Oral Health WA Dementia Training Study Centre Tuesday 22 nd June 2010

1. Oral HealthWA Dementia Training Study CentreTuesday22nd June 2010 Clive Rogers BDSc, Grad Dip Ed (Pr), Cert IV Trainer & Assessor The Visiting Dentist cliverogers@aapt.net.au

2. Objectives of this presentation: • Briefly discuss the nature of and current knowledge about two common oral diseases; tooth decay and gum disease • Introduction to the daily management care of tooth decay and gum disease • Stressing the words ‘Briefly’ and ‘Introduction’ • (A summary)

3. I appreciate the opportunity to give you any information I can, However, Summaries in teaching achieve very little in training primary or foundational knowledge and hand-skills.

4. It was suggest that: - I target the information of this talk at an informed general public level. - The informed general public has basic knowledge of oral hygiene and are conversant with most issues but are unaware of details/consequences, etc. (????) - Most importantly target the information for care-workers about what they can do to improve/maintain the oral health of their clients with dementia.

5. However given the high level of oral disease in the general public: The ‘informed general public’ has a limited basic knowledge of oral hygiene and are not conversant with most issues and are unaware of details/consequences.

6. The understanding and competency in the knowledge and skills required of a care-worker to implement daily oral/dental care for people with varying special needs in the workplace, is definitely not general knowledge. Not every care-worker needs to be an oral-carer. (or be an: medication-carer, or OT-carer or, physio-carer or, etc) Total daily oral care of another person is : - not easy to understand or implement, - not able to be learnt in one lecture, - not able to be learnt in one day

7. The care of people with special needs is best done by a Team • In an effective Team; • Members of the team have unique knowledge and skills. • There is an understanding of, and respect for the members of the team and their unique knowledge and skills.

8. It is illogical and impractical, given our understanding of training and education best-practices: To expect care-workers, such as nurses, to be able to learn and become knowledgeable and skilled as oral-carers for people with disability in a one-day (6hrs) training session. Poor education planning - Leads to poor education

9. “I understand that I am attending this course to be trained as a trainer. On completion of this course I will train and support aged care workers in the residential facility in which I am employed, in order to maintain the daily oral hygiene of the facilities residents” Source: Better Oral Health in Residential Care Training (funded by the Department of Health and Ageing)

10. “Two Registered nurses from each care facility” “Undertake oral health assessments and care plans.” “Ensuring residents daily oral hygiene is maintained” And “trained as a trainer” Source: Better Oral Health in Residential Care Training (funded by the Department of Health and Ageing) All this to be learnt and implemented, to the work-place standard, for vulnerable people with special needs, in a one-day (six hours). Impossible to do. Disrespectful to care-workers.

11. A student undertaking qualification, to become a TAFE Certificate IV Trainer and Assessor, would fail • if in their final assignment/assessment, they planned a training program such as the government is conducting in the Better Oral Health in Residential Care Training . • If you wish to be a Trainer, I recommend that you undertake the Certificate IV Trainer and Assessor course • 12 day TAFE course, spread over 6mths, with assignments – approx cost $2200

12. In the short time we have here. Outcomes of this lecture: I believe it is important that each one of you feels you have gained something, been empowered, learnt, or consolidated some knowledge about your oral health. This may also in some small way improve your knowledge and ability to provide, facilitate, or coordinate dental care for a person with dementia to improve their oral/dental health.

13. What is Oral? “Relating to the mouth” Source: Stedman's medical dictionary 26th edition - the teeth. - gums (gingiva), oral mucosa, hard and soft palate, alveolar bone (tooth related bone), floor of the mouth, any man-made appliances (prosthetics) placed/used in the mouth both fixed and removable – crowns, bridges, full and partial dentures, implants to name a few , etc. - saliva and the tongue, have major roles in the function, and health of the oral cavity .

14. What is Health? ” 1. The State of the organism when it functions optimally without evidence of disease or abnormality. 2. A state of dynamic balance in which an individual's or group's capacity to cope with all the circumstances of living is at an optimal level 3. A state characterised by anatomical, physiological, and psychological integrity, ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, functional, and social stress; a feeling of well-being; freedom from risk of disease and untimely death.” Stedman's medical dictionary 1995

21. “Within the Australian adult population oral diseases are pervasive: one in four adults have untreated dental decay and a similar proportion have destructive periodontal disease. They cause symptoms ranging from pain to difficulties eating among as many as one in five people. The frequency of oral disease and related symptoms are in equitably distributed being greater in groups that are already disadvantaged.” Source: Australians Dental Generations, The National Survey of Adult Oral Health 2004-06, Australian Government Australian Institute of Health and Welfare. P236

28. I put to you that the most common things happen the most often. I would also put to you that rather than wondering: - How well we are going to care for a person with dementia, with a specific level/type? - How well do we just care for a person? It's the person that comes first. If we sort out the problems that just happened for people in general; then what is left may be related to a disability, or may not.

29. The two most common oral diseases, which affect people in general, not just people with dementia are: Gum Disease, and Tooth Decay.

30. These both can, in advanced stages, affect general health. • Gum disease: bacteraemia, aspiration pneumonia, pain. • Tooth decay: pain, when advanced – local abscess formation, pus draining from abscess, aspiration pneumonia, systemic toxicity. • Advanced Gum Disease, and Tooth Decay is commonly seen in RACF

31. As I have said given the exceptionally limited time of this talk for such a broad topic. I wish to focus on the major factors.

32. It is not sensible to disregard the most significant factors in a disease, while wasting time adjusting factors of minor significance.

33. I fully knowledge there are unique, isolated, minor factors which can have some influence over an individual person's dental health, which for that individual person, may be significant to some degree. However that is not particularly relevant if the major factors have been ignored in examining, diagnosing, or caring for a person. Usually: Deal with the major significant factors first.

34. Tooth decay (Dental Caries) is preventable In a nutshell: If people who have teeth did not put fermentable carbohydrate (sugars - especially sucrose) in their mouth at high frequency, and at inappropriate times throughout the day, the vast majority all tooth decay would not develop, and if it had developed this tooth decay would stop, repair, and become in-active (heal).

35. However, sugar marketing, sweet food addictions, and diet misunderstanding is the norm. People who have teeth and a disability, which places food selection and nutritional control in the hands of carers, are susceptible to tooth decay if this carer orally feeds them sugar at a high frequency. Tooth decay is basically a dietary disease.

36. Gum Disease – Gingivitis, Periodontal disease (in its many forms) is generally preventable. In a nutshell: If people gently and adequately (or efficiently) cleaned, or had their, teeth/gum interface (gingival pocket) cleaned on a daily basis close to 100% clean, (similar to the way we try to clean dishes after a meal or our hands and body in the shower) the vast majority all gum disease would not occur.

37. However, This cleaning/hygiene task is not easy to do adequately Some people have not been taught how to do this adequately, Some have chosen not to learn how to do this adequately Some people have limitations both physical and mental, which prevent them doing this task adequately on a daily basis, Some people just don't care or lack the motivation or discipline, Some people have very difficult shapes around their teeth which are hard to clean (however they should not be impossible to clean), Some people consult dentists for whom gum disease and/or tooth decay is not their strong area of understanding, interest and/or ability. Most people who are unable to brush their teeth because of disability, lack a carer who has the knowledge and skills, supported by managerial incentives, policies, payment, and time, to do this task for them.

45. How and why both these nutshells about gum disease and tooth decay are in general accurate requires knowledge to understand. Hopefully I will have time to tell you some of this.

46. Periodontal probe Surrounded by saliva 2mm Enamel Gingiva -pink, firm Dentine Gingival pocket 1-2 mm (shallow) Periodontal Ligament Gingival Mucosa Bone Nerves & blood vessels suppling the Dental Pulp inside the tooth A Patient Guide for Tooth and Gum Care, Oral-B (Modified)

47. Tooth decay or Dental Caries “A localised, progressively destructive disease of the teeth, which starts at the external surface (usually the enamel) with the apparent dissolution of the inorganic components by organic acids that are produced in immediate proximity to the tooth by the enzymatic action of masses of micro-organisms (in the bacterial plaque) on carbohydrates.” Stedman's medical dictionary 1995

48. Tooth Decay (Dental Caries) There are four important factors in tooth decay: ·Bacteria ·Sugar ·Fluoride ·Saliva

49. Tooth Decay (Dental Caries) Bacteria live in our mouths (and all over us). They are not a problem to us unless they get out of balance with our body. Some bacteria in the mouth live off the sugared food we eat (‘decay’ bacteria). They breakdown this sugar into energy, to grow and multiply, then excrete acid as their waste. This acid builds up in the place where these bacteria live, that is - the plaque on the tooth surface.

50. Tooth Decay (Dental Caries) The acid dissolves the calcium and phosphate out of the tooth. We can’t do much about the bacteria. We can’t use a mouth rinse every day to kill or suppress the bacteria for the same reason we can’t take antibiotics every day to stop us getting an infection.