Document Title and Code: - Nursing Matters



Document Title and Code: |Policy for Oral Hygiene and Dental Care. NMA-ODC | |

|Version: |1 |

|Author: |Prepared by Nursing Matters and Associates. |

|Adapted for Local use by: | |

|Issue Date: |September 2012 |

|Review date: |September 2014 |

|Authorised by: | |

Policy Statement:

Good oral health for all residents will be promoted through person centred assessment and care planning for oral hygiene needs on admission, routinely every three months or sooner where the resident’s condition indicates.

Purpose:

The purpose of this policy is to promote good oral health for residents in the Centre.

Objectives:

1 To ensure that nurses are knowledgeable in assessment and care planning for resident’s oral hygiene and dental care needs.

2 To ensure that residents’ oral hygiene and dental care are addressed in accordance with their needs, known preferences and wishes.

3 To ensure that all care staff are knowledgeable in the delivery of oral hygiene care.

Scope:

This policy applies to all nursing and care staff in the Centre.

Definitions:

1 Oral: refers to the mouth including natural teeth, gingival and supporting tissues, hard and soft palate, mucosal lining of mouth and throat, tongue, salivary glands, chewing muscles, upper and lower jaw, lips (Hartford Institute for Geriatric Nursing, 2008)

2 Oral Cavity: consists of the cheeks and the hard and soft palate (Hartford Institute for Geriatric Nursing, 2008)

3 Oral hygiene / Mouth Care: Mouth care is the use of a toothbrush and paste, a mouthwash or other mouth cleaning preparation to help the patient to maintain the cleanliness of his teeth or dentures and to encourage the flow of salvia to maintain a healthy oropharyngeal mucosa. ( Jameieson et al ,1998 cited in Midland Health Board, 2003)

1. Quick Reference Guide: Management of Oral Hygiene and Dental Care Needs.

|Actions |Responsible Person. |

|This policy will be disseminated to and read by all nursing personnel involved in assessment and |Person in Charge/Director of Nursing. |

|care planning for resident. | |

|A record will be kept of all those who have signed the policy acknowledgement forms. |Person in Charge/Director of Nursing. |

|Where a new version of this policy is produced, the previous version will be removed and filed |Person in Charge/Director of Nursing. |

|away. | |

|Every new staff member who will have a role in assessment and care planning will be given an |Person in Charge/Director of Nursing or |

|explanation of this policy as part of his/her induction. |delegated to another named nurse. |

|Each new resident will be screened for oral hygiene and dental care needs on admission. |Admitting and/or designated nurse. |

|Resident will have an oral hygiene assessment using a validated screening tool within 48 hours or |Admitting or designated nurse. |

|sooner if indicated by their admission assessment. | |

|Each resident who has a condition / disease affecting oral hygiene and / or dental care will have a|Admitting and/or designated nurse. |

|written care plan developed in consultation with him/herself and /or the resident’s representative | |

|and other relevant healthcare personnel involved in the resident’s care. | |

|The resident’s plan of care to meet oral hygiene needs will be communicated to all those providing |Designated nurse. |

|direct care to the resident. | |

|Nurses will maintain their competence in assessment for, care planning for and implementation of |All registered nurses |

|oral hygiene needs and communicate any competency / knowledge deficits to their line manager/Person| |

|in Charge. | |

|Care given to residents will be in accordance with the plan of care developed and agreed by the |All healthcare staff providing care to |

|resident and / or representative and other healthcare professionals involved in the resident’s |residents. |

|care. | |

|Changes in a resident’s condition will be reported to the senior nurse in charge and changes to |All nurses, care assistants and other |

|care will be documented and communicated to all relevant healthcare professionals. |healthcare professionals involved in the |

| |resident’s care. |

Protocol for Oral Hygiene Assessment and Care Planning.

1 Admission Assessment.

1 Every resident will have an assessment of their oral health commenced on admission.

2 The admitting nurse should identify the following as part of the admission assessment:

← Any known oral diseases or conditions affecting the resident’s oral health. These may be recorded in the resident’s discharge notes or referral forms.

← The resident’s ability to carry out oral hygiene care independently.

← The resident’s usual routine for oral hygiene.

← Level of assistance required for oral hygiene care.

← Presence or absence of natural teeth or dentures.

← Any known difficulty with swallowing or chewing ability.

← Any specific needs related to oral / dental care.

← The views and observations of the resident or his/her representative regarding current oral/dental status and oral hygiene care.

3 Based on the above information, the nurse should use his/her professional judgment as to whether or not a physical assessment of the resident’s oral cavity is required at this stage or can be completed as part of the comprehensive nursing assessment.

2 Comprehensive assessment

3 Comprehensive assessment of the resident’s oral health needs will continue over the first seven days following admission and include the following:

1 The admitting or designated nurse will complete an assessment of the resident’s oral cavity using the Oral Health Assessment Tool or The Kayser-Jones Brief Oral Health Status Examination (BOHSE) as outlined in 7.4.

2 The admitting or designated nurse will collaborate with the resident as far as he / she is able to ascertain needs and wishes related to oral / dental care.

3 The admitting or designated nurse will involve the resident’s family, where the resident is unable to participate, in order to ascertain the resident’s needs and known wishes for oral / dental care.

4 The admitting or designated nurse will gather information from other nurses and care staff to identify care needs and preferences.

5 The admitting or designated nurse will liaise with other relevant healthcare professionals to ensure a team based approach to assessment and care planning. This may include the resident’s general practitioner; dentist; dietician and so on.

4 Conducting an Oral Cavity Assessment.

1 The oral health assessment involves assessing the following eight areas:

1. Lips.

2. Tongue.

3. Gums and Oral Tissue.

4. Saliva.

5. Natural Teeth.

6. Dentures.

7. Oral Cleanliness.

8. Dental Pain.

2 The following equipment should be assembled for the assessment:

➢ Pen torch light.

➢ Disposable gloves.

➢ Tongue depressor/ bent toothbrush.

➢ Tissues or wipes.

➢ Oral Health Assessment Tool.

3 It is useful to have a second member of nursing present so as to free up the nurse to carry out the inspection of the oral cavity. A second person may be required if the resident has responsive behaviour.

4 For residents with cognitive impairment, it may be necessary to have a family member present.

5 Procedure.

1 The nurse should introduce him/herself to the residents and explain the procedure to the resident and seek their permission to continue.

2 Assist the resident into a comfortable position. The resident should be positioned in a semi reclined position (45 degree angle).

3 Wash hands and apply gloves.

4 Start with examining the lips. Lips should be pink, moist and smooth. Observe for dryness, swelling, lumps or ulcerated patches. Also look for cracks and soreness at the corners of the mouth.

5 Using the tongue depressor and pen torch, examine the tongue. It should be moist and pink. Observe for any signs of patchy, coated, ulcerated or fissured areas. The presence of these may indicate that the mouth is too dry or the colonization of bacteria or fungi.

6 Check the oral tissue using gloved fingers or the backwards bent toothbrush to gain access to a better view of the mouth. Mucosa should be pink, moist and smooth. Observe for redness, swelling, bleeding, patchy or ulcerated mucosa.

7 Check for the presence of saliva. Saliva should be clear and free flowing. Dry and / or sticky mucosa or the resident reporting a dry mouth may indicate problems with saliva production or flow.

8 Next, examine the resident’s teeth. Again the toothbrush can be used as a retractor to help see the inside of the mouth. Observe for broken teeth, roots, broken or excessively worn teeth. If the resident has a denture or partial denture this should be removed and inspected. Inspect dentures for any damage or excessive wear. Also check the gums and oral tissue under the dentures.

9 Assess general oral cleanliness. The mouth should be smooth and moist with no food particles or tartar build up on teeth and / or dentures.

10 Throughout the procedure, check for pain by asking the resident about the presence of any soreness or pain. If the resident cannot communicate verbally, observe for non verbal cues such as face pulling; chewing lips or changed behaviour.

11 Remove gloves and wash hands.

12 Make sure the resident is comfortable.

13 Complete the Oral Health Assessment Tool or The Kayser-Jones Brief Oral Health Status Examination (BOHSE).

14 Refer to resident’s general practitioner or dentist as appropriate.

Fig 1: Oral Health Assessment Source Australian Government Department of Health and Ageing (2009).

|AREA |Healthy |See management protocol. |* Indicates referral to dentist. |

|LIPS |Smooth, pink and moist. |Dry, chapped or red at corners |Swelling or lump, red/white/ulcerated/bleeding. |

| | | |Bleeding/ulcerated at corners. * |

|TONGUE |Normal, moist roughness, pink. |Patchy, fissured, red or coated. |Patch that is red and / or white, ulcerated,swollen.|

| | | |* |

|GUMS/ORAL TISSUE |Pink, moist, smooth, no bleeding. |Dry, shiny, rough, red, swollen, one |Swollen, bleeding, ulcers, white/red patches, |

| | |ulcer/sore spot under dentures. |generalised redness under dentures. * |

|SALIVA |Moist tissues, watery and free flowing |Dry, sticky tissues, little saliva |Tissues parched and red, very little/no saliva |

| |saliva. |present, resident thinks they have a |present, saliva is thick, resident thinks they have |

| | |dry mouth. |a dry mouth. * |

|NATURAL |No decayed or broken teeth/roots. |1-3 decayed or broken teeth/roots or |Decayed or broken teeth/roots, or very worn down |

|TEETH | |very worn down teeth. |teeth or less than 4 teeth. * |

|DENTURES |No broken areas or teeth, dentures |1 broken area/tooth or dentures only |More than 1 broken area/tooth, denture missing or |

| |regularly worn, and labelled. |worn for 1-2 hrs daily. |not worn. * |

|ORAL |Clean and no food particles or tartar in |Food particles/tartar/plaque in 1-2 |Food particles/tartar/plaque in most areas of the |

|CLEANLINESS |mouth or on dentures |areas of the mouth or on small area |mouth or on most of dentures or severe bad breath. *|

| | |of dentures or halitosis (bad | |

| | |breath). | |

|DENTAL PAIN |No behavioural, verbal or physical signs |Verbal and / or behavioural signs of |Physical pain signs |

| |of dental pain. |pain such as pulling at face, chewing|(swelling of cheek or gum, broken teeth, ulcers), as|

| | |lips, not eating, aggression. |well as verbal and / or behavioural signs (pulling |

| | | |face, not eating, aggression. * |

6 Care Planning.

1 The admitting nurse must commence the resident’s care plan for oral / dental on the day of admission based on information available. The care plan will be developed further over the next seven days based on additional information received from observation; referrals and additional assessments carried out as part of the comprehensive assessment.

7 Each nurse must add to the care plan based on additional information received during their shift.

8 Identifying the resident’s care needs for the care plan will involve reviewing the following resident information:

➢ Past medical history

➢ Past history of oral diseases or infections.

➢ Current medications.

➢ Nutrition and hydration status.

➢ Smoking history.

➢ Details of past dental treatments as far as is practicable.

➢ The resident’s knowledge and usual practice of oral and dental care.

➢ Preferences or wishes the resident may have regarding oral hygiene.

➢ Level of assistance required

➢ Presence or absence of natural teeth or dentures.

➢ Natural teeth in tact; broken; decayed; food particles; halitosis.

➢ Ability to function with or without natural teeth or dentures.

➢ Speaking chewing swallowing ability.

1 Care planning for oral hygiene and healthcare needs should be agreed with the resident and/or representative and other relevant healthcare staff involved in the resident’s care.

2 Residents who require referral to a dentist or general practitioner as indicated by their assessment should be referred for further assessment.

3 The care plan for each resident’s oral hygiene and healthcare needs should include the following information:

➢ Any illnesses/conditions affecting the resident’s oral/dental care.

➢ Any risks identified related to the resident’s oral status and measures to address these.

➢ What the resident can do himself/herself.

➢ What care needs /assistance the resident requires to perform oral hygiene care.

➢ Any care needs for oral / dental care to maintain oral health.

➢ Additional care needs that may be required if the residents has communication and behaviour management needs.

4 The care plan should identify frequencies and methods for monitoring the resident’s oral health according to their needs.

5 The resident’s care needs for oral hygiene and healthcare should be communicated to all relevant healthcare staff involved in the resident’s care at shift handovers.

6 Review and reassessment of needs will be carried out by the designated nurse every tree months or where there is a change in the resident’s health status affecting oral / dental needs.

9 Monitoring and Evaluation.

1 Resident’s oral hygiene and dental care should be reviewed and amended according to specific review schedule.

2 Changes to care / condition should be recorded in the resident’s progress notes.

Performing Oral Hygiene for Residents.

1 Care of Natural Teeth.

1 Brushing is the most effective way of physically removing plaque.

2 Residents should be encouraged to brush their teeth twice daily using a soft toothbrush.

3 Where possible encourage and facilitate the resident to carry out his/her own mouth care.

4 Encourage consumption of sugar-free food and drinks between meals.

5 If the resident requires cleaning between teeth then consider using an inter-dental brush. Check with the resident’s dentist if unsure.

6 Ensure the resident has regular oral health assessments.

7 Toothbrushes should be changed every three months.

2 Procedure for Oral Hygiene Care.

1 Obtain permission from the resident and explain the procedure.

2 Assist the resident to sit out of bed to chair or in an upright position in bed. Depending on the older person’s mobility care can be provided in the bathroom while the resident is seated in a chair, a wheel chair, or in bed.

3 Wash and dry hands

4 If required, use personal protective equipment such as apron and clear safety glasses where splashing is anticipated.

5 Put on disposable gloves

6 Assemble all supplies you need for cleaning

➢ Toothbrush: Soft toothbrush is suitable for most people; powered toothbrush can be used for people with limited hand movements; Collis toothbrush or Dr. Barman’s toothbrush can be used for residents with limited co operation as all three surfaces are brushed at one (HSE, accessed 30/09/2012). Suction toothbrushes can be used for residents with Dysphagia or those at risk of aspiration.

➢ Fluoride toothpaste,

➢ Towel,

➢ Interdental brush and mouthwash if necessary.

7 Partial dentures should be removed before commencing oral hygiene care.

8 Ensure privacy and dignity is maintained.

9 Place a towel around the person’s shoulder to keep their clothes clean.

10 Encourage the resident to clean his or her own teeth, if possible. Watch and help clean missed areas.

11 If the person requires assistance it is best to stand behind the resident to one side in front of a sink or a table with a bowl for the resident to spit into (New Zealand Dental Association, 2010).

12 If brushing from behind the resident is not possible then stand in front of the resident and support their chin with your index finger and thumb, taking care not to place pressure on their throat with your remaining fingers (New Zealand Dental Association, 2010)

13 If the resident is in bed, cover his/her shoulders w with a towel to keep the bedding and clothes clean. Then use a finger or a bent toothbrush to carefully retract the cheek so you can see the teeth to be cleaned. Use another toothbrush to clean their teeth. You can use a bowl for the person to spit into (New Zealand Dental Association, 2010)

14 Apply a pea size amount of toothpaste to the resident’s toothbrush.

15 Brush back and forth over chewing surfaces spending at least 5 seconds on each tooth.

16 Move systematically around the mouth to ensure all surfaces have been cleaned.

17 Complete by brushing the top surface of the tongue from back to front.

18 After brushing, it is best if the person spits the toothpaste out and does not rinse as this will wash the fluoride away from teeth (New Zealand Dental Association, 2010)

19 It may be useful to use another toothbrush to move the cheeks away for better visual access.

20 Observe precautions for aspiration.

21 Clean dentures using a personal toothbrush and water using an up and down motion.

22 Report abnormalities / refer appropriately (line manager/general practitioner/dentist)

23 Document any abnormalities and referrals in the residents care plan.

24 When carrying out oral hygiene, observe for abnormalities such as dry mouth; ulceration; infection; bleeding and so on.

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3 Denture Care

1 Many problems can occur in residents with dentures. If dentures are not removed, allowing for the tissues to rest, infections such as thrush, or denture sore mouth can develop.

2 Poorly fitting dentures can also lead to soreness or cracking at the corners of the mouth. In people who wear partial dentures, the natural cleansing ability of saliva is reduced, so more thorough cleaning is needed to prevent infections and tooth decay from developing.

3 Over time, dentures can wear out and the shape of the gums and jaws can change. Because of this dentures may need to be relined or re-made to cater for these changes.

4 The amount of saliva can also affect the ability to wear dentures comfortably. Decreased saliva flow, which can be a side effect of many medications, or ageing, can cause dentures to become loose making them less stable during eating and speaking.

5 Denture containers must always be labelled with the resident’s name.

6 Nursing and care staff should encourage the resident to remove dentures nightly to allow the denture bearing gums to breathe as this helps prevent infections and maintains oral health.

7 Dentures must be soaked in cold water and denture cleaning agent e.g. sterident tablet, to prevent plaque build-up or distortion of dentures over time.

8 Procedure for denture care.

9 To clean, cradle the denture between the thumb and base of the index finger for a stable hold.

10 Dentures can be cleaned with soap and a toothbrush. Regular toothpaste should be avoided as it can be too abrasive for dentures, alternatively denture toothpaste can be sought.

11 Remove all food and plaque from both surfaces of the denture, especially the surface that rests against the tissues.

12 For more ingrained stains, soak in 1/2 vinegar, 1/2 water solution overnight.

13 Denture adhesive can also be used to prevent rubbing and irritation and to hold dentures more firmly in place.

4 Removing and Replacing Dentures.

1 To remove upper complete denture: with the thumb and index finger hold the front teeth of the upper denture and move it up and down until the vacuum is broken. Now remove the denture at a sideways angle and place it immediately into the denture container.

2 Lower complete denture: gently press down on one side of the denture until it lifts slightly. Remove the denture carefully and place it immediately in the denture container.

3 Upper partial denture: using your finger tips, gently push down the clasps that cling onto the natural teeth. Once the denture is loose hold the plastic part of the denture and lift it out of the mouth.

4 Upper partial denture: using your finger tips, gently push down the clasps that cling onto the natural teeth. Once the denture is loose hold the plastic part of the denture and lift it out of the mouth.

5 To replace dentures: Rinse dentures well before replacing in the mouth.

6 If required, apply denture adhesive according to instructions on the product.

7 Insert the upper denture first followed by the lower denture. Hold the denture sideways while inserting in the mouth and then rotate into position. Gently, push up the plastic part of the denture that covers the roof of the mouth to ensure proper fit of the upper denture.

8 For partial dentures the metal clasps should be clicked into their position.

Source: New Zealand Dental Association, 2010.

Oral Hygiene Care for Residents with Dementia.

1 Residents with cognitive impairment are at particular risk of oral disease.

2 Oral Diseases and Adults with Dementia.

Studies indicate that adults with dementia are more prone to oral diseases and conditions. These include:

• Decline in salivary gland function.

• Greater accumulation of dental plaque and calculus on natural teeth and dentures.

• Increased levels of behaviour problems during oral hygiene care.

• Increased need for assistance with oral hygiene care.

• Higher experience, prevalence and incidence of dental caries.

• Increased experience and higher incidence of gum diseases.

• Greater dental needs but decreased usage of dental services.

• Reduced ability to self care.

• Reduced ability to communicate pain and discomfort.

1 The following communication and behaviour management techniques are recommended for successfully performing oral hygiene care for residents with dementia to increase cooperation and maximize the resident’s own ability.

➢ Develop a routine with oral hygiene care at the same time every day.

➢ Undertake oral hygiene care in a quiet distraction free environment.

➢ Use short simple sentences and directions.

➢ Use task breakdown and one-step instructions.

➢ Use non-verbal cues to reassure.

➢ Use gentle touch to promote trust.

➢ Use reminders and prompts for oral hygiene.

➢ Provide distraction to occupy hands where there is grabbing behaviour.

➢ Use of chaining, bridging and rescuing techniques for communication.

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Source: Joanna Briggs Institute, 2004. New Zealand Dental Association, 2010.

Oral Health Guidance.

|Condition. |Effects. |Interventions. |

|Dental Caries and Tooth Loss due to: |Poor chewing ability. |Refer to dentist. |

|A susceptible tooth, bacteria and frequency |Altered vocal sounds. |Reduce frequency of sugar intake between |

|of dietary intake of sugar. |Social inhibition. |meals. |

|Oral neglect. |Dietary restrictions. |Encourage a drink of water after meals and |

|Poor oral hygiene. |Lower intake of vegetables and fruit. |snacks. |

|Gum recession. |Less dietary fibre. |Regular tooth brushing – at least twice a |

| |Greater carbohydrate intake. |day. |

|Xerostomia (Dry Mouth) from: |Speaking and eating difficulty. |Frequent rinsing and sips of water. |

|Stroke. |Reduced taste sensation; Limited tolerance |Saliva substitutes. |

|Parkinson’s disease. |of dentures; |Water based lip moisturizers eg. KY |

|Dehydration. |Loss of appetite and poor nutritional |Jelly/Oral Base Gel. |

|Diabetes |intake. | |

|Stroke. | |Avoid sugar intake between meals. |

|Mouth breathing. |Corners of the mouth and lips can become |Avoid sugary drinks/fruit juices. |

|Anti anxiety agents. |dry and cracked. | |

|Anti cholinergics. | |Review ‘tooth friendly’ sugar substitutes and|

|Diuretics. |Halitosis. |lollipops with the resident’s GP – note |

|Antihistamines. |Oral and salivary gland infections. |excessive consumption of these can cause |

|Cytotoxics. | |diarrhoea. |

|Anti hypertensives | | |

|Anti Parkinson agents. | |Medication review. |

|Anti psychotics. | | |

|Chemotherapy. | | |

|Glossitis from fungal infection. |Reddened, smooth area of tongue. |GP review. |

| |Tongue is generally sore and swollen. |Administer meds as prescribed. |

| | |Soft brush can be used if the tongue is |

| | |coated. |

| | |Replace toothbrush before treatment commences|

| | |and after treatment completed. |

| |Creamy white coatings or yellow curd like |Water based lip moisturizer. |

|Fungal Infections common among denture |plaques. |Nystatin or amphoterecin can be prescribed. |

|wearers. | |Remove dentures at night or for several hours|

| | |during the day. Disinfect denture and |

| | |container daily until infection resolved |

| | |using steradent or chlorhexidine (Alcohol |

| | |free) solution. |

| | |If treating angular cheilitis, apply |

| | |antifungal gel to corners of mouth as |

| | |prescribed. |

|Cause /Predisposing Factors. |Effects. |Interventions. |

|Oral Infections and ulcerations due to |Pain, redness, erosions and ulcerations. |Refer to GP for treatment of infection. |

|Increased friability of mucosa with age, |Soreness / difficulty swallowing. |Normal saline rinses three to four times a |

|immunological abnormalities, |Can lead to chest infections, including |day promote healing and granulation of |

|Gastro intestinal disorders, |aspiration pneumonia if left untreated. |tissue. |

|Vitamin A, B, C, folic acid, zinc and Iron | |Remove denture if it is the cause of |

|deficiencies. | |irritation until the tissue is healed. |

| | |Avoid acidic, spicy food and foods with sharp|

| | |edges until tissue is healed. |

| | |Offer cold soft foods. |

| | |Oral pain relief medication such as Difflam |

| | |mouth gel can be prescribed. |

|Gum disease: Gingivitis and periodontitis. |Bleeding gums when brushing teeth. |Brush teeth and gums with high fluoride |

| |Red, swollen or tender gums. |toothpaste morning and night. |

| |Detachment of gums from the teeth. |Use a soft toothbrush. |

| |Chronic bad breath or bad taste. |High strength chlorhexidine (Alcohol free) |

| |Teeth can appear to look longer and become |can be prescribed for daily brushing after |

| |loose because of receding gums and bone |main meal. |

| |loss. | |

| | |Chlorhexidine and toothpaste containing |

| | |sodium lauryl sulphate should not be used |

| | |within 2 hours of each other as product |

| | |effectiveness is reduced. |

|Dental Pain. |Verbal reports of pain. |Assess oral health to identify cause of pain.|

| |Non verbal cues of pain such as face |Liaise with GP for prescribed pain relief. |

| |pulling, chewing lips, agitation. |Commence pain chart. |

| |Changed behaviour. |Provide pain relief. |

| |Loss of appetite. |Manage underlying cause as outlined in this |

| | |protocol. |

|Poorly fitting Dentures. |Loss of appetite. |Liaise with dentist re denture adhesive |

