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Oral Care: Part 5 Preparing for Oral Care and Communication Techniques


Oral Care: Part 5 Preparing for Oral Care and Communication Techniques Using a Best Practice Approach in Long-Term Care February 2008 Central South ... – PowerPoint PPT presentation

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Title: Oral Care: Part 5 Preparing for Oral Care and Communication Techniques

Oral Care Part 5 Preparing for
Oral Care and Communication Techniques
  • Using a Best Practice Approach in
  • Long-Term Care

Introduction Learning Objectives
  • Learn about
  • A best practices approach to oral hygiene care
  • Implementing general oral hygiene care strategies
  • Preparing for oral care
  • Toothpaste and Toothbrush Tips
  • Denture Care Tips
  • Communication techniques for oral care

Evidence-Based Approach to Oral
Care for Older Adults from IOWA
  • This evidence-based model of the importance of
    oral hygiene care and dental treatment on
    maintaining oral health from IOWA highlights
    several key areas
  • Regular daily oral care
  • Preventive oral care
  • Assessment
  • Secondary tertiary dental care
  • ?
  • Impacts
  • Systemic health
  • Nutrition
  • Quality of life
  • Overall well-being

Develop an Individualized Oral Hygiene
Care Plan
An individualized Oral Hygiene Care Plan enables
care providers to focus on appropriate oral care
interventions for the resident Oral Hygiene Care
Plan should be developed on admission, quarterly
and as a residents oral status or self care
abilities, cognitive or functional impairment
RNAO Oral Health BPG Care Planning
RNAO Oral Health BPG Care Planning
RNAO Oral Health BPG Care Planning
A Best Practices Approach to Oral Care in LTC
  • Care Planning Strategies
  • Implement general oral hygiene care strategies
  • Preparing for oral care
  • Toothpaste and toothbrush tips Natural teeth
  • Denture care
  • Communication techniques for oral care
  • Techniques for getting in the mouth
  • Handling responsive behaviours
  • Handling communication, cognition functional
  • Dry mouth and swallowing problems
  • Palliative oral hygiene care

Preparing for Oral Care
  • Familiarize yourself with
  • Severity of residents cognitive impairment
    residents responsive behaviours (pushing,
    turning head, biting)
  • Residents communication sensory impairments
  • Residents functional impairments (arthritis in
    hands, mobility)

Preparing for Oral Care
  • Oral care should be completed at least 2x each
  • Never awaken a resident to complete oral care
  • Oral care should be done in the bathroom,
    whenever possible, because of its physical cues
    (i.e., sink, water, etc.)
  • Review the residents oral care plan
  • Review if the resident has dysphasia
    (i.e., problems swallowing,
    choking, spitting)

Preparing for Oral Care
  • Assemble all oral care supplies and have them
    ready to use in the residents bathroom, before
    you bring them into the bathroom
  • Check that the oral care supplies are labeled
    with the residents name
  • NEVER use toothpaste or mouth rinses with
    residents with swallowing difficulties WATER
  • NEVER use lemon glycerin swabs for oral care

Preparing for Oral Care
  • Always communicate to the resident what you are
    planning to do talk about it when getting
    youre ready no surprises !
  • Have the resident do as much of their oral care
    as they can possibly do. It may not be perfect
    and offer to finish areas they may have missed
  • Explain to the resident and describe the oral
    care tasks (steps) you want them to do or will be
  • Remember Always use proper body positioning
    when providing oral care

Toothpaste Tips
  • Natural Teeth
  • Use pea-sized amounts of toothpaste,
    squeezing out a long strip of toothpaste
    is too much
  • Most toothpastes have a strong taste, many
    residents dont like this, not appealing to
    residents with Alzheimers Disease
  • Foaming action of toothpaste increases saliva
    flow will result in the resident wanting to
    spit gtgt choke, gag
  • DO NOT use toothpaste for residents who have
    dysphagia, who cannot swallow or spit/rinse
    properly, have high level of dementia - there
    are oral cleansing gels available

Toothbrush Tips
  • Natural Teeth
  • The best type of toothbrush to use for residents
  • is one with a small head, soft bristles, larger
    handle with rubberized grip
  • 2-Toothbrush Technique
  • For residents who bite down during care, consider
    using 2 toothbrushes one to prop the mouth open
    and one for cleansing
  • Replace toothbrush
  • every 3 months or after an infection

Denture Care
  • Plaque tartar form on dentures just the same as
    they form on natural teeth
  • Remove dentures daily for at least 3 hours for
    gums to rest, overnight is easiest
  • Ask the resident to remove their dentures.
    Assist, if they cant
  • For upper dentures
  • slide your index finger along the dentures side
    then push gently against the back of the denture
    to break the seal. Grasp it and remove by
    rotating it. Grasp lower dentures at the front
    and rotate.
  • For partial dentures
  • place thumbnails over or under the clasps, apply
    pressure, being careful to not bend the clasps
    and catch them on lips or gums.

Denture Care
  • Cleaning dentures
  • Wear gloves
  • Line the sink with a towel. Fill it with some
    cool water just in case the dentures slip and
    fall. Hot water can warp dentures.
  • Rinse with cold water to remove food
  • Scrub dentures using a denture brush and denture
  • Thoroughly brush all surfaces especially those
    that touch the gums. Rinse well.

Denture Care
  • Cleaning dentures
  • At bedtime, place dentures in denture cup with
    cool water and vinegar (½ water and ½ vinegar)
  • Only soaking them overnight with a cleansing
    table is not sufficient it doesnt clean off
    the plaque
  • NEVER use denture tablets for soaking dentures of
    residents with dementia - ingestion of
    tablets/solution is serious
  • Never use vinegar on dentures with any metal on
    them as this will cause the metal to turn black.

Denture Care
  • Clean the mouths of residents who wear dentures
  • If the residents lips are dry, moisten them with
    a non-petroleum based product (e.g. Lipsol)
  • Always brush mouth tissues with a regular soft
    bristled toothbrush
  • including the tongue, palate, cheeks and ridges
    of mouth
  • In morning, rinse dentures well before placing in
    residents mouth
  • Always put the upper denture in first then lower
    one to avoid gagging
  • Denture cups should be scrubbed weekly to prevent
    bacterial or fungal growth and replaced monthly

Communication Techniques for Oral Care
Task Breakdown the activity or task is broken down into steps which are individually and slowly presented Distraction the use of singing, holding items, gentle touch and talking to distract a resident from a distressing situation
Share an example of how you might use task breakdown when assisting a resident with oral care . . . How might you distract a resident so that you can proceed with oral care ?.
Communication Techniques for Oral Care
Hand-Over-Hand the caregivers hand is placed over the residents hand to guide the resident through the activity Rescuing a second caregiver enters a situation and offers to help the resident by taking over for the initial caregiver
Have you ever used this technique? How did it work? For residents with dementia, have you ever used this technique? Share an example when it worked.
Communication Techniques for Oral Care
Bridging to improve sensory connection and task focus, the resident holds the same object while the caregiver carries out the activity Chaining the caregiver starts an activity and the resident completes it
Have you ever used this technique? How did it work? Have you used a different object? Its cueing or prompting with an additional jumpstart of showing. Have you ever used it for oral care?
Resource Tools
Resource Tools
Resource Tools
  • Halton Region Health Departments Dental Health
    Division has developed an extensive oral care
    education program called K.I.S.S. for LTC
  • to assist staff to develop better oral care
  • with full explanations and picture-based
    step-by-step instructions

  • Canadian
  • The Registered Nurses Association of Ontario
    (2008) . Oral health. Nursing assessment and
    interventions. Toronto, ON Author. www.rnao.org
    (Recommendations Fall 2007).
  • The Registered Nurses Association of Ontario and
    Halton Region Health Department (Summer 2007).
    Oral care for resident with dementia
    (DVD)Toronto, ON Author. www.rnao.org or phone
    Dir (416) 907-7965 Fax(416) 907-7962 15
  • ML van der Horst (April 2007). The BP Blogger.
    Myth busting The mouth issue. Monthly
    newsletter for LTC that dispels care myths with
    evidence from best practice guidelines. Available
    at www.rgpc.ca
  • Halton Region Health Department (2006). Dental
    health manual for LTC home staff. Halton oral
    health outreach project. Oakville, ON Author.
  • Centre for Community Oral Health- Long Term Care
    Fact Sheets. Nov 2006 www.umanitoba.ca/faculties/
  • Best Practice Coordinators in Long-Term Care
    Initiative Central South/South West (February
    2008). Best Practices Approach to Oral Care
    Resource Kit. www.rgpc.ca
  • Oral Care.ca www.oralcare.ca

  • Others
  • The University of Iowa College of Nursing (2002).
    Oral hygiene care for functionally dependent and
    cognitively impaired older adults.
    Evidence-based practice guideline. Iowa City,
    Iowa Author/Gerontological Nursing Interventions
    Research Center. www.nursing.uiowa.edu
  • Joanna Briggs Institute (2004). Oral hygiene
    care for adults with dementia in residential aged
    care facilities. Best Practice, 8(4). Adelaide,
    Australia Author. www.joannabriggs.edu.au

  • Fallon, T., Buikstra, E., Cameron, M., Hegney,
    D., Mackenzie, D., March, J., Moloney, C.,
    Pitt, J. (2006). Implementation of oral health
    recommendation into two residential aged care
    facilities in a regional Australian city.
    International Journal of Evidence-Based
    Healthcare, 4, 162-119.
  • Federal, Provincial and Territorial Dental
    Directors. (2005). A Canadian oral health
    strategy. Accessed January 4, 2007. Available at
  • Frenkel, HF., Harvey, I., Needs, KM. (2002).
    Oral health care education and its effect on
    caregivers knowledge and attitudes a randomised
    controlled trial. Community Dentistry and oral
    Epidemiology, 30, 91-100.
  • Frenkel, H., Harvey, I., Newcombe, RG. (2001).
    Improving oral health in institutionalised
    elderly people by educating caregivers a
    randomised controlled trial, 29, 289-297.
  • Nicol, R., Sweney, MP., McHugh, S., Bagg, J.
    (2005). Effectiveness of health care worker
    training on the oral health of elderly residents
    of nursing homes. Community Dentistry and Oral
    Epidemiology, 33, 115-124.
  • Pearson, A. Chalmers, J. (2004). Oral hygiene
    care for adults with dementia in residential aged
    care facilities. Systematic review. JBI Reports,
    2, 65-113.

  • Seniors Oral Health Collaboration for the Nova
    Scotia Department of Health (SOHC). (2006). The
    oral health of seniors in Nova Scotia. Policy
    Scan and Analysis Synthesis report. Accessed
    January 15, 2007. Available at
  • Thorne SE, Kazanjian A, MacEntee. (2001). Oral
    health in long term care The implications of
    organisational culture. Journal of Aging Studies,
    15, 271-283.
  • US Department of Health and Human Services (US
    DHHS) (2000). Oral Health in America A Report of
    the Surgeon General. Rockville, MD National
    Institute of Dental and Craniofacial Research,
    National Institutes of Health. Accessed January
    15, 2007. Available at http/www.nidr/nih.gov/sgr
  • Wardh, I., Hallberg, L., Berggren, U.,
    Sorensen, S. (2003). Oral health education for
    nursing personnel experiences among specially
    trained oral care aides One-year follow-up
    interviews with oral care aides at a nursing
    facility. Scandinavian Journal of Caring Science,
    17, 250-256.
  • WHO. (2003). The world oral health report.
    Continuous improvement of oral health in the 21st
    century the approach of the WHO Global Oral
    Health Programme. Geneva, SW author. Accessed
    January 15, 2007. Available at

For more information
  • Mary-Lou van der Horst, RN, BScN, MScN, MBA
  • Regional Best Practice Coordinator Long-Term Care
  • Central South Region-Ministry of Health and
    Long-Term Care
  •  Village of Wentworth Heights LTC Home
  • 1620 Upper Wentworth Street, Hamilton, ON Canada
    L9B 2W3
  •   email    mvanderhorst_at_oakwoodretirement.com    
  • tel     905.541.0656 
  •      fax     905.575.4450    
    LTC Best Practice Resource Centre
  • www.rgpc.ca
  • Donna Scott, RN, BScN, CHRP
  • Regional Best Practice Coordinator Long-Term Care
  • Southwest Region-Ministry of Health and Long-Term
  • Parkwood Hospital
  • 801 Commissioner's Road East
  • London, ON Canada N6C 5J1
  • Email donna.scott_at_sjhc.london.on.ca
  • Tel 519-685-4292 x42337
  • .
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