Brusing Up on Mouth Care: An Oral Health Resource for Care Staff

Brusing Up on Mouth Care: An Oral Health Resource for Care Staff
ACKNOWLEDGEMENTS
This oral care educational resource binder was developed as part of the following project:
Oral Care in Continuing Care Settings:
Collaborating to Improve Policies and Practices (2008-2012)
Project funded by: The Nova Scotia Health Research Foundation
Principal Investigator:
Mary McNally - Faculty of Dentistry, Dalhousie University
Community Partner:
Eastern Shore Tri-Facilities, Capital District Health Authority (Nova Scotia)
Sheila Martin – Health Services Director, Eastern Shore Tri-Facilities, Capital District Health Authority
SPECIAL THANKS to the administration and care staff at the long-term care sites
for their involvement with the design and development of these materials.
Harold Taylor
Cathy Logan
Darlene Lace
Diana Graham
Mary Grant
Lorrie Boutlier
Marilyn Cipak
Clasina MacKinnon
Audrey Engbersen
Co-Investigators:
Debora Matthews - Faculty of Dentistry, Dalhousie University
Joanne Clovis - Faculty of Dentistry, Dalhousie University
Ruth Martin-Misener - School of Nursing, Dalhousie University
Paige Moorhouse - Geriatric Medicine, Dalhousie University & Capital District Health Authority
Christopher Wyatt - Faculty of Dentistry, University of British Columbia
Michael Leiter – Centre for Organizational Research & Development, Acadia University
Paul Allison - Faculty of Dentistry, McGill University
Associates:
Sandra Crowell - Atlantic Health Promotion Research Centre, Dalhousie University
Sandi Berwick - Eastern Shore Tri-Facilities, Capital District Health Authority
Research Coordinator:
Karen McNeil – Faculty of Dentistry, Dalhousie University
Team Hygienist:
Janet Munn – Faculty of Dentistry, Dalhousie University
Sincere appreciation
to those who assisted in the development of these materials
Trevor Doherty – Graphic Design
Julie Hopkins – Graphic Design
Mark Pineo - Audio
Marilyn Klein – Photography
Bev Baillie – Volunteer
Linda Cochrane - Volunteer
Kim Berkers - Volunteer
Challenging Behaviours Resource Consultants
Northwoodcare Inc. & Northwood Homecare
Nova Scotia Community College & Eastern College
Copyright © Dalhousie University 2011
Permission for use of these materials is for educational purposes only.
These materials may not be copied or republished in part or in whole
in any form or by any means or media without prior written permission
from Dr. Mary McNally, Principal Investigator; Dalhousie University,
PO Box 15000, Halifax, NS B3H 4R2
www.ahprc.dal.ca/projects/oral-care/
!
Please note that these educational resources were developed
for use in Long Term Care and therefore the term ʻresidentʼ is
used throughout to describe the recipient of care. This
information is also valuable to those providing care in other
settings such as home care and acute care. In these
instances, please take the term ʻresidentʼ to mean client,
patient, loved one, or whatever term best describes the
person you are caring for.
TOOL-KITS &
CARE CARDS
Explanation of the Oral Health Toolkit and samples
of the various oral care cards
ASSESSMENT FORMS
Daily Oral Health Assessment Form, Oral Health
Assessment Tool & Oral Hygiene Care Plan
INFORMATION SHEETS
Information on various oral health conditions and
tips & tricks for providing effective oral care to
older adults
ORAL HEALTH
PRODUCTS/AIDS
Information on a variety of oral health
products/aids
EDUCATIONAL VIDEOS
Educational videos on various topics related to oral
health and mouth care
ORAL HEALTH TOOLKITS
It is important that oral care supplies be stored together in an appropriate place.
An Oral Health Toolkit should be made for each resident. These toolkits are used to
store oral care supplies ONLY. The suggested model includes a metal basket
containing a disposable plastic cup. This model was selected for the following reasons:
- The basket is portable and provides an easy way to transport oral care supplies
into the washroom OR the basket can be mounted to the wall of the washroom
- The metal basket is deep enough to hold the plastic cup (without fear of it falling
over), it is wide enough to store a denture cup/container, and it is easy to clean
- The plastic cup is easy to label, tall enough to keep the toothbrush upright to
dry, and disposable so it can be replaced when it gets dirty
Supplies that may be stored in the toolkit include:
⇒
⇒
⇒
⇒
⇒
⇒
⇒
⇒
Toothbrush
Toothpaste
Mouthrinse
Floss
Floss handle
Proxabrush
Toothettes
Mouth prop
⇒
⇒
⇒
⇒
⇒
⇒
⇒
Facecloth(s)
Denture cup/container
Dentures or partial plates
Denture cleaner
Denture brush
Emesis/kidney basin
Care cards*
For a complete break down of various oral health supplies and their uses,
please see section #4 of this manual
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
Oral Care in
TOOLKIT ASSEMBLY: Suggested Guidelines
#1) Mount the metal basket securely to the wall at a
height that is appropriate for the resident
- If possible, avoid mounting behind or beside the
toilet
- Toolkit may be placed in cupboard if required
#2) Be sure that all oral care supplies are labeled with the resident’s name or initials
- Plastic cup
- Toothbrush
- Toothpaste
- Denture brush
- Dentures
- Denture cup
- Mouth rinse
- Oral care card
#3) Use the cup to stand the resident’s toothbrush and denture brush
(if necessary) to air dry
- Toothpaste, flossers, and/or proxabrushes may also be placed in the
cup
- The cup will need to be replaced OR washed when the resident’s
toothbrush is replaced
#4) Place plastic cup in basket. Any other oral
supplies can be placed in the other side of the basket
- i.e. Denture cup, mouth rinse, face cloth, etc.
#5) Oral care cards can stand in the back of the basket
OR can be pinned to the wall
- Placing the card in a large ziplock bag may help
to prevent smudging
#6) ONLY oral care supplies should be stored in the
basket.
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
ORAL CARE CARDS
The daily oral care needs older adults depend on their current oral health status.
Oral care cards outline the necessary steps for providing daily oral care to someone
with natural teeth, dentures, partials, or a combination of natural teeth and
dentures/partials. There is also a card available for those residents who have difficulty
swallowing. Each resident, should be provided with a care card appropriate for his
or her needs.
The resident’s name should be placed on the front of the card along with any special
instructions. Special instructions may include personal preferences such as the time of
day they prefer to have mouth care done.
On the back of every card
there is a space to record:
a) The date the
resident’s
toothbrush was
last changed
b) The date of the
resident’s last visit
with an oral health
professional
Care cards should be stored wit h or near t he oral health tool kit.
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
LEGEND - DENTAL CARDS
Pink
=
NATURAL TEETH
Purple
=
NATURAL TEETH + PARTIAL DENTURES
Blue
=
NATURAL TEETH + DENTURES
Yellow
=
NO NATURAL TEETH + DENTURES
Green
=
NO NATURAL TEETH + NO DENTURES
Red
=
UNABLE TO SWALLOW
B r u s hing
Up
Care
uth
o
on M
Faculty of Dentistry
AHPRC
Atlantic Health Promotion Research Centre
© Dalhousie University 2011
|
www.ahprc.dal.ca/projects/oral-care/
Daily mouth-care Card for people with
Name :
NATURAL TEETH
Instructions or comments:
• Check mouth for abnormalities
• Brush teeth
• Brush tongue from back to front
• Floss or alternative (if possible)*
• Rinse mouth with mouth rinse**/salt water
• Rinse toothbrush and store to air dry
• Record success on flow sheet
Up
B r u s hing th Care
*Alternatives to flossing include a proxabrush, floss handle, or flossers
**Avoid alcohol-based mouth rinse (tends to dry out the mouth)
ou
on M
Required supplies: toothbrush, toothpaste, mouth rinse (non-alcohol)
Additional supplies (if necessary): floss (OR proxabrush, floss handle, flossers), facecloth, towel,
tongue cleaner, lip lubrication, mouth props, gloves, gauze, kidney basin
Further details about personal oral care
• Record any abnormalities on the ‘Resident Oral
Health Assessment’ sheet
• Lubricate lips with lip lubricant (not just water
or saliva)
DATE
When toothbrush was last changed: _______________
Of last visit to dentist: ___________________________
• Brush teeth minimum once daily (thoroughly)
• Gently massage gums with toothbrush at
45 degrees to the gums
• For those who cannot reach the sink, have
kidney basin available to spit
• For those who have trouble swallowing,
dry the mouth and teeth with gauze
Faculty of Dentistry
AHPRC
Atlantic Health Promotion Research Centre
© Dalhousie University 2011
|
www.ahprc.dal.ca/projects/oral-care/
Daily mouth-care Card for people with
Name :
NATURAL TEETH + PARTIAL DENTURES
STEP 1 (Teeth)
Instructions or comments:
• Remove partials and rinse
• Check mouth for abnormalities
• Brush teeth and tongue
• Floss or alternative (if possible)*
• Rinse mouth with mouth rinse**/salt water
• Rinse toothbrush and air dry
• Record success on flow sheet
*Alternatives to flossing include a proxabrush, floss handle, or flossers
**Avoid alcohol-based mouth rinse (tends to dry out the mouth)
STEP 2 (Partial)
• Brush partial with liquid soap (NOT toothpaste)* and rinse
• Check partial for problems
• Air dry partial or soak in water with denture cleaning
product (NOT bleach) overnight
Up
B r u s hing th Care
• Rinse partial before placing back in mouth
ou
on M
*Toothpaste is abrasive and will scratch partial allowing bacteria to build-up
Required supplies: toothbrush, toothpaste, mouth rinse (non-alcohol), denture brush, liquid soap,
storage container
Additional supplies (if necessary): floss (OR proxabrush, floss handle, flossers), facecloth, towel,
tongue cleaner, lip lubrication, mouth props, denture cleaning solutions, gloves, gauze, kidney basin
Further details about personal oral care
STEP 1 (Teeth)
STEP 2 (Partial)
• Record any abnormalities on the ‘Resident Oral
• Get resident to remove partial if able
• Look for plaque and tartar buildup on partial
• If plaque and tartar buildup present, place
Health Assessment’ sheet
• Lubricate lips with lip lubricant (not just water
or saliva)
• Brush teeth minimum once daily (thoroughly)
• Gently massage gums with toothbrush at
45 degrees to the gums
• For those who cannot reach the sink, have
kidney basin available to spit
partial in container with denture cleaner for
30 to 60 minutes
DATE
When toothbrush was last changed: _______________
Of last visit to dentist: ___________________________
• For those who have trouble swallowing,
dry the mouth and teeth with gauze
Faculty of Dentistry
AHPRC
Atlantic Health Promotion Research Centre
© Dalhousie University 2011
|
www.ahprc.dal.ca/projects/oral-care/
Daily mouth-care Card for people with
Name :
NATURAL TEETH + DENTURES
STEP 1 (Teeth)
Instructions or comments:
• Remove dentures and rinse
• Check mouth for abnormalities
• Brush teeth and tongue
• Floss or alternative (if possible)*
• Rinse mouth with mouth rinse**/salt water
• Rinse toothbrush and air dry
