When Poor Oral Care Causes Death


AJN’s June feature article

“Take care of your teeth”—it’s something we’re told as soon as we’re old enough to hold a toothbrush. But it’s not so straightforward for the nursing personnel who provide oral care in nursing homes. According to a 2000 Surgeon General report on oral health,  “Mouth care is often considered an unpleasant task and is often delegated to nursing auxiliaries, who have even less oral health training than registered nursing staff.”

This month AJN features a case study of a patient that proves this point.  A severely disabled man received such poor oral care from nursing home personnel that his oral and nasopharyngeal secretions built up (“inspissated”), and he died from asphyxia. The lead author, Joseph A. Prahlow, was the pathologist in charge of the autopsy; the article features graphic photos of the thickened secretions that blocked his airway. A companion article by two dentists, Pamela S. Stein and Robert G. Henry, gives nurses suggestions on how they can overcome barriers to providing oral care to patients.

And what are those barriers? Performing oral care on a fully dependent patient requires time and patience—two things that might be in short supply when patient acuity increases and nursing staff decreases. Administering medications, monitoring patients, educating patients and family, and conferring with other professionals can take up a lot of a nurse’s time. Add a patient’s combative behavior to the mix, and oral care may become even harder to consider a priority.

In citing a study that looked at oral care given in nursing homes, Stein and Henry say that “only 16% of residents received any oral care, with an average toothbrushing time per resident of only 16.2 seconds”—a period that Stein and Henry say is “woefully inadequate.”

Parents constantly remind their kids to brush their teeth in hopes of instilling good habits and not be in a rush to get to a Chandler dentist to fix their teeth when it’s too late already. Toothbrushing at least twice a day in the method outlined by your dental care provider, prevents dental cavities, bad breath, and gum disease, but research has shown us it does so much more. According to the Centers for Disease Control and Prevention,  “recent studies point to associations between

[gum disease] and diabetes, heart disease, stroke, and preterm, low-weight births.”

Is it easy to see how nurses can let oral care fall through the cracks? We encourage nurses and other health care providers to read these articles in AJN’s June issue; it might save lives. And we invite you to share your own experiences: how is oral care (and the lack of it) addressed at your facility?

—Christine Moffa, MS, RN, clinical editor, and Joy Jacobson, managing editor

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2017-07-06T12:36:07+00:00 June 15th, 2009|nursing perspective|1 Comment

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One Comment

  1. J. Wyrick Dumas, RN, BSN June 15, 2009 at 2:37 pm

    I enjoyed this article and I think that it is essential for all members of the health care team to be actively involved in the daily care of our patients. I have worked in long term care and medical surgical in the past and can say that all too often the patients that are described in this article are “overlooked” and have serious health implications due to this. We are the lifeline for our patients and by not attending to their every need we are simply hurting the plan of care overall. If these tasks are deligated to other staff members (ie. NA, CNA, MA, LPN, etc) the charge nurse must be dillegent in following up that the care was performed properly and give adequate training pertaining to these tasks…furthermore, the charge nurse must be willing to take full responsibility for these patients care!

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