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  • 1. Oral Care: Part 5 Preparing for Oral Care and Communication Techniques Using a Best Practice Approach in Long-Term Care February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 2. Introduction: Learning Objectives
    • Learn about
      • A best practices approach to oral hygiene care
      • Implementing general oral hygiene care strategies
        • Preparing for oral care
          • Toothpaste and Toothbrush Tips
          • Denture Care Tips
        • Communication techniques for oral care
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 3. Evidence-Based Approach to Oral Care for Older Adults from IOWA February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
    • This evidence-based model of the importance of oral hygiene care and dental treatment on maintaining oral health from IOWA highlights several key areas:
    • Regular daily oral care
    • Preventive oral care
    • Assessment
    • Secondary & tertiary dental care
    • Impacts
    • Systemic health
    • Nutrition
    • Quality of life
    • Overall well-being
  • 4. Develop an Individualized Oral Hygiene Care Plan February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative An individualized Oral Hygiene Care Plan enables care providers to focus on appropriate oral care interventions for the resident Oral Hygiene Care Plan should be developed on admission, quarterly and as a resident’s oral status or self care abilities, cognitive or functional impairment changes
  • 5. RNAO Oral Health BPG Care Planning February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 6. RNAO Oral Health BPG Care Planning February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 7. RNAO Oral Health BPG Care Planning February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 8. A Best Practices Approach to Oral Care in LTC homes February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
    • Care Planning Strategies
    • Implement general oral hygiene care strategies
        • Preparing for oral care
        • Toothpaste and toothbrush tips: Natural teeth
        • Denture care
        • Communication techniques for oral care
        • Techniques for getting in the mouth
        • Handling responsive behaviours
        • Handling communication, cognition & functional issues
        • Dry mouth and swallowing problems
        • Palliative oral hygiene care
  • 9. Preparing for Oral Care
    • Familiarize yourself with:
      • Severity of resident’s cognitive impairment & resident’s responsive behaviours (pushing, turning head, biting)
      • Resident’s communication & sensory impairments
      • Resident’s functional impairments (arthritis in hands, mobility)
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 10. Preparing for Oral Care
    • Oral care should be completed at least 2x each day
    • Never awaken a resident to complete oral care
    • Oral care should be done in the bathroom , whenever possible, because of its “physical cues” (i.e., sink, water, etc.)
    • Review the resident’s oral care plan
    • Review if the resident has dysphasia (i.e., problems swallowing, choking, spitting)
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 11. Preparing for Oral Care
    • Assemble all oral care supplies and have them ready to use in the resident’s bathroom, before you bring them into the bathroom
    • Check that the oral care supplies are labeled with the resident’s name
    • NEVER use toothpaste or mouth rinses with residents with swallowing difficulties – WATER ONLY
    • NEVER use lemon glycerin swabs for oral care
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 12. Preparing for Oral Care
    • Always communicate to the resident what you are planning to do – talk about it when getting you’re ready – no surprises !
    • Have the resident do as much of their oral care as they can possibly do. It may not be perfect and offer to finish areas they may have missed
    • Explain to the resident and describe the oral care tasks (steps) you want them to do or will be doing
    • Remember: Always use proper body positioning when providing oral care
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 13. Toothpaste Tips
    • Natural Teeth
          • Use pea-sized amounts of toothpaste, squeezing out a long strip of toothpaste is too much
          • Most toothpastes have a strong taste, many residents don’t like this, not appealing to residents with Alzheimer’s Disease
          • Foaming action of toothpaste increases saliva flow & will result in the resident wanting to spit >> choke, gag
          • DO NOT use toothpaste for residents who have dysphagia , who cannot swallow or spit/rinse properly, have high level of dementia - there are oral cleansing gels available
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 14. Toothbrush Tips
    • Natural Teeth
      • The best type of toothbrush to use for residents
        • is one with a small head, soft bristles, larger handle with rubberized grip
      • 2-Toothbrush Technique :
        • For residents who bite down during care , consider using 2 toothbrushes – one to prop the mouth open and one for cleansing
      • Replace toothbrush:
        • every 3 months or after an infection
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 15. Denture Care
    • Plaque & tartar form on dentures just the same as they form on natural teeth
    • Remove dentures daily for at least 3 hours for gums to rest, overnight is easiest
    • Ask the resident to remove their dentures. Assist, if they can’t
      • For upper dentures
        • slide your index finger along the denture’s 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.
        • For partial dentures
          • place thumbnails over or under the clasps, apply pressure, being careful to not bend the clasps and catch them on lips or gums.
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 16. Denture Care
    • Cleaning dentures:
      • Wear gloves
      • 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.
      • Rinse with cold water to remove food
      • Scrub dentures using a denture brush and denture paste
        • Thoroughly brush all surfaces especially those that touch the gums. Rinse well.
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 17. Denture Care
      • Cleaning dentures:
      • At bedtime, place dentures in denture cup with cool water and vinegar (½ water and ½ vinegar)
      • Only soaking them overnight with a cleansing table is not sufficient – it doesn’t clean off the plaque
        • NEVER use denture tablets for soaking dentures of residents with dementia - ingestion of tablets/solution is serious
        • Never use vinegar on dentures with any metal on them as this will cause the metal to turn black.
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 18. Denture Care
      • Clean the mouths of residents who wear dentures:
    • If the resident’s lips are dry, moisten them with a non-petroleum based product (e.g. Lipsol)
    • Always brush mouth tissues with a regular soft bristled toothbrush
      • including the tongue, palate, cheeks and ridges of mouth
      • In morning, rinse dentures well before placing in resident’s mouth
    • Always put the upper denture in first then lower one to avoid gagging
      • Denture cups should be scrubbed weekly to prevent bacterial or fungal growth and replaced monthly
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 19. Communication Techniques for Oral Care February 2008 Central South/South West Best 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 breakdown when assisting a resident with oral care . . . How might you distract a resident so that you can proceed with oral care ?.
  • 20. Communication Techniques for Oral Care February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative Hand-Over-Hand : the caregiver’s hand is placed over the resident’s 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 caregiver Have 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 Techniques for Oral Care February 2008 Central South/South West Best 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? It’s cueing or prompting with an additional jumpstart of showing. Have you ever used it for oral care?
  • 22. Resource Tools February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 23. Resource Tools February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
  • 24. Resource Tools February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative
    • Halton Region Health Department’s 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 2008 Central South/South West Best 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 Ontario and Halton Region Health Department (Summer 2007). Oral care for resident with dementia (DVD) Toronto, ON: Author. www. rnao .org or phone Dir: (416) 907-7965 Fax:(416) 907-7962 $15 CDN ML van der Horst (April 2007). The BP Blogger. Myth busting: The mouth issue. Monthly newsletter 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 2006 www. 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.ca www. oralcare .ca
  • 26. Resources February 2008 Central South/South West Best 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 2008 Central South/South West Best 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 st century – 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 2008 Central South/South West Best 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, ON Canada L9B 2W3
    •   email:     mvanderhorst @ oakwoodretirement . com          
    • tel:     905.541.0656 
    •      fax:     905.575.4450     LTC Best Practice Resource Centre :
    • www. rgpc .ca
    • Donna Scott , RN, BScN, CHRP www. shrtn .on.ca
    • Regional Best Practice Coordinator Long-Term Care
    • Southwest Region-Ministry of Health and Long-Term Care
    • Parkwood Hospital
    • 801 Commissioner's Road East
    • London, ON Canada N6C 5J1
    • Email: donna . scott @ sjhc . london .on.ca
    • Tel: 519-685-4292 x42337
    • .
    February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative