Oppose oral health ltc-

All relevant data needed for interested researchers to replicate our study's findings are within the paper and its Supporting Information files. Poor oral health has been a persistent problem in nursing home residents for decades, with severe consequences for residents and the health care system. Two reviewers independently a screened titles, abstracts and retrieved full-texts; b searched key journal contents, key author publications, and reference lists of all included studies; and c assessed methodological quality of included studies. Discrepancies at any stage were resolved by consensus. We conducted a narrative synthesis of study results.

Prevalence and correlates of potentially undetected dementia among residents of institutional care facilities in Ontario, Oppose, — Minn N. Open in a separate window. Coleman P, Watson NM. Flossing should follow, when possible. Regardless of dietary restrictions and existing conditions, daily oral hygiene care may be provided by moistening a toothbrush with a small amount of water or mouthrinse, and brushing the teeth.

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Dental caries status. This article has three objectives:. The nursing home also has financial incentives to prevent pneumonia. The disease prevalence rates for this population of LTC Opposs fell within the ranges reported by other studies of institutionalized older people in industrialized Kedra wilkinson nude photos. Detail six strategies for overcoming care-resistant behavior. The average time to complete the oral examination was Describe the oral and dental health changes that may affect the rest of the body and how these effects occur. The mechanism of these effects is still uncertain. More than half They Oppose oral health ltc have dental insurance once they are no longer employed. Neoplasms Approximately one-half of the 30, cases of oral cancer reported each year are found in patients over 65 years of age.

By providing education and training resources to caregivers, dental teams can help improve the daily oral hygiene of long term care facility residents.

  • Advanced periodontitis—fairly common in the elderly—-reduces the ability to chew, exacerbates problems in the control of types 1 and 2 diabetes, and has been found to be a risk factor in pneumonia, cardiovascular disorders, and stroke.
  • By providing education and training resources to caregivers, dental teams can help improve the daily oral hygiene of long term care facility residents.
  • Calibrated personnel administered standard clinical and quality-of-life instruments.
  • Documents found in this resource are evidence-based, but it is not a program plan.
  • .

All relevant data needed for interested researchers to replicate our study's findings are within the paper and its Supporting Information files. Poor oral health has been a persistent problem in nursing home residents for decades, with severe consequences for residents and the health care system.

Two reviewers independently a screened titles, abstracts and retrieved full-texts; b searched key journal contents, key author publications, and reference lists of all included studies; and c assessed methodological quality of included studies. Discrepancies at any stage were resolved by consensus. We conducted a narrative synthesis of study results.

We included three one-group pre-test, post-test studies, and one cross-sectional study. All studies reported improvements of at least some of the outcomes measured, but interpretation is limited due to methodological problems. However, studies assessing these strategies have a high risk for bias.

To overcome oral health problems in nursing homes, care providers will need practical strategies whose effectiveness was assessed in robust studies. A significant and growing portion of older adults require long-term care services [ 1 ]. Nursing home residents total almost thousand in Canada [ 3 ], 1.

These numbers are expected to increase substantially as the population continues to age [ 5 , 6 ]. Nursing home residents frequently require partial or complete assistance in conducting activities of daily living, including oral care [ 2 , 4 , 7 , 8 ]. Currently, there is no effective therapy to prevent, cure or treat dementia, and without dramatic breakthroughs, the global number of people living with dementia Complexity of care demands in nursing homes will further increase as persons with dementia stay at home longer with community care and enter nursing homes only at more advanced stages of disease [ 14 , 15 ].

These demographic shifts highlight a need for proven effective strategies within nursing homes to adequately meet the basic care needs of this vulnerable population. Poor oral health is frequently seen in nursing home residents as a consequence of inadequate care. Despite professional guidelines for what constitutes proper provision of oral care in older adults [ 16 — 19 ], nursing home residents continue to display less than optimal oral health.

Sixty two percent of nursing home residents present with unacceptable levels of oral hygiene [ 20 — 22 ]. Oral conditions have widespread effects on both physical and psychosocial health. Furthermore, poor oral health elevates health care costs and the risk of malnutrition, respiratory infections, diabetes, cardiovascular diseases, and even premature death e.

Provision of oral care presents with its own unique challenges. An increasing number of residents are entering facilities with their natural teeth, supported by prostheses such as implants and bridges, which require increased and more complex oral care than previous generations [ 40 ].

