facilities in upstate New York found only 16 percent of residents received any oral care at all.

The problem has been graphically documented in state and federal inspections of nursing homes.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

Nearly 30 percent of the residents had “substantial oral debris on at least two-thirds of their teeth,” according to a report issued by the Kansas Bureau of Oral Health.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

While residents now require more dental care than in the past, nursing home employees are rarely prepared to provide it.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

The lack of daily oral care in nursing facilities is “an epidemic that’s almost universally overlooked,” said Dr. Sarah J. Dirks, a dentist who treats nursing home residents in San Antonio.

In Wisconsin, nearly 1,100 residents from 24 homes were examined.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

Just as nursing home workers are expected to help residents bathe or reposition them to avoid bed sores, they are supposed to brush the teeth of residents who cannot do it themselves.

Just as nursing home workers are expected to help residents bathe or reposition them to avoid bed sores, they are supposed to brush the teeth of residents who cannot do it themselves.

Worse, new studies suggest that this problem may be contributing to another: pneumonia, a leading killer of institutionalized older people.

“I’m there every day, pointing out he’s in pain — and he had dental insurance.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

Whitney for The New York Times Dentures are easier for nursing home staff to clean.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

At the Raleigh Court Health and Rehabilitation Center in Roanoke, where Mr. Piercy was a resident, the administrator, Mark Tubbs, said in a statement that he could not discuss Mr. Piercy’s case because of federal privacy laws, and he could not corroborate Ms. Ford’s account.

One was Kansas, where dental hygienists examined 540 older residents in 20 long-term-care facilities.

The screeners saw plenty of fillings and crowns but concluded that “regular dental care has become a thing of the past” for many of the residents.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

But after he complained of a severe, unrelenting headache, she said, she badgered the staff to make an appointment for him with his dentist.

Medicare does not cover routine dental care like cleanings and fillings.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

More than one-third had untreated decay.

Many arrive at nursing homes with poor teeth, he added, after long periods without seeing a dentist.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

The lack of daily oral care in nursing facilities is “an epidemic that’s almost universally overlooked,” said Dr. Sarah J. Dirks, a dentist who treats nursing home residents in San Antonio.

Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

Roughly one in 10 cases of deaths from pneumonia in nursing homes could be prevented by improving oral hygiene, according to a 2008 systematic review published in The Journal of the American Geriatrics Society.

“I’m there every day, pointing out he’s in pain — and he had dental insurance.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

More than one-third had untreated decay.

“Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

But after he complained of a severe, unrelenting headache, she said, she badgered the staff to make an appointment for him with his dentist.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

Roughly one in 10 cases of deaths from pneumonia in nursing homes could be prevented by improving oral hygiene, according to a 2008 systematic review published in The Journal of the American Geriatrics Society.

Without daily oral care, older people taking such drugs are especially prone to “a relatively rapid deterioration,” said Dr. Ira Lamster, a dentist and a professor of health policy at the Mailman School of Public Health at Columbia.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

Nearly 30 percent of the residents had “substantial oral debris on at least two-thirds of their teeth,” according to a report issued by the Kansas Bureau of Oral Health.

The lack of daily oral care in nursing facilities is “an epidemic that’s almost universally overlooked,” said Dr. Sarah J. Dirks, a dentist who treats nursing home residents in San Antonio.

But even when residents and their families know that better oral care is needed, paying for it can be a challenge.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

The screeners saw plenty of fillings and crowns but concluded that “regular dental care has become a thing of the past” for many of the residents.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

Dentures are easier for nursing home staff to clean.Jennifer

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

“Before, they came in with dentures,” said Barbara J. Smith, the manager of geriatric and special-needs populations at the American Dental Association.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

Most states provide at least some dental services to adults on Medicaid, but coverage varies widely, and finding a local dentist who accepts Medicaid payments can be difficult.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

The screeners saw plenty of fillings and crowns but concluded that “regular dental care has become a thing of the past” for many of the residents.

About 31 percent had teeth broken to the gums, with visible roots; 35 percent had substantial oral debris.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

The lack of daily oral care in nursing facilities is “an epidemic that’s almost universally overlooked,” said Dr. Sarah J. Dirks, a dentist who treats nursing home residents in San Antonio.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

But even when residents and their families know that better oral care is needed, paying for it can be a challenge.

“Before, they came in with dentures,” said Barbara J. Smith, the manager of geriatric and special-needs populations at the American Dental Association.

