Good Oral Health: The Path to Good Overall Health Leading Age Spring Conference May 2, 2018 Carole Ferch, RDH Carol Van Aernam, RDH, BA Copyright 2018 IOWA CAREGIVERS All Rights Reserved Multi-stakeholder Coalition With Shared Goal: Ensure access to optimal oral health for aging Iowans We Represent Two (of 3) Lifelong Smiles Coalition-Led Projects Funded by Delta Dental of Iowa Foundation I-Smile Silver - Project of Iowa Department of Public Health Mouth Care Matters Project of Iowa CareGivers University of Iowa College of Dentistry Center for Education and Training 1
Oral Health Education & Training I-Smile Silver provides high quality in-services on oral health and hygiene care which may meet your requirements for staff training in this area (Calhoun, Des Moines, Hamilton, Humboldt, Lee, Pocahontas, Scott, Van Buren, Webster, and Wright Counties) Mouth Care Matters (MCM) is a one-day oral health specialty training suitable for all staff. MCM instructors can also provide in-services The health of our mouths impacts the rest of the body. Problems in the mouth can negatively affect a person s overall health and wellness. 2
Do you need your teeth? Good Oral Health Allows People To: Eat healthy food for good nutrition Chew food for healthy digestion Taste and enjoy food Speak clearly to interact with others Feel good about themselves Maintain an attractive appearance 3
Germs (bacteria) in the mouth Plaque is a sticky, colorless film of germs that collects on teeth. If not brushed and flossed off regularly, it causes tooth decay and gum disease. Tooth Decay + Germs/Plaque Carbohydrates Acid + Acid Tooth Cavity (tooth decay) 4
Cavities (tooth decay) The FORM of food matters Stickier food stays on teeth longer How often that food is eaten matters (FREQUENCY) Acid stays in the mouth for several minutes Limit eating sugary and starchy foods/drinks to meals Gum disease Gingivitis: germs cause inflamed (red), bleeding gums Gum Disease (Periodontitis) germs begin to break down the bone and gums around teeth 5
THE ORAL SYSTEMIC CONNECTION The Oral Systemic Connection A healthy mouth is especially important for frail, vulnerable older adults. Germs from unclean teeth can enter the bloodstream through infected gums. Germs from infections in the mouth can reach the heart, lung, kidneys, brain, and joints. 6
Gum Disease and Tooth Decay are Bacterial Infections = The Oral Systemic Connection: Diabetes Diabetics with gum disease have more difficulty controlling their blood sugar level (and vice versa) Gum disease is a strong predictor of death from complications of diabetes.. 7
The Oral Systemic Connection: Aspiration Pneumonia Not brushing teeth to remove germs is a significant risk factor for aspiration pneumonia. Germs may be aspirated into the lungs Good Oral Hygiene is Important Pneumonia is the number one cause of death in nursing homes. EFFECTIVE ORAL CARE CAN DECREASE MORTALITY DUE TO PNEUMONIA BY HALF 8
A Look at Conditions in the Mouth Normal vs. Abnormal Lips Healthy: Smooth, pink, moist Changes: Dry, chapped, or red at corners Unhealthy: Swelling or lumps, white/red/ulcerated patch, bleeding/ulcerated at corners 9
Natural Teeth Healthy: No decay, no broken teeth/roots 1-3 decayed or broken teeth/roots or very worn down teeth 4+ decayed or broken teeth/roots, worn down teeth, or less than 4 teeth Tongue Normal, moist, roughness, pink Patchy, fissured, red, coated Patch that is red and/or white, ulcerated, swollen 10
Gums and Tissues Pink, moist, smooth, no bleeding Dry, shiny, rough, red, swollen, one ulcer/sore spot under dentures Swollen, bleeding, ulcers, white/red patches, generalized redness under dentures Saliva Moist tissues, watery and free flowing saliva Dry sticky tissues, little saliva present, residents thinks they have a dry mouth Tissues parched and red, very little/no saliva present, saliva is thick, resident thinks they have a dry mouth 11
I m not sure if what I is see is normal or unhealthy? What should I do? OBSERVE AND REPORT Saliva is Important! Gets food ready to be swallowed for good digestion Makes the mouth less acidic Remineralize (strengthens) weak tooth enamel Keeps the mouth moist so it is easier to eat, taste, swallow, and speak 24 12
Common Causes of Dry Mouth (Xerostomia) Medications Cancer Treatment Radiation Treatment Dehydration Alcohol Use Smoking Mouth Breathing Age Oral Care for Dry Mouth Sip water throughout the day Use sugar-free gum and mints (with xylitol) Brush regularly Do NOT use cough drops or hard candy Use special products: Rinses for dry mouth (Biotene), Prescription fluoride toothpaste, Alcohol-free mouthrinse with fluoride 13
The Role Direct Care Workers Decide: Can the person served brush on their own? Then prompt, assist, or perform oral hygiene care daily Follow recommendations made by dentists or hygienists Watch closely to see if there are changes to the mouth (lips, gums, teeth) Observe and report problems to the nursing supervisor Non-Verbal Signs of Oral Problems Weight loss Becoming agitated at mealtime Refusing to eat Changing food preferences Touching cheek/mouth more often Swelling, uneven facial features Warm, puffy cheeks or chin Refusing to wear dentures or removing them to eat Bad breath 14
BEFORE YOU BEGIN, consider these things: Oral hygiene care should be completed AT LEAST twice a day, or as often as the assessment indicates Provide oral hygiene care in the bathroom or best location and time Avoid awakening the person served; provide oral hygiene care when he/she is alert Before Brushing By Staff After Brushing By Staff 15
Denture Care Cleaning the dentures and gingiva (gums) of the mouth are just as important as brushing natural teeth. Plaque accumulation is only removed by brushing. Photo taken on long term care unit.. 32 16
CANDIDA Pointers! Tips! Select a good time of day and location Smile Explain what you are doing Sing songs Have the person served hold a familiar object Compliment often! 17
Pointers! Tips! Always let the person served know what you will be doing Have the person served do as much as they can, then finish what they could not do Stand behind or at side of person served while providing care Always use universal precautions DAILY ORAL CARE = INFECTION CONTROL 18
Good Oral Health Healthy Mouth Healthy Brain Healthy Body AVAILABLE RESOURCES: IOWA CAREGIVERS (IC) MOUTH CARE MATTERS (MCM) 8-HOUR CLASS FOR DIRECT CARE STAFF Classroom instruction and hands-on practice. Taught by certified MCM instructors. Learn to identify common oral health problems. Learn basic oral care and various approaches. Learn how oral care impacts one s overall health. Iowa CareGivers issued certificate with permanent records maintained for portability. MOUTH CARE MATTERS (MCM) FOR NURSES, SOCIAL WORKERS, SUPERVISORY AND OTHER STAFF 19
AVAILABLE RESOURCES: IN-SERVICES: 3 ONE-HOUR CLASSES FOR DIRECT CARE STAFF Provided by I-Smile Silver Coordinators in Calhoun, Des Moines, Hamilton, Humboldt, Lee, Pocahontas, Scott, Van Buren, Webster, and Wright Counties or Iowa CareGivers As Funding Permits and/or Fee for Service Oral Health for Caregivers Approaches for Providing Oral Hygiene Care Helpful Techniques for Oral Hygiene Care More Information About FUTURE TRAINING Mouth Care Matters (MCM) September 18, 2018 Davenport Efforts underway to provide more as $ allows www.iowacaregivers.org/education/mouth-care-matters.php 20
FOR MORE INFORMATION ABOUT THIS PROGRAM: CONTACT: Carole Ferch: Carole.Ferch@scottcountyiowa.com Carol Van Aernam: cvanaernam@aol.com 21
Lifelong Smiles Coalition: http://www.lifelongsmilescoalition.com/ I-Smile Silver - Project of Iowa Department of Public Health: Tracy.rodgers@idph.iowa.gov https://ismile.idph.iowa.gov/about-ismile/silver Mouth Care Matters Project of Iowa CareGivers MaryAnn@iowacaregivers.org www.iowacaregivers.org University of Iowa College of Dentistry Center for Education and Training www.dentistry.uowa.edu/ce THANK YOU: Iowa CareGivers Mouth Care Matters Iowa Department of Public Health I-Smile Silver Lifelong Smiles Coalition 22