Whats all the fuss with oral care ? Emma Riley Healthcare Services - - PowerPoint PPT Presentation

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Whats all the fuss with oral care ? Emma Riley Healthcare Services - - PowerPoint PPT Presentation

Sep 10, 2023 318 likes •767 views

Whats all the fuss with oral care ? Emma Riley Healthcare Services Director RIS Healthcare oral health for adults in care homes Nice guidelines 5 th July 2017 Staff should understand the importance of residents oral health and the

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What’s all the fuss with

  • ral care ?

Emma Riley Healthcare Services Director RIS Healthcare

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SLIDE 2
  • ral health for adults in care homes

Nice guidelines 5th July 2017

  • “Staff should understand the importance of residents
  • ral health and the potential impact on their general

health, well being and dignity”

NICE will be marking homes on levels of oral care

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SLIDE 3
  • An 80-year-old man with a history dementia, Parkinson’s disease,

seizures

  • Admitted to hospital from his nursing home with a two day history of

shortness of breath.

  • He was unable to provide a history due to his dementia, although the

possibility of aspiration, (swallow) of a denture was suggested by staff.

  • Examination revealed reduced air entry on the right side and a chest X-ray

showed collapse of the right lung but no foreign body. He could not tolerate a chest CT as he was not able to lie flat due to breathlessness

  • Due to his significant medical history palliative therapy was chosen and he

died the following day.

  • Post mortem revealed… Graphic Photo Alert!!

Failure to remove a dangerous denture

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SLIDE 4

Sorry its graphic

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SLIDE 5
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Mouthcare is changing

  • 24.7% of 5 year old's have tooth decay, 1 in 4 will have decay when

they start school

  • Almost half of UK adults have a fear of the dentist, 12% of theses

suffer from extreme dental phobia

  • 700,00 people in the UK on the Autism spectrum, 1 in 100
  • 1.5 million in the UK with learning disabilities
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SLIDE 7
  • 850,000 people in UK with Dementia figures to rise

to over 1 million by 2025- 70% of people in care homes have Dementia

  • There are 2.5 million people in the UK living with

cancer

  • Over the past 20 years Mouth (oral) Cancer figures

have risen by 68%

Chronic Conditions kill 39.5 Million every year Oral Diseases affect 3.9 Billion worldwide

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Putting the mouth back into the body

Treating the mouth with the respect it deserves

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The mouth (oral cavity)

  • Lips
  • Inside of the lips
  • Cheeks
  • Teeth and Gums
  • Front two-thirds of tongue
  • Floor of mouth
  • Below tongue
  • Upper and lower jaw
  • Salivary Glands
  • Bony roof of mouth (hard

palate)

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Think mouth, Think health

Oral Health General Health A two way relationship

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Poor oral health has been linked to general health

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Poor oral health can cause

  • Behaviour Problems
  • Inability To Eat and speak
  • Diet, Nutritional And Hydration Problems
  • Weight Changes
  • Problems With Social Interactions
  • Medical Complications-aspiration Pneumonia
  • Poor Quality Of Life
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Would you ignore this?

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But this gets ignore…….Why?

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@NHS_HealthEdEng @MCM_HEKSS #mouthcare

Jacks story – 25th January 2016

82 year old male Sent from hospital to home after long stay Jack wasn’t eating or drinking This improved after 24 hours of mouth care Sadly jack passed shortly after

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Elizabeth’s story

  • Hospitals are trying to get oral

care classed a ‘6th harm’ in long term hospitalisation

  • Elizabeth McGaw, 87, died after

her denture had to be surgically

  • removed. She was admitted

from a care home in Scotland in December 2006.

  • Coroner concluded although

poor oral care was not the cause

  • f death, it was contributing

factor

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Vap-Ventilator Associated Pneumonia

  • VAP- ventilator associated pneumonia (vap) is

pneumonia occurring in a patient within 48 hours

  • r more after intubation with an endotracheal

tube or tracheostomy tube and which was not present before

  • VAP increases length of icu stay by 28% and

each incidence of vap is estimated to generate an increased cost of £6000- £22000!!!!

  • IT’S A TICKING TIMEBOMB!!!!!!
  • BJMP 2009:2(2) 16-19
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Defining HAP and CAP

  • Hospital-Acquired Pneumonia

(HAP)

  • is defined as pneumonia that
  • ccurs 48 hours or more after

hospital admission and that was not present at the time of admission.

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/in fectious-disease/health-care-associated-pneumonia/

  • Community-acquired pneumonia

(CAP)

  • Community-acquired pneumonia

refers to pneumonia acquired

  • utside of hospitals or extended-

care facilities.

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/in fectious-disease/community-acquired-pneumonia

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Those at risk

  • Neurological dysphagia
  • Stroke
  • Copd
  • Malignancy
  • Renal disease
  • Recent surgery or trauma
  • Dementia
  • Liver disease
  • Enteral feeding
  • Suppressed immune systems
  • Surgery to treat cancer of mouth,

throat or neck

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SLIDE 20

Patients with Learning Disabilities deserve a healthy mouth too!

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Function of saliva

  • 1st Stage Of Digestion
  • Lubricates
  • Taste
  • Antibacterial
  • Regulates Oral Ph
  • Facilitates Re-mineralization
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SLIDE 22

Salivary glands

Parotid Sublingual Submandibular

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The wonderful world of dentures…….

