1. IN-SERVICE TRAINING GUIDE
ORAL HYGIENE
IN-SERVICE TRAINING GUIDE

2. Oral Hygiene Importance
Proper oral hygiene and dental care are vital to the health and well being of the nursing home resident.
Improper or inadequate oral hygiene can result in unintended weight loss, reduction in quality of life, and dehydration and infection.
Good oral hygiene can increase food and liquid intake, which supports better nutrition and hydration.

3. Geriatric Oral Health and Pneumonia Risk
The oral cavity is a complex microenvironment consisting of multiple bacterial and fungal species.
Multiple infectious consequences of poor oral health have been extensively described and primarily affect older adults.
Probably the most common consequence of poor oral health in aged persons is the risk of aspiration pneumonia.

4. Did You Know ?
A resident may be isolating themselves from others due to poor oral care.
A resident may not eat due to poor oral care.
A resident may lose weight due to poor oral care.
A resident may not smile due to poor oral care.
A resident may not talk due to poor oral care

5. Did You Know cont…
A resident can develop infections like pneumonia and bacteremia due to poor oral care.
Poor oral care can cause severe pain, both physically and emotionally.
Poor oral care can lead to death.

6. Oral Hygiene Disease Factors
Missing teeth and poorly fitted dentures predispose to aspiration
Infected teeth and poor oral hygiene predispose to pneumonia following aspiration of contaminated oral secretions
Tube feeding is associated with significant pathogenic colonization of the mouth

7. Why is Oral Care Neglected?
Lack of personal perception of oral health problems by residents and staff
Family members and staff placing dental care as a low priority
Specialized care not available within the area

8. Other Reasons for Oral Care Neglect
Staffing shortages – care gets overlooked
Lack of oral care education
Staff’s approach to residents – care is refused
Poor dietary habits

9. Basic Interventions and Practical Solutions For Best Practice Development

10. Best Practices – Oral Care
FIRST AND FOREMOST, ALWAYS TELL THE RESIDENT WHAT YOU ARE GOING TO DO!
Gentle strokes, soft bristle brush
Rinse mouth thoroughly
Remember the tongue
Apply moisturizing products to lips if necessary
Approximately 60 seconds of brush time

11. Best Practices – Oral Care
Can be performed on conscious and unconscious residents
Numerous products available for the unconscious resident
Should be done at least twice a day

12. Positioning During Oral Care
Place an unconscious resident on their side or sitting up with support (may need a second caregiver to assist)
Ensure head is positioned to allow liquid to flow out of mouth.
Use the minimal amount of water needed
Ensure a conscious resident is sitting up, at a 45 degree angle.

13. Best Practice Oral Care Steps
1. Gathered all supplies 2. Knock on door, greet resident, identify self and explain procedure 3. Close door, privacy curtains and window curtains; Even in private rooms 4. Set up supplies for use on a clean surface 5. Wash hands and apply gloves 6. Position resident appropriately if necessary 7. Provide a barrier to protect resident clothing 8. Encourage resident to brush own teeth; assist as necessary. Brush downward on upper teeth and upward on lower teeth. Start at the gum line and brush to the edge of the tooth. 9. Rinse resident mouth with a cup of warm water or diluted mouthwash.

14. Best practice Oral Care Steps cont.…
10. Offer resident the opportunity to rinse out mouth and spit into emesis basin as needed. 11. Inspect mouth and gums for irritation or open areas. 12. Wash and dry resident face. 13. Change gloves 14. Place lip balm or petroleum jelly on lips 15. Clean up workstation 16. Remove gloves 17. Place in trash bag 18. Wash hands 19. Place call light in reach if necessary

15. Oral Care Tips
Since most of the plaque is found at the gum line, use a soft toothbrush and angle the bristles at a 45 degree angle to the gum line.
This should be done twice a day; after breakfast and most importantly before bed. The mouth should also be rinsed after meals.
Oral care is not just for grooming, it is for….
INFECTION CONTROL.

16. Oral Care Tips
Toothbrushes can be adapted with a bicycle handle or a soft rubber ball for patients/residents with limited hand closure
Good for stroke and arthritis patients

17. Oral Care Tips
Since partials are made of both metal and acrylic, there are special tablets available for soaking
There are also special brushes tapered to clean around the clasps

18. Conclusion
People in residential or continuing care have an equal right to good oral health as people residing in the community.
Good oral hygiene can increase nutritional intake.
Oral care is an important part of the resident’s personal grooming care.
Oral care is very important to our residents….
Let’s make sure it is equally
Important to Staff!

19. Thank you taking care of our residents’ smile!