Learning Outcomes

1. 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)

2. Training outline • Presentation/Group Work • Tooth brushing /Denture care • Oral soft tissue • Practising Oral Care

3. 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

4. Oral care is the responsibility of every individual carer. Care is required 24 hours a day so this includes both night and day staff.

5. 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

6. 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.

7. 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

8. 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

9. 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

10. Healthy mouth, teethand gums • What is a healthy mouth?

11. 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.

12. 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).

13. How do you remove plaque? • By thoroughly toothbrushing at least twice daily. • Tartar can only be removed by professional cleaning.

14. 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

15. Dental decay

16. Prevention of Decay • Reducing the number of times that an acid attacks occur • Brushing teeth twice daily with a fluoride toothpaste

17. 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

18. 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

19. Advanced stage – Periodontitis • Periodontis is irreversible • Teeth can be lost through this • Loose teeth can cause numerous problems

20. 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.

21. 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.

22. What type of toothbrush

23. 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. Dentures

24. 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.

25. 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

26. Cleaning the tongue

27. 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.

28. Cleaning soft tissues with damp gauze

29. Lips • Dry cracked lips are uncomfortable for any individual • Lips should be cleaned with a water based cream

30. Dry Mouth • 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

31. 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.

32. 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

33. 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 Infection prevention & control

34. 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

36. Position for brushing upper teeth and gums Position for brushing lower teeth and gums

37. Removing full dentures for cleaning: Lower denture rotating out Lower denture removed completely

38. ‘Breaking the seal’ of upper denture ‘Breaking the seal’ of upper denture – first stage – second stage

39. 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

40. 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%

41. Inserting Dentures Full Dentures 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 • 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

42. 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.

43. Supporting Resident's with Dementia • Bridging • Chaining • Hand over hand • Distraction – • Rescuing

44. 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.

45. Multiple choice exam - 30 minutes • Practical Skills competency Framework • Direct observation of practice.

46. Finish Thank you Please remember to complete your Evaluation