Healthy Mouths for Dependent People

Why good oral health is important. Recognise the factors that contribute to poor oral health. Confidently carry out daily oral care. Know when to report any oral health concerns. Be able to carry out an oral health risk assessment. Understand what strategies can help those who resist oral care. Outcome s

The Challenge for the Elderly Lack of dexterity. Health problems – e.g. diabetes, heart. Medication - dry mouth, high sugar content. Mental Deterioration – poor cognitive skills, memory. Stroke – facial paralysis slurred speech difficulty in swallowing difficulty in understanding. Mobility – getting to dentist.

Leads to Can’t clear food -> rampant dental decay. Link with oral hygiene and aspiration pneumonia. Brushing more difficult. Communication more difficult. Poor nutrition. Difficulty with dentures – chewing. Food pooling on side of paralysis in stroke. Sip feeding increases decay.

Tooth decay. What it looks like What causes it How it can be prevented How to look after someone else’s teeth – toothbrushing. How to look after someone else’s mouth. Healthy Eating. We’ll be looking at…

Oral Health is Paramount Infections Prevention of pain Adequate nutrition Ability to speak Ability to express emotion

3 steps to keep the mouth healthy Brush twice a day with fluoride (1450ppm) toothpaste. Keep sugary snacks and drinks to mealtimes. Have a dental check-up at least every year.

Tooth decay … …is one of the most common diseases; …it can be stopped.

How Teeth Decay … There are millions of GOOD and BAD bacteria in our mouths. The bad bacteria in plaque eats the sugar and changes it into acid. The acid damages the enamel on the teeth. Which then causes decay (caries) or holes (cavities) in our teeth.

What can cause tooth decay? Frequency of eating and drinking lots of sugary snacks and drinks. Not brushing teeth twice a day with fluoride toothpaste.

Effect of sugar on the teeth AM PM (Acid levels in the mouth over 24 hours) Morning Acid Neutral Afternoon

Eating Pattern Bad for Teeth Morning Acid Neutral (Acid levels in the mouth over 24 hours) Afternoon AM PM 2

Healthy Snacks Bread Breadsticks Vegetables Fruit SandwichesCrackers

When it comes to thirst…drink tap water first! Encourage water as only night time drink. Avoid sugary drinks in-between meals. Drink well

Drinks that damage their teeth

Gum Disease Can be caused by… the build up of plaque. lack of brushing. Smoking. It is divided into: Gingivitis. Periodontitis.

Gingivitis Early stage gum disease. Gums become red, swollen and bleed when brushed. Some people suffer from bad breath. Reversible.

Periodontitis Advanced stage with supporting bone destroyed by plaque under gum. Teeth become loose and can be lost. This can affect eating, speaking and quality of life. Loose teeth can be inhaled.

What might help Oral health assessment – dietary analysis, risk of decay or gum disease. Self care - Individual’s ability or level of dependence for oral hygiene. Electric brushes to aid cleaning. May need help to maintain oral hygiene. Consider oral side-effects of medication.

Routine Mouth Care When possible, teach and encourage self care. Use torch when examining mouth. Wear non-latex gloves. If dental treatment required, ask for home visit. May often be unrewarding and difficult. Provide as much as patient can tolerate. Prevents sore mouth and permits comfortable eating, drinking and speech.

How to clean Take out dentures. If necessary insert a mouth prop. Brush all surfaces using fluoride toothpaste > 1450ppm or corsodyl gel at least twice daily. Floss or use tepes between teeth. Use chlorhexidene if appropriate. Gently clean rest of mouth and lips using damp gauze.

Steps for brushing Wear non-latex gloves. Seat the resident and stand behind them. Remove partial dentures. Support head, draw back lips with thumb and fingers. Use small-headed, medium toothbrush and > 1450 ppm fluoride toothpaste. Brush two or three teeth at a time, also the gums. Allow the resident to spit out and rinse brush.

Flossing For getting in between the teeth where the tooth brush does not reach. Reduces the chances of decay in between teeth and gum disease.

The result of poor oral hygiene Decay – especially root decay. Use brushing, flossing, mouthwash, fluoride. Gum disease – poor OH, Smoking.

Dry mouth Altered taste, difficulty in chewing, retention of dentures. Increased risk of infection. Increased risk of decay – root caries. Most common causes are prescribed drugs. Switch to a sugar free alternative– get GPs advice. Drink water frequently, chew SF gum.

How to manage dry mouth Ask patient if lips feel dry or uncomfortable. Ensure soft tissues are kept clean. Provide liquids – water, ice, artificial substitutes. Ensure sugar free lubrication.

Denture Care Dentures should be brushed twice daily. Clean dentures over filled sink with unperfumed soap and rinse thoroughly in running water. Check them for cracks, sharp edges or missing teeth. Dentures should be left out at night and soaked in water for plastic. Metal dentures can use chlorhexidene. Mark with owner’s name.

Denture wearing problems Assist in chewing and swallowing. Fixative. Especially stroke. May need dental advice.

Soft tissues Ulcer – due to dentures rubbing. Contact Dentist. Tongue – black hairy geographic tongue. Needs to be kept clean. If dry, clean with damp gauze and protect. Angular cheilitis – redness, cracks or crusting. May be fungal and / or bacterial. Candida infection – redness under denture white plaque.

Oral Cancer Oral cancer is twice as common among males. Beware white, red or speckled patches. Ulcers or sores that do not heal within 14 days. Lumps in mouth or lip. Risk factors:People who smoke and drink alcohol heavily. Cancer on lips can be result of exposure to sun.

Uncooperative Patients Be caring and calm. Position yourself at the same eye level, from the front. Simplify any instruction and praise when completed. Can demonstrate, guide hand, distract or try someone else.

Guide to a Healthy Mouth Good brushing twice a day with fluoride toothpaste A good balanced diet Regular care for the less able The healthier your teeth are the happier you will be!