A resident needed dental extractions and was initially told the safest course was oral surgery under GA in a hospital setting, but the referral was not acted on for months. In-house dental notes later continued to recommend FMX, extractions of retained roots, and dentures, yet x-rays were not completed and extraction attempts were unsuccessful; the DON acknowledged the hospital oral surgery process was not started until much later.
A resident reported needing dental cleaning and waiting months for the facility to make an appointment. The record showed a physician ordered a referral for dental care, but follow-up remained pending and the resident was still unaware of any appointment. The DON stated the resident had previously refused dental services, but did not explain why the later order was not addressed.
A facility failed to ensure timely dental services for two residents. One resident had repeated reports of tooth pain, provider notes documenting a pending dental consult, and only later had a dental appointment arranged by family. Another resident reported needing dentures, and MDS assessments showed obvious or likely cavity or broken natural teeth, but the Administrator could not find documentation of any follow-up dental care.
Facility staff failed to ensure two residents received required routine and follow-up dental care. One resident, observed to have few or no teeth, had no documented dental consult for over a year and had not been seen by a dentist since the prior year, despite requirements for at least annual oral assessments. Another resident with missing teeth and cavities had sporadic dental encounters, including attempted visits where the resident was unavailable or in isolation, and a recommended dental hygiene visit that was never rescheduled. A nursing note documented that a molar tooth came out while the resident was talking, and the resident was ordered to be seen by dental services, with the next documented dental visit occurring only after this event.
A resident with no teeth or dentures reported discomfort from chewing on their gums, and the surveyor observed the resident eating breakfast without teeth. Record review showed multiple dental/oral evaluations that did not mention a pending consult, while the resident’s last dental appointment was for extractions and an earlier dental consult recommended scheduling dental surgery and then starting the denture process.
A resident reviewed for dental concerns had no documented dental consults since admission. The DON stated that no dental visit was obtained because there were no complaints from the resident or family, even though an outside dental evaluation was required on an annual basis.
A resident did not receive routine dental services, and the resident reported not seeing a dentist or having a dentist visit the facility for over a year. The Unit Manager said staff only call the dentist when residents complain or show a need, and the clinical record contained no dental consult or dental visit. The DON also could not find any record that the resident had ever gone to the dentist.
Failure to provide ordered and routine dental services affected three residents. One resident had a physician referral for severe periodontal disease with broken and eroded tooth roots, but the facility could not initially produce dental follow-up records and later provided only routine in-facility exams. Another resident reported never seeing a dentist despite an order for consults as needed and a care plan noting oral/dental problems, and a third resident with broken and missing teeth had no documented dental evaluation or routine dental services since admission; the DON confirmed no annual oral health assessment or routine dental services for that resident.
Delayed Dental Consultation: A resident was observed pointing to his/her mouth and saying it hurt, and had two dental consult orders for teeth complications and difficulty chewing. The dental visit was not documented until months after the first order and nearly a month after the second. The Unit Manager described a monthly Health Drive process, and the DON stated she expected dental consults to be scheduled immediately for discomfort or difficulty chewing.
Failure to Provide Requested Dental Services: A resident was not seen by the in-house dental service despite repeated family requests during care plan conferences. The family reported bad breath and provided mouth wash for staff use, while the record showed SW notes about needing a dental appt and follow-up on oral care concerns. The DON stated there was no dental policy and later acknowledged that nursing and SW were responsible for follow-up but the team failed to get the resident seen.
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