BACKGROUND:Orofacial appearance remains socially meaningful throughout later life, as facial and dental features may shape first impressions and social judgments. Yet little is known about how older adults perceive the orofacial appearance of their peers. Against this background, this study explored how adults aged 65 years and older perceive their peers' orofacial appearance (OA). METHODS:Semi-structured interviews were conducted with 20 participants (aged 68-76), strategically recruited from the Swedish National Study on Aging and Care-Blekinge (SNAC-B) in Karlskrona. To identify patterns in the data, a thematic analysis was used to analyze the interviews. RESULTS:The older adults' perceptions of other people's OA were represented in three themes: (i) charisma and personality overshadow orofacial appearance; (ii) it is easy to attribute characteristics as a result of the appearance; (iii) adherence to established norms is expected. CONCLUSION:This study highlights how older adults' perceptions of peers' OA are shaped by interpersonal impressions and social norms. Charisma, warmth, and facial expression could reduce the importance of specific orofacial features, whereas missing teeth, visible poor oral health, or appearance changes perceived as outside age-appropriate norms could trigger assumptions about lifestyle, vulnerability, or self-care.

BACKGROUND:The prevalence of periodontitis increases with aging. The present study aimed to assess descriptively the changes in periodontal status over an 18-year period among individuals aged 60 and 66 years at baseline who participated in the Swedish National Study on Aging and Care in Karlskrona, Sweden. METHODS:This longitudinal study used quantitative methods based on data from the ongoing project, The Swedish National Study on Aging and Care (SNAC) in Karlskrona, Sweden. A total of 340 individuals aged 60 and 66 years underwent periodontal and radiographic examinations at baseline (2001-2003). Follow-up assessments were conducted after 12 years (2013-2015; n = 217) and after 18 years (2019-2021; n = 79). A paired t-test, McNemar's test, and binary logistic regression were performed for the statistical analysis. Statistical significance was determined at p < 0.05. RESULTS:Overall, the mean value BOP (SD) increased from 19.71(17.6) % at baseline to 32.73 (21.7) % at the 18-year follow-up (Cohen's d = ‒0.57; 95%CI: ‒0.81 to ‒0.33; p < 0.001). The proportion of participants with at least one site exhibiting a bone level ≥ 5 mm increased significantly, from 49.4% at baseline to 88.6% at the 18-year follow-up, corresponding to an absolute increase of 39.2 percentage points (p < 0.001). In addition, the prevalence of periodontitis increased from 7.8% to 19.5% over the same period, an absolute increase of 11.7 percentage points (p = 0.035). CONCLUSIONS:The present study indicates that periodontal status deteriorates over 18 years among participants aged 60 and 66 years at baseline. PLAIN LANGUAGE SUMMARY:This study followed an older population over an 18-year period to describe how their periodontal status (gum conditions, periodontal pocket depth, and alveolar bone levels) changed over time. The participants were part of the Swedish National Study on Aging and Care in Karlskrona, Sweden. A total of 340 individuals who were 60 or 66 years old at the start (2001-2003) were included. They underwent periodontal and radiographic (x-ray) examinations at baseline and again after 12 years (2013-2015) and 18 years (2019-2021). Over time, periodontal status worsened, with more inflammation, more bone loss around the teeth, and a higher proportion of individuals classified as having periodontitis according to the definition used in this study.

Objective: The present study aimed to investigate the association between baseline moderate-to-severe periodontitis and all-cause mortality over a 23-year follow-up among individuals aged 60 and 66 years. Materials and methods: This longitudinal study was based on data from the Swedish National Study on Aging and Care in Karlskrona, Blekinge, Sweden. A total of 340 participants aged 60 and 66 years old at baseline (2001–2003) who underwent periodontal and radiographic examination were included. Baseline data on age, sex, number of medications, smoking status, cash margin, and education were collected. Results: At baseline, 16.2% of participants had moderate-to-severe periodontitis. During the 23-year follow-up, 52.7% of participants with moderate-to-severe periodontitis died. In the adjusted survival analysis, moderate-to-severe periodontitis was associated with an increased risk of all-cause mortality (hazard ratio = 1.56; 95% confidence interval [CI] = 1.00–2.44, p = 0.050). Conclusions: Over 23-year follow-up, baseline moderate-to-severe periodontitis was associated with a higher risk of all-cause mortality among individuals aged 60 and 66 years. However, although the association was statistically significant, any sex-specific findings should be considered exploratory due to the limited number of events and the resulting wide CIs.

BACKGROUND:Oral diseases and poor oral hygiene are prevalent among frail older adults in nursing homes. Despite well-known organizational barriers such as low prioritization, time and staff shortages, and lack of routines and training, research on the perspective of nursing home management remains limited in this area. PURPOSE:To investigate the views and experiences of professionals in leadership roles regarding oral health needs and routines as well as barriers and facilitators in providing effective oral care for frail older adults in nursing homes. METHODS:A web-based survey was sent to 1,526 nursing home professionals (managers, coordinators and registered nurses) in Sweden. The survey comprised a 52-item questionnaire covering oral health needs, oral care barriers and facilitators, routines, education, collaboration with dental care services, and the use of the quality register Senior Alert, designed to support a preventive approach in nursing care and the Revised Oral Assessment Guide-Jönköping (ROAG-J). RESULTS:Responses were received from 166 managers, 55 coordinators and 243 nurses, yielding a 32% response rate. About half of the respondents perceived residents' oral health as poor, and 83% reported that most residents required assistance with oral care. The main barriers were difficulties for nursing staff to perform oral care and residents' unwillingness to participate, often due to dementia. Increased and regular training in oral care for nursing staff was viewed as the most important facilitator; however, only 41% of respondents reported that their staff had received training regularly. The Senior Alert register and the ROAG-J were widely used and generally perceived as effective. Oral health was also frequently discussed during regular Senior Alert team meetings, with a high level of management involvement. CONCLUSIONS:The significant and complex oral care needs of older adults in nursing homes, coupled with the fact that nursing staff often lack adequate training, stress the importance of management allocating resources, ensuring regular staff training and strengthening collaboration with dental care services. Senior Alert's structured approach seems to have the potential to enhance the engagement of nursing home professionals in managing residents' oral health.

OBJECTIVE:This study aimed to explore how people aged 65 years and older experience their orofacial appearance (OA). METHOD:Semi-structured interviews were conducted with 20 strategically recruited participants aged 65-79 years from the Swedish National Study on Aging and Care-Blekinge (SNAC-B) in Karlskrona. A semi-structured interview guide was developed, and the interviews were analysed using thematic analysis to identify patterns in the data. RESULTS:The older adults' experience of their OA was represented in four themes: (i) you kind of have to like the situation as it is now-to accept orofacial appearance in its current state; (ii) an ageing orofacial appearance-a slow continuous downhill slope; (iii) looking good for others to fit the social norm; and (iv) keeping up orofacial appearance-seemingly without effort. CONCLUSION:The older adults in this study had a dual perception in relation to their own OA. Although society often values a younger looking appearance, striving for a youthful appearance is seen negatively, which may potentially reflect the complexities of the perceptions of one's own ageing OA. Only those with dental issues found the impact of teeth on OA perception to be particularly significant.

To evaluate the reliability of the new Oral Hygiene Ability Instrument (OHAI) developed to assess the cause of any inability for older adults to manage oral hygiene self-care. Oral hygiene is an important part of oral health. The inability to manage oral hygiene, combined with other risk factors, often results in poor oral health and impaired quality of life. A reliable OHAI could benefit preventive oral health care. The preliminary OHAI uses 33 items in three parts: (I) interview, (II) clinical examination and (III) observation of oral hygiene activities. A total of 37 older adults participated in a test-retest study of Part I. Inclusion criteria were age ≥ 65 years, have at least one tooth and be able to oral hygiene self-care. The intra- and inter-rater reliability of parts II and III used films and photographs of OHAI assessments of 15 different individuals. These films/photographs were assessed twice by four dental professionals who had participated in the OHAI data collection. For statistical analyses of the reliability, per cent agreement, Krippendorff's alpha and E. Svensson's method were used. The test-retest for Part I items showed acceptable-to-good agreement and no systematic disagreement. In Part II, two items showed somewhat limited reliability. Part III showed good intra- and inter-rater reliability. The OHAI items seem stable and reliable for the intended sample, and the instrument may be a valuable tool to identify older adults at risk of impaired oral health. However, two items may need to be reformulated.

