Part 1 – How to Perform an Oral Assessment in Long-Term Care: The Normal

Mouth

Presenters: Paige Henry and Amanda Monette Algonquin College Dental Hygiene Students

Originally recorded on March 17, 2015

AcknowledgementsThis presentation was created through a partnership between the

RNAO Long-Term Care Best Practices Program (LTC BPP) Coordinators working within the Champlain and North West LHINs and the Dental Hygiene Program at Algonquin College.

Funding used to support the development of this Oral Health Assessment Series was from the LTC BPP through the Ministry of Health and Long-Term Care and from an Algonquin College Innovation Funding grant.

The following dental hygiene students: Paige Henry, Brieanna Duffy, Yingke Zhang, Kelci Cape, Amanda Monette and Ashley Hartin developed this presentation as part of DEN4466 - Community Health Outreach, with support and direction from Professor Tonia Peachman-Faust, and LTC BP Coordinators - Heather Woodbeck and Ibo MacDonald.

We would like to recognize Angela Nuelle, Full Time Faculty in the Dental Hygiene Program at Algonquin College for her leadership and coordination of this Oral Care Partnership 2

Objectives• To demonstrate an approach to oral

health status assessment in residents

• To illustrate normal changes in oral health status associated with aging

Required equipment: Gloves and a maskTongue depressor• Helps to control the tongue

Gauze• Helps with holding the tongue (when able)• May be used to remove debris

Light source

Optional equipment: Hand-held disposable oral mirror• Helps to effectively examine tissues/teeth at the back of the mouth

Head lamp

Oral Health Status Assessment

During the Exam• Introduce yourself • Explain what you’re going to do• Get resident’s consent• Seek feedback continuously • Monitor for body language, visual and verbal cues• Stop if the resident no longer cooperates

Oral Health Status Assessment Video

Image: Canterino and Katsman Dentistry

Image: Soda Head

Image: Mead Family Dental

Debris Is NOT normal and must be removed. It is important to recognize the many variations:

Plaque - bacterial debris in the mouth - it can be seen on all oral tissues.

Food debris – seen in between teeth

**Both of these should be removed daily by brushing**

Calculus is hardened plaque build-up which can only be removed during a dental visit

- it appears chalky white, stained brown, or grey/black.

Examples:

Image: Oral Care

Debris (cont’d)

Image: Oral Care

Image: Oral Care

Image: EPPLEY Plastic Surgery

Image: DermNet NZ

LipsNormal age related changes:• More wrinkles• Thinner lips

At rest, lips should be touchingFailure to close may cause

dry mouth May be moist, dry, or cracked Lesions associated with aging

Although frequently benign, these findings should be recorded and monitored for changes

Image: MedicineNet.com

Image: Smiles By Design

Image: Smiles By Design

Image: Mouths Matter

Image: NYC dentist

Image: Sarkissiandds

Image: South Charlotte Dentistry

TeethNormal age related changes: Generally even in color

but different shades of white/yellow- Staining is normal

Recession or seeing exposed root surfaces

Missing teeth/no teeth Teeth may be straight,

appear crowded, tilted, or rotated

Heavily restored teeth – i.e. fillings

Signs of wear (attrition)

Image: Easy Notecards (Chapter 7 Flashcards)

Gums (gingiva)

Image: Oral Health Patient Information, Gum Disease

Normal age related changes:

Pink, firm, moistIdeally pointed to fill

interdental spacesOften blunted and/or cratered (missing) in an aged mouth Variation of normal:

Pigmentation Image: Oral Health Buzz

Image: National Institute of Dental and Craniofacial Research

Linea Alba

Tissue trauma

Canker sores

Variations of normal

If any lesion remains after 2 weeks it must be looked at by a physician or dentist

Normal: Pink and moist

Oral Tissues

Image:Maher Dental Specialty Clinic

Image: Study Blue

Image: StarBrite Dental

o .

TongueNormal:

Pink in colour and covered with different sized taste buds

Image: Introduction to Preliminary Diagnosis of Oral Lesions

Image: Maria Tigner – Introduction to preliminary Diagnosis of Oral Lesions

Coated Tongueo Results from debris,

bacteria and dead cells getting caught between the taste buds

Geographic Tongueo Red patches with white

borders o Exacerbated by stressFissured Tongueo Deep fissures or grooves

on the top of the tongue

Tongue – Variations of Normal

Images: Maria Tigner - Introduction to Preliminary Diagnosis of Oral Lesions

Images: Maria Tigner - Introduction to Preliminary Diagnosis of Oral Lesions

Must note:• Presence/amount of saliva – light, medium,

abundant • Consistency of saliva – on a continuum from watery

to thick*The ideal finding is medium - abundant,

watery saliva*

Saliva

Image: WikiHow

Abundant & watery

Image: Indian Journal of Palliative Care

Light & thick

Challenges to Oral Exam

• Resident won’t open mouth - try stroking the cheek• Prioritize- Do as much as you can, - Focus should be on RAI-MDS section L

- Debris present in mouth prior to going to bed at night

- Has dentures or removable bridges- Some or all natural teeth lost – does not have or

does not use dentures or partial plates- Broken, loose, or carious teeth- Inflamed gums, swollen or bleeding gums,

oral abscesses, ulcers or rashes

Bruch, J., & Treister, N. (2010). Clinical oral medicine and pathology. New York: Humana Press Canterino and Katsman Dentistry. [on-line image]. Retrieved February 18, 2015, from www.jacantennodds.comDermNet NZ. [on-line image]. Retrieved February 18th, 2015 from http://www.dermnetnz.org/lesions/labial-melanosis.htmlEasy Notecards (Print Chapter 7 Pictures flashcards). [on-line image]. Retrieved March 16, 2015, from http://www.easynotecards.com/print_list/6167EPPLEY Plastic Surgery. [on-line image]. Retrieved February 18th, 2015 from http://www.exploreplasticsurgery.com/tag/lip-wrinkles/Ibsen, O., & Andersen Phelan, J. (2014). Oral pathology for the dental hygienist (6th ed.). St. Louis: Saunders Elsevier.Indian Journal of Palliative Care. [on-line image]. Retrieved February 18th, 2015 from http://www.jpalliativecare.com/article.asp?issn=0973-1075;year=2010;volume=16;issue=2;spage=74;epage=78;aulast=MolJohnson, T. (2014, October 29). Yeast Infections (Candidiasis) in Men and Women. Retrieved February 11, 2015 from http://www.webmd.com/skin-problems-and-treatments/guide/candidiasis-yeast-infectionKummer, A. (n.d.). The ASHA Leader. Retrieved February 24, 2015 from http://www.asha.org/publications/leader/2005/051227a.htm Madden, R. (n.d.). Tra-oral Examination: Intra-oral Examination: Normal Anatomy Normal Anatomy. Retrieved February 24, 2015 from http://student.ahc.umn.edu/dental/2012/5121/PEI-Intraoral_anat_2009.pdfMaher Dental Specialty Clinic [on-line image] Retrieved March 15, 2015, from http://dentistrajkot.com.Mead Family Dental [on-line image]. Retrieved February 18, 2015, from http://meadfamilydental.com/2011/11/plaque-vs-biofilm- and-the-research-that-could-change-dentistry-as-we-know-it/MedicineNet. [on-line image]. Retrieved March 14th, 2015 from http://www.medicinenet.com/image-collection/venous_lakes_picture/picture.htmMouths Matter [on-line image] retrieved on March 03, 2015 from http://www.mouthmattersbook.com/mrsdalloway/wp- content/gallery/book-images/gum_recession.jpgNational Institute of Dental and Craniofacial Research. [on-line image]. Retrieved March 15, 2015, from http://www.nidcr.nih.gov.Neild-Gehrig, J.S. (2010). Oral Examination. Patient Assessment Tutorials: A step-by-step guide for the dental hygienist (2nd ed., pp. 465- 473). Philadelphia, PA: Lippincott, Williams, & Wilkins NYC Dentist [on-line image] retrieved on March 03, 2015 from http://www.nycdentist.com/blog/2008/12/page/2/Oral Care. [on-line image]. Retrieved February 18th, 2015 from www.oralcare.comOral Health Buzz. [on-line image]. Retrieved March 16, 2015, from http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/ColgateNewandNow/Personal/2013/April/article/SW

-281474979063347.cvspOral Health Patient Information | Gum Disease. [on-line image]. Retrieved March 16, 2015, from http://www.mypil.net/gumdisease.htm

References

Sarkissiandds [on-line image] retrieved on March 03, 2015 from http://sarkissiandds.com/articles/amalgam/7-galvanism-3.jpgSmiles By Design [on-line image] retrieved on March 03, 2015 from http://www.smilesbd.com/SmileGallery.htmlSoda Head. [on-line image]. Retrieved February 18, 2015 from www.sodahead.comSouth Charlotte Dentisry [On-line Image] Retrieved on March 03, 2015 from http://south-charlotte-dentistry.com/wp- content/uploads/2011/05/ground-teeth2.jpg StarBrite Dental. [on-line image]. Retrieved March 15, 2015, from http://eastbaydentist.com.Study Blue. [on-line image]. Retrieved March 15, 2015, from https://www.studyblue.com.Tigner, M. (Fall, 2013). Introduction to preliminary diagnosis of oral lesions [Powerpoint presentation slides]. Retrieved from https://blackboard.algonquincollege.com/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_179912_1%26url%3DWikiHow. [on-line image]. Retrieved on February 18th, 2015 from http://www.wikihow.com/Blow-Saliva-BubblesWilkins, E. M. (2013). Extraoral and intraoral examination. Clinical Practice of the Dental Hygienist E4(11th ed., pp. 146-149). Philadelphia, PA: Lippincott, Williams, & Wilkins Wyatt Jr., A. (2014, June 23). Bad Breath Causes, Treatments, and Prevention. Retrieved February 11, 2015 from

http://www.webmd.com/oral-health/guide/bad-breath

References (cont’d)