Oral Care: Part 6b Oral Care Techniques

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Oral Care Part 6b Oral Care
Techniques

• Using a Best Practice Approach in
• Long-Term Care

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Introduction Learning Objectives

• Learn about
• A best practices approach to oral hygiene care
• Implementing general oral hygiene care techniques
• Dry mouth and swallowing problems
• Palliative oral hygiene care

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Evidence-Based Approach to Oral
Care for Older Adults from IOWA

• This evidence-based model of the importance of
  oral hygiene care and dental treatment on
  maintaining oral health from IOWA highlights
  several key areas
• Regular daily oral care
• Preventive oral care
• Assessment
• Secondary tertiary dental care
• ?
• Impacts
• Systemic health
• Nutrition
• Quality of life
• Overall well-being

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Develop an Individualized Oral Hygiene
Care Plan
An individualized Oral Hygiene Care Plan enables
care providers to focus on appropriate oral care
interventions for the resident Oral Hygiene Care
Plan should be developed on admission, quarterly
and as a residents oral status or self care
abilities, cognitive or functional impairment
changes
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RNAO Oral Health BPGCare Planning
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RNAO Oral Health BPGCare Planning
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RNAO Oral Health BPGCare Planning
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A Best Practices Approach to Oral Care in LTC
homes

• Care Planning Strategies
• Implement general oral hygiene care strategies
• Preparing for oral care
• Toothpaste and toothbrush tips Natural teeth
• Denture care
• Communication techniques for oral care
• Techniques for getting in the mouth
• Handling responsive behaviours
• Handling communication, cognition functional
  issues
• Dry mouth and swallowing problems
• Palliative oral hygiene care

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Dry Mouth (Xerostomia)

• The sensation of a dry mouth is medically termed
  xerostomia
• Residents with low salivary flow experience many
  problems such as
• Xerostomia (dry mouth)
• Increased tartar deposits and dental decay
• Difficulty clearing food and bacteria into the
  throat
• Pain - mucosal soreness, gingivitis, cheilitis in
  the corners of the mouth, fissuring on the
  tongue, burning in the mouth
• Salivary duct infections, yeast infections
• Difficulty chewing, speaking, swallowing, and
  wearing dentures
• Its important to remember that saliva plays a
  key role in the
• Maintaining oropharyngeal health oral cleansing,
  pH balance, speech, taste
• Many functions of the gastrointestinal
  environment swallowing and digestion

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Dry Mouth (Xerostomia)

• Medication side effect of a dry mouth
• is the most common cause of Xerostomia
• More than 250 medications can cause a dry mouth
• Medications with oral side effects include
  antidepressants, narcotics, antipsychotics,
  antiparkisonian, antiasthmatics,
  antihypertensives
• Residents who are taking medications which can
  cause xerostomia are at increased risk for
  plaque-related diseases and tooth decay
• In a dry mouth, the oral environment is more
  acidic, oral bacteria thrive as there is less
  saliva for counteracting them, causing the rate
  of tooth decay and oral infections to increase

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Dry Mouth (Xerostomia)
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Dry Mouth What to Look For and What You
Can Do

• What to Look For
• Dry, irritated, cracked lips,
  
  corners of mouth, tongue
• Trouble chewing, swallowing, eating, speaking,
• Lips that stick to teeth or dentures
• Red gums that bleed easily
• Bad breath
• Stringy, thick saliva
• Problems wearing dentures

• What You Can Do
• Review of current medication
• Sip water or suck on ice chips
• Rinse mouth with club soda
• Use special mouth moisturizing products
• such as artificial saliva
• Use special toothpastes
• Apply water-based lip lubricant
• Use sugar-free gum/candies
• Use a cool mist humidifier, especially
• at night
• Consult with an oral health professional

• What to Avoid
• Avoid lemon/glycerin swabs, mouth-rinses and
  toothpastes that contain alcohol, sodium lauryl
  sulfate (most brands) or flavouring agents,
  candies or mints, sweet/spicy or bulky foods,
  caffeine, tobacco, and avoid mouth breathing.

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Swallowing Problems

• Dysphagia is an uncomfortable, frightening and
  potentially life-threatening condition because it
  
• interferes with the oral intake of food and
  liquids
• can lead to aspiration, choking, suffocation,
  dehydration, malnutrition, decreased quality of
  life and frustration for residents, family and
  staff and
• Interferes with oral care
• Up to 70 of residents will have signs of
  swallowing
• problems gtgt creating oral care challenges

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Swallowing Problems Oral Care Tips

• Positioning
• In a supine position (back) at about 45 or
• Lying on their side with towel placed on pillow
  (this
  allow fluids to pool in the cheeks rather than
  being at risk of aspirating them)
• Check the mouth look inside -to remove debris
  around teeth
• Use propping devices when necessary but make sure
  there are no loose or broken teeth
• May not be able to spit very well or clear their
  throat
• Place residents chin in neutral position to help
  prevent choking or aspiration
• Depending on the severity of the dysphagia or
  swallowing problem, the resident may
  require the use of
• Suctioning as necessary
• A suction-type toothbrush (cant use toothpastes
  as it blocks the suctioning)

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Swallowing Problems Oral Care Tips

• Toothbrush with water or mouthwash
• Regular soft toothbrush should be dipped into
  water or mouthwash to brush teeth, clean tongue
  and gums
• Gently massage gums and palate
• Never use sponges or toothettes
• Preferable to not use toothpastes
• If toothpaste is used, select a non-foaming
  toothpaste
• Water is also used for flushing the suction
  toothbrush if needed
• Make sure debris and liquid is cleaned out of the
  mouth, may need to use a thin cloth such as a
  J-cloth
• Apply non-petroleum lip balm
•  

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Oral Care for Palliating Residents

• 2 Ontario palliative clinical guidelines that
  include
• mouth care guidelines that promote oral comfort
  and oral care for palliating residents
  with dry mouth, mucositis/stomatitis, candida/
  herpes/bacteria infections
• http//www.ccac-ont.ca/Upload/esc/General/Palliat
  ive_Care_Managment_Tool_v3.2.pdf
• http//www.hpcconnection.ca/tools/pdf/clinical_pra
  ctice_guidelines.pdf

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Oral Care for Palliating Residents
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Oral Care for Palliating Residents
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Oral Care for Palliating Residents
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Oral Care for Palliating Residents
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Resource Tools
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Resource Tools
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Resource Tools

• Halton Region Health Departments Dental Health
  Division has developed an extensive oral care
  education program called K.I.S.S. for LTC
  staff
• to assist staff to develop better oral care
  techniques
• with full explanations and picture-based
  step-by-step instructions

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Resource Tools
Registered Nurses Association of Ontario DVD I
Oral Care for Residents with Dementia (Spring
2007) DVD II Oral Care for Xerostomia,
Dysphagia and Mucositis (Spring
2008) www.rnao.org
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Resources

• Canadian
• The Registered Nurses Association of Ontario
  (2008) . Oral health. Nursing assessment and
  interventions. Toronto, ON Author. www.rnao.org
  (Recommendations Fall 2007).
• The Registered Nurses Association of Ontario and
  Halton Region Health Department (Summer 2007).
  Oral care for resident with dementia
  (DVD)Toronto, ON Author. www.rnao.org or phone
  Dir [phone] Fax[phone]
  CDN
• ML van der Horst (April 2007). The BP Blogger.
  Myth busting The mouth issue. Monthly
  newsletter for LTC that dispels care myths with
  evidence from best practice guidelines. Available
  at www.rgpc.ca
• Halton Region Health Department (2006). Dental
  health manual for LTC home staff. Halton oral
  health outreach project. Oakville, ON Author.
• Centre for Community Oral Health- Long Term Care
  Fact Sheets. Nov 2006 www.umanitoba.ca/faculties/
  dentistry/ccoh
• Best Practice Coordinators in Long-Term Care
  Initiative Central South/South West (February
  2008). Best Practices Approach to Oral Care
  Resource Kit. www.rgpc.ca
• Oral Care.ca www.oralcare.ca

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Resources

• Others
• The University of Iowa College of Nursing (2002).
  Oral hygiene care for functionally dependent and
  cognitively impaired older adults.
  Evidence-based practice guideline. Iowa City,
  Iowa Author/Gerontological Nursing Interventions
  Research Center. www.nursing.uiowa.edu
• Joanna Briggs Institute (2004). Oral hygiene
  care for adults with dementia in residential aged
  care facilities. Best Practice, 8(4). Adelaide,
  Australia Author. www.joannabriggs.edu.au

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References

• Fallon, T., Buikstra, E., Cameron, M., Hegney,
  D., Mackenzie, D., March, J., Moloney, C.,
  Pitt, J. (2006). Implementation of oral health
  recommendation into two residential aged care
  facilities in a regional Australian city.
  International Journal of Evidence-Based
  Healthcare, 4, 162-119.
• Federal, Provincial and Territorial Dental
  Directors. (2005). A Canadian oral health
  strategy. Accessed January 4, 2007. Available at
  http//www.fptdd.ca/Canadian20Oral20Health20Str
  ategy20-20Final.pdf.
• Frenkel, HF., Harvey, I., Needs, KM. (2002).
  Oral health care education and its effect on
  caregivers knowledge and attitudes a randomised
  controlled trial. Community Dentistry and oral
  Epidemiology, 30, 91-100.
• Frenkel, H., Harvey, I., Newcombe, RG. (2001).
  Improving oral health in institutionalised
  elderly people by educating caregivers a
  randomised controlled trial, 29, 289-297.
• Nicol, R., Sweney, MP., McHugh, S., Bagg, J.
  (2005). Effectiveness of health care worker
  training on the oral health of elderly residents
  of nursing homes. Community Dentistry and Oral
  Epidemiology, 33, 115-124.
• Pearson, A. Chalmers, J. (2004). Oral hygiene
  care for adults with dementia in residential aged
  care facilities. Systematic review. JBI Reports,
  2, 65-113.

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References

• Seniors Oral Health Collaboration for the Nova
  Scotia Department of Health (SOHC). (2006). The
  oral health of seniors in Nova Scotia. Policy
  Scan and Analysis Synthesis report. Accessed
  January 15, 2007. Available at
  http//www.ahprc.dal.ca/oralhealth/Reports/FINAL.p
  df
• Thorne SE, Kazanjian A, MacEntee. (2001). Oral
  health in long term care The implications of
  organisational culture. Journal of Aging Studies,
  15, 271-283.
•  
• US Department of Health and Human Services (US
  DHHS) (2000). Oral Health in America A Report of
  the Surgeon General. Rockville, MD National
  Institute of Dental and Craniofacial Research,
  National Institutes of Health. Accessed January
  15, 2007. Available at http/www.nidr/nih.gov/sgr
  /oralhealth.asp
• Wardh, I., Hallberg, L., Berggren, U.,
  Sorensen, S. (2003). Oral health education for
  nursing personnel experiences among specially
  trained oral care aides One-year follow-up
  interviews with oral care aides at a nursing
  facility. Scandinavian Journal of Caring Science,
  17, 250-256.
• WHO. (2003). The world oral health report.
  Continuous improvement of oral health in the 21st
  century the approach of the WHO Global Oral
  Health Programme. Geneva, SW author. Accessed
  January 15, 2007. Available at
  http//www.who.int/oral_health/publications/report
  03/en/

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For more information

• Mary-Lou van der Horst, RN, BScN, MScN, MBA
• Regional Best Practice Coordinator Long-Term Care
  
• Central South Region-Ministry of Health and
  Long-Term Care
•  Village of Wentworth Heights LTC Home
• 1620 Upper Wentworth Street, Hamilton, ON Canada
  L9B 2W3
•   email    mvanderhorst_at_oakwoodretirement.com    
      
• tel     [phone] 
•      fax     [phone]    
  LTC Best Practice Resource Centre
• www.rgpc.ca
• Donna Scott, RN, BScN, CHRP
  www.shrtn.on.ca
• Regional Best Practice Coordinator Long-Term Care
  
• Southwest Region-Ministry of Health and Long-Term
  Care
• Parkwood Hospital
• 801 Commissioner's Road East
• London, ON Canada N6C 5J1
• Email donna.scott_at_sjhc.london.on.ca
• Tel [phone] x42337
• .