This document discusses best practices for oral care in long-term care facilities. It outlines that caregivers often lack knowledge and training regarding oral health. Successful oral health programs take a multidisciplinary approach, appoint an oral health coordinator, provide educational training and materials to caregivers, and ensure funding for resident dental treatment. The Better Oral Health in Residential Care program and Brushing Up on Mouth Care project provide examples of toolkits and resources to implement good oral care practices.

1. BEST PRACTICES FOR NON-DENTAL
PROFESSIONALS PROVIDING ORAL
CARE IN LONG TERM CARE
FACILITIES
By
Vidya Shanmugam

2. CAREGIVERS PERCEPTION OF POOR ORAL
CARE IN LONG TERM CARE FACILITIES
1.
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Lack of knowledge of basic oral health and oral diseases
among care providers in the facilities.
Inadequate training at university level or at the LTC
facility about oral health and training on oral care
provision.
Time constraint faced by the staff, due to various other
works that has to be completed within a timeframe
Even if care staff were willing to provide oral care, the
most common barrier they faced were uncooperative
residents.
Lack of oral care supplies available to the care providers
for provision of daily oral care to the residents.

3. ORAL HEALTH EDUCATION PROGRAMS
Unsuccessful Programs
1.
2.
3.
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5.
Lack of attendance of care staff for the training
program.
Lack of knowledge and training to provide adequate
oral care.
Time constraint faced by the care givers.
Lack of standard of oral care practice.
Lack of interest in oral care among both the
administrators and the care staff.

4. ORAL HEALTH EDUCATION PROGRAMS
Successful Programs (Conducted in Canada, Australia, United
Kingdom and Norway)
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A multidisciplinary approach should be made. This team should include
care givers, oral health professionals, general physicians, facility
managers and other key stakeholders.
An oral health coordinator (a dental hygienists/dental therapist) should
be appointed, who aides in running the program.
An OCLN or “Oral Health Contact Person” (a qualified RN/LPN) can also
be appointed. This person can aide in training other new caregivers and
also help in checking if daily oral care is provided to the residents.
Caregivers should be pursued to follow guidelines and standard protocols
when providing oral care.
Educational training should be provided to all caregivers. This training
should be both theoretical and hands-on demonstrations.
Educational materials (information sheets, manuals) should also be
provided along with training.
Funding should be made available for residents, who cannot afford to pay
for their dental treatment.

5. BETTER ORAL HEALTH IN RESIDENTIAL
CARE (BOHRC) PROGRAM

“Gold Standard” program
Established to create an evidence based model which
can be utilized by general physicians, nurses and
other care workers in residential aged care.

The four key elements of the program were:



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Oral health assessment, conducted by a general practitioner
and a registered nurse.
Oral care planning, to be developed by registered nurses.
Preventive oral care to be implemented by nursing staff and
other care workers.
Based on the oral assessment, dental referral should be done
for detailed oral examination and treatment.

6. EBPRAC - . Encouraging best Practice in Residential Aged Care program
ARCPOH - Australian Research Centre for Population Oral Health
BOHRC - Better Oral Health in Residential Care

7. BETTER ORAL HEALTH IN RESIDENTIAL
CARE (BOHRC) PROGRAM
Oral Health Education Toolkit
Professional portfolio
This portfolio was developed for General
Physicians and Registered Nurses as a selflearning tool.
It contains,
 Oral Health Assessment Toolkit
 Oral Health Care Planning Guidelines
 Dental Referral Protocol

8. BETTER ORAL HEALTH IN RESIDENTIAL CARE
(BOHRC) PROGRAM
Facilitator Portfolios
This portfolio was developed for the Registered Nurses, for
them to provide educational training for the care workers.
It contains information on,
 Principles in adult learning
 Presentation tips
 Competency outlines, session plans
 Facilitator notes
 DVD ( Dental Rescue)
 CD with powerpoint presentation, pre and post quiz with
downloadable answers
 Resource kit
 Posters

9. BETTER ORAL HEALTH IN RESIDENTIAL CARE
(BOHRC) PROGRAM
Staff Portfolios
It was developed for the direct care nurses and care
workers.
It comprises of three modules:
Module 1 – Good oral health is essential for healthy
ageing ( knowledge)
Module 2 – Protect your residents oral health (
skills)
Module 3 – It takes a team approach to maintain a
healthy mouth.

10. BRUSHING UP ON MOUTH CARE PROJECT
Developed in Nova Scotia in 2008
 The purpose of this project was to examine the
effect of implementing oral care for frail and
dependent older adults in variety of continuing
care settings in Nova Scotia.


11. BRUSHING UP ON MOUTH CARE PROJECT
Educational Training Toolkit
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Oral health manual
Oral care toolkit
Care Cards
Daily and annual oral health assessments
Posters
Information sheets on topics such as proper technique
for brushing and flossing
Oral care products and aids
Educational videos

12. BRUSHING UP ON MOUTH CARE PROJECT
Oral Care Toolkit

13. BRUSHING UP ON MOUTH CARE PROJECT
Oral Care Cards

15. ORAL HEALTH ASSESSMENT

Brief Oral Health Status Examination (BOHSE)

16. 
Oral Health Assessment Tool (OHAT)

19. RECOMMENDATIONS
What steps should be taken to ensure a
resident admitted in a LTC facility receives
good oral care?
This question can be answered if the following
subset of questions can be answered.
 Who plays the key role in maintaining good oral
health of the residents?
 What oral care measures have to be taken?
 How will oral care be provided?
 Where will oral treatment be provided?

20. RECOMMENDATIONS
Who plays the key role in maintaining good oral
health of the residents?
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Policy makers
Long Term Care facility’s administrators/managers
Care staff
Oral health professionals
General physicians
Oral health coordinator

21. RECOMMENDATIONS
What oral care measures have to be taken?
Four key elements are important in providing oral
care to residents:
1.
2.
3.
4.
Oral Health Assessment
Oral Health Care Plan
Daily Oral Hygiene
Dental Treatment

22. RECOMMENDATIONS
Oral Health Assessment
Brief Oral Health Status Examination (BOHSE)
 Oral Health Assessment Tool (OHAT)
 Modified Oral Health Assessment Tool


23. Oral Health Care Plan

24. RECOMMENDATIONS
How will oral care be provided?
Care of Natural teeth
 Care of Dentures
 Prevention of gum disease
 Relief of dry mouth
 Reduce Tooth decay


25. RECOMMENDATIONS
Where will oral treatment be provided?

Dental services should be provided at the facility.
(or)
 Transportation arrangements should be
available for the residents to travel to the dental
clinic.