Oral Care: Part 1 Introduction

1. Oral Care: Part 1 Introduction Using a Best Practice Approach in Long-Term Care February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

2. Introduction: Learning Objectives Learn about The relationship between general health and oral health, consequences of poor oral hygiene, importance of good oral care Who’s at risk of oral diseases and who can benefit from good oral care Oral vocabulary February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

3. Introduction What We Know: • Deteriorating oral health starts before older persons are admitted to LTC homes and continues to decline after admission • Interrelationship between oral health and general health is pronounced among older persons • As their general health declines – their oral health may also decline February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

4. Introduction What We Know: The older persons’ oral health issues • Are progressive and cumulative • Profoundly affect quality of life • Have significant consequences • May become more critical as more older persons have teeth on admission to LTC February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

5. Introduction • Regular oral hygiene is an important but often overlooked health care service in older persons • Oral problems experienced by older persons are usually • Preventable and • Not due to aging . . . . . and can have an effect on their • General health • Nutrition and • Quality of life. February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

6. Introduction • What We Know: • There is a steady increase in the number of LTC residents retaining their own teeth • Approx. 95% of residents require assistance with their daily oral care • Approx. 35% of residents have dysphagia & swallowing problems • Approx. 80% of residents have some form of dementia which may complicate oral care February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

7. Introduction • Any dental treatment provided to residents WILL FAIL in the long-term if adequate daily regular preventative oral care is not provided • The probability is high that the majority of older adults residing in long-term care homes will be in a high risk group and experience severe oral diseases at some time during their residence in LTC February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

8. Introduction • What does this mean for Long-Term Care residents?…… • Providing, assisting or cueing residents with oral careis an important part of the quality care provided in LTC homes ! February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

9. Importance of Oral Hygiene Care in Reducing Risk for Plaque-Related Oral Diseases • Regular assessment of the oral cavity is critical for the prevention of many problems and more serious outcomes • Ability to adequately chew and swallow impacts nutritional intake • Oral pain can lead to behavioural problems in cognitively impaired residents • Severe periodontal disease may result in emergency or complex dental procedures (abscesses, tooth extraction) • Regular oral hygiene contributes to the prevention of dental caries (decay)and periodontal diseases (gum disease) February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

10. Individuals at Risk for Oral Diseases • Cognitively impaired  History of tooth decay • Neurological conditions  Swallowing problems • Dry mouth / under active salivary glands  Diabetes • Behavioural problems during oral hygiene • Immunocompromised Individuals who experience any of these problems are at increased risk for plaque-related oral diseases . . . . . related to their inability to perform adequate self-care and their medical, mental, physical and/or psychosocial conditions REMEMBER: cultural and personal beliefs about oral care may increase risk for oral diseases February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

11. Individuals at Risk for Oral Diseases Cognitively impaired elderly are at HIGH RISK for dental diseases because they • Often forget • May be unable to continue oral hygiene • May resist assistance • Have difficulty perceiving and reporting pain or discomfort February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

12. Who would benefit the most from a best practices approach to oral hygiene care ? Older persons in long-term care homes who • Are cognitively impaired • Are functionally impaired • Require assistance with daily oral hygiene or are completely dependent • Are complaining of a dry mouth February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

13. Who would benefit the most from a best practices approach to oral hygiene care ? LTC Residents who have chronic medical conditions that affect their mouths • Diabetes, head & neck radiation, immunocompromised • Take medications with adverse oral side effects: • antidepressants, antipsychotics, antiparkisonian, antiasthmatics, narcotics, antihypertensives, etc. • Have nutritional problems and/or • Have swallowing problems February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

14. Vocabulary Let’s review some definitions: Oral – mouth (teeth, gums, supporting tissues, hard and soft palate, mucosal lining of the mouth and throat, tongue, lips salivary glands, chewing muscles, upper and lower jaw) Oral Cavity – inside area of the mouth that is enclosed by the palate, cheeks and lips February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

15. Vocabulary Oral Health– Free of chronic oral-facial pain conditions, oral and throat cancers, oral soft tissue lesions, birth defects, and other diseases and disorder that affect the oral, dental and craniofacial tissues Oral Hygiene Care – Prevention of plaque-related diseases through the disruption of plaque through the mechanical action of tooth brushing and flossing or use of other oral hygiene aids February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

16. Vocabulary Plaque-Related Oral Diseases– Dental caries (decay) and periodontal (gum) disease are plaque-related diseases and arise in areas of the mouth where plaque is abundant and stagnant Oral Health Assessment – Assessment tool is used to determine the current status of oral health and hygiene care prior to the implementation of an individualized oral hygiene care plan February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

17. Vocabulary • Oral Hygiene Care Plan– An individualized plan of care for oral hygiene care that focuses the care providers on appropriate oral care interventions. It should be developed on admission to LTC, then routinely updated as the resident’s cognitive or functional impairments, oral status or self care abilities change. • Evidence Based Practice(Best Practice Guidelines) • “systematically developed statements (based on best available evidence) to assist practitioner and patient decisions about appropriate health care for specific clinical (practice) circumstances” (Field and Lohr, 1990) February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

18. Fact When oral hygiene care in a LTC home is a LOW PRIORITY, or nursing and PSW staff have not received adequate education in oral (hygiene) care, dependent and cognitively impaired residents are not likely to receive daily preventive oral care. February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