Oral health problems are common among care-dependent older adults living in nursing homes. Developing strategies to prevent the deterioration of oral health is therefore crucial to avoid pain and tooth loss. A standardized work widely used in nursing homes in Sweden is the quality register Senior Alert (SA), which assesses age-related risks concerning e.g. pressure sores, falls, malnutrition and oral health. The oral health assessment is performed with the Revised Oral Assessment Guide-Jönköping (ROAG-J), which also includes planning and implementation of preventive oral care interventions with the goal of achieving good quality care. However, what facilitates and hinders healthcare workers in working with oral health in SA remains unexplored. The aim of this study was to describe healthcare workers’ experiences of assessing oral health with the ROAG-J, planning and performing preventive oral health care actions in accordance with SA in nursing homes. Healthcare workers (n = 28) in nursing homes in two Swedish municipalities participated and data was collected through six focus group interviews. Reflexive thematic analysis was used to identify patterns of meaning in the data. Themes generated in the analysis were: The structured way of working increases staff awareness and prioritization of oral health in nursing homes. The main challenges for the healthcare workers were residents’ reluctance to participate in oral care activities and oral care being more complicated since most older adults today are dentate. Organizational challenges lay in creating good routines and clarifying staff roles and responsibilities, which will require continuous staff training and increased management involvement.

Objectives: To analyze whether self-perceived oral health and orofacial appearance change with increasing age. Methods: This longitudinal study is based on data from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprises 160 participants 60 years of age at baseline 2001–2003. The same participants were re-examined at 66-, 72-, and 78 years of age. To analyze whether perceptions of oral health and orofacial appearance changed with increasing age, Cochran’s Q test was conducted. Statistical significance was considered at p ≤ 0.05, and the calculated value Q must be equal to or greater than the critical chi-square value (Q ≥ 7.82). Significance values have been adjusted for the Bonferroni correction for multiple tests. Results: Self-perceived mouth dryness, both day (Q = 7.94) and night (Q = 23.41), increased over the 18-year follow-up. When divided by gender, significant differences were only seen for mouth dryness at nighttime. A decrease in sensitive teeth was perceived with increasing age, and an increase in self-perceived satisfaction with dental appearance, and a decrease in self-perceived problems with dental gaps between the ages of 60 and 78. These changes were, however, not statistically significant. Men experienced a higher proportion of discomfort with discolored teeth at age 78 than at 60 (Q = 9.09). Conclusions: Self-perceived oral health and orofacial appearance were relatively stable, with few changes over an 18-year follow-up.

OBJECTIVE:To evaluate the validity of the newly developed Oral Hygiene Ability Instrument (OHAI), created to assess the cause of any inability of older adults to perform oral hygiene, and to revise the instrument based on the results. BACKGROUND:Good oral hygiene is among the most important prophylactic measures for oral health. This applies especially to older adults, among whom risk factors and physical and cognitive barriers are more common and can hamper oral hygiene. METHODS:The OHAI contains (I) an interview, (II) clinical examination, (III) observation of oral hygiene activities and a summarising part. In the study, 149 older adults in three groups participated: stroke, cognitive disorder and general dental patients. Inclusion criteria were to be ≥65 years old, have at least one tooth and to manage oral hygiene without assistance. For criterion validity, sensitivity and specificity were calculated using eight reference instruments. To determine construct validity, we used known group validity, factor analysis and Rasch analysis. RESULTS:The criterion and construct validity of the OHAI were found to be acceptable to good. In the stroke group, balance and fine motor skills were assessed to affect oral hygiene most; in the cognitive disorder group, it was balance, coordination, spatial ability and cognitive functions. Analyses revealed that one item had no added value and that some response options were not optimal. CONCLUSION:The OHAI proved to be valid for the group it is intended for, with only minor revisions needed, resulting in a 32-item instrument. The OHAI could be a valuable person-centred tool in prophylactic work with older adults with failing oral hygiene.

OBJECTIVE:To describe participants' experiences of being treated for peri-implant mucositis. METHODS:A qualitative study with nine individual, semistructured interviews was performed. The interview guide was based on a focus group interview. The participants had recently been treated for peri-implant mucositis on one dental implant in a randomised controlled trial (RCT). The treatment included information, oral hygiene instructions, nonsurgical treatment with Er:YAG laser or ultrasonic scaler and professional cleaning in several sessions over 6 months. The interviews performed were analysed using qualitative manifest and latent content analysis. RESULTS:The manifest results showed that learning how to brush the teeth, and repeated feedback, was appreciated, and increased the motivation to improve oral hygiene habits. Most participants experienced no discomfort from the treatment. The participants had an understanding that a longer treatment time was required to ensure the quality of the treatment. Respect and attention were important elements of the personal treatment. The latent results suggest that treatment with a laser or an ultrasonic scaler was not perceived as the most important part of the treatment. Participants felt that receiving information about the treatment process was more important; moreover, a person-centred approach gave a feeling of good and safe care. CONCLUSIONS:The present study highlights factors of importance in treatment of peri-implant mucositis with laser and ultrasonic scaler. A person-centred approach with respect and attention is important for a good and safe experience and may be important factors in future treatments.

Objective: This study investigated oral health status in 60-year-old individuals over 12 years. Materials and Methods: Data were obtained from The Swedish National Study on Aging and Care (SNAC). One hundred nineteen 60-year-old individuals (48% females) underwent a clinical and radiographic baseline examination (2001-2003) and follow-up examination in 2013-2015. For statistical analyses, paired t-tests and McNemar's test were performed. Statistical significance was determined at p < 0.05. Results: At the 12-year follow-up, the mean number of teeth and the proportion of individuals having >= 20 teeth decreased (p < 0.001). The mean number of teeth with buccal/lingual and approximal caries lesions increased (p < 0.029 and p < 0.031). Individuals with a distance from the cement-enamel junction to the bone of >= 5 mm increased in total (p < 0.002) and in males (p < 0.006). The prevalence of gingivitis increased in total (p < 0.001). The prevalence of periodontitis showed a significant increase in total (p < 0.043) and in females (p < 0.039). Conclusion: The present study indicates that oral health status in 60-year-old individuals deteriorates over 12 years. However, the deteriorations were minor in terms of tooth loss, caries lesions, and changes in periodontal status.

OBJECTIVEThe study aimed to compare self-perceived oral health and orofacial appearance in three different cohorts of 60-year-old individuals.METHODA cross-sectional design, based on data obtained from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprised 478 individuals, from baseline, 2001-2003 (n = 191), 2007-2009 (n = 218) and 2014-2015 (n = 69). Comparisons were made within and between the cohorts, with bivariate analysis and Fisher's exact test. Statistical significance was considered at p < 0.05.RESULTSThe result showed that a low number of the participants reported self-perceived problems with oral health. Of the problems reported, a higher proportion in cohort 2014-2015 (39.3%) experienced problems with bleeding gums. The experience of bleeding gums increased between the cohorts 2001-2003 and 2014-2015 (p = 0.040) and between 2007-2009 and 2014-2015 (p = 0.017). The prevalence of discomfort with sensitive teeth was experienced in 7%-32%. Twice as many women compared to men experienced discomfort in all cohorts (no significant differences between the cohorts). Satisfaction with dental appearance was experienced in 75%-84%. Twice as many women compared to men were dissatisfied with their dental appearance in 2001-2003 (p = 0.011) and with discoloured teeth (p = 0.020). No significant differences could be seen between the cohorts regarding discomfort with dental appearance or discoloured teeth.CONCLUSIONThe 60-year-olds irrespective of birth cohort, perceived their oral health and orofacial appearance as satisfactory.

