Oral Health for Caregivers Part 3 - Hands-on Practice and Demonstrations - Script

Transcription

1 Oral Health for Caregivers Part 3 - Hands-on Practice and Demonstrations - Script Daily Routines - Flossing & Brushing; Denture Care The Uncooperative Cl ient; Monitoring Oral Health; Referrals The next pages contain step-by-step directions for performing oral health care. If teaching a lo-hour class, set up stations for the oral health activities. Demonstrate; have students work in groups of 3 to read the steps, demonstrate the activity, and record the proficiency. Everyone gets a turn at each aspect. See "Proficiency Stations" at the end of this section, p to If teaching a 5-hour class, introduce the activities within the slide program and allow time to practice the skills. Daily Routines [;J Personal Health Activity Mouth care is a very personal and sensitive activity that you can perform caringly and confidently. You might have a client who is uncooperative or who refuses to allow you to perform your duties. Other clients may not be able to keep their mouths open very well. With practice and patience you will learn to perform daily care. I;] Protect Yourself and Your Client Consider your safety when working with such clients. o Use a mouth prop or other device (a rolled washcloth works well) to keep the client's mouth open if biting is a concern. o Do not insert your fingers between your client's upper and lower teeth if there is a chance that you could be bitten. o Work from behind the client if there is a chance of being hit during oral care. Trainer - Hands-on Practice - Script 3-1

2 Practice good body mechanics to decrease the chances of injuring yourself. a Avoid unnecessary twisting and reaching while performing oral care. a Choose to work from the position most comfortable for you and for your client's situation, whether from the back or the side/front. a Try different positions to find the ones that work best. Ask your client to turn his/her head (if mobility allows) to make your tasks easier. Infection Control Issues To protect against cross-contamination, follow Infection Control Guidelines and Universal Precautions when performing oral care. a Wash hands before and after oral care. a Wear gloves and other protective gear. Depending on your client's medical situation and your risk for infection, the extras may include a mask, gown or apron, and safety glasses or goggles. a Be careful not to touch the toothbrush bristles or any of the oral health items to other surfaces such as the counter, the sink, your bare hands, etc. a Do not contaminate faucets, drawer handles, or other surfaces by touching with gloves that have been in contact with the client's mouth. a Use a clean paper towel when turning faucets on and off (when wetting toothbrush or scrubbing dentures) to prevent contamination of your gloves. a Gather all of your supplies before you start. [;] Suggested Supplies - Flossing & Brushing (See "Tool Kit" Contents.) For clients with natural teeth (no removable appliances or dentures): Gloves, mask, goggles, gown or apron, as needed Basin Paper cup with small amount of water Towel to place on client's chest Trainer - Hands-on Practice - Script 3-2

3 Paper towels Lubricant for lips (Vaseline) on applicator (Q-tip) Dental floss-about 18 inches OR Floss holder loaded with floss Moistened soft toothbrush with fluoride toothpaste Other aids (mini-brushes for cleaning between the teeth, toothpicks, or dental sticks) as needed or per client's preference ~ Get ready to floss and brush Ask your client if s/he can eat comfortably and if there are any sore areas in the mouth. To prevent pulling or cracking of the lips, place a small amount of Vaseline on a swab and apply to the lips. Watch for any sore areas, changes in tissue, or anything unusual. ~ Flossing Routine Floss once each day to clean between teeth where the brush misses Flossing before brushing allows you to loosen and remove food and plaque from between the teeth, then brush and rinse it away. *Caution: If your client has not flossed before, the gums may bleed when you try to floss. If s/he has heavy calculus or tartar deposits on the teeth, you may have difficulty getting the floss between the teeth. This is a situation beyond your scope of practice and you should record and report. Professional cleaning and instructions in oral hygiene techniques by the dentist or hygienist probably will be needed. Floss with fingers:. Follow a pattern so no teeth are missed. Use about 18 inches of floss; wrap loosely around 1 finger on each hand. Slip the floss gently between the first 2 teeth, pull the floss tight against one tooth (make a "C" shape around the tooth), gently slide the floss under the gum and scrape the plaque from the teeth in about 5 up-and-down motions. Trainer - Hands-on Practice - Script 3-3

