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Oral health care planning in residential care

The second step to help maintain a resident's oral health is oral health care planning. The outcome of the oral health assessment will help inform the care planning process.

Residents, particularly those with dementia, are at high risk of poor oral health. The provision of oral health care in the residential aged care setting has a strong focus on quality of life and treatment to relieve symptoms rather than curing oral disease.

A targeted approach to oral health care is taken to protect residents against further deterioration of their oral health status. This includes the use of dental products such as high fluoride toothpaste and antibacterial products.

Protective oral care regimen

Care of natural teeth

  • use high strength 5000ppm fluoride toothpaste
  • brush teeth twice a day
  • use a soft toothbrush and a pea sized amount of toothpaste
  • encourage spit but don’t rinse after brushing
  • modify toothbrushes as necessary by bending backwards or forwards to help access a resident’s mouth
  • change toothbrushes every three months.

Care of dentures

  • brush dentures twice a day
  • use a denture brush with mild liquid soap and water or a denture paste
  • use a soft toothbrush to clean gums and tongue
  • remove dentures overnight storing them in a sealed container of clean water
  • disinfect dentures once a week
  • ensure dentures are labelled with the resident’s name.

Care of gums

  • apply an alcohol free, non-teeth staining chlorhexidine product once a day after lunch.

Relief of dry mouth

  • use saliva substitutes and stimulants
  • keep the mouth moist by sipping plain tap water
  • limit sugary food or drinks, juice, tea and coffee
  • use a water-based lip moisturiser.

Reduce tooth decay

  • reduce the frequency of sugar intake between meals
  • encourage a selection of tooth friendly alternatives in food, drinks and medication
  • encourage a drink of plain tap water after meals, snacks, other drinks and medications.

Oral health care and changed behaviours

Residents, especially those with dementia, can behave in ways that makes it difficult for aged care staff to provide oral health care.

Recommended strategies for managing changed behaviours include:

  • using effective verbal and non-verbal communication
  • using behavioural intervention techniques such as bridging, chaining, hand-over-hand, distraction and rescuing
  • using modified oral hygiene aids such as a backward bent toothbrush
  • modifying oral care application techniques; for example, using short-term alternatives to brushing, such as spray bottles.

Palliative care considerations

The protective oral hygiene care regimen aims to maintain the best possible oral health and provide comfort to the resident. This regimen and additional treatments as prescribed by a GP and/or a dentist can be implemented to the end of life. At the end stages, modified oral hygiene aids and modified oral care application techniques can help aged care staff to maintain a resident’s oral comfort.

Oral swabs are frequently used in palliative care. They are useful for applying products to treat oral infection. Gentle brushing with a soft or very soft brush, with aged care staff using a backward bent toothbrush to access the mouth, may be more effective than swabs at removing dental plaque.

Discomfort from dry mouth is common at the end stages of life. Dry mouth products are more therapeutic than moistened swabs to hydrate the mouth.

Solutions or substances with a pH lower than 5.5 (acid condition) are not recommended as they can irritate the mouth and cause pain. Similarly, citric substances such as lemon may increase the sensation of dry mouth. Products with alcohol as an ingredient should be avoided as they can also contribute to dry mouth and damage oral tissue.

Self learning activities

Learn more about oral health care planning

Oral Health Care Planning Guidelines (PDF 897KB) provides a concise description of the rationale and oral care recommendations for the standard protective oral care regimen, additional oral care management, oral care and changed behaviour and palliative care considerations.

 

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