Learning Outcomes Explain why Good Oral Health is important for older people in care Recognize the...
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Learning Outcomes
• Explain why Good Oral Health is important for older people in care
• Recognize the factors that contribute to Poor Oral Health
• Demonstrate good practice in day to day oral care for residents who require assistance
• Know how and when to report any oral health concerns(referring to local protocols & carrying out a risk assessment)
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Training outline
• Presentation/Group Work
• Tooth brushing /Denture care
• Oral soft tissue
• Practising Oral Care
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Group Discussion
• How often do you brush your teeth
• How often do you visit the Dentist
• How you feel about Dental treatment
• Do you use any other oral aids
• Your experience of carrying out mouth care
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Oral care is the responsibility of every individual carer.
Care is required 24 hours aday so this includes both night and day staff.
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Good oral health is important for five
main reasons
• Overall health
• Prevention of pain and suffering
• Adequate nutrition and hydration
• Quality of life and comfort
• Communication, socialisation and appearance
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Benefits for Carers
A painful mouth can cause behavioural problems. Good oral care can help prevent dental disease.
This in turn may:• encourage the resident to be more cooperative• mean that residents have fewer problems with eating• reduce bad breath and therefore create a more pleasant atmosphere.
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• Oral health Risk assessment should be done within 48 hours of admission
• Helps identify Residents who have current oral health problems which may require the attention of a dentist
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• The oral care plan is developed as a result of the findings of the oral health risk assessment.
• Referral process in your areas is included in the local information section of the Caring for Smiles Guide
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Supporting Residents with oral care – promote self care as
much as possible
• When helping a resident with oral care, remember to prompt, encourage and support
• Document daily oral care and non compliance
• All staff have a responsibility to start the referral process to a dentist
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Healthy mouth, teethand gums
What is a healthy mouth?
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Key messages
• Care staff should encourage the resident to spit out toothpaste and don’t rinse, although there may be exceptions to this in older people
• Toothbrushing, diet and dental visits are the main steps towards good oral health, but may need some adaptations for older people
Oral care should be enhanced if older people need a higher intake of food or drinks containing sugar to ensure adequate calorie intake, or are on nutritional supplements.
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What is Dental plaque?
• It is present in all mouths.
• It is a sticky film of bacteria that forms minutes after brushing.
• It can form on all surfaces of the teeth, dentures, crowns and bridges.
• It contributes to decay and is the major cause of gum disease.
• If it is left in the mouth it can harden and become tartar (calculus).
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How do you remove plaque?
• By thoroughly toothbrushing at least twice daily.
• Tartar can only be removed by professional cleaning.
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What is Dental Decay
• Frequent acid attacks soften the enamel of the tooth, when weakened it can break off and form a hole in the tooth
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Dental decay
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Prevention of Decay
• Reducing the number of times that an acid attacks occur
• Brushing teeth twice daily with a fluoride toothpaste
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Gum Disease
Early stage – gingivitis
• At this stage gum disease can be reversed and the gums restored to health
• The gums around the teeth become red and swollen and bleed when they are brushed
• In many cases people will suffer from bad breath
• The first sign can be blood on the toothbrush or after spitting out
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Good practice point: toothbrushing and gum
disease
• If the gums bleed slightly, continue to brush them. The bleeding is usually the result of plaque build-up and continued brushing will improve gum health
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Advanced stage – Periodontitis
• Periodontis is irreversible
• Teeth can be lost through this
• Loose teeth can cause numerous problems
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How is gum disease prevented?
• Regular and methodical removal of dental plaque by thoroughly brushing twice daily.
• Information can be sought from dental professionals about effective oral care aids.
• Mouthwashes should be used under the advice of either medical or dental professionals. Ideally all mouthwashes should be alcohol-free.
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Toothpaste
• Using fluoride toothpaste twice daily increases the teeth’s defences against decay.
• Some fluoride toothpastes can contain higher amounts of fluoride which gives extra protection against decay.
• A dentist will prescribe these for a resident if necessary.
• Non-foaming toothpastes are available for people with swallowing problem.
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What type of toothbrush
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Dentures
Like natural teeth, dentures need to be kept clean
Plaque can also build up on dentures and if not cleaned regularly can cause denture-related infections such as stomatitis (thrush).