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Types of dentures

Full and Partial Dentures Dentures with Implants

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The wonderful world of dentures

  • Toothpaste Not Recommended
  • Manual Cleaning Is A Must
  • To Be Cleaned With Liquid Soap Or Denture Cream Cleaner
  • Nail Brush/Denture Brush
  • Denture Soaking Solutions To Be Used As Per Instructions
  • If Fungal Infection Present Consider Soaking In A Dilute Milton

Solution, Each Evening For 10 Mins (plastic dentures-Corsodyl for Chrome)

  • Treat Denture With Anti Fungal Treatment
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  • Remove dentures from person’s

mouth

  • Clean dentures in soapy water with

nail/denture brush

  • Disinfect denture by soaking in

dilute Milton solution for 30 seconds (if a metal denture use a Denutral cleaning solution)

  • Dry denture
  • Use an indelible pen to write

residents initials near back of

  • denture. Wait to dry
  • Apply fine layer clear nail varnish
  • Rinse with water

Denture Marking

Adapted from resources from RIS Healthcare and Salford Royal NHS foundation Trust. Reproduced with permission

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Dental Implants…….treat them just like teeth!

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Drooling

  • “Saliva Beyond The Margin Of The Lips”
  • Common In Lewy Bodies
  • Prevalent In 70% Of Parkinson Sufferers
  • 1 In 2 Patients With Motor Neuron Disease
  • 1 In 5 Needs Continuous Saliva Elimination
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Managing Drooling of Saliva.

  • Medication- Hyoscine, Glycopyrronium bromide,

Amitriptyline.

  • Postural Changes/Support Collars.
  • Suction, Training Required.
  • Botox Or Radiation To Salivary Glands.
  • Surgical Intervention To Remove Salivary Glands Is

Sometimes Required.

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Dry Mouth : Signs

  • Sticky, dry feeling in the mouth
  • Trouble chewing, swallowing,

tasting, or speaking

  • Burning feeling in the mouth
  • Dry feeling in the throat
  • Cracked lips and or corners of

the mouth.

  • Dry, rough tongue
  • Sore painful mouth and tongue
  • Oral fungal infections
  • Lips sticking to the teeth and

taste disturbance

  • Bad breath ( odour )
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Why is the mouth dry?

Diabetes Chemotherapy. Head & Neck Radiotherapy. Medication – More Than 400 Drugs Can Cause A Dry Mouth-90% Of All Cases. Oxygen. Mouth Breathing. Enteral Fed A DRY MOUTH IS A CONDITION NOT A SIDE EFFECT

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Managing a dry mouth

Artificial saliva and lubricants Ice chips Sugar free gum

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Oral care

  • LEVINE(1993) stated “THE SINGLE MOST IMPORTANT PLAQUE CONTROL

METHOD IS TOOTHBRUSHING.”

  • Brush natural teeth twice daily with a fluoride toothpaste.
  • When Toothbrushes Are Old They Become Ineffective And Harbour

Bacteria.

  • They Will Need To Be Changed Every 2-3 Months.
  • Sick People Are Advised To Change Their Toothbrush At The Beginning Of

Illness And When They Are Better.

  • Toothbrushes Should Be Changed Every Few Days If A Fungal Infection Is

Present

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SLIDE 36

Periodontal disease (bleeding gums)

  • Bacteria in dental plaque
  • Gum disease
  • Swelling and bleeding gums
  • Loose teeth
  • Bleeding gums often

frighten carers. The gums will bleed if they are

  • unhealthy. The only way to

make gums better is to brush bacteria away.

This hoto by Unknown Author is licensed under CC BY-SA

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Toothbrushes

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Looking after bleeding gums

  • Gentle brushing where the

teeth meet the gums

  • They will bleed
  • Bleeding eventually stop
  • Consider that they May need

a dental referral

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TOOTHPASTES

  • Some Toothpastes May Contain SLS (Sodium Lauryl Sulfate) Which

May Irritate Oral Mucosa.

  • Sls Is Also What Makes Toothpastes Foam.
  • Non Foaming Toothpastes Help To Reduce The Risk Of Aspiration

During Oral Care.

  • Unflavoured Toothpastes For Patients With Sensitive Mucosa.
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Mouth care for residents with challenging behaviour

  • Calm and kind approach, maintain eye

contact

  • Choose location where resident most

comfortable (bedroom or bathroom)

  • Ask family or carer for assistance
  • Try different times of day
  • Short bursts
  • Familiar toothpaste/toothbrush
  • Oral sensitivity, consider flavourless/non

foaming toothpaste

Adapted from resources from RIS Healthcare and Salford Royal NHS foundation Trust. Reproduced with permission

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This Photo by Unknown Author is licensed under CC BY-SA-NC

Practical tips……..

  • Distraction – Place

a familiar item in their hands, Toothbrush, towel,

  • r cushion
  • Play familiar music

to distract or relax If Resident refuses make a record in notes but KEEP TRYING

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Quality of life

The end-of life deserves as much beauty, care, and respect as the beginning

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Prevention is better than cure!

  • 102 Year Old Lady
  • Last Hours Of Life
  • Mouth Smells
  • Lips Stuck To Teeth
  • Mouth Extremely Dry
  • Crusty Plugs All Over Inside Of

Mouth

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In Conclusion

  • Oral care assessment should be completed within 48hrs of admission
  • The management of dry mouth should be included in the patients care plan
  • Mouth care be carried out as often as necessary to maintain a clean mouth
  • Prevent cracking lips – lubricating gel, if patient on oxygen apply a water based

solution

  • Assess the patient regularly, in terminal phase mouth may need moistening

every 30 – 60mins