Purpose:Orthogeriatric hospitalised patients with fractures of the lower limb constitute a vulnerable population with increased risk of morbidity, polypharmacy, and mortality as well as impaired oral health. The aim of this cross-sectional study was to investigate whether any relationship existed between oral health issues in older orthopaedic patients and mortality.Material and Methods:The study population consisted of older orthopedic patients emergently admitted to a hospital in southern Sweden due to mainly fractures of the hip. Their oral health at admission was assessed by trained nurses using the revised oral assessment guide (ROAG), as well as examined by dental hygienists. Medical and demographic data were collected from medical records and mortality from the national population registry. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Data were analysed using foremost dichotomized data derived from mean values and then processed using multiple logistic regression adjusted for identified probable confounders.Results:Of the 187 study patients (≥65 years) with a mean age of 81 (SD 7.9) years, 71% were women, mean CCI score was 6.7 and 90-days mortality 12.3%. Oral health issues (ROAG >8, 73%) consisted mainly of problems with teeth/dentures (41%), tongue (36%), lips (35%), and saliva (28%). In patients with any oral health impairment (ROAG >8) the 90-days mortality was significantly increased (p=0.040), using logistic regression analysis adjusted for age, gender, comorbidity, and use of ≥5 drugs. In patients with a ROAG score ≥10 (≥mean) the association remained at 90-days (p=0.029) and 180-days (p=0.013). Decayed teeth were present in 24% and was significantly associated with ROAG >8 (p=0.020).Conclusion:The main finding of this study was a possible relationship between oral health impairment at admission and early mortality in orthogeriatric hospitalised patients. The opportunity to identify their oral health problems can help improving further care planning and care.

Objective This study aimed to analyze the oral health status of four different birth cohorts: two cohorts of 60-year-olds born in 1941–1943 and 1954–1955 and 2 cohorts of 81-year-olds born in 1920–1922 and 1933–1934. Material and methods The study was based on data from an ongoing longitudinal population project, The Swedish National Study on Aging and Care (SNAC). Oral health status was repeatedly examined clinically and radiographically in 2001–2003 and 2014–2015, including 60- and 81-year-olds, in total 412 individuals. Statistical analyses were performed using independent-samples t test and Pearson’s χ 2 test. Results More individuals were dentate in 2014–2015 compared to 2001–2003 in the two age groups: 60 and 81 years ( p < 0.001 for both). The mean number of teeth increased in the 60-year-olds from 24.2 to 27.0 and in the 81-year-olds from 14.3 to 20.2. The numbers of at least one intact tooth increased for both age groups ( p < 0.001 and p < 0.004, respectively). In the age groups 81 years, there was an increase in having at least one PPD ≥ 6 mm ( p < 0.016) and bone loss ≥ 5 mm ( p < 0.029) between the two examinations. No such differences were found in the age groups of 60 years. Conclusion Over 13 years, oral health improved for both 60- and 81-year-old age groups. The most significant changes were in the 81-year-olds where oral health had improved except for periodontal status. Clinical relevance More natural teeth and impaired periodontal status potentially impact oral health and should increase focus on preventive and supportive dental care in older individuals.

Poor oral health is common among older people in nursing homes. To identify and prevent oral health problems among the residents, ROAG-J (Revised Oral Assessment Guide–Jönköping), a risk-assessment instrument, is used by nursing staff routinely, and the outcome is registered in the web-based Swedish quality register Senior Alert. This study aims to investigate the preventive actions registered when oral health problems are identified and the effect of these actions longitudinally. ROAG-J data registered at nursing homes in Sweden during 2011–2016 were obtained from the Senior Alert database. Out of 52,740 residents (≥65 years), 41% had oral health problems, of whom 62% had preventive actions registered. The most common action was “Assistance with cleaning teeth”. Longitudinally, during the five-year observation period, a slight increase in oral health problems assessed with ROAG-J was found. Registered preventive actions, however, led to significant improvement in the subsequent assessment for the ROAG items lips, tongue, and dentures. Standardised risk assessments like ROAG-J provide an opportunity to detect problems early and establish preventive actions. The study, however, indicates a further need for structured education and a continuous follow-up in ROAG-J. Moreover, increased collaboration between nursing and dental care to improve oral health for older residents at nursing homes is needed.

INTRODUCTION:Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication.MATERIAL AND METHODS:The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy.RESULTS:Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy.CONCLUSION:The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.