| |Poor nutritional status. |product. |

| |Sore spots. |Add small amount of denture adhesive to |

| |Difficulty with talking and eating. |underside of denture as per product |

| | |instructions. |

| | |Clean adhesive from dentures at each oral |

| | |hygiene session before reapplying. |

| | |Seek dental assessment if denture continues |

| | |to be ill fitting. |

|Cause /Predisposing Factors. |Effects. |Interventions. |

|. Oral Cancer |Unexplained red and white patches of the |Referral to GP. |

| |oral mucosa that are painful, swollen and | |

| |bleeding. | |

| |Unexplained ulceration of the oral mucosa | |

| |for more than three weeks. | |

| |Tooth mobility persisting for more than | |

| |three weeks. | |

| |(National Institute for Health and Clinical| |

| |Excellence, 2005). | |

|Dysphagia. | | |

| | |Use soft toothbrush or suction toothbrush, |

| | |with a smear of non foaming fluoride |

| | |toothpaste. |

| | |Clean mucosa with soft toothbrush or water |

| | |moistened gauzed fingers or foam sticks. |

| | |Ensure resident is sitting in an upright |

| | |position. |

| | | |

|Unconscious Resident. | |Clean teeth using small soft toothbrush or |

| | |foamstick and non-foaming fluoride toothpaste|

| | |or suction toothbrush. |

| | |Rinse using foamstick soaked in water. |

| | |Clean tongue and oral mucosa with foamstick |

| | |and water or mouthwash. |

| | |Water based lubricant to lips – KY Jelly or |

| | |Oral Balance Gel. |

| | |Increase frequency of oral hygiene as |

| | |tolerated. |

References

1. Joanna Briggs Institute ((2004) Oral hygiene care for adults with dementia in residential care facilities .Best Practice Vol 8(4) pp. 1-6.

2. Hartford Institute for Geriatric Nursing. Oral Healthcare in Ageing. Accessed 10/03/2008 @

3. NHS Quality Improvement Scotland (2005) Best Practice Statement. Working with Dependant Older people to Achieve Good Oral Health.

4. British Society for Disability and Oral health (2000) Nursing standards for oral health in continuing care. UK

12. Australian Dental Association/Oral Health in Aged Care Working Group(2004) Oral Health Protocols for Residential Aged Care Facilities.

13. New Zealand Dental Association. 2010. Healthy Mouth, Healthy Ageing: Oral Health Guide for Caregivers of Older People. Auckland: New Zealand Dental Association.

14. Registered Nurses’ Association of Ontario Nursing Best Practice Guideline Oral Health: Nursing Assessment and Interventions accessed 30/09/2012 at

15. Health Services Executive (2011) Oral Care Information and Practical Advice: A Guide for Carers accessed

16. Royal College of Nursing (2011) Promoting Older People’s Oral Health accessed

17. Australian Government Department of Health and Ageing (2009) Better Oral Health in Residential Care Professional Portfolio

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Admission Assessment of Oral Hygiene Needs Includes:

• The resident’s ability to carry out oral hygiene care independently.

• Level of assistance required for oral hygiene care.

• Presence or absence of natural teeth or dentures.

• Any known difficulty with swallowing or chewing ability.

• Any specific needs related to oral / dental care.

• The views and observations of the resident or his/her representative regarding current oral/dental status and oral hygiene care.

• Inspection of Oral Cavity if indicated by above –consent.

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Comprehensive Oral Hygiene Assessment.

• Inspection of Oral Cavity if not done at admission adhering to requirements for consent.

• Use of Oral assessment screening tool.

• Past medical history

• Past history of oral diseases or infections.

• Current medications.

• Nutrition and hydration.

• Smoking history.

• Past dental treatments.

• Last dental visit.

• Knowledge and practice of oral and dental care.

• Level of assistance required

• Natural teeth in tact; broken; decayed; food particles; halitosis.

• Ability to function with or without natural teeth or dentures.

• Speaking chewing swallowing ability – refer for swallow assessment as required.

• Preferences/wishes of resident/representative.

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Care Planning Process.

Liaise with the resident and/or representative; resident’s GP/dentist and other healthcare personnel involved in the residents care and:

◙ Identify and document specific oral hygiene needs.

◙ Identify and document interventions and /or aids to maximise the resident’s ability to self care.

◙ Document oral hygiene schedule for those requiring assistance.

◙ Refer to oral hygiene protocol for specific needs.

◙ Agree review schedule to monitor the resident’s response to interventions.

◙ Care plan documented and communicated to other healthcare team members involved in the resident’s care.

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Evaluation

◙ Resident’s oral hygiene and dental care reviewed and amended according to specific review schedule.

◙ Resident’s care and condition recorded as per facility policy.

◙ Changes to care / condition recorded in progress notes.

◙ Routine reassessment every three months or sooner where risk factors or residents changing condition indicate.

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Oral disorders (particularly gum disease) have been linked to an increased risk of heart disease, stroke, hardening of the arteries, pneumonia and other respiratory diseases (National Council on Aging and Older People, 2007).

Oral health can also impact on the resident’s psychosocial aspects of quality of life. Damage to teeth, lips, mouth and jaws can have negative implications for self-image, self-esteem, well-being and identity (US Dept. of Health and Human Services, 2000).

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