Dental Care Regulations for Nursing Homes

Both Federal and State laws governing nursing homes include rules concerning dental care. At the Federal level, nursing homes which accept Medicare or Medicaid residents must comply with a law called "OBRA '87" which covers almost all aspects of care, including dental care.

OBRA '87 makes each nursing home directly responsible for providing both routine and emergency dental services.

Minnesota's Long Term Care Regulatory Reform Task Force has developed a set of objectives for oral health care in Minnesota's nursing homes:

  1. Oral health care must be provided to prevent disease, maintain chewing and speaking ability, and to preserve comfort, hygiene, and dignity.
  2. Both the standard of oral health care and access to it must be equal to that in the community at large.
  3. Residents or their representatives must have the right to freely choose: (1) whether or not to receive oral health care, (2) who will provide their care, and (3) what specific oral health services will be provided.
  4. All caregivers must advocate against the neglect of oral health problems suffered by vulnerable adults who cannot advocate for themselves.

New Minnesota regulations developed by the Long Term Care Regulatory Reform Task Force. These new regulations are designed to comply with the requirements of OBRA '87.

The following is a copy of the regulations:

Oral Care In Nursing Homes
Minnesota Rules, Parts 4658.0720, 4658.0725 and 4658.0730

4658.0720 Providing Daily Oral Care
Subpart 1. Daily oral care plan
A nursing home must establish a daily oral care plan for each resident as part of the initial resident consistent with the results of the comprehensive resident assessment.

A. Each resident's daily oral care plan must indicate whether or not the resident has natural teeth and/or wears removable dentures or partials. It must also indicate whether the resident is able to maintain hygiene independently, needs supervision, or is dependent on others.

B. A nursing home must provide each resident with the supplies and assistance necessary to carry out their daily oral care plan. Such supplies must include at a minimum: toothbrushes, fluoride toothpaste, mouth rinses, dental floss, denture cups, denture brushes, denture cleaning products, and denture adhesive products.

C. The nursing home must make the daily oral care plan available to the attending dentist before each checkup, and must modify the plan according to the dentist's, dental hygienist's or other dental practitioner's directions.

Subpart 2. Labeling Dentures
The nursing home must label full and partial dentures with the resident's name or other identifiers within 7 days of admission.

4658.0725 Providing Routine and Emergency Oral Health Services
Subpart 1. Routine dental services
A nursing home must provide or obtain from an outside resource routine dental services to meet the needs of each resident. Routine dental services include dental exams and cleanings, fillings and crowns, root canals, periodontal care, oral surgery, bridges and removable dentures, orthodontic procedures, and adjunctive services that are provided for similar dental patients in the community at large, as limited by third party reimbursement policies.

Subpart 2. Annual dental visit
A. Within 90 days after admission, each resident shall be referred for an initial dental examination, unless the resident has received a dental examination within the 6 months prior to admission.

B. After the initial dental examination, a nursing home must ask the resident if the resident wants to see a dentist and then provide any necessary help to make the appointment, on a least an annual basis. This opportunity for an annual dental checkup must be provided within one year from the date of the initial dental examination or within one year from the date of the examination done within the six months before admission.

Subpart 3. Emergency dental service
A. A nursing home must provide, or obtain from an outside resource, emergency dental services to meet the needs of each resident. When emergency dental problems arise, the facility must contact a dentist within 24 hours, describe the dental problem, and document the dentist's plans and orders.

B. When emergency dental problems arise, a nursing home must contact a dentist within 24 hours, describe the dental problem, and document and implement the dentist’s plans and orders.

Subpart 4. Dental records
For each dental visit, the clinical record must include the name of the dentist or dental hygienist, date of the service, specific dental services provided, medications administered, medical-dental consultations, and follow-up orders.

4658.0730 Nursing Home Requirements
Subpart 1. Training
Nursing home staff providing daily oral care must be trained and competent to provide daily oral care for all residents.

Subpart 2. Written agreement
A nursing home must maintain a written dental provider agreement with at least one dentist, licensed by the Board of Dentistry, who agrees to provide:

A. routine and emergency dental care for facility's residents;

B. consultation on the facility's oral health policies and procedures; and

C. oral health training for facility's staff.

Subpart 3. Making appointments
A nursing home must assist residents in making dental appointments and arranging for transportation n to and from the dentist’s office.

Subpart 4. On-site services
A nursing home must arrange for on-site dental services for residents who cannot travel, if those services are available in the community.

Subpart 5. List of dentists
A nursing home must maintain a list of dentists in the service area willing and able to provide routine or emergency dental services for the nursing home’s residents. Copies of this list shall be readily accessible to the nursing personnel.

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