1. Oral care is important for long term care residents to maintain comfort, dignity and quality of life as 95% need assistance and many have medical issues like dementia, dysphagia, or dry mouth. 2. Proper supplies and techniques are needed to safely provide oral care like using washcloths to remove debris before brushing and not using toothpaste if a resident can't spit. 3. Challenging behaviors during oral care can be addressed through distraction, reassurance, and involving family or medical staff if needed for a resident's safety and compliance.

1. Oral Care for Long Term Care ResidentsSteady increase of LTC residents that are retaining their own teeth

2. Approximately 95% of LTC residents need assistance with daily oral care

3. Approximately 35% have dysphagia (problems swallowing)

4. Approximately 80% have some form of dementiaWhy the Concern for Oral Care?Client comfort

5. Client free from pain and infection with no additional behaviour issues due to oral problems

6. Dignity

7. Quality of LifeCommon Oral Problems in Alzheimer Care Dry Mouth

8. Soreness

9. Thrush (yeast infection)

10. Swallowing Problems

11. Lip Soreness

12. Tastes/ Odours

13. Denture Fit/ Swallowing RiskOral Care Supplies Gel (Perivex®)/ Mouthwash (Oradent® for dry mouth)/ Water

14. Two toothbrushes with wide handles

15. Washcloth (disposable cloths)

16. Hand towelUse of a Washcloth / Disposable Cloth to:Remove debris prior to brushing eg. Dysphasgia

17. Moisturize mouth prior to brushing

18. Mop up saliva as you brush

19. Massage gums, polish teeth after brushingReminder: Oral care can be performed anywhere using this method (TV, radio is a good distraction for patients)

20. Why You Should NOT Use ToothpasteFoaming action increases saliva flow and the number of times a patient will want to spit

21. Foaming action of toothpaste decreases visibility for the caregiver

22. Swallowing defects – a person can choke on the paste

23. Majority of toothpastes have a strong taste that does not appeal to older adults eg. Alzheimer’s patients

24. NOTE: Toothpaste should only be used when a patient can spit and swallow properlyReducing Aerosol Splatter When Brushing TeethSequence:Mop and go for debris removalTeeth together, if possibleBrush upper outside surfaces first, using whatever technique worksBrush upper inside teeth using back and forth or circlesBrush upper inside back teeth back and forth or circles

25. Reducing Aerosol Splatter When Brushing Teeth6. Brush inside lower front teeth back and forth or circles7. Lower back teeth inside last brushing area Reminders: Sequencing reduces the risk of a gag reflex

26. Mop saliva and debris frequently throughout brushing time to eliminate need to spit

27. Do not flick toothbrush out while brushingFlossing Not realistic for many caregivers or clients, high risk of being bitten – better luck with inter-dental brushes, proxy brushes and stimudentsFinal Tooth and Gum Wipe Down Use water, gel, non-alcoholic mouthwash, or prescription chlorhexidine product

28. Use on washcloth, polish teeth

29. High dementia, biting patients – do not do thisUsing Two Toothbrushes Easy clean-up, more sanitary than just one

30. Can use one as a prop to hold the mouth open and the other as the toothbrushDealing With Caregiver’s Fear of Being Bitten Remember: No Means No! If the patient is refusing to cooperate, try again laterFinger Placement RemindersPlace finger in a C-curve in the cheek so the finger can get away fastPull lower lip out; no pain generated