4 Move to the adjacent tooth and do the same thing. Be careful not to cut the gum or jam the floss into the gum. Remove the floss and move to the next 2 teeth. As the floss becomes soiled, unwind the floss from one finger and wind on the other. Allow the client to rinse or swish with water and to spit it out. Floss with holder: Follow a pattern so no teeth are missed. Load floss on the holder or use single-use flossers. Use the holder in the same manner as described above, being careful not to cut or damage the gum tissue. You may need to "saw" back and forth to get the floss to slide between the teeth. Try to work the floss in an up and down motion as much as possible when cleaning the teeth. Allow the client to rinse or swish with water and to spit it out. Trainer - Hands-on Practice - Script 3-4

5 ~ Brushing Routine Brush two times per day, after breakfast and before bed The bedtime brushing is the most important one. We must clean our mouths at the end of the day so that food and plaque are not in the mouth all night. ~ Get ready to brush To prevent pulling or cracking of the lips, place a small amount of Vaseline on a swab and apply to the lips. (It is not necessary to reapply if you have just completed flossing.) Wet the toothbrush. Place just enough fluoride toothpaste on the brush to cover the bristles. Be sure that your client's head is stable. Have the client lean into a chair back or cradle his head in your arm. [;J Follow a routine for brushing Clean entire mouth with brush or toothette** (including tongue and all surfaces of teeth), using gentle motions. Follow a pattern so no teeth are missed. Place the bristles where the gums and teeth meet I make short brush strokes (small circles, "jiggles or wiggles"), count to 5 in each area, move to the next small area. Repeat. Start on the outside of the upper right side, brush around to the upper left, then move to the upper left inside (near the roof of the mouth) and around to the upper right inside. Brush the biting surfaces (grooves and pits hold food and germs) on all upper teeth. Repeat pattern for the lower teeth. Remember to brush the tongue and the roof of the mouth. Continue in this manner until you have brushed the outside, inside, and biting surfaces of all the upper and lower teeth. Allow the client to rinse or swish with water and to spit it out. o **Note: Toothettes, moistened gauze pads, or "Oral B Brush Ups" may not adequately clean the teeth and may push food further into the spaces between the teeth. They are useful in cleaning mouth tissues when there are no teeth or just a few teeth, or for a client who is comatose or unable to open his mouth. Trainer - Hands-on Practice - Script 3-5

6 o There have been incidents where the sponge came loose from a Toothette and became lodged in the client's throat. Extreme care should be used with this device. It is best for tissue care, applying medications, moisturizing dry tissue, or for clearing soft, non-attached soft debris from the mouth. ;] Rinsing If the service/care plan allows or requires, have your client rinse with fluoride rinse (over-the-counter item, such as ACT or Fluorigard) or antibacterial rinse (prescription item, such as chlorhexidine). Follow directions exactly. Avoid alcohol-loaded mouthwashes if your client has problems with dry mouth. Trainer - Hands-on Practice - Script 3-6

7 Denture Care r;] Denture Care Like natural teeth, dentures must be properly cared for to last. If the client does not have any teeth or wears dentures, the gums and. mouth should be cleaned once or more each day. Watch for, document, and report any problems a client may have with dentures such as discomfort, trouble eating, speech problems, complaints of the dentures not fitting correctly, sore spots under or around the denture, or odor. Use care in handling dentures. They can be very slippery and are easily broken if dropped even just a few inches. Replacing broken dentures can be very expensive-several hundred dollars per denture. Place a towel in the sink or fill the sink with water to prevent damage if the denture should drop. Do not soak dentures in bleach water. Bleach can remove the pink coloring, discolor the metal on a partial denture, or create a "metallic taste." [;J Suggested Supplies For clients with dentures or partials: Gloves, mask, goggles, gown or apron Basin Paper cup with small amount of water Towel Paper towels Denture cup Denture cleaning tablet Denture brush with regular or denture toothpaste or mild liquid detergent Lubricant for lips (Vaseline) on applicator (Q-tip) Toothette or gauze pads Moistened soft toothbrush with fluoride toothpaste (if client has some natural teeth) Dental floss (if client has some natural teeth) Floss holder loaded with floss (if client has some natural teeth) Other aids (mini-brushes for cleaning between the teeth, toothpicks, or dental sticks) as needed or per client's preference. Trainer - Hands-on Practice - Script 3-7

