We re Passionate About

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1 Oral Health Training Marie Burgum Oral Health Advisor Tees Community Dental Service We re Passionate About Putting patients first Quality, safety and patient experience Transforming services to meet the health needs of future generations

2 Aim To ensure staff are providing evidence based oral health advice. Objectives: Summarise the preventative Oral Health messages. Discuss the importance of regular and effective mouth care Identify practical opportunities for the promotion of Oral Health messages.

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4 A healthy mouth Lips and tongue pink and moist Teeth and gums are clean Teeth are not broken or loose No decay or broken fillings Clean and well fitting dentures Adequate Salivation No mouth ulcers, sores or other conditions

5 Gum Disease Red swollen and bleeding gums

6 Mouth Care Products Small-headed toothbrush/electric. Soft to medium texture alternatives such as 3 headed brush and, aspirating are available. Fluoride paste - higher concentrations can be prescribed by GDP and also Sodium lauryl sulphate (SLF) free toothpaste are available. Dry mouth moisturising gels

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8 Dental Decay

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10 Dental Decay

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14 Xerostomia (Dry mouth) Xersotomia is the lack of saliva in the mouth. Saliva - clear watery liquid that is produced and released from the salivary glands around the mouth. - lubricates the mouth and aids swallowing and talking & regulates ph levels. Signs - clingy, stringy, frothy saliva, lips sticking together, dry and crusted lips or tongue sticking to palate & difficulty swallowing or talking. Symptoms - pain with eating, swallowing or speaking, dry cough and burning sensation.

15 Thrush is a common fungal infection. Thrush Risk factors for thrush are: Poor denture hygiene i.e. not leaving dentures out at night and poor cleaning routines Dry mouth Patient on steroids Antibiotic use Smoking

16 Treatment of thrush Good oral hygiene - ensure that the mouth, teeth, gums and tongue are cleaned at least twice daily with a small headed single use toothbrush. Treat a dry mouth - report to senior staff to arrange diagnosis and antifungal medication. - Use saline and gauze to remove debris if brushing is not possible before massaging oral gel into all areas of mouth. Dentures - Remove and clean dentures with single use tooth brushes/denture brush, to reduce the risk of reinfection. Refrain from Smoking Rinse any inhalers well with water, to reduce risk of infection.

17 Angular cheilitis Condition where corners mouth can be red, wet, inflamed, crusted or cracked. May become infected by bacteria or candida. Poorly fitting dentures Drooling Chronic bowel problems Iron or vitamin B deficiency Low immunity and diabetes are also at increased risk. Causes:- Treatment:- Gels, lip balm, fusidic acid and hydrocortisone cream if bacterial. For fungal infections treat with miconazole gel or nystatin. Refer patients with poor fitting dentures to see own dentist.

18 Mouth Ulcers Painful mouth sore, usually clears itself within a few days. Round or oval with inflammation. Causes can be due to infections, viral, bacterial, chronic conditions, smoking, oral cancer and trauma. If present for more than 2-3 weeks please see dentist.

19 Mucositis Inflammation and ulceration to lining of the mouth Mouth will be red and inflamed, ulcers may bleed. Side effect after chemotherapy and head and neck radiotherapy. Moisturise the mouth regularly with an oral gel Oral gels and liquids can be used prior to meals to ease pain. Use an SLS free toothpaste Benzydamine hydrocloride mouth wash/spray or Chlorohexidine may help.

20 Remove dentures once a day preferably at night or for at least 20mins each day. Use a tooth/denture brush and a denture cleaning paste (or a fragrance free liquid soap) to remove plaque and food. Soak in water or a suitable denture solution (refer to instructions) Check they are a good fit, cracks, missing teeth and sharp edges. Remember oral care for the whole mouth. Denture Care

21 Oral Cancer Most common sign - ulcer that does not heal (around 80% cases) Persistent pain or discomfort in the mouth White or red patches in the mouth or throat Difficulty in swallowing and/or speech problems A lump in the neck, lip, mouth or throat Sudden weight loss Bad breath Unusual bleeding or numbness in the mouth Loose teeth for no apparent reason Difficulty moving the jaw Any concerns please visit the dentist for advice.

22 Campaigns that link with Oral Health

23 Help and Support For information and advice - NHS Choices website - NHS England Training - Oral Health Promotion Department University Hospital Of North Tees

24 Aim To ensure staff are providing evidence based oral health advice. Objectives: Summarise the preventative Oral Health messages. Discuss the importance of regular and effective mouth care Identify practical opportunities for the promotion of Oral Health messages.

25 References British Association for the Study of Community Dentistry (2014) Delivering Better Oral Health. An evidence based toolkit for prevention Third Edition. [Online] Available at: (accessed May 2018) Health Education England (2016) Mouth Care Matters A guide for hospital healthcare professionals [Online] Available at: Levine, RS and Stillman-Lowe, CR (2009) The Scientific Basis of Oral Health Education, Sixth Edition. British Dental Association: London Public Health England, Health Matters: Chilld dental health, (accessed May 2018)