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Montana Dentist Provides Care to Elderly People in Nursing Homes

August 12, 2014

Before starting his private practice eight years ago in Kalispell, a town of about 20,000 people that serves as the gateway to Glacier National Park in northwest Montana, Dr. David Keim provided dental care for those people living on the nearby Blackfeet Indian Reservation.

It was there that he learned that many of his vulnerable elderly patients face greater barriers to accessing dental care than any other group of people. 

At the time, he was serving as a Lieutenant Commander in the United States Public Health Services and was stationed at the Blackfeet Community Hospital in Browning. He also served as the coordinator of the Blackfeet Nursing Home.

“These patients would come into the office and you could tell there was quite a bit of neglect,” said Dr. Keim. “When people are admitted into care facilities, they are at a point in their lives at which they need assistance caring for themselves. They require help with their general hygiene – specifically their oral hygiene – because of deterioration of their manual dexterity.”

When patients start to develop physical impediments, many can no longer brush properly.

Dr. Keim, who is president-elect of the Montana Dental Association, now provides care to the residents of four nursing homes in Kalispell. He says that he is able to reach all of these patients with the help of his hygienist, Pam Yeager, who has a limited access permit that allows her to clean teeth without direct supervision from a dentist.

“I provide the preliminary diagnoses, and then she goes into the nursing homes on Fridays and Saturdays when our office is closed,” said Dr. Keim. “If she notices something urgent, then she schedules the patient to come in and see us.” 

One barrier to accessing dental care is that many people lose contact with their primary dentist when they move into a long-term care facility. 

“They move away from their homes, so there’s not a good transition of making sure they have regular check-ups,” said Dr. Keim. 

Educating both nursing home residents and staff is also key to maintaining preventive care, he noted.

“We discuss hygiene and proper brushing habits,” said Dr. Keim. “When the residents’ manual dexterity skills and their cognitive skills start to drop, it becomes someone else’s job to take care of their teeth, and that’s where the breakdown happens.”

Dr. Keim is among the many dentists who have developed sustainable models – those that will work over the long term – for delivering care to the elderly. Providing care to the vulnerable elderly in nursing homes is one of eight initiatives that comprise the American Dental Association’s Action for Dental Health movement, a nationwide, grassroots movement aimed at ending the country’s dental health crisis.