Oral Care - Guidelines for residents and carers

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5 CARELINES ISSUE #1 Oral Care - Guidelines for residents and carers Authors: Yvonne Brugmans RN BN MEd(Adult) JP Nurse Educator Health Professions Education Consultancy (HPEC), Rachael Brugmans, Confident Care Products Over the last 30 years dental needs have changed significantly. Older Australians are now retaining their natural teeth. However, tooth decay is still the most common health condition. Dental decay is the most costly diet related disease in Australia ahead of coronary disease, hypertension and diabetes. 1 Oral diseases and conditions can impact on quality of life, including comfort, eating, pain, appearance & behaviour. Within the increasing older Australian population, there is a significant group at very high risk for developing complex oral diseases and dental problems in older adults. Those residing in Australian residential care facilities are in the higher risk category with many general health, functional, cognitive, social and financial problems. Older adults need to eat and talk comfortably, to feel happy with their appearance, to stay pain free, to maintain self-esteem, and to maintain habits/standards of hygiene and care that they have had throughout their lives. 2 In the Australian residential aged care community, it is the carers who play an essential role in the delivery of oral hygiene care and the maintenance of residents oral health. By providing clear guidelines to these carers, the delivery of appropriate and high quality oral care will ensure that there is timely identification of oral health problems in residents. In several studies Oral care is reported to have a low priority in nursing care of older adults, and repeated assessments to detect oral health problems are seldom performed. 3 Therefore, nurses are at the forefront in providing such services, and it is recommended they integrate oral health care into their routine nursing care plans. 3 In order to assist the older person to maintain good oral healthcare practices the carer/aged care worker must have a good understanding of the components of the mouth 4 as follows: TEETH (natural) Maintain clean teeth by regular brushing for two minutes after each meal using high fluoride toothpaste on a soft flexible toothbrush on teeth, tongue and gum. Change toothbrushes every three months, it is recommended that a colour coding system be used. This can be done at the commencement of each season for e.g. Spring Purple Summer Yellow Autumn Green and Winter White. Apply an antibacterial product after Lunch each day. Minimise sugar intake, especially sugary drinks between meals. Keep mouth moist, medication can often lead to a dry mouth. Flossing between teeth assists in removing trapped particles of food that can lead to decay, gum disease and mouth odour (halitosis). If using mouthwash, choose alcohol-free. Consideration must be given to those with sensitive teeth and gums and that gentle brushing technique should always be applied. Carry out an Oral Cavity assessment regularly and report and record any changes including, loose teeth, bleeding, inflammation, sores or presence of odour. RESIDENTS WITH DENTURES Dentures (false teeth) are custom made to fit correctly. Dentures can be a full row of teeth or partial consisting of one or more teeth. Care of dentures should be part of a routine mouth care regime and cleaned as often as natural teeth. It is imperative that the mouth is thoroughly cleaned after denture removal with either an ultra soft bristle toothbrush with a small amount of toothpaste or a foam oral swab impregnated with low strength sodium bicarbonate. As dentures are expensive and given that they can be easily broken, they should be handled with care especially when wet as they can be slippery to handle. When not in use dentures must be cleaned and placed in a suitable denture container clearly labelled with the residents details. As a person ages dentures can often become ill fitting as the gums recede. Poorly fitting dentures can be evident by movement when speaking or eating, this may irritate gums and traumatise soft tissue. Any sign of ulcers or spots is indicative of poorly fitting dentures. As with natural teeth an Oral Cavity assessment should be carried out regularly. TONGUE Regular cleaning of the tongue can assist in the prevention of Glossitis (sore tongue) and Candidiasis (thrush). Tongue cleaning can be carried out by the use of a specific tongue cleaner/ scraper or a foam oral swab. Glossitis May indicate a sign of general health problems and is commonly caused by fungal infection. The tongue becomes red, smooth and swollen. Candidiasis (thrush) A yeast like fungus present in the mucous membrane of the mouth with the most common pathogen being Candida Albicans. A white exudate (pruritis) develops which leaves a raw area when wiped away and can easily bleed. The tongue becomes red and inflamed and can be treated with oral antifungal drugs such as nystatin and clotrimazole

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