19. Time to Think and Share What are some of the challenges you have experienced when providing oral hygiene care to LTC? Think about . . . • Assessing residents’ oral health • Providing oral hygiene care • Feeding • Observing and dealing with responsive behaviours February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

20. Resources Canadian: The Registered Nurses Association of Ontario (2008) . Oral health. Nursing assessment and interventions. Toronto, ON: Author. www.rnao.org(Recommendations Fall 2007). The Registered Nurses Association of Ontario and Halton Region Health Department (Summer 2007). Oral care for resident with dementia (DVD)Toronto, ON: Author. www.rnao.org or phone Dir: (416) 907-7965 Fax:(416) 907-7962 $15 CDN ML van der Horst (April 2007). The BP Blogger. Myth busting: The mouth issue. Monthly newsletter for LTC that dispels care myths with evidence from best practice guidelines. Available at: www.rgpc.ca Halton Region Health Department (2006). Dental health manual for LTC home staff. Halton oral health outreach project. Oakville, ON: Author. Centre for Community Oral Health- Long Term Care Fact Sheets. Nov 2006 www.umanitoba.ca/faculties/dentistry/ccoh Best Practice Coordinators in Long-Term Care Initiative – Central South/South West (February 2008). Best Practices Approach to Oral Care Resource Kit.www.rgpc.ca Oral Care.ca www.oralcare.ca February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

21. Resources Others: The University of Iowa College of Nursing (2002). Oral hygiene care for functionally dependent and cognitively impaired older adults. Evidence-based practice guideline. Iowa City, Iowa: Author/Gerontological Nursing Interventions Research Center. www.nursing.uiowa.edu Joanna Briggs Institute (2004). Oral hygiene care for adults with dementia in residential aged care facilities. Best Practice, 8(4). Adelaide, Australia: Author. www.joannabriggs.edu.au February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

22. References Fallon, T., Buikstra, E., Cameron, M., Hegney, D., Mackenzie, D., March, J., Moloney, C., & Pitt, J. (2006). Implementation of oral health recommendation into two residential aged care facilities in a regional Australian city. International Journal of Evidence-Based Healthcare, 4, 162-119. Federal, Provincial and Territorial Dental Directors. (2005). A Canadian oral health strategy. Accessed January 4, 2007. Available at: http://www.fptdd.ca/Canadian%20Oral%20Health%20Strategy%20-%20Final.pdf. Frenkel, HF., Harvey, I., & Needs, KM. (2002). Oral health care education and its effect on caregivers’ knowledge and attitudes: a randomised controlled trial. Community Dentistry and oral Epidemiology, 30, 91-100. Frenkel, H., Harvey, I., & Newcombe, RG. (2001). Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial, 29, 289-297. Nicol, R., Sweney, MP., McHugh, S., & Bagg, J. (2005). Effectiveness of health care worker training on the oral health of elderly residents of nursing homes. Community Dentistry and Oral Epidemiology, 33, 115-124. Pearson, A. & Chalmers, J. (2004). Oral hygiene care for adults with dementia in residential aged care facilities. Systematic review. JBI Reports, 2, 65-113. February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

23. References Seniors Oral Health Collaboration for the Nova Scotia Department of Health (SOHC). (2006). The oral health of seniors in Nova Scotia. Policy Scan and Analysis: Synthesis report. Accessed January 15, 2007. Available at: http://www.ahprc.dal.ca/oralhealth/Reports/FINAL.pdf Thorne SE, Kazanjian A, & MacEntee. (2001). Oral health in long term care: The implications of organisational culture. Journal of Aging Studies, 15, 271-283. US Department of Health and Human Services (US DHHS) (2000). Oral Health in America: A Report of the Surgeon General. Rockville, MD: National Institute of Dental and Craniofacial Research, National Institutes of Health. Accessed January 15, 2007. Available at: http:/www.nidr/nih.gov/sgr/oralhealth.asp Wardh, I., Hallberg, L., Berggren, U., & Sorensen, S. (2003). Oral health education for nursing personnel: experiences among specially trained oral care aides: One-year follow-up interviews with oral care aides at a nursing facility. Scandinavian Journal of Caring Science, 17, 250-256. WHO. (2003). The world oral health report. Continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Geneva, SW: author. Accessed: January 15, 2007. Available at: http://www.who.int/oral_health/publications/report03/en/ February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

24. For more information: Mary-Lou van der Horst, RN, BScN, MScN, MBA Regional Best Practice Coordinator Long-Term Care Central South Region-Ministry of Health and Long-Term Care  Village of Wentworth Heights LTC Home 1620 Upper Wentworth Street, Hamilton, ON Canada L9B 2W3 email:    mvanderhorst@oakwoodretirement.com tel:     905.541.0656  fax:     905.575.4450   LTC Best Practice Resource Centre: www.rgpc.ca Donna Scott, RN, BScN, CHRP www.shrtn.on.ca Regional Best Practice Coordinator Long-Term Care Southwest Region-Ministry of Health and Long-Term Care Parkwood Hospital 801 Commissioner's Road East London, ON Canada N6C 5J1 Email: donna.scott@sjhc.london.on.ca Tel: 519-685-4292 x42337 February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative