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Wrinkles are among the common signs of aging, but as Mark Twain wisely said, “Wrinkles should merely indicate where smiles have been.” While wrinkles and gray hair are inevitable, tooth loss does not have to be. Maintaining a healthy smile becomes increasingly important as the population of older adults continues to grow.

According to a 2023 and a Baby Boom generation , advances in health care, nutrition and medical technology, along with higher birth rates during the baby boomer era, have contributed to longer life expectancies and greater tooth retention. This trend requires additional prevention strategies for this vulnerable population. Globally, the number of older adults, particularly those over 85, is rising rapidly, highlighting the need for specialized oral care.

Current confirms that oral health is closely tied to overall health. Poor oral hygiene has been linked to systemic conditions such as diabetes, cardiovascular disease, stroke, respiratory infections and Alzheimer’s disease. Maintaining dentition not only enhances quality of life but also supports general health. Older adults, especially those in institutionalized settings, often face increasing levels of dependency as they age. Complex medical histories and multiple medications put them at greater risk for conditions such as dry mouth, root caries and periodontal disease, which affect their ability to eat, speak and socialize.

have shown that there are reliable dependency scales that can help guide care planning. The MDS-ADL or Katz Index of Independence in Activities of Daily Living (ADL) is commonly used in nursing homes to assess functional status, ranging from bathing and dressing to feeding and mobility. As dependency increases, so do oral health needs. Building a strong foundation in geriatric dental care, including didactic teaching, clinical exposure and research, is essential for preparing future dentists to serve this population with competence and compassion.

Hands-on, compassionate care

At Inspiration Hills Nursing Home, smiles are being nurtured in a very special way, through the care, compassion and creativity of predoctoral dental students. Inspiration Hills, a skilled nursing facility in San Antonio, provides long-term residential care, rehabilitation services and daily assistance for older adults with varying levels of dependency.

During the summer of 2025, senior dental students from The University of San Antonio School of Dentistry volunteered for a geriatric elective course that included outreach and education at nursing homes. The program aimed to educate residents on oral health and encourage referrals among medical providers.

For the residents, smiles carry stories of resilience, wisdom and love. Thanks to a unique partnership between the dental students, school faculty and community leaders, those smiles are also receiving the attention they deserve. As the older adult population grows, the importance of compassionate, patient-focused geriatric dentistry is greater than ever. The Inspiration Hills program responds to this need by giving dental students hands-on exposure to high-need, deeply meaningful clinical care.

A glimpse into the program

Through this program, students screen nursing home residents with diverse needs, including moderate to severe oral health issues, cognitive or mobility impairments and complex medical conditions. Bedside or mobile clinic assessments are conducted for those who are chair-bound or unable to visit the clinic, reflecting the realities of geriatric dentistry. These experiences teach students to adapt their clinical techniques, documentation and communication to each patient’s unique situation, while also gaining humility, patience and a deeper appreciation for dignity in care, key traits for any clinician.

The visits extend beyond oral health care. Smiles exchanged in the hallways, laughter sparked by a piano tune or magic trick, and quiet personal interactions all reinforce the same lesson: when education and service come together, communities grow stronger. For residents, these moments spark joy, awaken memories and build bonds. For students, they serve as reminders that caring for older adults means caring for the whole person, not just their teeth.

“My experience at Inspiration Hills Rehabilitation Center was a humbling and eye-opening opportunity that gave me a greater perspective on the importance of oral health care. Conducting oral health screenings for the residents emphasized how crucial access to oral care is, particularly for those in vulnerable stages of life. While there, I also had the chance to play the piano for the residents. Though not the central part of my visit, it was a meaningful way to brighten their day, reminding me that compassion in health care is also about bringing comfort, dignity and moments of joy to those we serve,” commented Nathan Tylor Yang, a fourth-year dental student.

By providing early exposure, the program plants seeds of understanding that will influence how students care for older adults throughout their careers.

Collaboration and vision

The program’s success rests on the dedication of its contributors and the vision of leaders who guide and support its implementation. At Inspiration Hills, the nursing home administrator and social worker play key roles, welcoming students and coordinating visits to ensure residents feel comfortable and cared for.

Laurice Alvarado, LBSW, part of the Inspiration Hills team working with the dental students, said, “As a social worker, I see every day how much it means to residents to be treated with dignity and compassion. This program not only enriches the lives of our residents but also gives the dental students a deeper understanding of the human side of care. It is a real pleasure collaborating with the dental school leadership. Our residents feel cared for, the students gain invaluable experience and our community grows stronger.”

Support from the School of Dentistry’s leadership, including , director of the Geriatric Dental Clinic; , chair of predoctoral dentistry; , dean of the School of Dentistry; and , associate dean of patient care, was instrumental in transforming the initiative from a summer elective course into a sustainable, integral part of the curriculum. This collaboration between nursing home staff, community partners and dental school leadership exemplifies how education can be both compassionate and impactful.

The School of Dentistry’s (HOPE) initiative, a dynamic public-health model funded by a Centers for Medicare and Medicaid Services (CMS) grant over three years and led by associate dean for strategic initiatives, laid a strong foundation for nursing-home outreach. Although the clinical phase of HOPE concluded in 2023, its framework has proven invaluable, shaping the school’s current nursing home outreach efforts and providing a replicable, compassionate model that continues to guide future dental student engagement.

Meeting a growing demand

“Providing oral health care to nursing home residents is not only a lifeline for one of our most vulnerable populations in our community, but also an unparalleled experience for our students,” noted Dr. Soto. “For nursing home residents, access to oral healthcare restores dignity and comfort and the ability to confidently eat, speak and smile. For our students, these moments affirm that patient care is at the heart of dentistry and shape the clinicians they will become.”

This initiative met a critical need for the patients while offering students a transformative experience, enhancing both their skills and empathy. Their reflections following the course highlighted the vital role of geriatric dentistry in the curriculum. It was also rewarding to welcome some of the nursing home residents into the Geriatric Dental Clinic through the support of the nursing home staff and our school’s leadership team.

Geriatric dental education, which emphasizes individualized and patient-focused care, is essential to meet the needs of an aging population. Programs like this not only improve oral health for older adults but also cultivate a generation of dental professionals who understand the psychological, social and medical complexities of aging. In doing so, they ensure smiles remain a source of joy and dignity across generations.

 , is an assistant professor clinical in the Department of Comprehensive Dentistry at the UT San Antonio School of Dentistry with a graduate certificate in geriatrics and special needs (University of Iowa). She played a leading role in providing dental care at nursing facilities through the Holistic Oral Health Program for the Elderly. Dr. Kundapur, along with Annetty Soto, DMD, Geriatric Dental Clinic director, leads the School of Dentistry’s initiative to address the need for dental care among nursing home residents while also preparing dental students to meet these needs