Kent Community D ental S ervice Aims B e able to provide oral health education to the carers to improve knowledge on oral health To be able to build carers confidence in completing oral health assessment ID: 910486
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Slide1
Smiling mattersOral Health care in care homes
Kent Community
D
ental
S
ervice
Slide2Aims
B
e able to provide oral health education to the carers to improve knowledge on oral health
To be able to build carers confidence in completing oral health assessment
To understand the importance of brushingTo understand what dry mouth is and how to manage it.To provide information on denture careTo demonstrated how to assess oral health
Objectives
Slide3Why is this training being provided?
CQC report “
Smiling
matters: oral health care in care homes” June 2019.52% care homes did not have policy to promote and protect people’s oral health,73% of care plan reviews did not cover oral health47% of the staff members had never received training in oral health care. CQC stated that “it wants care home to embrace oral health and ensure that it receives the same priority ad physical and mental health”.
Slide4Why is it important…??We use our mouth to: chew, swallow, taste food, communicate/talk, express emotions
Some bacteria associated with general health- pneumonia, cardiovascular disease, Alzheimer's, Diabetes
How can dental pain affect our daily life??
Unable to eat/drink: lack of nutrition, affect on general health- immune system
Affects mood: grumpy, angry, tearful, unresponsiveUnable to sleepTrouble talkingCost- travelling to/for appointments, payments for the treatmentDepend on carers or family members for self care
Slide5Slide6Why is this training important?
Holistic care
Prevention: reduce risk of caries, gum disease, keep the teeth longer
Older people are more at risk of oral diseaseMedication side effectsFrail and dependent due to reduced manual dexterity Inadequate oral hygiene care
Slide7Dry mouth
Brushing
Denture care
Topics Assessing oral health
PlaqueTooth decay (caries)
Gum disease
Slide8Slide9Gum disease
Inflammation of the gingiva (gum)
Gingivitis
: early stage, short duration characterised as inflammation of the gum and its reversible.Periodontitis: irreversible, long duration characterised by inflammation of the gums and the supporting periodontium; periodontal ligament and the bones which are destroyed/lost.Diabetic has increases risk of developing periodontal diseaseSign and symptoms:BleedingBad breathRed and sore gumsLoose teethSensitivityRecessionPlaque and calculus present
Slide10Slide11Brushing
Reduce bacterial load
as some bacteria found in the mouth are associated with severe disease to general health (e.g. heart disease)
Why is
brushing important?
Reduce caries
Prevent pain
Prevent infection
Fresh breath
Remove plaque
Prevent bleeding
Prevent bad taste
Prevent inflammation
Slide12Brushing
Use fluoride tooth paste (1350-1500ppm)
Place the toothbrush at the gum line
Angle the toothbrush head slightly towards the gumSmall gentle circular motionEnsure to brush inside, outside and chewing surfaces Brush for at least 2 minutes
Slide13Most important to brush
Before bed time-
reduced saliva production, increased bacterial activity due to reduced saliva antibacterial/buffering properties
Any time during the daySpit no rinseRequires a lot of patience and time Ask the residents how they would like to brush and what form of help they want
Slide14What type of tooth brush..?
Electric or manual
Small headed
Tooth brush adaptorsTennis ballPutty/clay gripSuper brush Use of weight to control muscle movements
Slide15Where to look for fluoride content in a toothpaste package
1350-1500ppm
Fluoride
Sodium fluorideStannous fluoride
Slide16Dry mouth
Absence
or
reduction of saliva production/flow, this could be due to age, reduced salivary glands function, diabetes, side effects of medication, post radiotherapy or chemotherapy, mouth breathing etc.Saliva acts as lubricant, has anti-microbial/bacterial properties, neutralised the oral cavity; pH neutralSome medications that can cause dry mouth: High blood pressureAntihistamineAntidepressant
Slide17How to identify it?
Lips
: looks very
dry and chapped, sore and cracked corner of the lipsMouth red and shiny Unable or difficulties to eat/chew/swallowing food, taking very long time to eatDifficulties on talkingIncreased cariesBad breathComplaint about having thick and stringy salivaBurning/tingly sensation or sensitive to certain food; spicy, citric, alcohol Unable to wear the dentures
Slide18Management
Drink plenty of water, sip plain water through out the day
Salivary stimulants/substitutes: gel, spray, tablets, lozenges- consult with GP
Sugar free sweets If breathing through mouth consult with GP to assess any issues with nasal passageReduce alcohol, tea and coffee contentStop smokingIf dry mouth is due to medications, consult with GP regarding alternative medications Avoid tooth paste containing Sodium Lauryl Sulphate (SLS)Avoid citrus and spicy food
Slide19Other conditions associated with poor oral hygiene
Candida infections: white patch, e.g. thrush
Ulcerations
Stomatitis Angular chelitis; sore and cracking of the corner of the lips/mouthOral cancer General health: Bacteria associated with:Cardiovascular (heart) disease; infective endocarditis- bacteria causing infection, increases risk of Alzheimer’s, PneumoniaIf in doubt book an urgent appointment with GP or dentist
Slide20Slide21Denture care
Clean them after meal
Remove the denture, run it under cold water for few minutes, ensure that the denture is held above a small pot. Denture brush can be used to remove debris on the denture.
Avoid using toothpaste as this can create pores and damage the denture. Once a week the denture can be soaked in a denture solution. Remove them every night and store it in labelled denture pot with cool water.If visible debris are present and the denture brush is unable to remove it book an appointment with the dentist for the denture to be cleaned professionallyIf the denture does not fit well, is rubbing against the gum or palate, causing discomfort while eating, book and appointment with the dentist.Denture adhesion can be used to keep the denture in place but liaise with the dentist first
Slide22Oral Health Foundation:Denture care guidelines
Slide23Slide24How to assess oral health?
Face: is it symmetrical?
Lips: is it cry/chapped?
Corner of the mouth: crackingInside the mouth:Inside of the lipsTongue: top, left, right and underneathCheeksPalateGumsTeeth: loose, lost filling, broken teeth, sharpTongue, cheeks, lips, gums- assess that its smooth and pink/red. No presence of swelling, lumps, ulcer, blisters.How clean is the mouth? Plaque: soft and cream/white around the gums, calculus: hard/discoloured/blackCheck that the dentures fit well
Slide25Slide26Medication that can have an effect on oral health
Common examples are:
Antihypertension (high blood pressure); calcium channel blockers
Anti depressantsAntihistaminesAnti-epileptic drug: phenytoin Immunosuppressant: cyclosporine If unsure about the presence of the signs please liaise with the GP.Alternative medication can be requested to prevent or reduce the side-effects of the medications on the oral health.
Slide27Seeing a dentist
E
nsure that all resident registered to the dentist and having a regular
check-up. NHS choice- search for dental practice near the care home Local general dental practice: some dental practice have few emergency slots available but this does not mean they will see them as there might be other patients who is in need of the dentist more Out of hour dental service: DentalineHome visitsComplex cases: referral to community dental service
Slide28www.kentcht.nhs.uk/services/dentalDental Domiciliary Service Download packs
Online referral form
Referral Management team: 0330 123 9438
Slide29Resources
CQC report: June 2019 “Smiling matters- Oral health care in care homes”
Oral Health Foundation: Denture care guidelines
https://www.dentalhealth.org/denturecareguidelines Dent-O-Care: OH aidsNHS choiceDelivering better oral health: an evidence-based toolkit for preventionMouth care mattersAlzheimer’s society: https://www.alzheimers.org.uk/get-support/daily-living/dental-care