- 1. Oral Care: Part 5 Preparing for Oral Care andCommunication
TechniquesUsing a Best Practice Approach inLong-Term Care February
2008Central South/South WestBest Practice Coordinator in Long-Term
Care Initiative
2. Introduction:Learning Objectives
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- A best practices approach to oral hygiene care
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- Implementing general oral hygiene care strategies
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- Toothpaste and Toothbrush Tips
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- Communication techniques for oral care
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 3. Evidence-Based Approach toOral Care
for Older Adults from IOWA February 2008Central South/South
WestBest Practice Coordinator in Long-Term Care Initiative
- This evidence-based model ofthe importance of oral hygiene care
and dental treatment onmaintaining oral healthfrom IOWA highlights
several key areas:
- Secondary & tertiary dental care
4. Develop an IndividualizedOral Hygiene Care Plan February
2008Central South/South WestBest Practice Coordinator in Long-Term
Care Initiative An individualizedOral Hygiene Care Planenables care
providers to focus on appropriate oral care interventions for the
resident Oral Hygiene Care Planshould be developed on admission,
quarterly and as a residents oral status or self care abilities,
cognitive or functional impairment changes 5. RNAO Oral Health BPG
Care Planning February 2008Central South/South WestBest Practice
Coordinator in Long-Term Care Initiative 6. RNAO Oral Health BPG
Care Planning February 2008Central South/South WestBest Practice
Coordinator in Long-Term Care Initiative 7. RNAO Oral Health BPG
Care Planning February 2008Central South/South WestBest Practice
Coordinator in Long-Term Care Initiative 8. A Best Practices
Approach toOral Care in LTC homes February 2008Central South/South
WestBest Practice Coordinator in Long-Term Care Initiative
- Implement general oral hygiene care strategies
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- Toothpaste and toothbrush tips: Natural teeth
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- Communication techniques for oral care
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- Techniques for getting in the mouth
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- Handling responsive behaviours
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- Handling communication, cognition & functional issues
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- Dry mouth and swallowing problems
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- Palliative oral hygiene care
9. Preparing for Oral Care
- Familiarizeyourself with:
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- Severity of residents cognitive impairment & residents
responsive behaviours (pushing, turning head, biting)
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- Residents communication & sensory impairments
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- Residents functional impairments (arthritis in hands,
mobility)
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 10. Preparing for Oral Care
- Oral care should be completed at least2x each day
- Never awakena resident to complete oral care
- Oral care should be donein the bathroom , whenever possible,
because of its physical cues(i.e., sink, water, etc.)
- Review the residents oral care plan
- Review if the resident hasdysphasia (i.e., problems swallowing,
choking, spitting)
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 11. Preparing for Oral Care
- Assembleall oral care supplies and have them ready to use in
the residents bathroom,beforeyou bring them into the bathroom
- Check that theoral care supplies arelabeled with the residents
name
- NEVERuse toothpasteor mouth rinses with residents
withswallowing difficulties WATER ONLY
- NEVER use lemonglycerin swabsfor oral care
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 12. Preparing for Oral Care
- Alwayscommunicateto the resident what you are planning to do
talk about it when getting youre ready no surprises !
- Have the resident doas much of their oral care as they can
possibly do. It may not be perfect and offer to finish areas they
may have missed
- Explainto the resident and describe the oral caretasks
(steps)you want them to do or will be doing
- Remember:Always use properbody positioningwhen providing oral
care
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 13. Toothpaste Tips
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- Usepea-sizedamounts of toothpaste,squeezing out a long strip of
toothpaste is too much
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- Most toothpastes have a strong taste,many residents dont like
this, not appealing to residents with Alzheimers Disease
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- Foaming action of toothpaste increases saliva flow &will
result in the resident wanting to spit >> choke, gag
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- DO NOTuse toothpaste for residents who havedysphagia ,
whocannot swallow or spit/rinseproperly, have high level ofdementia
- there areoral cleansing gelsavailable
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 14. Toothbrush Tips
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- Thebest typeof toothbrush to use for residents
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- is one with asmall head, soft bristles, larger handle
withrubberized grip
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- For residentswho bite down during care , consider using 2
toothbrushes one to prop the mouth open and one for cleansing
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- every3 monthsor after aninfection
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 15. Denture Care
- Plaque & tartarform on dentures just the same as they form
on natural teeth
- Removedentures daily for at least3 hoursfor gums to rest,
overnight is easiest
- Ask the resident to remove their dentures.Assist, if they
cant
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- slide your index finger along the dentures side then push
gently against the back of the denture to break the seal.Grasp it
and remove by rotating it.Grasp lower dentures at the front and
rotate.
