Nurses' dental assessments and subsequent care in Minnesota nursing homes

Concerns about the quality of care in US nursing homes led to 1987 federal regulations mandating a national standardized resident assessment. This assessment, or Minimum Data Set (MDS), is performed by nurses on all residents and includes items to detect oral health problems. As yet, however, there are few data on the utility of these MDS oral health evaluations. In this study, we analyzed data from Minnesota nursing homes to determine the prevalence of oral health problems ("triggers") requiring dental referral from the MDS, version 1 (Items L and M). We also analyzed the relationship between these MDS assessments and subsequent dental care. Data came from a 1994 Minnesota nursing home dental utilization study containing information on 466 residents (dental users and non-users) sampled from 21 nursing homes. Nurses identified 3.2% of residents as having oral debris, 3.0% with broken, loose, or carious teeth, and only four (0.9%) residents with gum inflammation/soft tissue problems. Only one resident (0.2%) was identified with mouth pain. Regression analyses of data from 135 residents admitted since 1992 revealed no relationship between the presence of MDS "triggers" and subsequent utilization measured in visits/year and gross charges/year. Nurses' MDS assessments identified few oral health problems, and those problems identified did not translate into dental treatment, raising questions about the utility of the current approach.