• Record success on flow sheet
*Alternatives to flossing include a proxabrush, floss handle, or flossers
**Avoid alcohol-based mouth rinse (tends to dry out the mouth)
STEP 2 (Denture)
• Brush denture with liquid soap (NOT toothpaste)* and rinse
• Check denture for problems
• Soak overnight in water with 1 tsp bleach or denture
cleaning product
Up
B r u s hing th Care
• Rinse denture before placing back in mouth
ou
on M
*Toothpaste is abrasive and will scratch denture allowing bacteria to build-up
Required supplies: toothbrush, toothpaste, mouth rinse (non-alcohol), denture brush, liquid soap,
storage container
Additional supplies (if necessary): floss (OR proxabrush, floss handle, flossers), facecloth, towel,
tongue cleaner, lip lubrication, mouth props, denture cleaning solutions, gloves, gauze, kidney basin
Further details about personal oral care
STEP 1 (Teeth)
STEP 2 (Denture)
• Record any abnormalities on the ‘Resident Oral
• Get resident to remove denture if able
• Look for plaque and tartar buildup
• If plaque and tartar buildup present, place
Health Assessment’ sheet
• Lubricate lips with lip lubricant (not just water
or saliva)
• Brush teeth minimum once daily (thoroughly)
• Gently massage gums with toothbrush at
45 degrees to the gums
• For those who cannot reach the sink, have
kidney basin available to spit
denture in container with denture cleaner for
30 to 60 minutes
DATE
When toothbrush was last changed: _______________
Of last visit to dentist: ___________________________
• For those who have trouble swallowing,
dry the mouth and teeth with gauze
Faculty of Dentistry
AHPRC
Atlantic Health Promotion Research Centre
© Dalhousie University 2011
|
www.ahprc.dal.ca/projects/oral-care/
Daily mouth-care Card for people with
Name :
NO NATURAL TEETH + DENTURES
STEP 1 (Mouth)
Instructions or comments:
• Remove dentures and rinse
• Check mouth for abnormalities
• Gently brush tongue and palate*
• Rinse mouth with mouth rinse**/salt water
• Rinse toothbrush and air dry
• Record success on flow sheet
*Brush with mouth rinse (preferred) or toothpaste
**Avoid alcohol-based mouth rinse (tends to dry out the mouth)
STEP 2 (Denture)
• Brush denture with liquid soap (NOT toothpaste)* and rinse
• Check denture for problems
• Soak overnight in water with 1 tsp bleach or denture
cleaning product
Up
B r u s hing th Care
• Rinse denture before placing back in mouth
ou
on M
Required supplies: toothbrush, mouth rinse (non-alcohol), denture brush, liquid soap,
denture container
Additional supplies (if necessary): facecloth, towel, tongue cleaner, lip lubrication, mouth props,
denture cleaning solutions, gloves, gauze, kidney basin
Further details about personal oral care
STEP 1 (Mouth)
STEP 2 (Denture)
• Record any abnormalities on the ‘Resident Oral
• Get resident to remove denture if able
• Look for plaque and tartar buildup
• If plaque and tartar buildup present, place
Health Assessment’ sheet
• Lubricate lips with lip lubricant (not just water
or saliva)
• Brush teeth minimum once daily (thoroughly)
• Gently massage gums with toothbrush at
45 degrees to the gums
• For those who cannot reach the sink, have
kidney basin available to spit
denture in container with denture cleaner for
30 to 60 minutes
DATE
When toothbrush was last changed: _______________
Of last visit to dentist: ___________________________
• For those who have trouble swallowing,
dry the mouth and teeth with gauze
Faculty of Dentistry
AHPRC
Atlantic Health Promotion Research Centre
© Dalhousie University 2011
|
www.ahprc.dal.ca/projects/oral-care/
Daily mouth-care Card for people with
Name :
NO NATURAL TEETH + NO DENTURES
Instructions or comments:
• Check mouth for abnormalities
• Gently brush tongue and palate*
• Rinse mouth with mouth rinse**/salt water
• Rinse toothbrush and air dry
• Record success on flow sheet
*Brush with mouth rinse (preferred) or toothpaste
**Avoid alcohol-based mouth rinse (tends to dry out the mouth)
Up
B r u s hing th Care
ou
on M
Required supplies: toothbrush, mouth rinse (non-alcohol), denture brush, liquid soap,
denture container
Additional supplies (if necessary): facecloth, towel, tongue cleaner, lip lubrication, mouth props,
denture cleaning solutions, gloves, gauze, kidney basin
Further details about personal oral care
• Record any abnormalities on the ‘Resident Oral
Health Assessment’ sheet
• Lubricate lips with lip lubricant (not just water
or saliva)
DATE
When toothbrush was last changed: _______________
Of last visit to dentist: ___________________________
• Brush mouth minimum once daily (thoroughly)
• Gently massage gums with toothbrush at
45 degrees to the gums
• For those who cannot reach the sink, have
kidney basin available to spit
• For those who have trouble swallowing,
dry the mouth and teeth with gauze
Faculty of Dentistry
AHPRC
Atlantic Health Promotion Research Centre
© Dalhousie University 2011
|
www.ahprc.dal.ca/projects/oral-care/
Daily mouth-care Card for people who are
Name :
UNABLE TO SWALLOW
Instructions or comments:
• Check mouth for abnormalities
• Sit upright or lie on side
• Lubricate lips (for resident comfort)
• Dip toothbrush in mouth rinse and brush
teeth / tongue / palate
• Dry teeth / tongue / palate with gauze*
• Rinse toothbrush and air dry
• Record success on flow sheet
Up
B r u s hing th Care
* This will remove excess moisture from the mouth
ou
on M
Required supplies: lip lubrication, toothbrush, mouth rinse (to dip toothbrush in), facecloth,
towel, gauze, kidney basin
Additional supplies (if necessary): tongue cleaner, mouth props, gloves
Further details about personal oral care
• Record any abnormalities on the ‘Resident Oral
Health Assessment’ sheet
• Brush teeth minimum once daily (thoroughly)
DATE
When toothbrush was last changed: _______________
Of last visit to dentist: ___________________________
• Gently massage gums with toothbrush at
45 degrees to the gums
Faculty of Dentistry
AHPRC
Atlantic Health Promotion Research Centre
© Dalhousie University 2011
|
www.ahprc.dal.ca/projects/oral-care/
DAILY ORAL HEALTH ASSESSMENT
Providing daily oral care to residents also presents an important opportunity to
check the mouth for any abnormalities.
Before providing daily oral care, we ask that you take 60
seconds to do a quick ‘check’ of the resident, patient, or
client’s mouth. Use the following principles to guide you:
LOOK: Look in the mouth for any abnormalities. Look at the
teeth, the roof of the mouth, the floor of the mouth, all
sides of the tongue, inside the cheeks and lips, and
along the gumline. If the resident has dentures or
partials, remove them from the mouth and inspect
them for any loose or broken pieces.
FEEL: Feel along the gum line and in the cheeks. DO NOT put
your fingers between the teeth.
TELL: If you notice something abnormal:
1) fill out the Daily Oral Health Assessment Form,
2) put it in the resident’s file,
3) TELL your supervisor.
An abnormality would be considered anything new,
or that wasn’t there before. It may present as red or
white patches, swelling/lumps, loose teeth, etc.
Using the legend provided, simply mark on the
mouth-diagram what you’ve noticed and where.
Place your name and date on the card. This will
provide a recorded timeline of any changes occurring
in the resident’s mouth.
Any abnormalities that do not resolve themselves
within 14 days should be looked at by a dental
professional.
Daily assessment forms only need to be completed when something abnormal is
found. Completed cards are then to be placed in the resident’s file. Since there are
many tasks that must be completed while in the washroom with the resident, we
recommend completing this form as soon as possible once you have completed care
for that resident.
SEE EDUCATIONAL VIDEO #5 FOR MORE INFORMATION ON HOW TO COMPLETE
THIS ASSESSMENT
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
Up
B r u s hing th Care
DAILY
ORAL HEALTH
ASSESSMENT SHEET
Legend
ou
on M
Please use the illustration below to record any problems observed
when performing the resident’s daily oral care routine
R
Red Patches
W
White Patches
Lumps, Bumps or Swelling
S
Sores
B
Bleeding
Loose/Broken Tooth
BE SURE TO REMOVE DENTURES/PARTIALS
BEFORE COMPLETING ASSESSMENT
Where to look
- Tongue (sides and front)
- Have resident stick out tongue
- Floor of the mouth (underneath the tongue)
- Have resident lift tongue OR move with toothbrush
- Roof of the mouth (hard & soft palate)
- Tilt resident’s head back slightly
- Cheeks
- Pull cheek away from teeth
- Gums & Teeth
Date:_________________________________________
Resident Name:________________________________
Staff Name:___________________________________
- Fold top lip up and bottom lip down to assess gums
- Lips
PLEASE REPORT ANY
PROBLEMS TO THE
RN ON DUTY
AHPRC
Atlantic Health Promotion Research Centre
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
AHPRC
ANNUAL ORAL HEALTH ASSESSMENT
A reside nt ’s or al st atus should be assesse d on a reg ul ar b asis, and in a r ou tine and
met hodic al m anner
Each new resident entering a care facility should have an assessment completed prior to
the development of their initial care plan. All residents should have their oral health
assessed annually by a member of the nursing staff. Ideally annual assessments will
be completed to coincide with annual care conferences.
The Oral Health Assessment Tool (OHAT) is a widely accepted validated tool for
assessing various aspects of oral health status. This quick and easy one page document
is used to identify common healthy and unhealthy conditions
associated with the mouth tissues and dentures.
The 8 categories we will examine are:
- LIPS NATURAL
- TONGUE - GUM & TISSUES
- ORAL CLEANLINESS
- TEETH
- DENTURE(S)
- SALIVA
- DENTAL PAIN
At the top of the page write the date, resident’s name, and indicate if this assessment is:
1) an ADMISSION assessment,
2) an ANNUAL assessment
3) a FOLLOW-UP assessment being completed on a resident who requires more attention
to their oral health
The OHAT is divided into columns:
Category: the areas and conditions to be examined
Assessment columns: Any section in these columns that is underlined with a star
indicates that a dental professional should be consulted to assess the issue.
0 = HEALTHY: the resident has good oral health; no intervention required
1 = CHANGES: some changes are apparent; an intervention or referral is required
2 = UNHEALTHY: the oral cavity is unhealthy; referral is required.
Score: add up the score from the assessment columns
Action Required: based on the score, indicate if referral and/or intervention is required
Action Completed: indicate if the referral or intervention been completed
At the bottom of the page there is space for follow-up and referral. The Oral Hygiene
Care Plan should be updated based on the results of the OHAT. A resident with abnormal
findings may need to have a follow-up assessment completed within the year. If referral to
an oral health professional was recommended and the resident or a family member
refuses the referral, there is a space for them to indicate why they refused and to sign.
SEE EDUCATIONAL VIDEO #5 FOR MORE INFORMATION ON HOW TO COMPLETE
THIS ASSESSMENT
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
ORAL HEALTH ASSESSMENT TOOL (OHAT) for LONG TERM CARE
Resident:
Admission Assessment  Annual Assessment  Follow-up Assessment 1 2 3
Date:
NOTE: A Star* and underline indicates referral to an oral health professional (i.e. dentist, dental hygienist, denturist) is required
Category
0 = HEALTHY
1 = CHANGES
2 = UNHEALTHY
Score
Action
Required
Action
Completed
Lips
Smooth, pink, moist
Dry, chapped, or red at corners
Swelling or lump, white/red/ulcerated
patch; bleeding/ ulcerated at corners*
1=intervention
2=refer
□ YES □NO
Tongue
Normal, moist, pink
Patchy, fissured, red, coated
Patch that is red and/or white,
ulcerated, swollen*
1=intervention
2=refer
□ YES □NO
Gums &
Tissues
Pink, moist, Smooth,
no bleeding
Dry, shiny, rough, red,
swollen around 1 to 6 teeth, one
ulcer or sore spot under denture*
Swollen, bleeding around 7 teeth or
more, loose teeth, ulcers and/or white
patches, generalized redness and/or
tenderness*
1 or 2 = refer
□ YES □NO
Saliva
Moist tissues, watery
and free flowing
saliva
Dry, sticky tissues, little saliva
present, resident thinks they have
dry mouth
Tissues parched and red, very little or
no saliva present; saliva is thick, ropey,
resident complains of dry mouth*
1=intervention
2=refer
□ YES □NO
Natural
Teeth
No decayed or
broken teeth/roots
1 to 3 decayed or broken
teeth/roots*
4 or more decayed or broken
teeth/roots, or very worn down teeth, or
less than 4 teeth with no denture*
1 or 2 = refer
□ YES □NO
No broken
areas/teeth, dentures
worn regularly and
labeled
1 broken area/tooth, or dentures
only worn for 1 to 2 hours daily, or
no name on denture(s)
More than 1 broken area/tooth, denture
missing or not worn due to poor fit, or
worn only with denture adhesive*
1=ID denture
2=refer
□ YES □NO
Oral
Cleanliness
Clean and no food
particles or tartar on
teeth or dentures
Food particles/ tartar/ debris in 1
or 2 areas of the mouth or on
small area of dentures;
occasional bad breath
Food particles, tartar, debris in most
areas of the mouth or on most areas of
denture(s), or severe halitosis (bad
breath)*
1=intervention
2=refer
□ YES □NO
Dental Pain
No behavioural,
verbal or physical
signs of pain
Verbal and/or behavioural signs
of pain such as pulling of face,
chewing lips, not eating,
aggression*
Physical signs such as swelling of
cheek or gum, broken teeth, ulcers,
ʻgum boilʼ, as well as verbal and or
behavioural signs*
1 or 2 = refer
□ YES □NO
□
Y
□
N
Denture(s)
□
Y
□
N
FOLLOW UP:
1) Oral Hygiene Care Plan updated –  Y  N
Date:___________________
2) OHAT to be repeated -  in one year
 on date ________________
Completed by:
REFERRAL:
a) REFERRAL to an oral health professional required  Y  N
b) REFERRAL made  Y (appointment date: __________________)  N (see below)
c) REFERRAL refused by resident/family/guardian  Y
Reason for refusal: ____________________________Signature:_________________________
(OHAT Tool, Chalmers 2004)
This version is based on modifications from the Halton Region’s Health Department (2007)
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
ORAL HYGIENE CARE PLAN
The care planning t ool can be use d t o ou tline wh at is require d t o ens ure t h at e ac h
resident is receiving ade q uate and ap pr opriat e or al care on a daily basis

This care plan should be reviewed and updated each time the Oral Health
Assessment Tool is completed: It provides a way for staff to communicate about
the oral care of individual residents and can also provide a record of whether or not
progress is being made over time.
It is important to fill in the patient’s name, who completed the chart, the date it was
completed, and, if they have one, the name and phone number of the resident’s dentist
for easy referral. The date of the resident’s last dental appointment and the date for their
next oral hygiene assessment and treatment can also be recorded here.
Assessment of dentures:
Circle whether the resident has upper or lower dentures or
both. Indicate whether they are full or partial dentures. If the
resident does not have any dentures, this should also be
noted here. Record if the dentures are labeled or not.
Assessment of natural teeth:
Here we indicate whether the resident has any natural teeth in either the upper or lower
arch. There is also an opportunity to record whether there are “root tips” present in either
arch. When the crown of a tooth breaks off at the gum-line, the part of the tooth that
remains in the arch is a root or root-tip. These are often stable in older adults and not a
cause for concern. However, they can become infected so need to be monitored
carefully.
Level of Assistance:
Record whether or not the resident is able to look after his
or her own teeth or denture care or what level of assistance
they may require.
Interventions for Oral Hygiene Care:
A variety of common oral hygiene interventions are itemized to cue the care-provider
about best approaches for a particular resident. For example, it may be observed that an
electronic toothbrush is indicated at least once a day.
Regular Barriers to Oral Care:
The itemized list helps to identify behaviors that might be expected of a particular resident
such as “won’t open mouth” or “aggressive”. These are noted in order to better prepare
the care-provider to deliver oral hygiene care.
SEE EDUCATIONAL VIDEO #5 FOR MORE INFORMATION ON HOW TO COMPLETE
THIS ARE PLAN
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
ORAL HYGIENE CARE PLAN for LONG TERM CARE
Resident:
Completed by:
Date:
Dentist:
Dentist Phone #:
Date of last dental appointment:
Assessment
of Dentures:
Date for next oral hygiene care plan review:
UPPER
FULL
PARTIAL
Name on denture: Yes
NOT WORN
No
NO DENTURE
Level of Assistance (please circle)
Denture Cleaning:
LOWER
FULL
PARTIAL
Name on denture: Yes
NOT WORN
No
NO DENTURE
Independent
some assistance
fully dependant
(please circle)
Assessment
of Natural
Teeth:
(please circle)
Interventions
for oral
hygiene care
(check all that
apply and
indicate
frequency as
needed)
UPPER
YES
NO
Root tips present
LOWER
YES
NO
Root tips present
Teeth Cleaning:
Independent
some assistance
fully dependant
□ Mouth swab…………….… □ a.m. □ p.m.
□ Electric toothbrush…….… □ a.m. □ p.m.
□ Suction toothbrush…….… □ a.m. □ p.m.
□ Regular toothbrush ……... □ a.m. □ p.m.
□ Use 2 toothbrushes……… □ a.m. □ p.m.
Regular
barriers
to oral
care
□ Forgets to do oral hygiene care
(check all
that apply)
□ No compliance with directions
□ Refuses oral hygiene care
□ Wonʼt open mouth
□ Aggressive / kicks / hits
□ Interproximal toothbrush / floss…. □ a.m. □ p.m.
□ Bites toothbrush and/or staff
□ Regular fluoride toothpaste……… □ a.m. □ p.m.
□ Canʼt swallow properly
□ Do not use toothpaste
□ Canʼt rinse / spit
□ Scrub denture/s with denture brush…….. □ a.m. □ p.m.
□ Constantly grinding / chewing
□ Soak denture/s over night in water with denture tablet
□ Head faces downwards / moves
□ Scrub denture bath weekly
□ Wonʼt take dentures out at night
□ Dry mouth products as needed ______________________________
□ Dexterity or hand problems / arthritis
□ Fluoride varnish or other fluoride products (Rx by dentist or physician)
□ Requires financial assistance
□ Chlorhexidine mouth rinse (Rx by dentist or physician)
□ Other:
□ Other:
(Modified from Chalmers, 2004)
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
Common Oral
Conditions
Dental Decay:
SIGNS: Dark, stained
holes and fractures of the
teeth (including the roots
along the gumline)
MANAGEMENT: The best
prevention is good daily
mouth care. Consumption
of sticky, sugary foods
and drinks (especially in
between meals) should be
limited. Using fluoridated
toothpastes, topical
fluoride gels and
varnishes can prevent
small shallow decayed
areas from getting bigger.
Most often, cavities
should be filled by a
dentist. .
Many oral
conditions
become more
prevalent with
age
© Dalhousie University 2011
Gingivitis:
SIGNS: Red, swollen or
bleeding gums
MANAGEMENT: Daily
brushing, flossing (or
alternative)
Periodontal Disease:
SIGNS: Gingivitis,
recession, loose teeth
MANAGEMENT: Good
oral hygiene, regular
dental exams and
professional cleaning
CAN CONTRIBUTE TO:
Systemic conditions such as
cardiovascular disease,
diabetes, or pneumonia
Angular Chelitis
Commonly seen in people who have lost
some or all of their teeth.
SIGNS: Red and ulcerated patches in the
corners of the mouth. It can be very painful to
open the mouth and can limit eating drinking
or speaking.
MANAGEMENT: Treatment with antifungal
agents and overall good nutrition
Denture Stomatitis:
SIGNS: Small red lesions (Petechia)
usually under the top denture. Not
usually painful.
MANAGEMENT: Remove the dentures at
night. Ensure dentures are thoroughly
cleaned. If severe, see a dentist for an
anti-fungal cream
This is one of the reasons dentures
should be removed at night.
Candidiasis:
SIGNS: White spots on the tissues that
can be wiped off (thrush), red burning
lesions, or fissures at the corners of the
mouth
MANAGEMENT: Topical or systemic
antifungal medication. (see a dental or
medical professional)
Xerostomia (Dry Mouth):
SIGNS: Red, cracked, swollen, dry tongue,
change in taste, difficulty eating, swallowing or
talking
Usually caused by medications, radiation to
the head & neck area, and smoking
MANAGEMENT: Frequent sips of water, sucking
ice cubes, chewing sugar free gum, or saliva
substitutes
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
American Academy of Periodontology. Gum disease: what you need to know [homepage on the internet].
Chicago, IL: American Academy of Periodontology; 2008 [updated 2011 May 04; cited 2010 Feb 20].
Available from: http://www.perio.org/consumer/gum-disease.htm
American Dental Association. How medications can affect your oral health. JADA 2005 June;137:831.
Canadian Dental Association. Your oral health: oral diseases [homepage on the internet]. Ottawa, ON:
Canadian Dental Association Inc; 2012 [cited 2010 Feb 18]. Available from: http://www.cda-adc.ca/en/
oral_health/complications/diseases/index.asp
Darby ML, Walsh MM. Dental hygiene theory and practice. 3rd ed. St-Louis, Missouri: Saunders Elsevier;
2010.
Ghezzi E, Ship J. Systemic diseases and their treatments in the elderly: impact on oral health. J Public
Health Dent 2000;60(4):289-96.
Sarin J, Balasubramaniam R, Corcoran AM, Laudenbach JM, Stoopler ET. Reducing the risk of aspiration
pneumonia among elderly patients in long-term care facilities through oral health interventions. J Am Med
Dir Assoc 2008;9(2):128-135.
Wyatt CCL, MacEntee MI. Daily Oral Care for Persons in Residential Care. 2nd ed. Vancouver, BC:
University of British Columbia; 2007.
Dehydration
Some reports
suggest that as
many as 30% of
long-term care
residents are
chronically
dehydrated
Dehydration in palliative
patients and the frail
elderly is a significant
problem.
Dehydration can occur for a
variety of reasons:
© Dalhousie University 2011
TECHNIQUES TO IMPROVE HYDRATION:
- 1) Sip on water throughout the day. Avoid juices
between meals as this can promote tooth decay
- 2) Suck on ice chips ONLY if this is appropriate for
the resident
- 3) Use a humidifier at night
The physiological mechanisms
that control the thirst reflex may
decline with age or be inhibited as
a side effect of medications.
Urinary tract dysfunction can be
painful and may reduce the intake
of fluids - however, dehydration
can also lead to urinary tract
dysfunction.
Elderly patients with dementia
may have decreased fluid intake
The elderly are particularly susceptible to dehydration because a lower percentage
of their body weight is made up of water.
An elderly person can have up to 7 liters less water in their bodies
compared to a 20 year old.
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
Cantimer Hydration measurement and monitoring [homepage on the internet]. Menlo Park, CA: Cantimer;
2009. [cited 2010 Oct 06]. Available from: http://www.cantimer.com/markets/hydration/elderly.html
Ferry M. The management of dehydration in an aged patient. Revue de Geriatrie 2001;26(10): 803-8.
Heart and Stroke Foundation of Ontario. Management of dysphagia in acute stroke: an educational manual
for the dysphagia screening professional. Toronto, ON: Heart and Stroke Foundation of Ontario; 2006 Jan.
Kedlaya D, Brandstater M. Swallowing, nutrition and hydration during acute stroke care. Top Stroke Rehabil
2002;9:23-38.
& Oral Care
DEMENTIA
People with dementia
are likely to need
various degrees of
assistance
The most
prominent form of
dementia is
Alzheimer’s
Disease
© Dalhousie University 2011
By 2038
approximately
3% of
Canadians will
be affected by
dementia
Signs & Symptoms:
Confusion, memory loss,
changes in behaviour &
personality, difficulty
organizing daily tasks
FACTS ABOUT ‘DEMENTIA’:
The cause is still unclear and is believed to be a
combination of family history, lifestyle and environment
As the disease progresses, people with dementia find it
difficult to work or participate in normal daily activities
Symptoms of dementia often worsen over time
There is no cure but there are medications that may help
slow the progression of the disease
As the brain loses its ability to process information the
person relies heavily on cues from their environment and
reacts without the ability to think through a situation or
problem solve to determine appropriate actions
Why
should
you
care?
Poor daily oral care can cause periodontal disease, difficulty chewing and
lead to poor nutrition
Oral care tasks will likely take more time as dementia progresses from early
to later stages
It is important to label all oral care products, including dentures, brushes,
etc. in case they go missing or end up in another room
People with dementia may appear to have a fearful reaction to a
non-threatening situation – such as someone attempting to brush their teeth
Understanding the Losses of Dementia - The 7 A’s
Anosognosia – no
knowledge of their illness or
disease: People with
dementia may become
angry with caregivers trying
to provide oral care, not
appreciating they need
assistance.
Amnesia – loss of
memory: Always introduce
yourself and the task you
intend to perform.
Aphasia – loss of
language: Speak slowly to
the person when engaging
them in the task of
performing oral care and
provide visual cues, like a
toothbrush, to indicate what
is about to take place.
Agnosia – loss of
recognition of people, objects
and sounds: Put yourself and
the object into context by
performing mouth care in
the bathroom and running
the water.
Apraxia – loss of
purposeful movement:
Provide simple instructions break down and
demonstrate each step, and
Changes in behaviour as a result of these losses
are common. It is important to try to understand what
you are seeing in a care recipient’s behavior and why
they may be behaving a certain way. With an
understanding of the losses of dementia (the 7 A’s) it
becomes easier to develop an individualized
approach for providing oral care.
In Canada in 2008, 231
million hours of informal
care were provided to
people with dementia.
By 2038 that number is
expected to rise to 756
million hours per year
Always encourage a
care recipient to
participate in their
own oral care if
possible
http://www.ahprc.dal.ca/projects/oral-care/
Thank you to the Canadian Dementia Knowledge Translation
Network (CDRAKE) for providing funding to develop this resource
initiate the task of brushing
the teeth.
Altered Perception changes in the way the
person walks or sits and
misinterpretation of objects
in their environment:
Approach the person from
the front when initiating oral
care.
Apathy – loss of
initiation: Initiate the activity
of brushing the teeth and
the person may be able to
complete the activity on their
own.
TIPS for providing oral care:
a) Set a routine time and place
for oral care
b) Identify yourself and what you
plan to do
c) Use visual & verbal cues, short
sentences, and simple words
d) Maintain a calm & quiet
atmosphere
e) Use positive reinforcement like
nodding head or thumbs up
f) Provide oral care after a meal
or when a care recipient is
most content and cooperative
g) Distract the care recipient by
singing or giving them
something to hold (like a
toothbrush or facecloth)
h) Initiate toothbrushing but
encourage participation from
the care recipient (put the
toothbrush in their hand and
guide it with your own)
i) Attempt to provide oral care
EVERYDAY
REFERENCES
OnMemory: A caregiver’s guide to Alzheimer's disease. Signs & symptoms [homepage on the internet]. [place
unkown]: Alzheimer Society of Canada; [date unkown] [cited 06 Oct 2010]. Available from: http://
www.onmemory.ca/en/signs_symptoms/
Cantimer Hydration measurement and monitoring [homepage on the internet]. Menlo Park, CA; 2009. [cited
2010 Oct 06]. Available from:http://www.cantimer.com/markets/hydration/elderly.html
Chalmers J, Pearson A. Oral hygiene care for residents with dementia: a literature review. J Adv Nurs
2005;52(4):410-419.
Chalmers JM. Behavior management and communication strategies for dental professionals when caring for
patients with dementia. Special Care in Dentistry 2000;20(4):147-154.
Connell BR, McConnell ES, Francis TG. Tailoring the environment of oral health care to the needs and abilities
of nursing home residents with dementia. Alzheimer's Care Today 2002;3(1):19.
Connell BR, McConnell ES. Treating excess disability among cognitively impaired nursing home residents. J Am
Geriatr Soc 2000 Apr;48(4):454-455.
Frenkel H. Behind the screens: care staff observations on delivery of oral health care in nursing homes.
Gerodontology 1999;16(2):75-80.
Ghezzi E, Ship J. Dementia and oral health. Oral Surgery, Oral Medicine, Oral Pathology 2000;89(1): 2-45.
Hamilton P, Harris D, LeClair JK, Collins J. Putting the P.I.E.C.E.S. together: A model for collaborative care and
changing practice. 6th ed (R). Canada: P.I.E.C.E.S. Consult Group; 2010 Feb.
Healia. Dementia guide: what causes dementia. [homepage on the internet]. Des Moines, IA: Healia/Meredith
Corporation; Modified 07 Jan 2009 [cited 20 Feb 2010]. Available from: http://www.healia.com/healthguide/
guides/dementia/what-causes-dementia
Heart and Stroke Foundation of Ontario. Management of dysphagia in acute stroke: an educational manual for
the dysphagia screening professional. Toronto, ON: Heart and Stroke Foundation of Ontario; 2006 Jan.
The Lancet Neurology. Time to confront the global dementia crisis. 2005 Sept;7(9):761.
Larson EB, Langa KM. The rising tide of dementia worldwide. Lancet 2008;372(9637):430-431.
Pearson A, Chalmers J. Oral hygiene care for adults with dementia in residential aged care facilities: Systematic
review. JBI Reports 2004;2: 65-113.
Smetanin P, Kobak P, Briante C, Stiff D, Sherman G, Ahmad S. Rising Tide: The impact of dementia in Canada
2008 to 2038. RiskAnalytica; 2009.
Dental Caries
& Diet
If there was no SUGAR
there would be no
CAVITIES!
How does dental decay occur?
Plaque & bacteria + sugar or starch = an acidic
environment. Starch & sugar are broken down by bacteria
in the mouth (a natural bacteria that is always present). A
by-product of this process is acid. The mouth goes from a
basic or neutral environment to acidic environment each
time food is consumed. This can soften the enamel of the
teeth for 5-15 minutes each time food is consumed
REDUCING THE RISK OF DECAY
Brush daily with a fluoridated toothpaste. Fluoride gel
may be recommended when there is a high risk for
cavities.
Starchy foods (such as bread, cereal, pasta) are
necessary for a healthy diet. Follow Canada’s Food Guide
to Healthy Eating to find healthy choices.
Minimize the time teeth are exposed to starch & sugar
by eating these foods with meals rather than snacking on
them throughout the day
Substitute sugary snacks with sugar-free gum and mints
(especially made with xylitol). This can also help reduce
dental cavities by increasing the saliva flow.
Drink high sugar beverages through a straw, then
rinse mouth with water, and brush within 30mins.
Rinsing with water or chewing sugarless gum helps
cleanse the teeth after a snack.
© Dalhousie University 2011
RISK FACTORS
Poor oral hygiene
Frequent or prolonged intake
of sugary foods (such as sucking a
hard candy) enables the bacteria
to maintain an acidic environment
on the surfaces of the teeth
The consistency of the sugary
foods. Soft and sticky foods cling
to the biting surfaces of the teeth
and stay there until brushed off.
Hard candy allows the saliva to
flow around the teeth causing
decay between the teeth as well
as the front and back of the
teeth.
Currently having one or more
dental cavities increases the risk
of developing more
Decreased saliva flow (dry
mouth) slows the clearance of the
sugary liquid from the oral cavity
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
Chalmers JM, Carter KD, Spencer AJ. Caries incidence and increments in community living older adults
with and without dementia. Gerodontology 2002;19:80-94.
Darby ML, Walsh MM. Dental hygiene theory and practice. 3rd ed. St-Louis, Missouri: Saunders Elsevier;
2010.
Wyatt CCL, MacEntee MI. Daily Oral Care for Persons in Residential Care. 2nd ed. Vancouver, BC:
University of British Columbia; 2007.
DENTURE
CARE
Dentures build
up plaque and
tartar just like
natural teeth
© Dalhousie University 2011
Helpful Hints
1) Dentures should be thoroughly cleaned everyday.
2) Soaking dentures in cleaning
solution about 30 minutes before
brushing will loosen tarter and plaque.
3) Brush dentures with a denture
brush and liquid soap or a foam
denture cleaner. These cleansers are
not abrasive and will not scratch the denture. Strong
bleach, harsh cleansers and toothpaste can scratch
the surface of dentures. Scratched surfaces allow
bacteria to accumulate more easily.
4) It is ideal to leave dentures out
all night if possible or 1-2 hours
per day minimum.
This will let gums rest and helps
prevent denture stomatitis
(inflammation). Dentures can be
stored overnight either dry or in
a mild cleanser to minimize
bacteria production. Dentures
that remain out of the mouth for
prolonged periods of time may distort.
5) Clean denture cup at least once a week.
6) Change denture brush on a yearly basis and denture
cups as required.
Denture Care 101:
Remove and clean dentures,
check and brush the oral cavity
daily.
- Get the resident to take the
dentures out themselves (if
possible)
- Otherwise, to remove denture,
put finger to the back of the
denture and gently push it down
and pop it out
It is important to remove
dentures, even when the patient
refuses.
- You may have to try at
different times throughout the day,
but the dentures must be removed
every day
Check dentures for broken or
cracked areas and check the mouth
for any oral concerns.
Gently brush (soft brush) all
tissues to stimulate the gums,
tongue, cheeks, and palate.
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
College of Dental Hygienists of Ontario. Oral health matters for denture wearers. 2002. www.cdho.org
Darby ML, Walsh MM. Dental hygiene theory and practice. 3rd ed. St-Louis, Missouri: Saunders Elsevier;
2010.
Johnson V, Chalmers J. Oral hygiene care for functionally dependent and cognitively
impaired older adults. In MG Titler (Series Ed.), Series on Evidence-Based Practice for Older Adults, Iowa
City: The University of Iowa Gerontological Nursing Interventions Research Center Research Translation
and Dissemination Core; 2002.
Stafford GD, Arendorf T, Huggett R. The effects of overnight drying and water immersion on candidal
colonization and properties of complete dentures. J. Dent 1986;14(2):52-6.
Wyatt CCL, MacEntee MI. Daily Oral Care for Persons in Residential Care. 2nd ed. Vancouver, BC:
University of British Columbia; 2007.
DRY
MOUTH
Xerostomia
affects up to
60% of older
adults
Dry Mouth
(Xerostomia)
is the result of
a decrease in
saliva
production
© Dalhousie University 2011
CAUSES OF DRY MOUTH
Medications (over 400
medications cause dry mouth)
Radiation to the head & neck
Cancer treatments
Smoking
Immune deficiency
Systemic diseases (Diabetes,
Parkinson’s, Sjogren
syndrome)
Salivary gland aplasia
If mouth is dry, avoid
the following...
➡Alcohol or alcohol products
(such as mouth rinses with
alcohol),
➡Glycerin or lemon toothette
swabs,
➡Food and drinks that
promote dry mouth
(caffeine, sweet sticky foods,
spicy, acidic or dry foods),
➡Lemon or cinnamon flavored
candy or gum
SIGNS:
*Red, cracked, or
swollen gum tissues
*Dry, cracked tongue
*Changes in taste
*Cracked corners of
the mouth
*Lips that stick to the
teeth
*Gums that bleed
easily
*Bad breath
*Problems wearing
dentures
*Frequent &
abundant cavities
*Difficulty eating,
swallowing or talking
MANAGEMENT
1) Careful daily mouth care
with fluoridated toothpaste
2) Clean between teeth with
floss or alternative
3) Sip water or suck on ice
cubes
4) Use water based lip lubricant
5) Chew sugar free gum or suck
sugar free candy
6) Use saliva substitutes
7) Use a mist humidifier at night
8) Reduce or change
medication (if possible) in
consultation with physician
9) Regular check-ups with a
dental professional
Saliva lubricates the
mouth and prevents
decay by protecting
tooth enamel and
fungal/bacterial
http://www.ahprc.dal.ca/projects/oral-care/
infections
REFERENCES
Heart and Stroke Foundation of Ontario. Management of dysphagia in acute stroke: an educational
manual for the dysphagia screening professional. Toronto, ON: Heart and Stroke Foundation of Ontario;
2006 Jan.
Registered Nurses' Association of Ontario. Oral health: Nursing assessment and interventions. Toronto,
ON: Registered Nurses' Association of Ontario Nursing Best Practice Guidelines Program; 2008, Dec.
Wyatt CCL, MacEntee MI. Daily Oral Care for Persons in Residential Care. 2nd ed. Vancouver, BC:
University of British Columbia; 2007.
GINGIVITIS
‘GINGIVITIS’
A mild or early
form of gum
disease
It’s more than just
bad breath!
Do YOU have GINGIVITIS?
16 million Canadians do!
THE FACTS ABOUT ‘GINGIVITIS’:
When teeth are not properly cleaned, plaque forms on
the tooth surface
Plaque causes irritation of the gums, making them red and
slightly swollen - this is gingivitis
More serious forms of gum disease (periodontitis) START
with gingivitis
YOU CAN REVERSE GINGIVITIS...
© Dalhousie University 2011
4 Steps to prevent &
reverse gingivitis:
1 BRUSH
2 FLOSS
3 RINSE with antiseptic
mouthwash
4 Get a regular CHECKUP
with a dental
PROFESSIONAL
YOU CANNOT REVERSE PERIODONTITIS
Signs & Symptoms:
Red, swollen, or tender gums that bleed when
brushed or flossed & Bad breath (Halitosis)
Why
should
you
care?
Only 33%
of Canadians
floss
Good management of gingivitis is a sign of good oral hygiene.
This prevents halitosis, bleeding gums, and other more serious
dental diseases like tooth decay and periodontal disease.
There is a link between oral health and overall health
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
American Academy of Periodontology. Gum disease: what you need to know [homepage on the internet].
Chicago, IL: American Academy of Periodontology; 2008 [updated 2011 May 04; cited 2010 Feb 20].
Available from: http://www.perio.org/consumer/gum-disease.htm
Canadian Dental Association. Your oral health: oral diseases [homepage on the internet]. Ottawa, ON:
Canadian Dental Association Inc; 2012 [cited 2010 Feb 18]. Available from: http://www.cda-adc.ca/en/
oral_health/complications/diseases/index.asp
Darby ML, Walsh MM. Dental hygiene theory and practice. 3rd ed. St-Louis, Missouri: Saunders Elsevier;
2010.
Registered Nurses' Association of Ontario. Oral health: Nursing assessment and interventions. Toronto, ON:
Registered Nurses' Association of Ontario Nursing Best Practice Guidelines Program; 2008, Dec.
Labeling
Dentures
Labeling can be
done
professionally
or at home
© Dalhousie University 2011
Denture labeling is
important for identifying
a resident’s dentures.
Dentures can be easily
misplaced at meals or
while soaking.
Resident’s can find it
difficult to speak, eat or
socialize without their
dentures.
Making new dentures
Do-it-yourself Denture Labeling:
You will need:
1 Spray disinfectant 2 Emory board
(nail file)
3 Indelible marker
4 CLEAR Acrylic nail
polish
is time consuming,
expensive and residents
may not be able to
tolerate or adjust to new
dentures.
Other
Options:
STEPS:
1) Always wear gloves
2) Clean and disinfect the
denture
3) Use an emery board to
roughen the cheek side of
the denture at the back
4) Print the resident’s name
on the area with a
permanent marker and
then seal it with clear
acrylic nail polish
5) Once dry, clean and
disinfect the denture again
and rinse thoroughly with
cool water
Permanent labeling can be done at the denturist or the dentist
office when the dentures are made.
Dental professionals can label dentures with an engraving tool
and apply acrylic over the top to make it permanent.
.
Denture ID kits are available.
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
Wilkins EM. Clinical practice of the dental hygienist. 9th ed. Baltimore, MD: Lippincott, Williams & Wilkins;
2004.
Wyatt CCL, MacEntee MI. Daily Oral Care for Persons in Residential Care. 2nd ed. Vancouver, BC:
University of British Columbia; 2007.
Oral Cancer
Early
detection is
critical
50% of people
diagnosed with
oral cancer do
not live longer
than 5 years
because it isn’t
detected early
enough
© Dalhousie University 2011
Take 60 seconds to check the
mouth daily for any changes
LOOK: Look on all sides of the
tongue, on the floor of the mouth, the
cheeks, the hard palate, the soft
palate, gums and teeth. Look for
anything abnormal or different from
the day before -any white or red
patches, sores, bleeding, loose or
broken teeth.
FEEL: Feel for any lumps , bumps,
sores that bleed and do not heal.
Check if the resident has trouble
chewing or swallowing.
TELL:
Write any concerns on the daily
oral health assessment sheet, along
with your name, the residents name,
and the date. Then let the RN on duty ,
or the LTC coordinator know about the
concern.
If the area of concern is still
present or continues to worsen 7-14
days after initial finding, make
arrangements for the resident to
see a dentist or a doctor.
In Canada, there are
3400 new cases of mouth
cancer every year and
1500 deaths associated
with mouth cancer.
Risk increases with:
AGE, tobacco use
(smoking, chewing),
alcohol, and prolonged sun
exposure
Cancer has a
high prevalence on
the tongue
Most common sites
oral cancer is found:
1 TONGUE
2 THROAT
3 FLOOR of the mouth
4 LIPS
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2011.
Toronto, ON: Canadian Cancer Society; 2011.
Shugars DC, Patton LL. Detecting, diagnosing, and preventing oral cancer. Nurse Pract 1997;22(6): 105-32.
Wilkins EM. Clinical practice of the dental hygienist. 9th ed. Baltimore, MD: Lippincott, Williams & Wilkins;
2004.
Oral Care
DURING
Cancer Treatment
Cancer
treatments can
reduce saliva
production
Dental concerns should be
looked after prior to cancer
treatment, and residents must be
made aware of the dental
complications of cancer
treatments.
Cancer treatments can cause
a a decrease in white blood
cells (which help the body fight
infection) and platelets (which
helps the blood to clot).
When these blood counts are
low, use an ultra soft
toothbrush, be very gentle when
brushing, and avoid flossing to
prevent bleeding. No
professional dental treatment
should be performed at this
time.
T
I
P
S
© Dalhousie University 2011
WHEN PROVIDING ORAL CARE...
Mouth problems can arise during cancer
treatment such as canker sores, dry mouth,
bleeding, thrush, changes in taste and appetite,
and development of cavities due to dry mouth
1) Brush teeth at least 2X per day using an ultra soft
brush
2) Brush after taking liquid medications as they may
contain sugar
3) Rinse with water after vomiting; do not brush for
at least 30 minutes because the enamel is soft
4) Rinse with non-alcoholic antibacterial mouth rinse
5) Apply a fluoride gel or mouth rinse gel once a
day and do not rinse for 30 minutes
6) Keep the mouth and lips moist (do not use
petroleum jelly)
7) Use saliva substitutes, gum, rinse, & toothpaste as
tolerated
Avoid sweet drinks and sugary snacks - SUGAR FREE CHEWING GUM IS GOOD TO
INCREASE SALIVA FLOW
Watch fruit drinks - they have a high concentration of sugar and acid which can damage
the teeth
Drink milk, or water - teas and coffee can dry out the mouth
Brush and/or rinse before bed
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2011.
Toronto, ON: Canadian Cancer Society; 2011.
Heart and Stroke Foundation of Ontario. Management of dysphagia in acute stroke: an educational manual
for the dysphagia screening professional. Toronto, ON: Heart and Stroke Foundation of Ontario; 2006 Jan.
Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Larson CR, Mittal BB, Pierce M. Swallowing and
tongue function following treatment for oral and oropharyngeal cancer. J Speech Lang Hear Res
2000;43:1011-23.
Miller M, Kearney N. Oral care for patients with cancer: a review of the literature. Cancer Nursing
2001;24(4):241-54.
Wilkins EM. Clinical practice of the dental hygienist. 9th ed. Baltimore, MD: Lippincott, Williams & Wilkins;
2004.
Oral swabs are
ORAL
SWABS
not a
replacement
for regular
toothbrushing!
© Dalhousie University 2011
Benefits of
the
brush...
A soft toothbrush removes the plaque and stimulates the gums
Toothbrushes dipped in non-alcoholic mouth rinse can kill bacteria that cause
bad breath, pneumonia and many other diseases
Toothbrushes are safe and effective for removing debris and plaque from all
oral tissues, including the tongue, palate, cheeks and teeth
The bristles stimulate the tissues in the mouth to initiate natural healing
★ Swabs lack the mechanical
action of a toothbrush and do
not meet criteria for safe &
effective oral hygiene
★ Oral swabs can be useful to:
★ remove pocketed food
prior to brushing, or
★ moisten a dry mouth
★ The spongey tip is:
★ too soft to stimulate the
gums or to remove plaque
from the surfaces of teeth
★ likely to push debris around
the mouth
★ small enough to be a
choking hazard so exercise
caution
LEMON GLYCERIN SWABS:
Lemon glycerin swabs are no longer recommended due
their high levels of acidity
The citric acid in lemon glycerin swabs was
thought to increase saliva flow but new research shows
citric acid actually dries out the tissues in the mouth
The acidity in lemon glycerin swabs contributes to the
erosion of tooth enamel & irritation of mouth tissues
When acidic swabs are used on broken or cut tissues it
can be painful
There is no actual cleaning product in the acidic solution
http://www.ahprc.dal.ca/projects/oral-care/
REFERENCES
Grap MJ, Munro CL, Ashtiani B, Bryant S. Oral care interventions in critical care: frequency and
documentation. Am J Crit Care 2003;12(2):113-8.
Meurman JH, Sorvari R, Pelttari A, Rytömaa I, Franssila S, Kroon L. Hospital mouth-cleaning aids may
cause dental erosion. Spec Care Dentist 1996;16(6):247-50.
Pearson LS, Hutton JL. A controlled trial to compare the ability of foam swabs and toothbrushes to remove
dental plaque. J Adv Nurs 2002;39:480-9
Sage Products Inc. Oral hygiene – toothette ® oral care [homepage on the internet]. Cary, IL: Sage
Products Inc; [date unknown] [cited 2010 Nov 11]. Available from: http://www.sageproducts.ca/products/
oral-hygiene/
Specialized Care Co, Inc. How to use the open wide mouth rest. Hampton, NH: Specialized Care Co, Inc;
2012. Available from: http://www.specializedcare.com/pdfs/How-to-Use-OWD0209.pdf
PALLIATIVE
Oral Care
A main focus of
palliative care is
pain
management.
This includes
pain caused by
various oral
conditions
© Dalhousie University 2011
Traditionally, we think of palliative care as care that is provided
for those with a terminal or life threatening illness such as
cancer. One of the primary goals is to provide comprehensive
care that alleviates suffering and promotes quality of life at the
end of life. While many older adults may not be suffering from a
specific terminal illness, advanced frailty and chronic diseases
often require us to apply similar goals to ensure optimum
comfort in the months and years preceding end of life
It is important to be diligent in providing oral care and evaluating
oral care needs on a daily basis. Oral health problems can
develop very quickly can effect a patient’s overall health.
Palliative patients are particularly susceptible to ulcerations,
infections, dryness, and coatings affecting mouth tissues. They
are also at a higher risk for tooth decay.
These are all sources of oral pain and discomfort.
COMMON CONDITIONS IN PALLIATIVE PATIENTS
Dry Mouth & Lips
Candida Infection
(Thrush/yeast)
Denture Stomatitis
Angular Cheilitis
Taste & Swallowing
Disorders
Chronic Dehydration
http://www.ahprc.dal.ca/projects/oral-care/
TIPS FOR PROVIDING CARE
Use an ultra soft Toothbrush 2x
day with a very gentle brushing or
patting action, the gums may be
tender
Rinse with saline, soda water or
neutral fluoride rinse after every
meal or use a moist gauze to wipe
out leftover food from the cheeks
and under the tongue.
Provide a saliva substitute to the
mouth 2-6 X daily to keep it moist.
This may help to prevent issues with
swallowing and to maintain oral
health.
Apply a non-petroleum, water
soluble moisturizer to the lips 2-6X
daily as needed. These types of
lubricants are available
commercially.
Clean dentures after each meal to
make sure that no food is left under
the denture which can cause
irritation and lead to infections.
REFERENCES
Fitch JA, Munro CL, Glass CA, Pellegrini J. Oral care in the adult intensive care unit. Am J Crit Care
1999;8:314-318.
Kelley AS, Meier DE. Palliative care—a shifting paradigm. N Engl J Med 2010;363(8):781-782.
Lorenz K. A guideline for palliative care and end of life care [homepage on the internet]. Los Angeles, CA:
National Guideline Clearinghouse; 2008 Aug 04 [cited 2010 Sept 13]. Available from: http://
guideline.gov/expert/expert-commentary.aspx?id=16446&search=palliative+care+and+end+of+life+care
NHS Lothian. Palliative care guidelines: Symptom control: Mouthcare [Internet]. Scotland: NHS Lothian;
2009 [cited 2010 Sept 13]. Available from: http://www.palliativecareguidelines.scot.nhs.uk/symptom
%5Fcontrol/mouthcare.asp
Westley J. Palliative care [homepage on the internet]. [Place unknown]: Mesothelioma; 2011 [cited 2010
Sept 10]. Available from: http://www.mesotheliomaweb.org/palliativecare.htm
Wiseman M. The treatment of oral problems in the palliative patient. J Can Dent Assoc 2006;72(5):453.
periodontal
disease
The silent mouth
disease
© Dalhousie University 2011
PERIODONTAL DISEASE FACTS:
It is a bacterial infection that
affects the gums, ligaments and
bone supporting the teeth
This bacteria lives in plaque, which
hardens over time and causes gum
irritation (i.e. gingivitis)
Signs & Symptoms:
- Red, swollen, or
tender gums that
bleed when brushed
or flossed
- Receding gums
- Loose or s p a c e d
teeth
Left untreated develops into a
bacterial infection which attacks
the supporting bone
-
It is called the silent disease
because without regular checkups
you may never know you have it
-
THE EFFECTS OF PERIODONTAL
DISEASE CANNOT BE REVERSED!
Why
should
you
care?
75% of adults
over the age of
35 show signs
of periodontal
disease
- Persistent bad breath
-
- Pus and sores in the
mouth
- Change in the fit of
partial dentures
-
- Change in bite
It is the leading cause of tooth loss in adults
and initial symptoms can go unnoticed
Bacteria that cause periodontal disease can
enter the blood stream; and may be related
to other diseases such as heart disease and
diabetes
http://www.ahprc.dal.ca/projects/oral-care/
4 Steps to PREVENT
periodontal disease:
1 BRUSH 2 FLOSS
3 Eat a BALANCED
DIET
4 Get regular ORAL
CHECKUPS AND
CLEANINGS
REFERENCES
American Academy of Periodontology. Gum disease: what you need to know [homepage on the internet].
Chicago, IL: American Academy of Periodontology; 2008 [updated 2011 May 04; cited 2010 Feb 20].
Available from: http://www.perio.org/consumer/gum-disease.htm
Canadian Dental Association. Your oral health: oral diseases [homepage on the internet]. Ottawa, ON:
Canadian Dental Association Inc; 2012 [cited 2010 Feb 18]. Available from: http://www.cda-adc.ca/en/
oral_health/complications/diseases/index.asp
Darby ML, Walsh MM. Dental hygiene theory and practice. 3rd ed. St-Louis, Missouri: Saunders Elsevier;
2010.
Sarin J, Balasubramaniam R, Corcoran AM, Laudenbach JM, Stoopler ET. Reducing the risk of aspiration
pneumonia among elderly patients in long-term care facilities through oral health interventions. J Am Med
Dir Assoc 2008;9(2):128-135.
Wyatt CCL, MacEntee MI. Daily Oral Care for Persons in Residential Care. 2nd ed. Vancouver, BC:
University of British Columbia; 2007.
Taste &
Swallowing
DISORDERS
For palliative
patients at the end
of life, swallowing
is often a problem.
© Dalhousie University 2011
The senses of taste and smell are so closely
linked that people who can't smell often
complain that they can't taste either. Taste buds
are located at various spots on the tongue and
olfactory (smell) cells are specialized cells found
in the nose. They both depend on zinc, and
other nutrients, for their growth and
maintenance
TASTE DISORDERS
CAUSES:
- Viral infections, head injuries, cancer
therapy and side effects of prescription
medications are common causes.
SYMPTOMS:
- Sensory changes, such as a metallic, bitter or
salty taste that can occur by themselves or be
triggered by foods or certain medications.
MANAGEMENT
- Eating foods with higher taste sensations.
- Using artificial saliva substitutes before eating.
- Using fluids like gravy and light cream sauces
to increase the fluid of the food and give it
more taste.
- Some people benefit from taking zinc
substitutes, to help increase their taste
sensation. Taste buds are especially
dependent on zinc.
http://www.ahprc.dal.ca/projects/oral-care/
SWALLOWING DISORDERS
CAUSES:
- Lack of saliva in the mouth caused by some
medications, mouth breathing, or dehydration
- Neurological disorders such as stroke,
Parkinson’s, or Alzheimer's disease
SYMPTOMS:
- The tongue cannot push the food to the back of
the throat while chewing
- Reduced use of the facial muscles - the mouth
and lips cannot close properly making it more
difficult for the food to be swallowed
- Loss of sensation in the mouth makes it difficult
to know where food is in the mouth - this results
in pocketing of food in the cheeks or under the
tongue.
Food must be removed by the care provider.
to prevent choking
MANAGEMENT:
- Swallowing is improved when the mouth is moist
and treating for dry mouth may help with
swallowing
- Ensuring that food is moist
- Pre-blending food to make food particle size
smaller and more manageable
- Using a suction machine (if available) or
wrapping a thin face-cloth or gauze around the
finger and sweeping the tissues may help to
remove food debris from the cheeks and under
the tongue
REFERENCES
American Dental Association. How medications can affect your oral health. JADA 2005, June; 136(6): 831.
Darby ML, Walsh MM. Dental hygiene theory and practice. 3rd ed. St-Louis, Missouri: Saunders Elsevier;
2010.
Heart and Stroke Foundation of Ontario. Management of dysphagia in acute stroke: an educational manual
for the dysphagia screening professional. Toronto, ON: Heart and Stroke Foundation of Ontario; 2006 Jan.
Registered Nurses' Association of Ontario. Oral health: Nursing assessment and interventions. Toronto, ON:
Registered Nurses' Association of Ontario Nursing Best Practice Guidelines Program; 2008, Dec.
Additional information available on educational video #2:
Brushing Techniques & Oral Health Products
TOOT H B RU S HE S
I
N
f
o
r
m
a
t
i
o
n
Toothbrushes remove debris and plaque from the surfaces of teeth and gums. They also stimulate the gums to
keep them pink and healthy. There are many different kinds of toothbrushes, the question is, which is the most
effective at removing plaque?
GUIDELINES FOR EFFECTIVE TOOTHBRUSHING:
The toothbrushing technique recommended by most dental professionals
removes plaque with minimal trauma to the teeth and gums. Here’s how to do it:
1) Hold the toothbrush handle in the palm of your
hand with your thumb against the handle. Your thumb
should be close enough to the head of the toothbrush
to manipulate it with control.
2) Direct the bristles toward the gums at a 45 degree
angle to the tooth. Place the bristles partly on the
gums and partly on the tooth surface.
3) Gently vibrate the bristles and roll slowly, moving
the bristles from the gums towards the top of the
tooth. Slowly count to 10 as you do this procedure.
4) Repeat these steps up to five more times in the same area. For the front teeth,
position brush on it’s end and place the narrow end of the brush head 45
degrees to the gums and teeth, vibrate and roll as described previously.
Always use a soft or ultra soft toothbrush.
★ Softer bristles are more effective at cleaning the gum-line (where the gum
meets the crown of the tooth) and are gentler on the gum tissues
★ Using a soft toothbrush reduces gum recession and toothbrush abrasion
★ Harder bristles can actually cause tooth enamel and dentin to wear
away weakening the crown of the tooth
DID YOU KNOW?
