2-Hour Module -- Advanced

Transcription

1 Slide 1: Oral Health: Nutrition, Disease Prevention, and Gaining Cooperation Thanks to Washington Dental Service Foundation for supporting the development of this module. Washington Dental Service Foundation Mission Eliminating i oral ldisease in order to improve overall llhealth lthfor all Focus on prevention and early treatment of oral disease They accomplish this by supporting projects and activities that Engage dentists, physicians, and other medical professionals in preventive oral health for children and older adults Increase access to dental services for children and older adults Promoting good oral health habits improves the quality of life for people of all ages 7-1

2 Slide 2: Agenda Note to Trainer: This is a good opportunity to engage the home care aides in improving oral health for themselves, their consumers, and their families, i.e., We applaud the work that you do and the quality of care that you provide to your consumers. As home care aides, you are able to become oral health champions because you 1. Are involved in the day-to-day routines of your consumer; and 2. have established a caring and trusting relationship with your consumer. 7-2

3 Slide 3: Why Oral Health Training for Home Care Aides? Oral health affects overall health What happens in the mouth can affect what happens in the rest of the body and can alert us to a health problem, such as: Difficulty in communicating due to oral disease. Difficulty in chewing and swallowing food. Oral disease can provide a potential entryway for other diseases. Prevention is the key Home care aides can help consumers prevent oral disease before problems become significant and expensive to treat. Because of their close relationship and understanding of the consumer s needs, home care aides have an excellent opportunity to help consumers accept oral care. Senior consumers may be at higher risk for decay and oral disease due to Health conditions like diabetes that can affect the gums Medications that cause dry mouth Arthritis or other problems with dexterity that make brushing/flossing difficult Dementia or cognitive disorders Lack of access to dental care many senior consumers have not seen a dental provider in a long time 7-3

4 Slide 4: Oral Health Overall Health Connection Oral health and overall health are related. What happens in the mouth is often a reflection of what is happening elsewhere in the body. We cannot view the mouth as an isolated area, disconnected from the rest of the body. Often the first signs of a medical condition may show in the mouth. Example 1: A person with undiagnosed or uncontrolled diabetes may have gum problems or difficulty healing because their blood sugar is not regulated properly. Example 2: People with gum disease often have heart problems as well. The exact relationship is not fully understood, whether one causes the other or exactly how they are associated. Note: Studies show a strong relationship between periodontal bacteria and cardiac disease. More research is being conducted in this area. 7-4

5 Slide 5: Be an Oral Health Champion Home care aides can help prevent oral disease using these four guidelines. Prompt, assist, or perform the oral health care for consumer Allow your consumer as much independence as possible, but remember that s/he may need assistance in one or more oral care routines. Monitor consumer s mouth for changes You may be the first person to spot an unusual condition or change in your consumer s oral health. Home care aides cannot make a diagnosis, but can report changes or unusual conditions. We do not expect you to become an expert or to make any kind of diagnosis, but you can be a caring observer. Educate consumer about oral health information Be willing to share your knowledge and help your consumer make better oral health decisions. Refer problems to supervisor or case manager If you notice signs of oral disease in the mouth tissues, lips, tongue, or teeth, make a note in your consumer s service/care plan AND report to your supervisor or your consumer s case manager. 7-5

6 Slide 6: Provide Safe Daily Care Personal Health Activity Mouth care is a very personal and sensitive activity that you can perform caringly and confidently. You might have a consumer who is uncooperative or who refuses to allow you to perform your duties. Other consumers may not be able to keep their mouths open very well. With practice and patience you will learn to perform daily care. Protect Yourself and Your Consumer Consider your safety when working with your consumers. Practice good body mechanics to decrease the chances of injuring yourself. Infection Control Issues Universal Precautions should be followed when performing oral care to ensure that you and your consumer are protected against cross-contamination. Wash hands before and after oral care. Wear gloves and other protective gear appropriate for your consumer s condition. (May include mask, gown, safety goggles.) Do not allow any of the oral health items to touch dirty surfaces like countertops or sinks. Do not contaminate faucets, drawer handles, or other surfaces by touching with dirty gloves. Note to Trainer: See Part 3 of the trainer manual for more information. 7-6

7 11/8/2011 4:02 PM Slide 7: Healthy Mouth/Unhealthy Mouth Photo Healthy Mouth (point out the features on photo) Teeth Clean, with no food between the teeth or near the gums, no plaque, and no tartar consumer s teeth need not be white and straight, but should be clean. No untreated decay may have fillings, crowns, or appliances (such as dentures or retainers), but should not have untreated cavities (white or brown spots), broken teeth, or broken fillings. Gums (gingiva) Clean, with no food, plaque, or tartar next to the gums. Light pink to brown according to skin tone, not red or inflamed, and no white areas. No swelling or redness of the gums (gingivitis), no bleeding, no tenderness. Gum tissue fits closely against the teeth. Photo Unhealthy Mouth (point out root caries/cavities progression) See how the decay progresses from #1 to #6 1. A tooth without caries 2. The beginning g stage of tooth decay, the white spot proper p prevention can stop the decay from progressing further 3. The enamel surface has broken down note the red gum tissue 4. A filling was placed, but the disease has not been stopped and new decay surrounds the filling 5. The decay process continues and breaks down more of the tooth 6. The tooth has fractured the effect of a process that could have been stopped at an early stage! Note to Trainer: Point out the plaque build-up on teeth numbered 3 & 4 in caries picture! 7-7

8 Slide 8: Tooth Decay Here is another way to understand the steps in getting tooth decay: Germs + Refined Carbohydrates = Acid Acid Attacks + Tooth = Decay Like gum disease, tooth decay is caused by germs in our plaque. Germs (bacteria) make acid from our food. The tooth decay germs love the same things we do sweet, sticky, or starchy foods like candy, cake, cookies, soda, chips, crackers, and pretzels (refined sugars and flours). Diet or sugar-free foods are better for our teeth because they don t provide food for the germs. However, diet sodas contain acids that can also dissolve our teeth (citric acid, phosphoric acid). Each time we eat, the acid remains for about 20 minutes ( acid attacks ). If we sip on a soda, nibble on crackers or cookies, or suck on sugared candies, we will have many acid attacks in a day. That s why we should eat just a few times per day, eat sweets or desserts with our meals (not as a separate event), and clean our mouths after eating. The acid makes holes called decay, cavities, or caries. More acid attacks per day = greater chance for new cavities. Our teeth need time to rest and rebuild between acid attacks. The acid weakens or demineralizes our teeth, but allowing our teeth to rest between attacks can help the tooth rebuild or remineralize. Note: Liquid medications often contain large amounts of sugar. 7-8

9 Slide 9: Progression of Decay Photo 1 Tooth Decay (cavity, caries) When a tooth decays, its enamel surface breaks down and allows acids and bacteria to enter the softer areas inside the tooth. Usually, decay begins as a small whitish area that, if left untreated, grows and darkens. Decay often occurs between the teeth where food particles are more difficult to remove. How many areas of decay do you see on this photo? (at least 7) Photo 2 Abscessed Teeth In this photo, untreated t decay has allowed infection to enter the teeth th and move into the teeth th roots. Swelling on the gum above these teeth (arrows) indicates infection (abscess) from the teeth that is draining into the mouth. Photo 3 Facial Swelling from Abscess If the infection isn t treated, the person s face may begin to swell as the infection spreads from the tooth to the surrounding area in the face or neck. People who are in a weakened immune state may have difficulty recovering from a dental abscess. In more serious cases, an untreated abscess can lead to serious widespread infection, often resulting in swelling of the face, and sometimes resulting in swelling of the brain or even death. Widespread infection can make people very ill. This is a matter that needs immediate attention! Often the dentist (or physician) will treat the infection with antibiotics first, then repair the tooth. Treatment could include root canal treatment (the nerve chamber is cleaned and sealed), placing a filling or crown, or extraction (removal) of the tooth. 7-9

10 Slide 10: Gum Problems: Development of Gingivitis & Periodontal Disease Bacterial Infection (Plaque) Germs clump together on our teeth and under the gums to form plaque (a soft, sticky mass), which irritates the gum tissues and can cause gum (gingiva) inflammation. Gingivitis: Red, puffy or bleeding gums The first signs of gum problems might be red, swollen, or bleeding gum tissue. This condition is called gingivitis. Note: The build up of plaque and calculus plays a key role in periodontal disease. Plaque and calculus need to be removed to have healthy gums and teeth. Periodontal Disease: Bone and Tooth Loss Periodontal disease is inflammation (swelling, redness, soreness) and breakdown of gums, bone, and teeth due to the plaque and tartar build-up. Note: The early stages of periodontal disease often go unnoticed because there is little or no pain. Your consumer may not be aware of any problems. 7-10

11 Slide 11: Gum Problems (point out the features in the photos) Photo Gingivitis i iti (infection of the gums) You can see the plaque on the teeth and gums at the gum line and in between the teeth. Remember to floss and brush daily to remove the plaque. If the plaque is not removed daily, gingivitis (bacterial infection) might occur. Symptoms include red, swollen, or bleeding gum tissue. If plaque remains on the teeth and gums, it turns to tartar or calculus (a hard crusty mass), which irritates the gums. The tartar or calculus cannot be removed by brushing and flossing. Tartar on the teeth needs to be removed (by having your teeth cleaned by a professional) before the gingivitis will improve. Your mouth might be tender at first, but at this stage it can be improved by brushing and flossing to promote healing (even though it bleeds). Professional care may be needed. Photo Periodontal Disease If the gingivitis is not treated or controlled, it can progress to a more serious condition, periodontal disease, where the bone holding the teeth in place dissolves. Eventually, the gums may detach and pull away (recede) from their original position, exposing the roots of the teeth. This allows decay and infection into tooth roots and also into the bone that supports the teeth. As the bone dissolves, the teeth will become loose and there may be a bad taste or odor. The loose teeth may become so painful that eating becomes difficult and severe infections may develop. The disease may be treatable or may require the teeth to be removed. 7-11

12 11/8/2011 4:02 PM Slide 12: Preventing Oral Disease Brush Twice per day; 2 minutes minimum; bedtime brushing is most important so that food and plaque are not in the mouth overnight. Remember to brush the tongue and tissue under a denture! Floss Once per day Cleans between teeth where the brush misses Fluoride (as recommended by the consumer s dentist) Found in toothpaste, mouth rinse, water supply Cover the bristles of the toothbrush with a fluoride toothpaste Fluoride rinses (ACT from Johnson & Johnson or Fluorigard from Colgate) to help prevent new cavities Drink fluoridated water if possible See your dentist Consumers need exams and professional care on a regular basis How often should be decided by the dentist Make healthy nutrition choices Eat more fruits, vegetables, cheese, and less sweet and sticky food 7-12

13 Slide 13: The Wonders of Saliva Saliva plays several important roles in protecting oral health Helps keep the mouth clean by washing away food particles Helps kill bacteria in the mouth that can cause infection and it neutralizes the acids that cause tooth decay Contains minerals like calcium and fluoride that help harden and repair the teeth Lubricates the mouth, making it easier to eat, taste, t swallow, and speak. This lubrication also helps defend the whole body against infection. When there is not enough saliva in the mouth, problems can develop quickly. There might be new decay (especially on exposed root surfaces), fungal infections, or mouth pain. 7-13

14 Slide 14: Dry Mouth Many people are likely to develop dry mouth, a serious condition that can cause major problems in the mouth. This is a condition beyond the normal drying of tissues that happens as we age. Dry mouth has many possible causes, including: Medication side-effects Medications used to treat high blood pressure, allergies, depression, and many other conditions can cause dry mouth. About 400 medications have dry mouth as a possible side effect. Many people take at least one of these medications, and your consumer may be taking several. Chemotherapy or radiation treatments Cancer treatments can damage or destroy mouth tissues. Dental care should be completed before treatments begin. Salivary glands do not work properly Certain medical conditions may create problems with the salivary glands. 7-14

15 Slide 15: Dry Mouth Side Effects & Photos Top photo Root decay (cavities, caries) When a person doesn t produce enough saliva, tooth decay can occur. Photo on left Cracks on corners of lips Cracks on the corners of the mouth may have a number of causes, including fungal infections and simple irritation, but often they are related to dry mouth. Caregivers should alert their supervisor or their client s case manager if they observe this condition. Middle photo Dry, painful tongue (also note cracks at corner of lips) A dry tongue often appears smooth, red, and slightly swollen. A dry tongue can make speaking, tasting, and swallowing difficult. Photo on right Possible fungal infection on tongue Some medical conditions may result in a fungal (yeast) infection that often affects the tongue. The heavy white coating is a possible indication that this type of infection is present. Record in progress notes and alert your supervisor. 7-15

16 Slide 16: Managing Dry Mouth Alert physician i The physician i may be able to change your consumer s medication. i Drink extra water throughout the day, especially fluoridated water Sipping water throughout the day helps maintain moisture and protect teeth. Taking small sips of water during meals helps with swallowing food. Keeping a glass of water at bedside is good for nighttime sipping, but may increase nighttime trips to the bathroom. Using a saliva substitute before bed and a humidifier during the night also may help prevent nighttime dry mouth. Protect teeth with fluoride Extra fluoride may be needed to protect teeth when the mouth is dry. Fluoride toothpaste, rinses, and prescription gels can provide this protection. Fluoride varnish may be applied at the dental or medical office. Use a saliva substitute Saliva substitutes replace missing moisture. (More info on the next slide.) Avoid Sugary snacks or drinks Sipping on sugary drinks or juices contributes to tooth decay Sucking on sugary candies or mints increases the chances of decay Beverages with caffeine or alcohol Caffeine and alcohol increase dryness Mouthwashes with alcohol Most mouthwashes contain high levels of alcohol, which increases dryness (Listerine contains about 25% alcohol; Scope about 10% alcohol check labels) Tobacco products Increase dryness and risk for developing oral cancer, gum disease, fungal infections Hard sugar candies Promote tooth decay try sugar-free candy (xylitol as a substitute) 7-16

17 Slide 17: Dry Mouth Aids Saliva Substitutes To increase moisture and comfort Increase moisture, decrease bacteria Use during the day and before bedtime Biotene and Orajel Dry Mouth Products Enzymes to increase moisture Xylitol to prevent decay Rinse, toothpaste, gum Note to Trainer: Show product display board. Xylitol Sugar substitute Prevents decay; repairs early decay (remineralization) Gum, mints, dry mouth products (Biotene, Carefree Koolerz gum, some flavors of Trident gum, Tom s of Maine toothpaste and rinse, Orajel products) Note to Trainer: Show product display board. 7-17

18 Slide 18: Poor Nutrition Resulting From Several factors could put your consumer at risk for poor nutrition. Disabilities may affect meal preparation and therefore impact oral health: arthritis; limited movement; vision or hearing problems; mental health problems; other conditions These all contribute to the poor nutrition/poor oral health cycle. These same disabilities may make it more difficult for your consumer to do simple oral health routines. Examples: Can t lift arms high enough to floss or brush; can t see well enough to watch in a mirror while flossing; can t hear well enough to understand directions on how to. Inadequate meals Failing appetite; too much bother Not interested in preparing or eating nutritious meals Altered taste, particularly in seniors Only half of our taste buds remain at age 75, so the ability to taste food is decreased. This may make eating less appealing. Chemotherapy, medications, and medical conditions also change taste. Poor quality or small quantity; soft diet Consumer eats smaller amounts of food or poor-quality food A soft diet restricts the variety of food choices Financial concerns Limited or low income restricts choices Higher-quality foods sometimes cost more 7-18

19 Slide 19: Poor Nutrition and Oral Health Problems Poor nutrition can affect a person s overall health, as well as oral health. Poor nutrition can cause oral health problems (point out features in the photos) Certain vitamin or mineral deficiencies may cause a smooth, red, or sore tongue. Nutrient deficiencies also may cause sores or cracks at the corners of the mouth; other causes can also produce problems that t look like these. It is not your responsibility to diagnose a condition; it is your responsibility to record and report unusual findings. Note in your consumer s service/care plan and report to your supervisor or consumer s case manager. Consumer may need a referral for professional care if these conditions do not go away within two weeks. Food residue on teeth can lead to decay (point out features in the photo on right) Soft diets can result in food remaining on the teeth, leading to decay. 7-19

20 Slide 20: Oral Health Problems and Poor Nutrition Oral health problems can impact nutrition Missing, broken, or decayed teeth can make it difficult to eat a balanced diet or a variety of foods. Chewing may become painful with decayed, broken, or loose teeth. Dry mouth can make it difficult to taste and swallow. 7-20

21 Slide 21: Preventing Nutrition Problems Home care aides can be involved in meal planning, shopping, and preparing. As a home care aide involved in meal planning and preparation, you may be able to influence your consumer s food choices. Choosing wisely can improve your consumer s oral health and overall health. Tip: Look through the sale ads in the newspaper with your consumer. This helps create an appetite and your consumer will be happy to find things on sale. The consumer gets to choose, but you help steer toward better choices. Help your consumers make smart food choices, within established diet restrictions. Choose a variety of fruits and vegetables, whole grains, proteins. Limit sweets, fats, and nutrient-poor foods or snacks (junk food). Be sure to follow diet restrictions listed in the consumer s service/care plan. Note: Small, frequent meals are often recommended d for consumers with acid reflux, Parkinson s, or Alzheimer s diseases. Note: Some people with diabetes are advised to eat a number of small protein-rich or vegetable snacks throughout the day to maintain sugar levels. Home care aides should refer to the consumer s service/care plan. 7-21

22 Slide 22: Make Smart Food Choices Help your consumer make smart food choices, within his/her established diet restrictions. Limit sweet or sticky snacks and drinks, i.e., raisins, dried fruits, candy, pop. Eat healthy snacks: cheese, fruits, vegetables. Eat full meals instead of sipping, nibbling, and/or grazing, as diets allow. Drink fluoridated water instead of juice or soda throughout the day; avoid sipping on sugary drinks. This will improve the health of their mouth and their overall health and will reduce their risk for disease. Note: Offer tips to counteract the effects of sweet and sticky snacking, especially when the consumer insists on these items, i.e., use a straw when sipping on sugary drinks, so liquid goes over the tongue and doesn t sit in the mouth. 7-22

23 Slide 23: Activity One: Brainstorm Small Groups: 1. Break participants into groups of three or four. Ask them to name three eating habits that, if changed, would improve their consumer s health; and 2. Identify three ideas to encourage these new healthy behaviors. One person from each group will share with the large group. Large Group: As they share each tip, write them down on a large post-it on the easel or on the white board. Encourage discussion including techniques for changing behavior. Note to Trainer: See Hands-on Practice on page 7-d for more information. 7-23

24 Slide 24: Reading Nutrition Labels Many products contain large amounts of hidden sugar. Learning to read the nutrition labels can help you identify those foods. 1. Look at total grams of sugar. 2. Does anyone know how large a gram is? (Is it big or little?) 3. A gram is very small; there are about 4 grams in a teaspoon of sugar. 4. Since we aren t as familiar with grams, let s convert the number to something we know better, teaspoons. 5. Divide the number of grams by 4; this will give the number of teaspoons. For our chocolate milk example, 28 divided by 4 = There are 7 teaspoons of sugar PER SERVING of chocolate milk. 7. How many servings in this container? 2 8. Multiply 7 teaspoons by 2; this gives the total amount of sugar in the carton of chocolate milk = 14 teaspoons. 9. How does that compare with some other foods or drinks? 10. Let s look at a can of soda Coke or Pepsi usually has about grams per 12-oz can, so 40 or 44 divided by 4 = 10 or 11 teaspoons; the soda has less sugar than the chocolate milk! 11. Which has better nutrition? (Chocolate milk calcium & protein) 12. What would be other better choices? (Plain milk, fluoridated water) 7-24

25 Slide 25: Assessing Consumer s Abilities Due to physical or cognitive limitations, consumers will have a varying ability to take care of their teeth and gums. Some consumers will be highly able. But they will likely still need you to prompt them (e.g., put toothpaste on brush, give encouragements), and you should always monitor their skills to ensure they are brushing correctly and thoroughly. Some consumers will be moderately able. They will need assistance with brushing and/or flossing. They may need you to place your hand on theirs to guide the activity. Or they may begin the task but need you to complete it. Some consumers will very limited. They will not be able to brush/floss their teeth. You will need to do this for them we will discuss strategies for this in a few minutes. Remember to allow the consumers to do as much as they are able to on their own. 7-25

26 Slide 26: Levels of Cooperation Assessing your consumer s level of acceptance of care will help you to determine a strategy of approach and how best to protect yourself. There are no absolutes. Cooperation by your consumer when approached for daily oral hygiene is relative. Some consumers may be cooperative with one home care aide and very resistive with another. Behaviors may change from day to day or even hour to hour. Do your best today and try again tomorrow! Acceptance can vary. A cooperative consumer will open mouth easily and not resist care. Some consumers will show resistance at first (clenching teeth, pursing lips) but with patience and coaxing will eventually allow care. Some consumers will be continually resistive and show combative behaviors. They may pull your hands away from their mouth, swing their arms at you, attempt to bite your fingers, scream, kick, or move their head back and forth. Some consumers will show even more obstructive behavior by moving away from you sitting on floor or leaving room, throwing up, screaming, spitting. 7-26

27 Slide 27: Self-Injurious Behavior Also, some consumers may use self-injurious behavior. This may be due to stress or be an outlet for communication. The consumers may bite or hit themselves, or pick at skin in or around the mouth. 7-27

28 Slide 28: Gaining Cooperation Clean teeth, gums, and dentures daily Select a good time of day The time should be good for both the home care aide (time when s/he is less rushed) and consumer (time when s/he tends to be in positive or more agreeable mood). Select a good location Be flexible oral care doesn t have to happen at a sink; bring supplies to consumer in bed or wheelchair; use towel on chest/shoulder to catch run-off of saliva/toothpaste. Reframe the task If needed, use words other than, Time to brush your teeth. Instead, try, Let s try this new toothbrush or I want to help you feel better. Use compliments often Thank you for helping me! or You re doing a great job! 7-28

29 Slide 29: Gaining Cooperation Ask for assistance from the consumer I need your help, this is a special brush, help me see if it works. We are doing a good job! Explain the procedure with the brush on the teeth How does this feel when I massage your teeth? (move brush in circles) Is it better over here? Am I doing okay? Sing songs, count Helps consumer to relax, gets consumer in on the game Place something in consumer s hands This will help to occupy them 7-29

30 Slide 30: Activity Two: Gaining Cooperation Ask for two volunteers: 1. One will be the HCA brushing the consumer s teeth 2. One will be the consumer at the needs encouragement cooperation level Setting: Have consumer sit in a chair; ask them to be somewhat uncooperative, i.e., won t open mouth Have the HCA work from behind and try to brush the consumer s teeth, modeling positive feedback and gaining cooperation techniques Note to Trainer: At any time, other participants can comment and suggest techniques. Debrief: Talk with the large group including thoughts and comments from the two volunteers about what went well, what other techniques could have been used, other scenarios that they have experienced and what they learned from them. Note to Trainer: Please see Hands-on Practice on page 7-d for more information. 7-30

31 Slide 31: Be an Oral Health Champion WDSF is producing additional continuing education modules on more complex health issues related to oral health. Watch for additional information. Be a Champion For Your Consumer You may be the only person who notices, monitors, reports changes, and suggests referrals. Suggest ways to improve your consumer s oral health Daily care (floss, brush, fluoride) Healthy diet and good nutrition Professional care Teach your consumer the things you have learned today Perhaps you learned a new idea today that will make oral care easier for both of you. Be a Champion For Yourself Protect your own oral health by practicing what you have learned today Now that you know more about how oral disease gets started and what you can do to prevent it, you can change your habits to improve your own oral health. The information you have learned today applies to everyone! Teach your family members this information You can improve the oral health of your spouse, children, or other family members or friends. Wrap-up: Answer questions, distribute evaluations and certificates. 7-31