1. Oral Care: Part 5 Preparing for Oral Care andCommunication TechniquesUsing a Best Practice Approach inLong-Term Care February 2008Central South/South WestBest 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 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 3. Evidence-Based Approach toOral Care for Older Adults from IOWA February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative

This evidence-based model ofthe importance of oral hygiene care and dental treatment onmaintaining oral healthfrom 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 IndividualizedOral Hygiene Care Plan February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative An individualizedOral Hygiene Care Planenables care providers to focus on appropriate oral care interventions for the resident Oral Hygiene Care Planshould be developed on admission, quarterly and as a residents oral status or self care abilities, cognitive or functional impairment changes 5. RNAO Oral Health BPG Care Planning February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 6. RNAO Oral Health BPG Care Planning February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 7. RNAO Oral Health BPG Care Planning February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 8. A Best Practices Approach toOral Care in LTC homes February 2008Central South/South WestBest 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

Familiarizeyourself with:

• Severity of residents cognitive impairment & residents responsive behaviours (pushing, turning head, biting)

• Residents communication & sensory impairments

• Residents functional impairments (arthritis in hands, mobility)

February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 10. Preparing for Oral Care

Oral care should be completed at least2x each day

Never awakena resident to complete oral care

Oral care should be donein the bathroom , whenever possible, because of its physical cues(i.e., sink, water, etc.)

Review the residents oral care plan

Review if the resident hasdysphasia (i.e., problems swallowing, choking, spitting)

February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 11. Preparing for Oral Care

Assembleall oral care supplies and have them ready to use in the residents bathroom,beforeyou bring them into the bathroom

Check that theoral care supplies arelabeled with the residents name

NEVERuse toothpasteor mouth rinses with residents withswallowing difficulties WATER ONLY

NEVER use lemonglycerin swabsfor oral care

February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 12. Preparing for Oral Care

Alwayscommunicateto the resident what you are planning to do talk about it when getting youre ready no surprises !

Have the resident doas much of their oral care as they can possibly do. It may not be perfect and offer to finish areas they may have missed

Explainto the resident and describe the oral caretasks (steps)you want them to do or will be doing

Remember:Always use properbody positioningwhen providing oral care

February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 13. Toothpaste Tips

Natural Teeth

• • • Usepea-sizedamounts of toothpaste,squeezing out a long strip of toothpaste is too much

• • • Most toothpastes have a strong taste,many residents dont like this, not appealing to residents with Alzheimers Disease

• • • Foaming action of toothpaste increases saliva flow &will result in the resident wanting to spit >> choke, gag

• • • DO NOTuse toothpaste for residents who havedysphagia , whocannot swallow or spit/rinseproperly, have high level ofdementia - there areoral cleansing gelsavailable

February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 14. Toothbrush Tips

Natural Teeth

• Thebest typeof toothbrush to use for residents

• • is one with asmall head, soft bristles, larger handle withrubberized grip

• 2-Toothbrush Technique :

• • For residentswho bite down during care , consider using 2 toothbrushes one to prop the mouth open and one for cleansing

• Replacetoothbrush:

• • every3 monthsor after aninfection

February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 15. Denture Care

Plaque & tartarform on dentures just the same as they form on natural teeth

Removedentures daily for at least3 hoursfor gums to rest, overnight is easiest

Ask the resident to remove their dentures.Assist, if they cant

• For upper dentures

• • slide your index finger along the dentures 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 2008Central South/South WestBest 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 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 17. Denture Care

• Cleaning dentures:

• At bedtime, place dentures in denture cup with cool water and vinegar(water and vinegar)

• Only soaking them overnight with a cleansing table is not sufficient it doesnt 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 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 18. Denture Care

• Clean the mouths of residents who wear dentures:

If the residents lips are dry, moisten them with a non-petroleum based product (e.g. Lipsol)

Alwaysbrush mouth tissueswith a regular soft bristled toothbrush

• including the tongue, palate, cheeks and ridges of mouth

• In morning, rinse dentures well before placing in residents mouth

Always put the upper denture in first then lower one to avoid gagging

• Denture cupsshould bescrubbed weeklyto prevent bacterial or fungal growth and replaced monthly

February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 19. Communication Techniquesfor Oral Care February 2008Central South/South WestBest 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 breakdownwhen assisting a resident with oral care . . .How might you distract a resident so that you can proceed with oral care ?. 20. Communication Techniquesfor Oral Care February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative Hand-Over-Hand :the caregivers hand is placed over the residents 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 caregiverHave 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 Techniquesfor Oral Care February 2008Central South/South WestBest 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? Its cueing or prompting with an additional jumpstart of showing. Have you ever used it for oral care? 22. Resource Tools February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 23. Resource Tools February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative 24. Resource Tools February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative

Halton Region Health Departments 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 2008Central South/South WestBest 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 Ontarioand Halton Region Health Department (Summer 2007).Oral care for resident with dementia (DVD) Toronto, ON: Author.www. rnao .org or phoneDir:(416) 907-7965Fax:(416) 907-7962$15 CDN ML van der Horst(April 2007).The BP Blogger.Myth busting: The mouth issue. Monthlynewsletter 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 2006www. 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.cawww. oralcare .ca 26. Resources February 2008Central South/South WestBest 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 2008Central South/South WestBest 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 stcentury 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 2008Central South/South WestBest 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, ONCanada 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, CHRPwww. 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, ONCanada N6C 5J1

Email:donna . scott @ sjhc . london .on.ca

Tel: 519-685-4292 x42337

.

February 2008Central South/South WestBest Practice Coordinator in Long-Term Care Initiative