Age and Tooth Loss in a Chronic Care Facility

Research Article

J Dent & Oral Disord. 2018; 4(3): 1091.

Age and Tooth Loss in a Chronic Care Facility

Salazar KS and Saunders RH*

Eastman Institute for Oral Health, University of Rochester, Rochester NY, USA

*Corresponding author: Saunders RH, Eastman Institute for Oral Health, University of Rochester NY, USA

Received: January 22, 2018; Accepted: February 19, 2018; Published: February 26, 2018


The presence or absence of teeth in a population is a primary indicator of oral health. Numerous recent surveys of essentially healthy community-based populations are revealing decreases in loss of teeth; however, the extent to which the decline in tooth loss is present among long-term care persons, many of whom are elderly, is not clear. Objective: This survey was to compare the prevalence of tooth loss in a single institution in 1982 with that in the same facility in 2015.

Methods: Data for the 2015 survey was retrieved from 464 (250 female/ 214 male) dental records at Monroe Community Hospital (MCH), a long-term care facility in Rochester, NY. The admission criteria of MCH remained essentially with same; most subjects had multiple chronic conditions characterized by ASA status 2 or 3. RESULTS included that maxillary edentulism declined from 61.3% in 1982 to 49.2% in 2015; mandibular edentulism declined from 53% to 42% during the same time interval. Statistically significant (p<0.05) declines were revealed in both the maxilla and mandible in the age interval 70–79 years, the age interval 80-89 years in the maxilla, and > 90 years in the mandible.

Conclusion: This survey of one facility suggests that tooth loss may be declining as is so among community-based persons, but to a lesser extent. Additional surveys will be needed to define the extent to which this finding is generalizable.

Keywords: Geriatrics; Tooth loss; Edentulousness; Long-term care


NY: New York; US: United States; MCH: Monroe Community Hospital; SNF: Skilled Nursing Facility; ASA: American Society of Anesthesiologists; NHANES: National Health and Nutrition Examination Survey; NYS: New York State


A primary indicator of the oral health, and possibly also general health, of a population is the presence or absence of teeth. A 1978 Monroe County, NY study reported that 63% of nursing home residents had no teeth [1]. Other studies completed near this time also reported rates of edentulousness in long-term care facilities from 50-77% [2-4]. A 1982 survey in a large Rochester nursing home found that that 64% of those age 60 years and above had no teeth [5].

Over the almost 35 years since that time, the number of missing teeth in the community-based population has decreased. For example, in 1973, 60% of those over age 80 in the U.S. were edentulous [6]. In 2015, only 26% of those age 75 and over had no teeth [7].The extent to which a decrease in tooth loss is being seen in special populations, such as nursing home residents, however, is not clear. This nursing home population is increasingly important as our population is aging; New York State has 637 nursing homes which provide care for 117,000 residents [8].As noted above, early studies of oral health in New York State nursing homes found levels of edentulousnessat 50% and above. A few more recent surveys of nursing home oral health, mostly completed elsewhere, have found mixed results. For example, a 2007 survey of 321 elderly long-term hospital patients in France found edentulousnes to be 27% [9]. In 31 nursing homes in Victoria, Australia, the prevalence of edentulousness was 46% [10]. Among 1369 older residents of all the “service houses” in Helsinki and Espoo, Finland, in 2014, edentulousness was 52% [11].Hopefully nursing home oral health would be improving everywhere; however, a 2013 New York Times article was titled, “In Nursing Homes, an Epidemic of Poor Dental Hygiene” [12]. The article included the observation that “There are no current national assessments of oral health in nursing homes.” The authors of this paper were unable to locate either local or national current studies of this issue. The purpose of this study was to begin to gather data that could, along with much broader future surveys, describe the current oral health of New York nursing home residents.

Materials and Methods

Monroe Community Hospital (MCH) is a county-supported facility for the chronically ill and aging (nursing home) in Rochester, NY.

This study consisted of a retrospective evaluation of the dental records of the 464 patients (250 female / 214 male) present during the calendar year 2015. The examinations were performed by the dental director and dental residents working under his direct supervision. Ambulatory patients were examined in the dental chair and using the operatory light; a headlight was used for no ambulatory persons in wheelchairs or stretchers. This examination protocol essentially replicated the protocol of a similar study in the same facility in 1982 [5].

Data was recorded from dental records to a computerized Excel spreadsheet for later summary and analyses. Because the data were largely in nominal form, tables of cross tabulations with accompanying nonparametric statistics were generated for analysis. Pearson’s chi-square test or Fisher’s exact test were used to evaluate the existence and strength of relationships between age and tooth loss.

Results and Discussion


Table 1 displays the distribution of the populations by gender and age in 1982 and 2015. The decrease in size of the overall population during this interval was due to the closing of two patient care units since 1982. The ratio of women to men (1.2 /1.0) was the same at the two time points.