Older Adults Case Study


“For increasing the interprofessional approach to patient care.”

Awarded by the Oral Health Nursing Education Program and Practice (OHNEP) 


Over Age 65? Oral Health Care Falls Off the Map


After age 65, millions of Americans go without regular oral health checkups and treatment — even though research has found that oral health problems like periodontal disease are associated with diabetes, cancer, heart and lung diseases, progression of dementia and Alzheimer’s, and other serious illnesses.

The problem is growing as Americans age. An estimated 10,000 baby boomers are turning 65 and retiring each day. By 2030, more than 70 million people are expected to be 65 or older. Of this “silver tsunami,” only an estimated 2% will have access to dental insurance benefits, according to State of Decay: Are Older Americans Coming of Age Without Oral Healthcare, a report by Oral Health America’s Wisdom Tooth Project. Factors such as limited income after retirement, the high cost of private dental insurance for older Americans, and the exclusion of dental care from Medicare benefits, all contribute to this neglect.

“A mouth infection is a very dangerous situation because older people are often more at risk for a cascade of infections,” says Dr. Tara Cortes, Executive Director of the Hartford Institute for Geriatric Nursing at NYU College of Nursing. “Nurses play a crucial role in educating the patient and other health care professionals about the need for regular health care,” she says. The Institute works closely with OHNEP to include oral health care in its outreach.


You can change this in your community. Here’s how.



Residents of the Fair Haven Retirement Community in Birmingham, Alabama, benefit from an interprofessional approach to prevent and treat oral health problems. The program is a community-based partnership between the University of Alabama-Birmingham (UAB) School of Dentistry and Fair Haven. It was funded by a Community Foundation of Greater Birmingham grant, gifts in kind from Henry Schein Dental, and private donations of equipment, materials and furnishings.

Thanks to a “light bulb moment” by Dr. Lillian M. Mitchell, more than 1,100 residents of the Fair Haven Retirement Community have received oral health care since 2010 from an interprofessional team of dentists, physicians, and other health professionals.  Dr. Mitchell is Director of Geriatric Dentistry at the University of Alabama at Birmingham (UAB) School of Dentistry.  Fair Haven, in Birmingham, is the state’s largest retirement community, with six levels of care from independent living to long-term nursing.

The idea was sparked in 2009. Dr. Mitchell had just completed interprofessional training through the university’s Geriatric Education Center’s (GEC) Faculty Scholar’s Program when she received word that eight sophomore UAB dental students who were trained to clean teeth were available for a clinical rotation. She knew that Fair Haven’s medical director wanted to find a way to improve oral hygiene for the residents. Dr. Mitchell coordinated the program with administrators of the UAB dental and medical schools. A community foundation provided seed money, and with support from the dental school Fair Haven, and industry, the program was born.

Dr. Mitchel

Dr. Mitchell and her interprofessional team train the Fair Haven nursing staff and certified nursing assistants in oral health and best practices for oral care of the long-term patient.

The clinic now has three modern dental treatment areas in Fair Haven, and will soon expand treatment to residents of other retirement homes in the community.  All participants receive interprofessional training. “The biggest outcome is that the nursing community on the Fair Haven units are proactive every day in identifying oral problems and making sure their patients get treated,” says Dr. Mitchell. There has been a decline in aspiration pneumonia, and swifter identification and treatment of oral problems before they lead to larger health issues.




Dr. Mitchell followed a multi-step approach, which OHNEP recommends, when developing a facility-based interprofessional oral health program in your community.

  1. Reach Out To People You Know. If you are affiliated with a university or with a retirement or nursing home facility, talk to the appropriate program director. If you are an interested member of the community, talk with your local senior citizen organizations, or other community or business groups that can help you build support.
  2. Identify A Clinic Or Dental Office That Will Dedicate Space. Partner with local business groups or nonprofit organizations to help you build support and find resources.
  3. Find Out Where Local Health Professionals Can Get Interprofessional Training In Oral Health Care.


    • OHNEP Resources for case studies, PowerPoints, videos and links to other professional groups advocating for the interprofessional approach to patient care.
    • OHA’s Wisdom Tooth Project’s State of Decay to find out how well your state ranks in oral care for older adults. OHA connects older adults, especially those most vulnerable, with affordable dental care to local resources in each state.
    • Hartford Institute for Geriatric Nursing at NYU College of Nursing for programs, resources, and for-credit continuing education courses in nursing that include oral health care for older adults.


    • Smiles for Life, the nation's only comprehensive oral health course, developed by the Society of Teachers Family Medicine Group on Oral Health.  It can be taken online. Identify in your community a health care provider who can provide hands-on clinical training in coordination with the online course.
    • Geriatric Education Centers at universities around the country, funded by the Health Resources and Services Administration (HRSA).
    • OHNEP, for the latest on interprofessional training, resources and links to other national organizations.)
  4. Get Community Support. Spread the word locally about the oral health for older adult initiative: through local newspapers (hard copy and online), radio, professional and community groups, events, and posts on social media.