Abstract Aim To investigate the extent to which the Revised Oral Assessment Guide–Jönköping (ROAG‐J) is used by nursing staff routinely in nursing homes in Sweden and to describe oral health status of the residents. Design An observational, retrospective register‐based study. Methods Data from different validated health assessments instruments, including ROAG‐J, for the period 2011–2016 were obtained from the Web‐based national quality register Senior Alert. The basis for the analyses was 190,016 assessments. Results About half of all residents had underwent at least one annual ROAG‐J assessment (2014–2016). During the period 2011–2016, 42% of the residents (n = 92,827) were registered to have oral health problems. Significantly more oral health problems were found for men and for those with younger age, poorer physical condition, neurophysiological problems, underweight, impaired mobility and many medications. In conclusion, poorer oral health was found for more care‐dependent individuals, which shows a need of preventive actions.

OBJECTIVES:To describe the development process of an instrument to assess the ability to manage daily oral hygiene and the cause of impaired oral hygiene. The instrument is initially aimed for use by the dental team in the ageing population.BACKGROUND:Oral hygiene is an important component of oral health. Inability to manage oral hygiene combined with other risk factors often results in poor oral health and impaired quality of life.METHODS:A guideline for instrument development was used during the construction of the instrument. The method included three phases: I. planning: the purpose and target group of the instrument were determined, and a literature review and qualitative focus-group study were conducted; II. construction: objectives were formulated, and a pool of items was built; and III. evaluation and validation, which included two pilot studies, interviews, item analyses and revision of the instrument.RESULTS:The planning and construction phases resulted in an instrument with 47 items comprising three parts: (a) interview, (b) clinical examination and (c) observation of activities of daily living (oral hygiene). After two pilot studies, the instrument was found to have good content validity. Analyses of qualitative and quantitative data resulted in a reduction in the number of items to 33.CONCLUSION:OHAI can be a valuable tool as a preventive method to identify older adults at risk of impaired oral health. However, the instrument needs further evaluation before wider use.

AIMS AND OBJECTIVE To describe oral health problems and planned measures in older people receiving nursing care. BACKGROUND Poor oral health conditions have a negative impact on the quality of life of older people. Therefore, oral care is an important task in daily nursing activities. METHODS Data were obtained from the web-based Swedish national quality register Senior Alert. Data regarding oral health status and planned measures in individuals ≥65 years from one county in Sweden between July 2014-June 2015 were included. The Revised Oral Assessment Guide-the Jönköping (ROAG-J) was used routinely by nursing staff in nursing care facilities to measure oral health status. RESULTS Oral assessments were made on 2,567 individuals (65.7% women). The most common oral health problem was related to "Teeth" (43.0%), which indicates deficient oral hygiene and/or broken teeth. At least one measure was planned in all the participants. The most common planned measures were "Moistening of the mouth" (16.6%), followed by "Brushing - assistance or complete help" (13.5%). CONCLUSION Oral health problems were common, and planned measures did not seem to be sufficient to address the identified problems. The results indicate that greater priority should be given to the oral health care of older people in nursing care. RELEVANCE TO CLINICAL PRACTICE The study highlights the importance of not only identifying oral health problems but also having knowledge and strategies for oral health care. Collaboration is needed to support nurses in caring for the oral health care of older people in nursing homes.

OBJECTIVE To describe the dental health status of elderly people in nursing homes receiving domiciliary dental care. DESIGN Case note review. CLINICAL SETTING Nursing homes in 8 Swedish counties. PARTICIPANTS Care dependent elderly people (≥65 years). METHODS Clinical data, including the number of remaining natural teeth, missing and decayed teeth (manifest dental caries) and root remnants, recorded by dentists according to standard practices. Medical and dental risk assessments were performed. RESULTS Data were available for 20,664 patients. Most were women (69.1%), with a mean age of 87.1 years (SD 7.42, range 65-109). The mean age for men was 83.5 years (SD 8.12, range 65-105). Two or more medical conditions were present in most of the population. A total of 16,210 individuals had existing teeth of whom 10,974 (67.7%) had manifest caries. The mean number of teeth with caries was 5.0 (SD 5.93) corresponding to 22.8% of existing teeth. One in four individuals were considered to have a very high risk in at least one professional dental risk assessment category. CONCLUSIONS Care dependent elderly in nursing homes have very poor oral health. There is a need to focus on the oral health-related quality of life for this group of frail elderly during their final period of life.