A toothbrush should be:
durable
flexible
light weight handle
strong bristles that are not
too rigid
easily manipulated
easily cleaned
meet individual
requirements
Not all toothbrushes are
appropriate for all people
Toothbrushes date back to 1600BC. Originally, they were twigs or
sticks cut from tree branches. The ends of the branch were frayed by
crushing the fibers to make bristles that are similar to the toothbrush
bristles we see today.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
TOOT H B RUS HES
The effective removal of plaque depends more on
brushing technique than on the toothbrush itself
Factors to consider when choosing a toothbrush for a resident:
1) What is their ability to use a brush effectively without causing
damage?
2) Are there physical conditions to consider such as problems with
manual dexterity, vision and so on?
3) Are they motivated and willing to do their own oral care?
ADAPTED HANDLES
Specialty grips can be custom
made to meet the needs of
individual residents. Some
examples of specialty grips
include:
a rubber bike handle:
This provides a better
grip for residents that
don’t have good manual
control
a tennis ball: This is good
for residents that cannot
grasp the small handle
of a regular toothbrush.
TYPES OF TOOTHBRUSHES
An electric toothbrush is a good alternative to
a manual brush, especially if the resident has
physical limitations that affect their ability to brush.
When used properly, certain electric toothbrushes
are known to be more effective than manual
brushes at removing plaque. Electric toothbrushes
have higher speeds and motions that cannot be
reproduced using a manual brush.
It is important to read the directions before
using an electric brush as they are all designed
slightly differently. Technique is still important
when using an electric toothbrush. If the bristles are
not placed properly at the gum line, the gums can
Long handled toothbrushes are
also available for residents that
cannot fully bend their arms
become irritated. There is no need to apply
pressure on the gums or teeth when using an
electric brush, it is designed to do the work for you.
Oscillating or rotating technology loosens and
sweeps away plaque.
A “Collis Curve” brush is specially designed so that the bristles are
curved. These curved bristles surround the tooth. This is meant to allow
both the inside and outside surfaces of the teeth to be brushed at the same
WHEN TO REPLACE A
TOOTHBRUSH
✓
Toothbrushes should be
replaced every 3 months
(at a minimum)
✓ Replace toothbrushes immediately
following a cold or flu to prevent
re-exposure to bacteria or viruses
time.
It may be necessary to use a child size toothbrush for residents who
have difficulty opening their mouths wide or have a small mouth. Children’s
toothbrushes have smaller heads and smaller handles. Smaller handles can
also be good for residents with small hands.
✓ Always replace a brush that looks
worn or frayed
Suction toothbrushes attach to suction machines and allow the care
provider to brush a resident’s teeth while the suction works to remove any
debris or saliva as they brush. This is ideal for residents who have difficulty
swallowing.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
Additional information available on educational video #2:
Brushing Techniques & Oral Health Products
MO U TH RIN S E S
I
N
f
o
r
m
a
t
i
o
n
Mouth rinses can be a good addition to brushing and flossing. Some provide benefits that go beyond
freshening the breath
GUIDELINES FOR USING MOUTH RINSES:
1) Pour a small amount of mouth rinse into a cup and
have the resident take it into their mouth. Have the
resident close their lips with teeth slightly apart.
2) Encourage them to force the fluid through the teeth
and swish the fluid back and forth between the teeth
and all around the mouth for 30-60 seconds.
3) Have them spit the mouth rinse out into the sink or
a basin. Do not allow the resident to swallow the
mouth rinse.
4) Make sure to read the manufacturers instructions
for appropriate frequency and length of time to rinse.
Remedies that can be used as alternatives to commercial mouth rinses.
A) A one-to-one mixture of hydrogen peroxide and saline or water;
B) Club Soda;
C) A mixture of a 1/2 teaspoon salt and 1/2 teaspoon baking soda in
one cup of water
Rinses can be therapeutic depending on the ingredients:
➡
➡
➡
➡
➡
➡
➡
➡
Oxygenating agents cleanse the mouth,
Astringents agents shrink tissues when they are inflamed
Anodyne ingredients reduce oral pain
Buffering agents reduce acidity in the mouth
Deodorizers neutralize odors in the mouth,
Antimicrobial agents kill or reduce bacteria in the mouth
Antiseptic agents inhibit the growth of bacteria in the mouth
Fluoride helps prevent tooth decay
DID YOU KNOW?
REMEMBER!
★ Residents should only
use mouth rinses if they
have the ability to swish
and spit properly
★ Fluoride rinses are an
important addition to
regular oral care
especially if the resident
is prone to tooth decay.
★Natural mouth rinses
containing aloe vera or
chamomile may help
reduce mouth
sensitivities.
Many commercial mouth rinses contain alcohol which can dry out
tissues. These should be avoided if the resident has dry mouth or is
a recovering alcoholic. Non-alcoholic rinses are available.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
Additional information available on educational video #2:
Brushing Techniques & Oral Health Products
F LOSS & FLOS S A I D S
I
N
f
o
r
m
a
t
i
o
n
Flossing is important because it cleans plaque and food debris from between the teeth where tooth brushing cannot
reach. Removing plaque from between the teeth will help prevent dental cavities and gingivitis.
GUIDELINES FOR EFFECTIVE FLOSSING:
When flossing a resident’s teeth, remember to position yourself so that your back,
neck and joints are comfortable and you have a clear view of the mouth.
1) Take about 18 inches of floss and wind it
around the middle fingers of each hand with
about 5 inches between your 2 hands.
2) Pinch your thumb and index fingers
together on the floss and leave about an inch
between your two hands.
3) Glide the floss between the resident’s
teeth. Hold the floss snug to the tooth and
make a C shape around the tooth. Slide the
floss under the gums. Use an up & down
motion along the side of each tooth.
4) Pull the floss out from between the teeth.
With a clean section of floss, then move to
the next tooth.
1
2
3
POINTS TO CONSIDER:
If the spaces between the
teeth are wide, something
as simple as a fine knitting
yarn can be used for
flossing
Waxed floss, slides easily
between teeth and does
not shred like other floss
For residents with limited
motor skills, floss can be
tied in a knot to make a
circle and looped around
the resident’s fingers.
Whenever possible, residents should be encouraged to floss their own
teeth. If limitations prevent a resident’s teeth from being flossed the
traditional way, there are a number of floss aids available commercially.
DID YOU KNOW?
Flossing technique will
improve with practice!
Gums may bleed with flossing at first but with regular flossing and
brushing this should stop within a few weeks.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
F LO S S & F LOS S A IDS
OTHER FLOSS AIDS
FLOSS HANDLES
A handle may allow some residents who could
not normally floss on their own to floss more easily.
Handles also prevent care providers from having to
place their fingers in between the resident’s teeth
when flossing.
Floss handles come in different shapes and
sizes. They can be used with residents that have
limited dexterity and can be used with only one
hand. There are a variety of floss handles on the
market today.
All floss handles have some type of handle with
the floss attached. There are some where only the
floss is removed and discarded after use. With these
models, the handle should be rinsed thoroughly
after use.
Disposable floss handles are also available.
These should be discarded once the floss becomes
broken or frayed.
Proper technique for using a floss handle
involves:
1 placing the floss in between two teeth on the
biting surface and gently pushing the floss into the
space between the teeth.
2 once inserted, pull the floss towards the side
of one tooth and rub up and down to remove any
debris on the surface of that tooth.
3 push the floss toward the opposite tooth and
use the same technique to clean all surfaces
between the two teeth.
4 move to the next tooth and repeat for all
surfaces.
RE-USABLE FLOSS HANDLE DISPOSABLE FLOSS HANDLE
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
INTERDENTAL BRUSHES have large handles and small
cylindrical brush heads that fit between the teeth. Some
models have permanent handles with replacement
brushes. These should be maintained the same as a
regular toothbrush. Some interdental brushes are
completely disposable. Interdental brushes can be
dipped in mouth rinse or have toothpaste added to
help clean between the teeth.
RE-USABLE
INTERDENTAL BRUSH
DISPOSABLE
INTERDENTAL BRUSH
DENTAL TOOTHPICKS are usually
made of wood such as birch,
which helps reduce splintering. The
shape is designed to allow them to
fit into the spaces between teeth
Toothpicks are sometimes called
interdental cleaners, dental wood
sticks, Stimudents, Dental pics, Soft
pics or Go betweens.
DENTAL
TOOTHPICK
INTERDENTAL TIPS are usually made of rubber or plastic.
and are attached to the end of a toothbrush handle. A
rubber tip is usually preferred because it fits between the
teeth more easily and is gentler on the gums than the
plastic tips. Proper use of an interdental tip involves
tracing the tip along the gumline and in between the
teeth. Be sure to rinse off the tip after use.
Additional information available on educational video #2:
Brushing Techniques & Oral Health Products
DENT UR E P RO DU C TS
I
N
f
o
r
m
a
t
i
o
n
Proper denture care is important for maintaining dentures, preventing sores, and limiting the amount of
bacteria in the mouth. Dentures should be cleaned and cared for daily.
GUIDELINES FOR CLEANING DENTURES:
A denture brush, or a toothbrush (used only to clean the denture), is
required for proper cleaning. Denture brushes have very soft bristles and have
been designed to clean all surfaces of the denture. Here are some guidelines:
1) Line the sink with a wet facecloth or fill it
1/4 full with water. This provides a buffer
to prevent damage should the dentures fall
while being cleaned.
2) Remove the dentures from the resident’s
mouth. Place your finger at the back of the
mouth by sliding it along the gum line.
Loosen dentures by pulling them down from
the roof of the mouth or up from the floor of
the mouth.
3) Hold the denture firmly between the thumb and forefinger of your nondominant hand. Never hold a denture or partial denture cupped in your hand this increases the likelihood of the denture being dropped. Partial dentures
can also be bent this way.
4) Rinse the denture to remove any loose debris and saliva.
5) Remove any denture adhesive materials that remain on the denture and
throughly brush all surfaces of the denture.
6) Use liquid soap or a foam denture cleaning product and brush for at least
90 seconds and rinse. Never use toothpaste as this may scratch the surfaces
of the denture.
Dentures should be cleaned at least once a day and checked
for any broken or worn parts.
DID YOU KNOW?
REMEMBER!
★ Always clean dentures
over the sink
★ Toothpaste is abrasive
and will scratch the
denture surface
★ A scratched denture is
more likely to collect
bacteria
★ Ensure that
dentures are moist before
placing them back in the
mouth to reduce irritation
to the tissues
Dentures are made of acrylic - a porous material that can be easily
scratched and damaged. Acrylic does not have germ-fighting properties
and bacteria can grow on the surface of the denture. This bacteria can
cause odors, sores and irritations under the denture.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
D E NT U R E P RODUCTS
There are many commercial denture care products available that
help reduce scratches and prevent damage during cleaning. These
products are usually foam or gels with antibacterial agents that kill
odor causing bacteria and micro-clean without scratching.
DENTURE COMFORT & ADHESIVES
SOAKING DENTURES
Residents should be
encouraged to remove their
dentures at night to allow the
gum tissues to rest. They should
be cleaned thoroughly and
placed in a soaking solution.
Doing a quick brushing without
soaking the dentures may not
provide the disinfection they
require.
Soaking will help to remove
hard tartar, debris and
bacteria that builds up on the
denture. Soak dentures in:
A) a mixture of one
teaspoon bleach and one
cup water or,
B) commercial denture
cleaning solution
Remember to put the clean
denture back into a clean
mouth - brush the resident’s
mouth with a soft toothbrush to
remove any debris and to
stimulate the gum tissues.