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- place thumbnails over or under the clasps, apply pressure,
being careful to not bend the clasps and catch them on lips or
gums.
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 16. Denture Care
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- Line the sink with a towel. Fill it with some cool water just
in case the dentures slip and fall. Hot water can warp
dentures.
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- Rinse with cold water to remove food
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- Scrub dentures using a denture brush and denture paste
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- Thoroughly brush all surfaces especially those that touch the
gums.Rinse well.
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 17. Denture Care
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- At bedtime, place dentures in denture cup with cool water and
vinegar(water and vinegar)
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- Only soaking them overnight with a cleansing table is not
sufficient it doesnt clean off the plaque
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- NEVER use denture tablets for soaking dentures of residents
with dementia - ingestion of tablets/solution is serious
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- Never use vinegar on dentures with any metal on them as this
will cause the metal to turn black.
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 18. Denture Care
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- Clean the mouths of residents who wear dentures:
- If the residents lips are dry, moisten them with a
non-petroleum based product (e.g. Lipsol)
- Alwaysbrush mouth tissueswith a regular soft bristled
toothbrush
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- including the tongue, palate, cheeks and ridges of mouth
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- In morning, rinse dentures well before placing in residents
mouth
- Always put the upper denture in first then lower one to avoid
gagging
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- Denture cupsshould bescrubbed weeklyto prevent bacterial or
fungal growth and replaced monthly
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 19. Communication Techniquesfor Oral
Care February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative Task Breakdown :the activity or task
is broken down into steps which are individually and slowly
presented Distraction:the use of singing, holding items, gentle
touch and talking to distract a resident from a distressing
situation Share an example of how you might use task breakdownwhen
assisting a resident with oral care . . .How might you distract a
resident so that you can proceed with oral care ?. 20.
Communication Techniquesfor Oral Care February 2008Central
South/South WestBest Practice Coordinator in Long-Term Care
Initiative Hand-Over-Hand :the caregivers hand is placed over the
residents hand to guide the resident through the activity Rescuing
:a second caregiver enters a situation and offers to help the
resident by taking over for the initial caregiverHave you ever used
this technique?How did it work? For residents with dementia, have
you ever used this technique? Share an example when it worked. 21.
Communication Techniquesfor Oral Care February 2008Central
South/South WestBest Practice Coordinator in Long-Term Care
Initiative Bridging :to improve sensory connection and task focus,
the resident holds the same object while the caregiver carries out
the activity Chaining :the caregiver starts an activity and the
resident completes it Have you ever used this technique?How did it
work? Have you used a different object? Its cueing or prompting
with an additional jumpstart of showing. Have you ever used it for
oral care? 22. Resource Tools February 2008Central South/South
WestBest Practice Coordinator in Long-Term Care Initiative 23.
Resource Tools February 2008Central South/South WestBest Practice
Coordinator in Long-Term Care Initiative 24. Resource Tools
February 2008Central South/South WestBest Practice Coordinator in
Long-Term Care Initiative
- Halton Region Health Departments Dental Health Division has
developed an extensive oral care education program called
K.I.S.S.for LTC staff
- to assist staff to develop better oral care techniques
- with full explanations and picture-based step-by-step
instructions
25. Resources February 2008Central South/South WestBest Practice
Coordinator in Long-Term Care Initiative 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
Ontarioand Halton Region Health Department (Summer 2007).Oral care
for resident with dementia (DVD) Toronto, ON: Author.www. rnao .org
or phoneDir:(416) 907-7965Fax:(416) 907-7962$15 CDN ML van der
Horst(April 2007).The BP Blogger.Myth busting: The mouth issue.
Monthlynewsletter 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
2006www. 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.cawww. oralcare .ca 26. Resources February
2008Central South/South WestBest Practice Coordinator in Long-Term
Care Initiative 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 27. 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 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 28. 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 21 stcentury 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 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative 29. 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, ONCanada L9B 2W3
- email: mvanderhorst @ oakwoodretirement . com
- fax: 905.575.4450 LTC Best Practice Resource Centre :
- Donna Scott ,RN, BScN, CHRPwww. shrtn .on.ca
- Regional Best Practice Coordinator Long-Term Care
- Southwest Region-Ministry of Health and Long-Term Care
- 801 Commissioner's Road East
- Email:donna . scott @ sjhc . london .on.ca
February 2008Central South/South WestBest Practice Coordinator
in Long-Term Care Initiative