Oral Care: Part 5 Preparing for Oral Care and Communication Techniques

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Oral Care Part 5 Preparing for
Oral Care and Communication 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 strategies
• Preparing for oral care
• Toothpaste and Toothbrush Tips
• Denture Care Tips
• Communication techniques for oral 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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Preparing for Oral Care

• Familiarize yourself with
• Severity of residents cognitive impairment
  residents responsive behaviours (pushing,
  turning head, biting)
• Residents communication sensory impairments
• Residents functional impairments (arthritis in
  hands, mobility)

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Preparing for Oral Care

• Oral care should be completed at least 2x each
  day
• Never awaken a resident to complete oral care
• Oral care should be done in the bathroom,
  whenever possible, because of its physical cues
  (i.e., sink, water, etc.)
• Review the residents oral care plan
• Review if the resident has dysphasia
  (i.e., problems swallowing,
  choking, spitting)

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Preparing for Oral Care

• Assemble all oral care supplies and have them
  ready to use in the residents bathroom, before
  you bring them into the bathroom
• Check that the oral care supplies are labeled
  with the residents name
• NEVER use toothpaste or mouth rinses with
  residents with swallowing difficulties WATER
  ONLY
• NEVER use lemon glycerin swabs for oral care

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Preparing for Oral Care

• Always communicate to the resident what you are
  planning to do talk about it when getting
  youre ready no surprises !
• Have the resident do as much of their oral care
  as they can possibly do. It may not be perfect
  and offer to finish areas they may have missed
• Explain to the resident and describe the oral
  care tasks (steps) you want them to do or will be
  doing
• Remember Always use proper body positioning
  when providing oral care

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Toothpaste Tips

• Natural Teeth
• Use pea-sized amounts of toothpaste,
  squeezing out a long strip of toothpaste
  is too much
• Most toothpastes have a strong taste, many
  residents dont like this, not appealing to
  residents with Alzheimers Disease
• Foaming action of toothpaste increases saliva
  flow will result in the resident wanting to
  spit gtgt choke, gag
• DO NOT use toothpaste for residents who have
  dysphagia, who cannot swallow or spit/rinse
  properly, have high level of dementia - there
  are oral cleansing gels available

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Toothbrush Tips

• Natural Teeth
• The best type of toothbrush to use for residents
• is one with a small head, soft bristles, larger
  handle with rubberized grip
• 2-Toothbrush Technique
• For residents who bite down during care, consider
  using 2 toothbrushes one to prop the mouth open
  and one for cleansing
• Replace toothbrush
• every 3 months or after an infection

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Denture Care

• Plaque tartar form on dentures just the same as
  they form on natural teeth
• Remove dentures daily for at least 3 hours for
  gums to rest, overnight is easiest
• Ask the resident to remove their dentures.
  Assist, if they cant
• For upper dentures
• slide your index finger along the dentures side
  then push gently against the back of the denture
  to break the seal. Grasp it and remove by
  rotating it. Grasp lower dentures at the front
  and rotate.
• For partial dentures
• place thumbnails over or under the clasps, apply
  pressure, being careful to not bend the clasps
  and catch them on lips or gums.

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Denture Care

• Cleaning dentures
• Wear gloves
• Line the sink with a towel. Fill it with some
  cool water just in case the dentures slip and
  fall. Hot water can warp dentures.
• Rinse with cold water to remove food
• Scrub dentures using a denture brush and denture
  paste
• Thoroughly brush all surfaces especially those
  that touch the gums. Rinse well.

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Denture Care

• Cleaning dentures
• At bedtime, place dentures in denture cup with
  cool water and vinegar (½ water and ½ vinegar)
• Only soaking them overnight with a cleansing
  table is not sufficient it doesnt clean off
  the plaque
• NEVER use denture tablets for soaking dentures of
  residents with dementia - ingestion of
  tablets/solution is serious
• Never use vinegar on dentures with any metal on
  them as this will cause the metal to turn black.

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Denture Care

• Clean the mouths of residents who wear dentures
• If the residents lips are dry, moisten them with
  a non-petroleum based product (e.g. Lipsol)
• Always brush mouth tissues with a regular soft
  bristled toothbrush
• including the tongue, palate, cheeks and ridges
  of mouth
• In morning, rinse dentures well before placing in
  residents mouth
• Always put the upper denture in first then lower
  one to avoid gagging
• Denture cups should be scrubbed weekly to prevent
  bacterial or fungal growth and replaced monthly

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Communication Techniques for Oral Care
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Communication Techniques for Oral Care
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Communication Techniques for Oral Care
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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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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
• .