For residents with dry mouth,
products such as water-soluble
lubricants can be placed under
the denture to help make it
more comfortable.
Dentures that fit properly should not require adhesive - the natural
suction between the denture and the roof or floor of the mouth should be
enough to hold them in place. Using a denture adhesive may help prevent
irritation caused by a loose fitting denture. Some people feel more
comfortable and secure when using a denture adhesive. Denture
adhesives come in three forms, paste, powder, or wafers.
DENTURE PASTE comes in a tube and is squeezed right
onto the denture. It comes in a variety of flavors and
strengths. To properly apply paste to denture:
clean dentures thoroughly and then follow the instructions on
the package. Paste can leave an unpleasant residue in the
mouth when the denture is removed. To remove excess
paste: use a slightly rough face cloth to wipe the remaining
paste from the mouth or have the resident drink carbonated
soda which will dissolve the paste.
POWDERED ADHESIVES change the bite less
than pastes and are easier to clean off the dentures.
To use a powdered adhesive: clean and
rinse the denture, shake powder onto the denture,
and place the denture in the resident’s mouth.
DENTURE WAFERS are cut to fit the shape of the denture and
work better if the denture is more of a snug fit. To apply
denture wafers: place the strips in the denture and seat
properly in the mouth. The saliva will help the wafer adhere to the
gum tissue.
Denture adhesives should not be used to compensate for an illfitting denture. A denturist or a dentist should be consulted to adjust
or reline the dentures so that they fit properly.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
Additional information available on educational video #2:
Brushing Techniques & Oral Health Products
D RY M OU T H P RO DU C TS
I
N
f
o
r
m
a
t
i
o
n
Xerostomia (or dry mouth) is a condition that causes a lack of saliva in the mouth resulting in dry mouth.
This can cause oral disease and discomfort.
DRY MOUTH:
Saliva is necessary to maintain the health of the teeth and gums. It
protects, lubricates and cleanses the mouth and aids in disease resistance.
Decreased saliva flow can be caused by medications, illness, chronic diseases
such as diabetes and hypothyroidism, or
from cancer therapy. Residents with a
dry mouth may find that their tongue
sticks to their palate and they may have
trouble speaking, chewing food or
swallowing. They may be thirsty and will
probably lick their lips frequently. They
may complain of a burning or sore
mouth. Some residents will complain that
their dentures hurt or do not fit properly.
Residents with dry mouth may stop eating because of discomfort when
chewing and trying to swallow food. They may need large amounts of
water to help moisten the food and to assist with swallowing.
POINTS TO CONSIDER:
Having a dry mouth can
cause plaque and tartar to
accumulate in the mouth
increasing the risk of
dental decay, particularly
along the gum line.
Placing a humidifier in a
resident’s room may help
alleviate some of the
discomfort associated with
dry mouth
Mouth rinses with alcohol,
glycerin or lemon
toothette swabs, and
certain foods and candies
can promote dry mouth.
DID YOU KNOW?
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
Dry mouth affects up to 60% of older adults
DRY M OUTH P RODUCTS
PRODUCTS TO TREAT DRY MOUTH
There are many ways to help residents with
dry mouth such as placing a humidifier in their
room, using toothpaste and rinses designed to
treat dry mouth, and using saliva substitutes
and lip lubricants. Some examples of
commercial products are Oral balance, BioXtra,
Xerostom, Moi-Stir, Mouth Kote, Optimoist,
Xero-Lube.
SALIVA SUBSTITUTES
Saliva substitutes are products that contain
physical and chemical properties similar to natural
saliva. Saliva substitutes can be applied throughout
the entire mouth as often as needed for comfort.
They provide lubrication that soothes and helps
relieve dry mouth.
LIP LUBRICANTS
Dry, cracked lips are also common in residents
who are dehydrated, are on many medications,
or have nutritional deficiencies. Dry lips can be
painful and embarrassing. It is important to keep
the lips moist to allow comfort when eating and
communicating. Lip lubricants contain lipid
hydrophobic bases that help prevent moisture
loss and softens the skin. Apply lip lubricants
generally as often as needed to the lip area.
Saliva substitutes can help reduce burning and
minor irritations and help with swallowing. Most
saliva substitutes are naturally sweetened with
xylitol.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
Additional information available on educational video #2:
Brushing Techniques & Oral Health Products
CO LD & C A NK E R S OR E
PRO DU C TS
I
N
f
o
r
m
a
t
i
o
n
Canker sores and cold sores are common and often contagious. These sores will usually heal on their own,
but to speed up the process and diminish the symptoms there are treatments and remedies available.
GUIDELINES FOR USING COLD SORE
PRODUCTS
★ Wash the resident’s hands, lips and
face with soap & water and dry with
a clean towel
COLD SORES
Cold sores are very common for many people and
are characterized by small, red blisters on the lips.
One common type is herpes simplex. This virus is very
common and highly contagious. After the initial
outbreak, these blisters can re-occur frequently and
there is no cure.
Many over the counter treatments are available. These
products typically contain docosonal or benzyl alcohol
and are usually available as gels or creams.
★ Apply the treatment with a cotton
swab directly to the cold sore
★
Discourage the resident from
licking their lips
★
Reapply according to the
manufacturer’s directions
For the best results,
use these products as soon as there is tingling on the lips.
This usually indicates a cold sore is starting to develop.
Common over the counter medications are
Abreva and Zilactin
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
C AN K E R & COLD SOR E PROD UCTS
Canker sores are found on the tissues inside the mouth. They are small
but painful blister-type sores that tend to heal on their own within 14
days. They are caused by a variety of factors and are sometimes
contagious.
TREATMENT OF CANKER SORES:
Treatment of canker sores depends on their type and severity. It is important
to try to determine what triggered the outbreak as prevention is often the
best treatment. There are no known cures but there are different remedies
and medications to help relieve the symptoms associated with canker sores.
REMEDIES INCLUDE:
CAUSES OF CANKER SORES
★ injury to the mouth
★ stress
★ unhealthy diet
★ certain medical
conditions
★ some medications
★ Nicotene gum
(switching to nicotine
spray or patches can
eliminate this issue)
To ease pain and
promote healing - AVOID
acidic foods when a
canker sore is present
DID YOU KNOW?
1) salt water rinses: Mix 1 teaspoon salt to 1 cup of warm
water. Swish the solution around the mouth and spit out.
2) ½ teaspoon of baking soda mixed with a few drops of
water until it makes a thick paste. You can use this paste to
cover the canker sore.
3) Hydrogen peroxide can be mixed 1 to 1 with water.
This solution can be applied to the sore using a cotton
swab.
4) Milk of magnesia can aid in the healing process and
reduce pain. Apply it directly 3-4 times a day.
5) There are many over the counter oral care products available (gels,
pastes and rinses) to help relieve the symptoms of canker sores and help
speed up the healing process. Use as directed.
6) In severe cases, oral medications can be prescribed by a physician or
dentist.
If a canker sore lasts longer
than 14 days or if the
resident develops a fever, a
physician or dentist should be
consulted
Canker sores are a type of herpetic lesion - also known as ‘aphthous
ulcers’. They are the most common type of mouth ulcer.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
Additional information available on educational video #2:
Brushing Techniques & Oral Health Products
OT HE R PRO DU C TS
I
N
f
o
r
m
a
t
i
o
n
There are a number of products available commercially to assist in the delivery of effective oral care.
Fluoride treatments, tongue cleaners, and mouth props are some examples.
Fluoride treatment is indicated for people with natural teeth
who have a history of dental decay, a high number of fillings,
and/or a dry mouth.
FLUORIDE PRODUCTS:
Fluoride products are used to prevent dental decay and strengthen
tooth enamel. There are a number of ways to apply fluoride and they
are typically prescribed or recommended by a dental professional or
primary health care provider. The frequency and method of applying
these products varies depending on the situation.
Daily fluoride rinses that are sold over the
counter are generally safe to use as directed.
Fluoride gels are also available at the
pharmacy. These products are designed for
daily use but should be used as directed or as
prescribed by a dental professional or
pharmacist.
Fluoride varnish is a more highly concentrated form of fluoride generally
applied by health professionals. It is painted onto the teeth with a special brush
and can take less than two minutes to apply. The varnish adheres to the teeth even in the presence of saliva. Fluoride is then released slowly over time to
help re-mineralize the surface of the teeth. It’s effects can last for several
weeks. Residents should wait until the day after fluoride varnish application to
brush their teeth.
DID YOU KNOW?
REMEMBER!
★ Daily fluorides should be
used immediately after
brushing and flossing and
just before bedtime
★ Any residue left in the
mouth after fluoride rinsing
or application should be
spit out
★ When residents are
unable to spit effectively,
fluoride must be used with
caution
It is important not to eat, drink, or rinse for 30 minutes after using a
topical fluoride - this allows the fluoride to adhere to the teeth
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
OTH ER P RODUCTS
There are many oral health products available today for many different purposes. The best way to
determine whether or not to use a particular product is to look at the physical abilities of the residents
and what their specific oral care needs are.
MOUTH PROPS
Mouth props are a
valuable tool to hold a
resident’s mouth open
while oral care is being
provided. Residents can
gently bite on the white
spongy mouth prop to help
relax the muscles of the jaw. Because the prop is soft,
it can be wedged in between the front teeth in the flat
position and then turned to assist with opening. The
prop should be resting on the back teeth, not on the
front teeth. The teeth should be positioned on the
ridges. When the prop is resting on one side of the
mouth, the opposite side of the mouth can be brushed.
Care providers can also dip the prop in a non-alcoholic
lubricant to help with insertion.
TONGUE CLEANERS
The tongue and mouth tissues can
accumulate bacteria on their surfaces. While
these surfaces can be brushed using a regular
toothbrush, commercial tongue cleaners are also
available.
Both the tongue and the cheeks should
be brushed during daily oral care.
Mouth props can be washed, labeled and re-used
Depending on the cleaner, there is often a
plastic edge used to ‘scrape’ coatings and debris
off the tongue. Sometimes there is another edge
with bristles to brush the inside of the cheeks and
the top of the tongue.
The handle of another toothbrush can be used in
place of a mouth prop if one is not available. This is
called the 2-toothbrush technique.
© Dalhousie University 2011
h t t p : / / w w w. a h p rc . d a l . c a / p ro j e c t s / o r a l - c a r e /
Some toothbrushes
now have tongue
cleaners on the
opposite side of the
toothbrush head.
ORAL HEALTH EDUCATION SERIES
Welcome to the “Brushing Up on Mouth Care” education series. In this series, we
are focusing on personal daily mouth care for older adults. When older adults
experience a decline in physical and mental health, they may require assistance
with their personal care needs.
There are five learning modules in this series that relate to various aspects of
providing daily mouth care.
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/

Please note that these educational videos were developed
for use in Long Term Care and therefore the term ʻresidentʼ
is used throughout to describe the recipient of care.
However, this information is also valuable to those
providing care in other settings such as home care and
acute care. In these instances, please take the term
ʻresidentʼ to mean client, patient, loved one, or whatever
term best describes the person you are caring for.
© Dalhousie University 2011
www.ahprc.dal.ca/projects/oral-care/
Was this manual useful for you? yes no
Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Download PDF

advertising