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)

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

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

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

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 5

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.

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 Importance of referring onto appropriate professional

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

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

Healthy mouth, teeth and gums What is a healthy mouth? Insert picture

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.

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).

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

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

Insert picture Dental decay

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

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 Insert picture

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

Advanced stage – Periodontitis Periodontis is irreversible Teeth can be lost through this Loose teeth can cause numerous problems Insert picture

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.

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.

What type of toothbrush Insert pictures

Dentures 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. Insert picture

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.

Soft tissues What 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 Insert healthy tongue picture

Cleaning the tongue Insert picture

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.

|Insert picture Cleaning soft tissues with damp gauze

Lips Dry cracked lips are uncomfortable for any individual Lips should be cleaned with a water based cream Insert picture

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 Insert picture or dry tongue and ask the group to consider how important saliva is?

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.

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

Infection prevention & control 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

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

Cover the importance of risk assessment and if providing oral care for resident, then ask participants to carry out an oral health risk assessment and develop a care plan from this. If tooth brushing on resident ask participant to carry out a risk assessment and develop a care plan from this. If not tooth brushing directly on resident, then cover the concepts of risk assessment. Importance of referring onto appropriate professional 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 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 An oral health risk assessment is recommended early after admission, as part of an overall health assessment. This should ideally be within 48 hours of a resident being admitted. An oral health risk assessment is necessary because it: helps identify residents who have current oral health problems which may require the attention of a dentist highlights those who are particularly at risk of future problems because of physical or cognitive impairment or poor oral care habits allows the development and implementation of an individual oral care plan which indicates the daily oral care assistance required. Training on how to undertake an oral health risk assessment is a key element of Caring for Smiles training. If you need help with conducting oral health assessments, contact your local NHS Caring for Smiles team. There should be no longer than six months between assessments. This is in order that the service complies with regulation 5(2)(b)(iii) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) which say that personal plans have to be reviewed at least once in every six-month period. Personal plans set out how a service user’s health, welfare and safety needs are to be met. This would therefore include their oral health needs. The ideal situation would be to bring oral health risk assessments in line with other review assessments carried out in the care home, for example nutritional risk assessments. Repeat assessments should consider if the resident’s capacity to self-care has changed. Denture marking should also be checked and reapplied if necessary.

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

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

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

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 Go over cleaning dentures

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% Go over cleaning dentures

Inserting Dentures Full Dentures Partial Dentures 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 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 Go over cleaning dentures

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. Give a brief overview of communication strategies that will help to engage residents. See CFS Guide. Cover the importance of referring to senior staff.

Supporting Resident's with Dementia Bridging Chaining Hand over hand Distraction – Rescuing Give a brief overview .

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. .

Multiple choice exam - 30 minutes Practical Skills competency Framework Direct observation of practice. Give out multiple choice exam and explain the procedure of practical skills and arrange time for DOP.

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