Other equipment, such as denture boxes, also need to be kept clean.
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Denture hygiene methods
• Ideally dentures should be rinsed after every meal, taken out at night, brushed and soaked
• Clean dentures morning and night using a toothbrush and denture cream or un-perfumed soap and water.
• Clean the roof of the mouth, gum ridges and tongue with a soft toothbrush.
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Soft tissuesWhat is a healthy
tongue?
• Pink and symmetrical, with a slightly rough surface.
• Like any surface in the mouth, the tongue should be kept clean and moist
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Cleaning the tongue
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Other soft tissues
• The lining of the mouth should also be cleaned
• For cleaning the soft tissue, use damp non fraying gauze (which has been thoroughly wetted in clean running water) wrapped round a gloved finger.
• The gauze should be changed when required and several pieces of gauze used to clean the mouth.
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Cleaning soft tissues with damp gauze
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•Dry cracked lips are uncomfortable for any individual
•Lips should be cleaned with a water based cream
Lips
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• A dry mouth can cause the tongue surface to become sore and cracked and requires a specialised cleaning regime
• Many of contributing factors to a dry mouth and it is a common side effect of many medications
• A lack of saliva causes difficulty in eating and swallowing
Dry Mouth
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Soft Tissue Conditions
• Fungal infections in the mouth are common in older people
• Good oral care and denture hygiene helps prevent or reduce oral infections in many cases
• Mouth ulcers – there are numerous causes of ulcers in the mouth, for example denture trauma, reaction to drugs, underlying disease or oral cancer
• Seek advice from a professional even if ulcers are painless.
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Oral Cancer
Key message:
• Early detection of mouth cancer is important so if in doubt, get checked out.
• Oral cancer can affect the lips, mouth or throat
• Any ulcer present for two weeks or more – even if painless must be investigated by a dentist
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Infection prevention & control
• All staff should undergo training on infection prevention and control
• The minimum personal protective equipment which should be used when cleaning a residents teeth is disposable gloves and apron
• NHS Education for Scotland – DVD on preventing infection in care
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Prompt – Encourage – Support
• Promote self-care as much as possible.
• Always ensure the resident’s comfort, privacy and dignity
• Wash hands thoroughly and use disposable gloves. Cuts, abrasions and breaks in the skin must be covered with a waterproof dressing.
• Explain the procedure appropriately to the resident
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Position for brushing upper teeth and gums
Position for brushing lower teeth and gums
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Removing full dentures for cleaning:
Lower denture rotating out Lower denture removed completely
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‘Breaking the seal’ of upper denture ‘Breaking the seal’ of upper denture– first stage – second stage
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Removing Partial Dentures
• If possible seek advice from a dental professional especially if caring for partial dentures is new to staff
• Ask the resident if they are able to remove their own dentures.
• If not carefully place your fingers under the clasps that are hooked on to the teeth and gently push downwards
• Take hold of the plastic part and pull carefully out of the resident’s mouth
• Avoid bending the wire
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Soaking Dentures
• Soak plastic dentures in disinfecting fluid for 20 minutes, then overnight in plain water
• Dentures with metal parts should be soaked in chlorhexidine 0.2%
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Inserting Dentures
Full Dentures
• Dentures should be rinsed under clean water before being replaced in the resident’s mouth
• Encourage independence if the resident is able to do this themselves
• Replace upper denture first
• Gently insert denture at angle, then rotate
Partial Dentures
• If the resident is able, encourage them to replace the denture
• If not after rinsing the denture in water, ask the resident to open their mouth, insert the denture at an angle and rotate and click into position
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Supporting Resident's with
Dementia
• Residents with Dementia may not be able to complain if they are suffering pain
• Communication Strategies
• The importance of reporting to the person in charge if a resident persistently refuses.
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Supporting Resident's with
Dementia• Bridging
• Chaining
• Hand over hand
• Distraction –
• Rescuing
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Palliative and end-of-life care
• Symptoms related to the mouth are prevalent when a person requires palliative and end-of-life care and it is important that oral care at this time is not overlooked by
staff caring for the resident.
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• Multiple choice exam - 30 minutes
• Practical Skills competency Framework
• Direct observation of practice.
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Finish
Thank you Please remember to
complete your Evaluation