8 ~ Get Ready to Clean Dentures or Partials Ask your client if s/he can eat comfortably and if there are any sore areas in the mouth. To prevent pulling or cracking of the lips, place a small amount of Vaseline on a swab and apply to the lips. Watch for any sore areas, changes in tissue, or anything unusual. Brush daily. o Remove the'dentures or have the client remove the dentures, lower first, then the upper. o To remove the upper denture: Have your client keep "loose lips" while you gently slide your finger tips along the border of the upper denture from center front toward the back. When you reach the back edge, your fingers should be able to break the suction that holds the denture in place. o Rinse with cool running water before brushing. o Peel off any denture adhesive that may be present on the denture. o Use a regular toothbrush or a denture brush with toothpaste or denture toothpaste. Denture toothpaste is less abrasive than regular toothpaste and therefore better for the dentures. o Scrub thoroughly. o Rinse completely. o Return dentures to client. o Be sure your client's mouth is clean before you reinsert the denture. Soak overnight. o Never soak dirty denturesl o Brush dentures as outlined above. o Rinse denture cup and fill with cool water and denture cleaning product. o Place clean (brushed) denture in clean denture cup. o AIlow denture to soak overnight, (or for several hours, depending on dentist's recommendations or clients' preference). o In the morning, drain the used water. Clean denture cup. o Scrub the denture to remove loosened debris. Rinse well. o Return denture to client. Trainer - Hands-on Practice - Script 3-8

9 o Note: Some people like to sleep with their dentures in their mouths. In some cases, a dentist may even recommend this. This is okay IF dentures are cleaned thoroughly before bed. Additional daytime cleanings or even a one- or two-hour daytime soak could help make up for the lack of overnight soaking. Gently brush the gums, roof of the mouth, and the tongue before reinserting the denture. o Use a soft toothbrush, a moist washcloth or gauze pad, a toothette (small sponge on a handle), or Oral B"Brush Up" to clean these areas. A small amount of toothpaste can be used on the brush or toothette to give a fresh taste. o o Note: Toothettes, washcloths, gauze pads, and Brush Ups may not adequately clean the teeth and may push food further into the spaces between teeth. They are useful in cleaning mouth tissues when there are no teeth or just a few teeth, or for a client who is comatose or unable to open his mouth. There have been incidents where the sponge came loose from a Toothette and became lodged in the client's throat. Extreme care should be used with this device. It is best for tissue care, applying medications, moisturizing dry tissue, or for clearing soft, nonattached soft debris from the mouth. Warning: "Do not put any liquids, toothpaste, etc. in the mouth of a client who is comatose, combative, or has swallowing defects. Use a toothbrush dipped in mouthwash to brush the gumline, teeth, and inside the mouth." Check for cracks, sharp edges, or broken teeth. o If you find cracks, sharp edges, or broken teeth, notify your supervisor or your client's case manager. o DO NOT attempt home repairs. o If you do NOT find a problem, return denture to client. o Rinse and clean the denture cup and supplies. o Remove gloves and wash hands. o Return supplies and denture cup to proper storage. o Record procedure. Report observations if necessary. Trainer - Hands-on Practice - Script 3-9

10 The Uncooperative Client ~ Dental Care and Uncooperative Clients Protect yourself Work from behind and NEVER place your fingers between the teeth if there is a fhance that you could be bitten. Create a favorable environment a Try to find a time or location that is comfortable for your client and comfortable for you. a Begin with "show-tell-do." Show your client the toothbrush or floss. Tell him/her what you would like to do. Do it. This shows respect and prepares the client for care. a Try soothing your client by: Asking (another) family member to hold client's hand Gently cradling client's head while working Singing or telling a story Other Tips a If client is reluctant to open mouth, try tapping gently with toothbrush along cheek toward mouth. Often this will encourage folks to open. a If client is unwilling or unable to open teeth but you can get a finger inside the lips, you may be able to brush the outside of the teeth and clean out any food the client may be pocketing there. a Just do the best job you can. Try again tomorrow. Trainer - Hands-on Practice - Script 3-10

11 Monitoring Oral Health ~ Oral Inspection Ask daily: a Are you able to eat comfortably? a Are you having any pain or discomfort? Monitor teeth, gums, tongue, lips monthly a Use a flashlight to look for red or white areas, sores, or other abnormalities. You can wrap the flashlight in plastic wrap or a sandwich bag to prevent cross-contamination. a Pick a date to inspect each month. Mark on the calendar! a This is in addition to the observations you make every day during oral care. a Follow the same pattern that you use in brushing and flossing. a (Example: Start on the upper right outside, work around all of the outside areas, then move to the inside of the upper, working back to the upper right. Follow the same routine for the lower teeth. Pull the lips out and check the space between the lips and the gums. Also check the tongue.) a a Be sure to record and report any problems. Any areas that don't heal within 2 weeks should be checked by a physician or a dentist. Replace toothbrush every 3 months (or sooner if the bristles are frayed) or after an illness like the flu or a cold. a Dentists recommend soft brushes because they are more gentle on teeth and gums. ~ When and How to Refer If you see something unusual, record in the service/care plan and report to your supervisor or your client's case manager. Identify what you see, where it is, the size, color, and shape, and any other important observations. Your supervisor or your client's case manager will then determine the appropriate action. Sores in the mouth that do not heal within 2 weeks should be checked by a medical or dental provider. Trainer - Hands-on Practice - Script 3-11

12 Oral Health for Caregivers Proficiency Stations for Hands-on Practice Divide into groups of 3: A performer, a reader/observer, a recorder. Each trainee will participate in all 3 activities at each station. You will find the "Hands-on Practice Checklist" in trainer's manual. Provide one for each student. Performer will demonstrate the skills. Reader/observer will coach performer on the steps to follow for each procedure, using the "Hands-on Practice" text from your manual. Recorder will mark the skills completed on Checklist. Recorder may also serve as the "client" for some stations. Station 1: Flossing, Brushing, Other Aids Supplies: Dental floss, floss holders, toothbrushes, fluoride toothpaste, interproximal brushes, adaptive aids (commercial or home-made), mouth model. Station 2: Denture Care Supplies: Denture or partial denture, or mouth model, or photos of dentures & partials; denture brush, denture toothpaste, denture cleaner product or mild (dishwashing) detergent. Station 3: Uncooperative Client Supplies: Toothbrush, toothpaste, washcloth or other mouth props. (The "client" may perform as an uncooperative person.) Station 4: Monitor & Document "Oral Health Photo Guide," flashlight, baggie or Saran Wrap, pen or pencil. Pretend to inspect your "client's" mouth, describing the pattern that you follow: Teeth, gums, cheeks, lips, tongue. Start on the upper right "outside," move to the upper left "outside," then to the upper left "inside," to the upper right "inside." Do the same for the lower. Check the lips and tongue. Trainer - Hands-on Practice - Script 3-12

13 Station 4: Monitor & Document Using the "Oral Health Photo Guide," choose one photo and pretend that you notice something unusual in your client's mouth when performing your monthly monitoring. Write below what you would record in the service/care plan. Answer all that apply. What do you see? Where do you see it? What is the size? Measurement, like";} inch" or "t inch" Description, like "the size of a pencil eraser" or "the size of a dime" What is the color? Brown, black, red, white, combination? What is the shape? Round, irregular, long, thin, thick? Is it tender or painful? Is it blistered or is it crusty? Is it "weeping" or "oozing"? Any other observations? Today's date _ _ Date to re-check (2 weeks from now) _ Trainer - Hands-on Practice - Script 3-13

14 Oral Health for Caregivers Hands-on Practice Checklist Student Name _ Date _ Station & Skills Completed Observer SWIPES technique used; supplies gathered (Check) Initials Station 1: Flossing, Brushing, Other Aids A. Flossing Uses fingers to floss between all teeth and behind the last tooth. Uses floss holder to demonstrate the same. B. Brushing Dispenses fluoride toothpaste to brush (imaginary). Brushes all upper and lower teeth using gentle circular or small vibrating motions, following a pattern so no teeth are missed. Brushes the tongue (imaginary). C. Other Aids Demonstrates the use of interproximal (mini) brushes. Demonstrates how to fashion and use adaptive aids for flossing or brushing. Describes use of fluoride rinse. Station 2: Denture Care A. Applies denture toothpaste or mild soap (imaginary) to denture brush. Brushes all teeth and the under side of denture. Rinses denture. Inspects for cracks, chips, or sharp edges. Returns denture to client. B. Soaks denture with commercial product (imaginary). Brushes soaked denture. Inspects for cracks, chips, or sharp edges. Returns denture to client. Station 3: Uncooperative Client A. Demonstrates use of washcloth or mouth prop. Uses "Show-Tell-Do" technique with "client." Demonstrates how to cradle "client's" head for stability. Station 4: Monitor & Document A. Inspects client's mouth using a flashlight. Follows a pattern so no areas are missed: Teeth, gums, cheeks, lips, tongue. B. Documents unusual findings: Location, si ze, color, shape, other significant observations. (See previous paqe for quidance.) Trainer - Hands-on Practice - Script 3-14