At the Raleigh Court Health and Rehabilitation Center in Roanoke, where Mr. Piercy was a resident, the administrator, Mark Tubbs, said in a statement that he could not discuss Mr. Piercy’s case because of federal privacy laws, and he could not corroborate Ms. Ford’s account.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

“Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

Nearly 30 percent of the residents had “substantial oral debris on at least two-thirds of their teeth,” according to a report issued by the Kansas Bureau of Oral Health.

The screeners saw plenty of fillings and crowns but concluded that “regular dental care has become a thing of the past” for many of the residents.

There are no current national assessments of oral health in nursing homes, but since 2011, at least seven states have evaluated residents using a survey developed by the Association of State and Territorial Dental Directors.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

“Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

The neglect can lead to terrible pain for the residents.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

So there’s no reason this wasn’t addressed.”

There are no current national assessments of oral health in nursing homes, but since 2011, at least seven states have evaluated residents using a survey developed by the Association of State and Territorial Dental Directors.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

“Before, they came in with dentures,” said Barbara J. Smith, the manager of geriatric and special-needs populations at the American Dental Association.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

Since 2004, when researchers first linked oral bacteria to the occurrence of hospital-acquired pneumonia in older people, a series of studies has shown that oral care — from regular brushing to professional dental care — might reduce the risk.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

At the Raleigh Court Health and Rehabilitation Center in Roanoke, where Mr. Piercy was a resident, the administrator, Mark Tubbs, said in a statement that he could not discuss Mr. Piercy’s case because of federal privacy laws, and he could not corroborate Ms. Ford’s account.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

There are no current national assessments of oral health in nursing homes, but since 2011, at least seven states have evaluated residents using a survey developed by the Association of State and Territorial Dental Directors.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

There are no current national assessments of oral health in nursing homes, but since 2011, at least seven states have evaluated residents using a survey developed by the Association of State and Territorial Dental Directors.

But after he complained of a severe, unrelenting headache, she said, she badgered the staff to make an appointment for him with his dentist.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

Medicare does not cover routine dental care like cleanings and fillings.

Dr. Dirks, the Texas dentist, said she would be “surprised if oral care was even on the radar of the medical directors” at nursing homes.

Whitney for The New York Times Dentures are easier for nursing home staff to clean.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

Most states provide at least some dental services to adults on Medicaid, but coverage varies widely, and finding a local dentist who accepts Medicaid payments can be difficult.

Nearly two-thirds of those who stay in a nursing home long term have dementia, and many resist oral care, clenching their mouth shut or even trying to hit aides.

In Wisconsin, nearly 1,100 residents from 24 homes were examined.

“Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

Whitney for The New York Times Dentures are easier for nursing home staff to clean.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

Most states provide at least some dental services to adults on Medicaid, but coverage varies widely, and finding a local dentist who accepts Medicaid payments can be difficult.

While residents now require more dental care than in the past, nursing home employees are rarely prepared to provide it.

Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth.

Whitney for The New York Times Dentures are easier for nursing home staff to clean.

Nearly two-thirds of those who stay in a nursing home long term have dementia, and many resist oral care, clenching their mouth shut or even trying to hit aides.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

But even when residents and their families know that better oral care is needed, paying for it can be a challenge.

The neglect can lead to terrible pain for the residents.

Just as nursing home workers are expected to help residents bathe or reposition them to avoid bed sores, they are supposed to brush the teeth of residents who cannot do it themselves.

Worse, new studies suggest that this problem may be contributing to another: pneumonia, a leading killer of institutionalized older people.

Roughly one in 10 cases of deaths from pneumonia in nursing homes could be prevented by improving oral hygiene, according to a 2008 systematic review published in The Journal of the American Geriatrics Society.

Worse, new studies suggest that this problem may be contributing to another: pneumonia, a leading killer of institutionalized older people.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

While residents now require more dental care than in the past, nursing home employees are rarely prepared to provide it.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

There are no current national assessments of oral health in nursing homes, but since 2011, at least seven states have evaluated residents using a survey developed by the Association of State and Territorial Dental Directors.

Edentulism, total tooth loss, in older people declined from 1988 to 2004, according to data from the National Health and Nutrition Examination Surveys.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

At the Raleigh Court Health and Rehabilitation Center in Roanoke, where Mr. Piercy was a resident, the administrator, Mark Tubbs, said in a statement that he could not discuss Mr. Piercy’s case because of federal privacy laws, and he could not corroborate Ms. Ford’s account.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

The screeners saw plenty of fillings and crowns but concluded that “regular dental care has become a thing of the past” for many of the residents.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

Many arrive at nursing homes with poor teeth, he added, after long periods without seeing a dentist.

Aides are swamped with other tasks, and when older charges must be helped to the toilet, fed or repositioned in bed, brushing their teeth often falls to the bottom of the to-do list.

Just as nursing home workers are expected to help residents bathe or reposition them to avoid bed sores, they are supposed to brush the teeth of residents who cannot do it themselves.

“All patients receive medically necessary, high-quality care, including oral care and hygiene,” Mr. Tubbs said.

Nearly two-thirds of those who stay in a nursing home long term have dementia, and many resist oral care, clenching their mouth shut or even trying to hit aides.

Indeed, her group practice used to contract with 62 nursing homes, but now works only with 24 that make oral health a priority.

There are no current national assessments of oral health in nursing homes, but since 2011, at least seven states have evaluated residents using a survey developed by the Association of State and Territorial Dental Directors.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

Indeed, her group practice used to contract with 62 nursing homes, but now works only with 24 that make oral health a priority.

There are no current national assessments of oral health in nursing homes, but since 2011, at least seven states have evaluated residents using a survey developed by the Association of State and Territorial Dental Directors.

Nearly two-thirds of those who stay in a nursing home long term have dementia, and many resist oral care, clenching their mouth shut or even trying to hit aides.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

More than one-third had untreated decay.

Katherine Ford visited her father, Dean Piercy, a World War II veteran with dementia, at a nursing home in Roanoke, Va., for months before she noticed the dust on his electric toothbrush.

In Texas, inspectors noted one resident with memory problems in too much pain to eat, her lower gums red, swollen and packed with food debris.

“They should be getting their care, but a lot of people don’t,” acknowledged Dr. David Gifford, the senior vice president of quality at the American Health Care Association, a trade group representing two-thirds of nursing homes nationwide.

Without daily oral care, older people taking such drugs are especially prone to “a relatively rapid deterioration,” said Dr. Ira Lamster, a dentist and a professor of health policy at the Mailman School of Public Health at Columbia.

“I’m there every day, pointing out he’s in pain — and he had dental insurance.

Nearly two-thirds of those who stay in a nursing home long term have dementia, and many resist oral care, clenching their mouth shut or even trying to hit aides.

Roughly one in 10 cases of deaths from pneumonia in nursing homes could be prevented by improving oral hygiene, according to a 2008 systematic review published in The Journal of the American Geriatrics Society.

One was Kansas, where dental hygienists examined 540 older residents in 20 long-term-care facilities.

Many prescription drugs — including some antidepressants, medications for high blood pressure and anti-seizure medications — can reduce saliva and dry out the mouth.

But even when residents and their families know that better oral care is needed, paying for it can be a challenge.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

Worse, new studies suggest that this problem may be contributing to another: pneumonia, a leading killer of institutionalized older people.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

“I’m there every day, pointing out he’s in pain — and he had dental insurance.

A 2006 study of five facilities in upstate New York found only 16 percent of residents received any oral care at all.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

The dentist found that a tooth had broken in two, and he showed Ms. Ford the part that had lodged in the roof of her father’s mouth.

“A lot of residents don’t want it, don’t like it and will ask not to have it.”

Without daily oral care, older people taking such drugs are especially prone to “a relatively rapid deterioration,” said Dr. Ira Lamster, a dentist and a professor of health policy at the Mailman School of Public Health at Columbia.

“Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

Without daily oral care, older people taking such drugs are especially prone to “a relatively rapid deterioration,” said Dr. Ira Lamster, a dentist and a professor of health policy at the Mailman School of Public Health at Columbia.

A 2006 study of five facilities in upstate New York found only 16 percent of residents received any oral care at all.

But after he complained of a severe, unrelenting headache, she said, she badgered the staff to make an appointment for him with his dentist.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

In nursing homes across the country, residents like Mr. Piercy are plagued by cavities, gum disease and cracked teeth, in part because their mouths are not kept clean.

Some residents decline help, he noted, and nursing home employees can do little about it.

“Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

“Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

“Aides change someone’s Depends, change a catheter or turn somebody every few hours, but teeth often don’t get brushed twice a day.”

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.

Even when care is available, few staff members are trained to cope with the rising numbers of residents with dementia who resist routine dental hygiene.

“I always say you can measure quality in a nursing home by looking in people’s mouths, because it’s one of the last things to be taken care of,” said Dr. Judith A. Jones, chairwoman of the department of general dentistry at Boston University.

The screeners saw plenty of fillings and crowns but concluded that “regular dental care has become a thing of the past” for many of the residents.

His teeth, she found, had not been brushed recently, so she began doing it herself after their lunches together.