What’s 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 potential impact on their general health, well being and dignity” NICE will be marking homes on levels of oral care
Failure to remove a dangerous denture 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!! •
Sorry its graphic
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
Oral Diseases affect 3.9 Billion worldwide • 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
Putting the mouth back into the body Treating the mouth with the respect it deserves
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)
Think mouth, Think health Oral Health General Health A two way relationship
Poor oral health has been linked to general health
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
Would you ignore this?
But this gets ignore…….Why?
Jacks story – 25 th 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 @NHS_HealthEdEng @MCM_HEKSS #mouthcare
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 of death, it was contributing factor
Vap-Ventilator Associated Pneumonia • VAP- ventilator associated pneumonia (vap) is pneumonia occurring in a patient within 48 hours or 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 •
Defining HAP and CAP • Hospital-Acquired Pneumonia • Community-acquired pneumonia (HAP) (CAP) • is defined as pneumonia that • Community-acquired pneumonia occurs 48 hours or more after refers to pneumonia acquired hospital admission and that was outside of hospitals or extended- not present at the time of care facilities. admission. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/in fectious-disease/community-acquired-pneumonia http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/in fectious-disease/health-care-associated-pneumonia/
Those at risk • Neurological dysphagia • Dementia • Stroke • Liver disease • Copd • Enteral feeding • Malignancy • Suppressed immune systems • Renal disease • Surgery to treat cancer of mouth, throat or neck • Recent surgery or trauma
Patients with Learning Disabilities deserve a healthy mouth too!
Function of saliva • 1 st Stage Of Digestion • Lubricates • Taste • Antibacterial • Regulates Oral Ph • Facilitates Re-mineralization
Salivary glands Parotid Sublingual Submandibular
The wonderful world of dentures…….
Types of dentures Full and Partial Dentures Dentures with Implants
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
Denture Marking • 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 Adapted from resources from RIS Healthcare and Salford Royal NHS foundation Trust. Reproduced with permission
Dental Implants…….treat them just like teeth!
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
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.
Dry Mouth : Signs • Dry, rough tongue • Sticky, dry feeling in the mouth • Sore painful mouth and tongue • Trouble chewing, swallowing, tasting, or speaking • Oral fungal infections • Burning feeling in the mouth • Lips sticking to the teeth and • Dry feeling in the throat taste disturbance • Cracked lips and or corners of • Bad breath ( odour ) the mouth.
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
Managing a dry mouth Artificial saliva and lubricants Ice chips Sugar free gum
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
Periodontal disease (bleeding gums) Bacteria in dental plaque • • Gum disease Swelling and bleeding gums • Loose teeth • Bleeding gums often • This hoto by Unknown Author is licensed under CC BY-SA frighten carers. The gums will bleed if they are unhealthy. The only way to make gums better is to brush bacteria away.
Toothbrushes
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
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.
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
Practical tips…….. • Distraction – Place a familiar item in their hands, Toothbrush, towel, or cushion • Play familiar music to distract or relax If Resident refuses make a record in notes but KEEP TRYING This Photo by Unknown Author is licensed under CC BY-SA-NC
Quality of life The end-of life deserves as much beauty, care, and respect as the beginning
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