Dental implants require meticulous care to mitigate the high risks of failure, inflammation, and even bone loss [ 41 ]. Responsive behaviors—defined as physical or verbal actions, such as grabbing, screaming, and resisting care, in response to a negatively perceived stimulus [ 53 , 54 ]—can make oral care provision time consuming, disruptive, and potentially distressing for the care provider [ 51 ].

The term responsive behaviours highlights that those behaviours are meaningful responses to environmental stress or unmet needs rather than just neuropathological symptoms [ 51 , 53 , 54 ]. Researchers have suggested that an enhanced multidisciplinary approach to care, including dentists and dental hygienists, is needed to improve oral health in care facilities [ 56 — 58 ]. While this suggestion has value, interventions and strategies directly targeting front-line care providers are still necessary, as these individuals are responsible for the majority of hands-on daily care, such as tooth brushing [ 42 , 43 ].

Several reviews have revealed educational interventions as a means to improving oral health [ 59 — 61 ]. These interventions are potentially effective, but study quality is generally low, and heterogeneity of interventions makes best practice recommendations difficult.

Furthermore, persons with cognitive impairments, are frequently excluded from these studies, limiting generalizability to a substantial portion of the population in care facilities [ 51 , 59 ]. Several reviews propose communication strategies to minimize behavioral responses in residents with dementia [ 62 — 64 ].

However, evidence on the effectiveness of these strategies is weak or inconclusive, and these strategies have not been tested in the context of daily oral care. A few specific strategies to reduce responsive behaviors during oral care have been suggested and trialed [ 65 , 66 ] but to date, no systematic review on the effectiveness of such strategies is available. In addition to strategies to reduce responsive behaviors, residents and care providers could also benefit from strategies to encourage and motivate residents to complete their own oral care when residents are capable of doing so independently.

A quarter of the regularly functioning adult population is not motivated to conduct tooth brushing twice a day [ 67 , 68 ]. Motivational barriers are further amplified if older adults have low socio-economic status, a history of dental neglect, and generally negative attitudes towards oral care [ 69 — 71 ].

Two systematic reviews have addressed psychological or motivational interventions in order to improve oral care adherence [ 72 , 73 ]. While included studies were generally of low quality, these reviews provide tentative support that psychological interventions may improve motivation for routine oral care.

No reviews have analyzed motivational techniques in the context of long-term care, in which care providers could encourage residents to conduct their own daily oral health care. The aim of this review is to identify and synthesize evidence on the effectiveness of interventions in nursing homes which provide care providers with such strategies.

This is a systematic review of quantitative intervention studies. Due to the small number and heterogeneity of included studies we were unable to conduct meta-analyses of study effects. Therefore, we present a narrative synthesis of the available evidence.

With a science librarian, we developed, pretested and applied a search strategy S1 Appendix combining terms related to oral health with terms related to care providers and residents in nursing homes. We did not limit language or year of publication, and retrieved all findings starting with the earliest reference available in the respective database. In addition, we searched key journals and key author publications by hand.

Based on the number and relevance of published papers, we selected four key journals Geriatrics and Gerontology , Gerodontology , International Journal of Nursing Studies , Journal of the American Geriatrics Society and ten key authors Jane M. Chalmers, Ronald L. Ettinger, Marianne Forsell, Rita A. Jablonski, Rie Konno, Michael I.

MacEntee, Debora C. Matthews, Mary E. McNally, Inger M. Finally, we screened reference lists of included studies. We used Zotero to carry out the title and abstract screenings, to attach PDF files of retrieved full texts to the respective references, and to conduct the full text screenings. All review team members received training in using Zotero before the screening process, and we conducted calibration exercises and held regular team meetings to ensure consistency of applying inclusion and exclusion criteria.

Detailed inclusion and exclusion criteria are listed in Table 1. We included references in any publication language. To assess eligibility of studies published in other languages, we collaborated with our professional contacts and researchers fluent in that language.

We included studies conducted in nursing homes only one of various terms used across countries and jurisdictions to describe these facilities [ 77 ] , which we define as facilities that [ 77 — 79 ]:. Primary, empirical, quantitative studies survey studies, randomized controlled trials, non-randomized trials with or without control group, cohort or case control studies, cross-sectional studies assessing the effectiveness of an eligible strategy.

Mixed-methods studies assessing the effectiveness of an eligible strategy quantitatively. Non-systematic selective reviews, qualitative studies qualitative interviews, focus groups, ethnographic observations, qualitative case studies.

Strategies that formal care providers can apply to motivate nursing home residents in performing oral health care themselves.

Strategies that formal care providers can apply to prevent or overcome nursing home residents' responsive behaviours towards oral health care provided by formal care staff. Any kind of placebo or comparison intervention e. Staff oral care practices i. Residential facilities that provide care for frail older adults over a prolonged time period nursing homes, personal care homes, special or complex care homes, residential long term care facilities, residential facilities, skilled nursing facilities, etc.

ResidentialResidential facilities providing care for relatively healthy and independent residents assisted living, supportive living, retirement homes, senior housing.

Formal, paid care providers providing oral care in nursing homes care aides, registered nurses, licensed practical nurses, dental hygienists, etc. After duplicates were removed, two review team members independently screened titles and abstracts of retrieved studies for inclusion. At all screening steps, reviewers resolved discrepancies in assignment of screened studies by consensus. Two review team members screened full texts independently for inclusion.

One team member carried out the hand search of key journals and key author publications. A second team member checked the studies included. Two team members independently screened the reference lists of all included studies. Two review team members independently assessed methodological quality of studies risk of bias. We discussed results of this step for each study with the full research team and resolved discrepancies by consensus.

We applied two validated checklists S3 Appendix , as appropriate to study design, to assess methodological quality of included studies—each of which were used and described in detail in previous systematic reviews [ 80 — 84 ]. It assesses the categories of selection bias, study design, confounders, blinding, data collection methods, withdrawals and drop-outs, intervention integrity, and analyses.

This tool was developed based on Cochrane guidelines [ 87 ] and other evidence-based criteria [ 88 , 89 ]. Reviewers assess methodological quality of studies on 12 items in the categories of sampling, measurement, and statistical analyses. We rated the overall quality of each study, using a scoring method developed by de Vet et al.

We first calculated the ratio of the obtained score to the maximum possible score, which varies with the checklist used and the number of checklist items applicable. One team member extracted the following study details into an Excel spread sheet template: first author, year of publication, title, journal or type of reference e.

A second team member double-checked data extraction for each study and discrepancies were resolved by consensus. We were not able to statistically pool results of included studies, as we could not identify a sufficient number of studies reporting similar designs, methods and outcomes. Therefore, we conducted a narrative synthesis of the included studies.

To assess reporting bias, we checked whether a study protocol was published before participants were recruited for each included study, and we compared available study protocols to the published studies.

We included a total of seven references [ 65 , 66 , 91 — 95 ], four of which report different aspects of one unique research project [ 66 , 92 — 94 ]. Therefore, these seven references represent four unique studies i. Fig 1 a modified version of the PRISMA flow diagram details the number of references included and excluded in each step of our review.

We did not identify any additional references in our hand search. As Table 2 illustrates, we were not able to identify any randomized trial assessing the effectiveness of any strategy of interest to this review. Three of the included research projects [ 65 , 66 , 91 — 94 ] were conducted in the USA and applied a one-group pre-test, post-test design, and one was a Canadian cross-sectional study [ 95 ].

Methodological quality was low for three of the included research projects [ 65 , 91 , 95 ] and low moderate for one [ 66 , 92 — 94 ] see S4 Appendix for detailed quality ratings. Modifications of the physical environment to compensate for other comorbid conditions that could interfere with oral self-care.

Instructions to staff regarding how to cue the resident to overcome cognitive deficits and foster use of preserved abilities.

The responsibility of oral hygiene care, such as toothbrushing, and cleaning and proper storage of dental prostheses, often falls to nursing staff with varying degrees of training. The recommended lifespan of toothbrushes, recent patient illnesses, and toothbrush storage should be also addressed to prevent the proliferation of pathogens and mold, which can compromise the health of individuals who are at increased risk of illness due to weakened immune systems. Acknowledgment Michele Karel, PhD, a geriatric clinical psychologist, offered valuable comments and suggestions during the preparation of this article. For the edentulous, the use of dentures both upper and lower all the time except at night was chosen as an indicator of oral health. More than half

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The responsibility of oral hygiene care, such as toothbrushing, and cleaning and proper storage of dental prostheses, often falls to nursing staff with varying degrees of training.

Nurses employed in LTCFs are required to examine the oral cavity during resident admission assessment. Research shows that oral assessments are more accurate when provided by nurses who have attended dental in-service training.

Appropriate oral health education for nursing staff has been shown to improve the plaque scores of LTCF residents. Associations between oral and systemic health, such as the increased risk of aspiration pneumonia in those with poor oral hygiene, should be incorporated into oral health education programs for nursing staff.

For example, 15 studies have shown daily oral hygiene decreases the risk of aspiration pneumonia in hospitalized patients and LTCF residents. Under the Affordable Care Act, hospitals are now reimbursed based on the percentage of preventable readmissions.

The nursing home also has financial incentives to prevent pneumonia. Safety precautions for the provision of daily oral hygiene are an important part of educational discussions. For example, LTCF residents — who are often evaluated for swallowing problems — may be placed on a restricted diet to lessen the risk of choking or aspiration.

These restrictions may prohibit consuming thin liquids, including water. Thus, a daily oral hygiene regimen that includes water, mouthrinse and toothpaste could pose a choking hazard.

Minimizing potential risks is further complicated because conditions experienced by LTCF residents change quickly, and they often directly impact dietary restrictions.

A resident who is approved to consume thin liquids on Monday, for example, may be reevaluated midweek, at which time his or her dietary restrictions could change to a recommendation of no thin liquids. In addition, some residents with dementia may not understand they need to expectorate mouthrinse, and may swallow or hold the liquid in their mouths.

Regardless of dietary restrictions and existing conditions, daily oral hygiene care may be provided by moistening a toothbrush with a small amount of water or mouthrinse, and brushing the teeth. Flossing should follow, when possible. Patient positioning is also a safety topic. The best position for oral hygiene care is standing or sitting, however, some LTCF residents may be unable to do either. Performing oral hygiene care while a resident lies supine in bed may lead to aspiration or choking.

This can be prevented by raising the head of the bed prior to providing care. A suction toothbrush may also help prevent aspiration among this patient population. Appropriate infection control during oral care should also be addressed. Coleman and Watson 10 conducted a study in New York nursing homes in which nursing assistants were observed, but were unaware of what was being evaluated.

The study found that none of the assistants provided oral hygiene care to LTCF residents while wearing clean examination gloves. Nursing staff should be reminded that clean gloves should be donned before any form of oral care is delivered. Individuals with cognitive impairments often need help with oral hygiene care, but may resist it. Thus, nursing staff need strategies to cope with care-resistant behaviors when providing daily oral hygiene services.

One of the barriers to maintaining oral health among residents of LTCFs is the lack of appropriate supplies. The recommended lifespan of toothbrushes, recent patient illnesses, and toothbrush storage should be also addressed to prevent the proliferation of pathogens and mold, which can compromise the health of individuals who are at increased risk of illness due to weakened immune systems.

Personal supplies, such as toothbrushes, are typically ordered by a central supply director, who may not understand the importance of ordering quality toothbrushes with small heads and soft bristles. Often, budgetary limitations yield inexpensive toothbrushes with large heads and hard bristles. Oral health professionals need to advocate for appropriate oral hygiene supplies with LTCF leadership. Some residents may receive monthly stipends for the purchase of personal care items that can be used to buy suitable oral hygiene supplies.

If residents are unable to go shopping, a family member or the facility activity director may assist in such purchases. For this reason, oral health education should also be provided for families and residents through a team-based approach. Numerous resources are available to help dental professionals train nursing staff to provide daily oral care in LTCFs Table 1.

It also provides information for nursing home staff and families of residents in LTCFs. The materials include a video showing a mouth with generalized periodontal disease and plaque. The pathogens in the plaque are shown filtering into the blood vessels of the surrounding gingiva, while the narrator explains the potential harm to systemic health when large amounts of periodontal pathogens enter the systemic bloodstream.

This animation may be particularly relevant because wound care is an important part of nursing services in LTCFs. Depicting the oral cavity as an overlooked, bacteria-infected wound — and discussing the importance of cleaning and debriding this wound — may resonate with nursing staff. The program includes CDs with printable forms, tests, manuals and workbooks, as well as videos for both trainers and trainees.

Daily oral hygiene care is a fundamental requirement, especially for residents of LTCFs, who tend to experience oral disease disproportionately when compared to their counterparts who live at home. Loss and nonreplacement or inadequate replacement of missing teeth causes major nutritional difficulties.

Smoking has been identified as a major risk factor for periodontitis, in addition to increasing susceptibility to oral cancer. Oral signs of AIDS are frequently misdiagnosed because many health practitioners are unaware of its presence in the elderly population. The multiple medications taken by many long-term care patients are often the cause of xerostomia dry mouth , and some cause gingival enlargement.

Many of the effects of oral disease may be prevented or treated by appropriate measures when a long-term care facility provides the resources and staff training. The mouth is involved in a wide range of activities, including eating, smiling, speaking, singing, smoking, and kissing. Any changes in oral health are likely to have multiple effects. This is further complicated by the functional and cognitive impairment and diminished cooperation of some residents in the performance of oral hygiene, by the reduced availability of dental care in many nursing homes compared with independent living, and by the lack of financial resources to pay for dental care.

This article has three objectives:. Describe the oral and dental health changes that may affect the rest of the body and how these effects occur. Describe the various ways that existing systemic conditions and diseases may affect the mouth. Suggest practical ways to improve the oral health of long-term care residents.

Oral health changes that may cause local problems and affect the rest of the body include periodontitis and other gingival conditions, dental caries, tooth loss and nonreplacement, inadequate replacement of missing teeth, salivary changes, mucocutaneous conditions, and oropharyngeal neoplasms.

Periodontitis Periodontitis is a chronic inflammatory disease of the gingiva and supporting tissues. Pain is not a prominent feature of early disease, and patients are often unaware of the condition until it is pointed out by a dentist or hygienist, teeth become noticeably loose, or abscesses develop. Since residents in long-term care facilities are often in their 70s and beyond, periodontal disease in those who still have their teeth has generally existed for many years and is often advanced.

Effects of Periodontitis One obvious effect of advanced periodontal disease is on nutrition. Patients with many loose teeth or missing teeth are often unable to chew any but the softest foods. They have a tendency to swallow mouthfuls unchewed rather than endure uncomfortable chewing.

Such inadequate mastication may result in choking and sometimes in digestive problems. The problem may be worse in residents who have existing swallowing difficulties, such as following a stroke. Chewing difficulties may persist even after loose teeth are removed if they are not replaced with a dental prosthesis or are inadequately replaced. Another long-recognized effect of periodontitis is its role in the presence of diabetes. Glucose levels in patients with type 1 or 2 diabetes with active, advanced periodontal disease are more difficult to manage than in patients without periodontal disease.

Conversely, when the diabetic state is uncontrolled, the patient is more susceptible to periodontal abscesses and rapid periodontal breakdown.

In the past decade, other effects of periodontitis have become apparent. Evidence is accumulating that the presence of periodontal infections increases susceptibility to pneumonia and other lung conditions,6 cardiovascular disease,7 and stroke. In a younger population, women of childbearing age with severe periodontitis appear to be at higher risk for preterm birth and low-birth-weight babies. The mechanism of these effects is still uncertain. It is apparent, however, that the treatment of periodontal disease is advisable at every age level to prevent such complications.

Gingival Enlargement At least three different types of medication produce gingival overgrowth that can interfere with chewing. The mechanism of the overgrowth is still unclear. The enlargement may be minimal and barely noticeable, or it may be so advanced that the tissue covers the teeth. The effect is cumulative: a patient on cyclosporine who is also given nifedipine often presents with greater gingival overgrowth than with either drug alone Figure 2. In addition to having difficulty chewing, the patient may be self-conscious and withdrawn because of the unpleasant appearance of the mouth.

Dental Caries Caries is generally thought of as a disease of young people because the highest incidence of new-enamel decay occurs during the first three decades of life in the enamel on the chewing surfaces and the proximal surfaces the surface at which each tooth contacts its neighbor. However, older adults are susceptible to root caries, a condition in which decay invades the exposed roots of teeth and may result in pain, tooth fracture, abscess formation, and pulp death, requiring root canal treatment or extraction.

Tooth Loss and Nonreplacement The nonreplacement of missing teeth is one of the principal causes of inability to chew. Many older people, especially those with low incomes, fail to have lost teeth replaced for financial reasons. They rarely have dental insurance once they are no longer employed. If many teeth are missing, chewing becomes more and more difficult, and malnutrition is likely to result. A related problem is the continued use of dentures that no longer fit properly.

The patient either leaves the dentures out of the mouth or uses them only intermittently. Even when a partial denture fits well, the patient is at higher risk for root caries unless the denture is removed daily, and both the denture and teeth are cleaned thoroughly.

Salivary Changes There has been a longstanding consensus in the health care community that patients in the over age group have a diminished salivary flow. They include antihypertensives, psychotropics, antihistamines, antiarrhymics, and many others. The reduced level of salivary flow increases susceptibility to root caries.

Dry mouth tends to make eating less enjoyable and makes swallowing of relatively dry foods difficult. Again, nutritional problems may result. Mucocutaneous Conditions There are a number of ulcerative, desquamative conditions that cause the oral tissues to be painful and make eating a highly unpleasant experience. They include candidiasis thrush , erosive lichen planus, herpes zoster shingles , and mucous membrane ulcerations resulting from chemotherapy.

Neoplasms Approximately one-half of the 30, cases of oral cancer reported each year are found in patients over 65 years of age. Many health care practitioners are only vaguely aware or are unaware of the possibility of HIV in an older patient, and the disease often is undiagnosed until it is far advanced. Smoking is now recognized as a major risk factor for periodontal disease,16 in addition to its role in heart disease, lung cancer, and other disorders.

Smoking is also implicated in the high incidence of oral and pharyngeal cancers that are found in elderly men who are both tobacco users and alcohol abusers. All forms of smoking—cigarettes, cigars, pipes—greatly increase the risk of oral and pharyngeal cancers, compared with nonsmokers. Similarly, patients with severe arthritis are unable to wield a toothbrush or floss their teeth.

By providing education and training resources to caregivers, dental teams can help improve the daily oral hygiene of long term care facility residents.

The authors have no commercial conflicts of interest to disclose. This 2 credit hour self-study activity is electronically mediated. In the United States, one in eight adults is age 65 or older. For those living in nursing homes or LTCFs, performing typical daily activities, such as bathing, dressing, transferring and eating, requires assistance from caregivers. This article will prepare dental professionals to deliver meaningful oral health education in LTCFs — with a focus on providing LTCF staff with appropriate recommendations and resources.

Unfortunately, many LTCF residents experience poor oral health due to reduced access to professional dental services, as well as difficulty maintaining effective oral self-care. While institutionalized populations may receive professional oral care services periodically, daily oral hygiene — which is considered an essential need, along with grooming and bathing — is often a neglected part of most nursing home care.

The responsibility of oral hygiene care, such as toothbrushing, and cleaning and proper storage of dental prostheses, often falls to nursing staff with varying degrees of training. Nurses employed in LTCFs are required to examine the oral cavity during resident admission assessment. Research shows that oral assessments are more accurate when provided by nurses who have attended dental in-service training.

Appropriate oral health education for nursing staff has been shown to improve the plaque scores of LTCF residents. Associations between oral and systemic health, such as the increased risk of aspiration pneumonia in those with poor oral hygiene, should be incorporated into oral health education programs for nursing staff. For example, 15 studies have shown daily oral hygiene decreases the risk of aspiration pneumonia in hospitalized patients and LTCF residents.

Under the Affordable Care Act, hospitals are now reimbursed based on the percentage of preventable readmissions. The nursing home also has financial incentives to prevent pneumonia.

Safety precautions for the provision of daily oral hygiene are an important part of educational discussions.

For example, LTCF residents — who are often evaluated for swallowing problems — may be placed on a restricted diet to lessen the risk of choking or aspiration. These restrictions may prohibit consuming thin liquids, including water. Thus, a daily oral hygiene regimen that includes water, mouthrinse and toothpaste could pose a choking hazard. Minimizing potential risks is further complicated because conditions experienced by LTCF residents change quickly, and they often directly impact dietary restrictions.

A resident who is approved to consume thin liquids on Monday, for example, may be reevaluated midweek, at which time his or her dietary restrictions could change to a recommendation of no thin liquids. In addition, some residents with dementia may not understand they need to expectorate mouthrinse, and may swallow or hold the liquid in their mouths. Regardless of dietary restrictions and existing conditions, daily oral hygiene care may be provided by moistening a toothbrush with a small amount of water or mouthrinse, and brushing the teeth.

Flossing should follow, when possible. Patient positioning is also a safety topic. The best position for oral hygiene care is standing or sitting, however, some LTCF residents may be unable to do either. Performing oral hygiene care while a resident lies supine in bed may lead to aspiration or choking.

This can be prevented by raising the head of the bed prior to providing care. A suction toothbrush may also help prevent aspiration among this patient population.

Appropriate infection control during oral care should also be addressed. Coleman and Watson 10 conducted a study in New York nursing homes in which nursing assistants were observed, but were unaware of what was being evaluated. The study found that none of the assistants provided oral hygiene care to LTCF residents while wearing clean examination gloves.

Nursing staff should be reminded that clean gloves should be donned before any form of oral care is delivered. Individuals with cognitive impairments often need help with oral hygiene care, but may resist it. Thus, nursing staff need strategies to cope with care-resistant behaviors when providing daily oral hygiene services. One of the barriers to maintaining oral health among residents of LTCFs is the lack of appropriate supplies.

The recommended lifespan of toothbrushes, recent patient illnesses, and toothbrush storage should be also addressed to prevent the proliferation of pathogens and mold, which can compromise the health of individuals who are at increased risk of illness due to weakened immune systems.

Personal supplies, such as toothbrushes, are typically ordered by a central supply director, who may not understand the importance of ordering quality toothbrushes with small heads and soft bristles. Often, budgetary limitations yield inexpensive toothbrushes with large heads and hard bristles. Oral health professionals need to advocate for appropriate oral hygiene supplies with LTCF leadership.

Some residents may receive monthly stipends for the purchase of personal care items that can be used to buy suitable oral hygiene supplies. If residents are unable to go shopping, a family member or the facility activity director may assist in such purchases.

For this reason, oral health education should also be provided for families and residents through a team-based approach. Numerous resources are available to help dental professionals train nursing staff to provide daily oral care in LTCFs Table 1. It also provides information for nursing home staff and families of residents in LTCFs.

The materials include a video showing a mouth with generalized periodontal disease and plaque. The pathogens in the plaque are shown filtering into the blood vessels of the surrounding gingiva, while the narrator explains the potential harm to systemic health when large amounts of periodontal pathogens enter the systemic bloodstream. This animation may be particularly relevant because wound care is an important part of nursing services in LTCFs. Depicting the oral cavity as an overlooked, bacteria-infected wound — and discussing the importance of cleaning and debriding this wound — may resonate with nursing staff.

The program includes CDs with printable forms, tests, manuals and workbooks, as well as videos for both trainers and trainees. Daily oral hygiene care is a fundamental requirement, especially for residents of LTCFs, who tend to experience oral disease disproportionately when compared to their counterparts who live at home. Oral health professionals are particularly well qualified to offer education that will help improve the provision of oral hygiene care in LTCFs.

This type of community involvement creates a sense of connectedness and fulfillment. Nursing home staff who receive such training — through in-service education or the aforementioned resources — are better prepared to deliver effective oral hygiene care.

This knowledge prepares them for numerous situations, including residents who are care resistant, confined to bed, or at risk of infection due to compromised immune systems. Prior to beginning her career in academia, Stein spent 13 years as the attending dentist at two nursing homes. She conducts research on sustainable strategies for improving the oral hygiene of nursing home residents, and has created an oral care curriculum for caregivers of older adults.

She works in the Division of Dental Public Health in research and outreach. She can be reached at joanna. Treatment Considerations for Patients With Cancer. Leave A Reply Cancel Reply. Save my name, email, and website in this browser for the next time I comment. Notify me of new posts by email. This site uses Akismet to reduce spam.

Learn how your comment data is processed. A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists. Likes Followers Subscribe. Start earning CE Units in minutes! In just a few clicks of your mouse you can be registered and taking Decisions Continuing Education courses. Discuss safety concerns during the provision of daily oral hygiene for LTCF residents.

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