**1. Introduction**

Properly implemented dental care is necessary not only for having a healthy, long lasting dentition, but also in maintaining overall systemic health and in promoting a sense of well-being. This is understandably true for the general populous, and is wholly acknowledged as such; yet there is an element of neglect in that sector of care dealing with the institutionalized elderly and infirmed.

Hospice and long-term care philosophy typically enshrouds palliation for the terminally ill and frail elderly, whose quality of life must include all aspects of comfort care management. Too often, however, medical and dental professionals and caregivers under their charge in both nursing homes and institutions simply do not elect to carry out oral care to any viable or reasonable extent. This may be from several reasons, such as difficulties encountered in patient compliance, issues with staff shortages, a sense of futility, and quite frequently an overall lack of education as to why regularly and properly implemented oral care for those unable to maintain adequate oral hygiene procedures without assistance must be given prioritization in the comfort care daily routine.

Having spent 25 years contracted with a nursing home in which I perform semi-annual oral evaluations on resident patients, and in visiting other such locales in the region, I have often witnessed the inadequacies common to most institutions where oral evaluation, preventive techniques, and palliative care of the mouth

are sorely lacking. In an effort to improve the standards of oral management in the dependent and incapable, I would urge all medical institutions to mandate that a dentist be on staff, and that minimum standards programs be instituted as are appropriate, yet this is seldom the case. Even in a local faith-based hospice for which I am the gratis dental consultant, I am not listed as a member of the staff team, but rather as a volunteer.

There are multiple obstacles to be overcome to correct these inadequacies, but with compassion, candor, and competency these challenges are indeed surmountable.
