Better Oral Health in Residential Care: Staff Portfolio
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Please refer to the following resources for more information:
This domain was developed by the South Australian Dental Service.
As the ageing population is increasingly retaining their natural teeth, their need for optimal oral health care also increases.
Older peoples’ mouths are prone to oral disease and those with natural teeth are more likely to have advanced gum disease (gingivitis or periodontitis). Oral health care for older people is often further complicated by a past dental history including crown and bridge work, partial dentures and implants.
Oral health is linked to general health, and oral conditions involving teeth, gums and dentures can significantly affect overall well-being and the ability to age positively.
For example:
Oral health care may be overlooked by community-living patients with decreasing levels of cognition, health and mobility. Cost and transport is also a factor affecting older people and their decisions around accessing dental treatment services.
As people age they tend to interact with a range of health workers more frequently than they do a dentist. For older people admitted to acute hospitals, oral health assessment and oral health care should be considered as an integral component of patient-centred care and a valuable opportunity to address these health issues.
Older people may have a range of health problems or disabilities that impact on their ability to care for their own oral health and may need assistance during their hospital stay as well as follow up care on discharge. This may be related to issues associated with cognitive impairment or functional limitations such as hand and upper limb function due to poor dexterity, pain and strength. It may also involve functional problems with mouth and tongue movements and swallowing.
Oral health care involves a multi-disciplinary approach and includes simple strategies to assess oral health and provide oral health care of the following:
Oral diseases and conditions are progressive and cumulative. If untreated they become more complex over time.
The following is a standard protective oral hygiene regimen for older people based on 6 of the best ways to maintain a healthy mouth.
Additional oral care management may be identified and prescribed by the doctor or dentist. For example: antifungal, antibiotic and pain medication.
An Occupational Therapy assessment may be required to facilitate the older person’s independence with oral hygiene tasks. This assessment will provide recommendations regarding the amount of personal assistance required and may suggest aids or adaptions such as enlarged handles or one handed techniques.
Six of the best ways to maintain a healthy mouth for older people:
Older people, especially those suffering dementia or delirium, can behave in ways that are resistive to oral health care.
Continence - Poor oral health affects food selection in particular the ability to chew foods with high fibre content. This can affect continence management.
Delirium - Chronic infection from poor oral health can compromise the immune system and contribute to a systemic inflammatory response. This in conjunction with oral pain can exacerbate a change in behaviour especially for older people with dementia.
Dementia - Older people with dementia are particularly at risk of developing complex oral disease and conditions. Dementia compromises their ability to reliably report their experience of oral health problems and dental pain. In addition, older people with dementia can sometimes behave in ways that make it difficult to provide oral health care.
Depression - Poor oral health may cause pain and discomfort, bad breath, impact on people’s ability to speak, sleep well, socialise and feel happy with their appearance.
Medication - Polypharmacy can impact on oral health by causing dry mouth (xerostomia). Drug classes which especially contribute to dry mouth are those with anticholinergic effects such as ACE inhibitors and diuretics. For further information contact the Therapeutic Advice and Information Service.
Mobility - As a consequence of poor oral health, nutritional status may suffer and have an impact on maintaining weight, muscle mass and strength.
Nutrition - Tooth loss, poorly fitting dentures and oral infections affect appetite, food enjoyment and ability to chew which impacts on food intake and food selection.
Skin integrity - As a consequence of poor oral health, nutritional status may suffer and have an impact on skin integrity and wound healing.
When assisting with an older person’s oral hygiene check for and report/follow up on signs of the following oral health conditions:
It is recommended that an appropriate health professional such as registered nurse or doctor perform an oral health assessment using the Oral Health Assessment Tool (OHAT) on admission and repeat as required
A ‘healthy’ or ‘changes’ assessment can be managed using the Oral Health Care Planning Guidelines.
An ‘unhealthy’ assessment indicates a referral to a dental professional is recommended. As most referrals are likely to be of a non-urgent nature, this information should be included in discharge planning advice and correspondence.
Management principals should be based on a Model of Oral Health Care which integrates 4 key oral health processes into general care:
Based on the findings of the Oral Health Assessment, discharge planning advice to the General Practitioner should acknowledge the patient’s need for dental examination. Options for dental treatment include both private and public pathways.
Further discharge planning may require Occupational Therapist or Dietitian follow up.
For healthy teeth and gums follow these simple steps: