Eldercare

Oral Health Care Information for Seniors

Terrific new resources are now available for dentists and their older adult patients. Check out the OralLongevity content area on http://www.ada.org/orallongevity.aspx

The OralLongevity initiative is designed to increase awareness about the need to enhance and preserve the oral health of older Americans.  OralLongevity educational materials explore the link between oral health and general health and discuss ways to keep your teeth for life. By tackling oral health problems that impact adults over 60, the information and resources help dentists and consumers work together to maintain and preserve oral health, a healthy body and a great look throughout life.

Oral Health Care Information for Caregivers

Many health care professionals and family members find themselves administering or assisting with the provision of oral health care for an elderly person. The following guide is designed to provide useful information on how to properly give daily mouth care.  

The Skills of Daily Mouth Care

Why Daily Mouth Care Is Important

Bacteria are the main cause of tooth decay, bleeding gums, and bad breath; it must be controlled! Controlling bacteria in the mouth improved the residents’ dental health and feeling of overall well-being.  It improved the appetite, decreases feeling of isolation, and helps residents to feel good about themselves.

EVERY individual or resident needs and deserves good mouth care.

1.     Daily mouth care removes and controls bacteria, makes the mouth feel clean, and maintains healthy mouth tissue.

2.     Bacteria are present in ALL residents and accumulates on gums cheeks, tongue, roof of mouth, dentures and partials.

3.     Bacteria cling to the teeth at the gumline and moved along the root surface destroying the bone that supports the teeth.  This is how teeth get loose and are lost.

4.     Bacteria (plaque) form in two to three hours after brushing and flossing.

5.     A bloody toothbrush indicated the presence of bacteria.  Continue to gently brush the gums. As the bacterial count decreases, the gums will stop bleeding and become more healthy. 

6.     Bacteria can be removed effectively in four (4) minutes of less.

How to Control Mouth Bacteria

CAUTION: Do not put any liquids, toothpastes etc. in the mouth of patient if comatose, combative, or has difficulty swallowing.

Mouth bacteria can be controlled mechanically and chemically.

Mechanical Control

1.     Brush all mouth tissue with a labeled, small, soft bristle toothbrush using a small circular motion.  Be especially careful to brush align the gumline.

2.     Floss between teeth – scrape the sides of the teeth all the way to the gumline.  This will clean bacteria that tends to collect between the teeth.

Chemical Control

1.     Mouthwash with fluoride swished between the teeth and used on the toothbrush helps control bacteria.

2.     Toothpastes containing fluoride helps reduce tooth decay.  Only a small amount of toothpastes is needed on the brush.

3.     To prevent the spread of bacteria, label all mouth care supplies with the patients’ name.  Use a permanent marker and coat the names with clear nail polish.

Additional Controls

1.     Limit the number and frequency of sweets, especially soft drinks.

2.     Clean and store supplies properly.

3.     Regular dental exams and cleaning help to promote oral health.  Dentists often can identify and restore small problems before they develop into major toothaches.

Guide for Routine Oral Hygiene

Equipment and Supplies

Residents with natural teeth Gloves                                                           
Gauze
Curved basin                                     
Labeled toothpaste with fluoride
Paper cups                                                     
Straw
Towel                                                             
Labeled, junior size soft toothbrush
Paper towels                                                  
Labeled fluoridated mouthrinse
Labeled, wax dental floss                             
Labeled floss holder
Lubricant for lips

CAUTION: Do not put any liquids, toothpastes etc. in the mouth of patient if comatose, combative, or has problems swallowing. Use a toothbrush dipped in mouthrinse to brush the gumline, teeth and inside the mouth.

Residents with Dentures or Removable partial dentures
Gloves                                                                       
Labeled, junior size soft toothbrush
Labeled denture cup                                     
Labeled, lip lubricant
Labeled denture brush                                  
Paper towels
Labeled denture cleaner                               
Paper cups
Labeled, denture cleanser toothpaste         
Towel
Labeled, fluoridated toothpaste                   
Curved basin
Labeled, fluoridated mouthrinse                  
Gauze
Labeled, floss holder                                    
Labeled waxed dental tape

Comatose or Combative Patient
Use appropriate supplies.  Do not use liquids or toothpaste.  Use only a toothbrush dampened with mouthrinse.

Independent Resident:
-Necessary supplies to encourage independence.
-Careful supervision to assure control of bacteria.
-Explain to the resident that as a caregiver, there may be a few areas that are difficult to reach and that you will be happy to provide assistance.
-Explain the need to remove all bacteria so the resident will enjoy fresher breath and healthier gum tissue.

Delivering Daily Mouth Care
(at least twice a day)

Preparing for Basic Mouth Care:

1.  Identify the amount of assistance resident requires.

2.  Greet the resident and explain the procedure you are about to do (even if the resident is comatose).

3.  Wash your hands thoroughly using warm water.

4.  Put on protective gloves (if latex gloves are being used, make sure that the resident is not allergic to latex.  If so, use nitrile gloved or other gloves that do not contain latex.)

5.  Using paper cups, pour one-half inch of mouthrinse in one, and fill the other with warm water.  (this maybe diluted if necessary.)

6.  Prepare the floss holder with a twelve inch piece of floss.

7.  Arrange supplies conveniently

8.  Provide for resident’s privacy and comfort.

9.  Protect resident’s clothing with a towel.

10. Apply lubricant to lips.

11. Remove any visible debris, if necessary, using gauze.

12. Ask patient if there are any sores and if he or she can eat without pain.

Brushing the Teeth – Be aware of any changes in tissue color or texture.

Look for red or white areas.
- Apply a small drop of toothpaste on the bristles.
- Brush teeth, roof of the mouth, cheeks, tongue and gums in a slow circular motion.
- Use the tip of the brush to clean difficult areas.
- Rinse with mouthwash.  Hold curved basin under chin.

Flossing the Teeth:
- Floss by sliding the floss between the teeth and gently scraping in an up and down motion.
- Offer the resident an opportunity to use a mouth rinse.
- Use the curved basin under their chin.  Wipe mouth with a towel.
- Lubricate lips.

Cleaning and Replacing Supplies:
- Talk to the patient and make sure he/she is comfortable.
- Rinse toothbrush, shake off excess water.
- Wrap toothbrush in a paper towel.
- Place supplied in basin and return to proper place.

Finish Procedure:
1.  Removes gloves.
2.  Wash hands.
3.  Provide written documentation of procedures accomplished.  Report any unusual observations or other concerns to the proper personnel.

For Denture Patients:
Prepare for Basic Mouth Care if teeth are present.  Brush mouth tissue with a soft toothbrush.
1.  Prepare denture brush with denture cleanser toothpaste.
2.  Scrub dentures.  Keep dentures above denture cup; never place dentures directly in the sink.
3.  Brush and rinse well.  Rinse and clean denture cup.
4.  Return dentures to resident.
5.  Overnight soaking.  Place clean dentures in a denture cup with a denture cleaning table (ex. Polident).  Never soak dirty dentures.

If Denture Has Been Soaking:
1.  Drain used water.
2.  Scrub the denture.
3.  Scrub the cup.
4.  Rinse well.
5.  Examine the denture.  Check for fractures, sharp edges, or any missing or chipped teeth.
6.  Never return a damaged denture to a resident.  Report for repair.

Finish Procedure:
- Remove gloves.
- Wash hands.
- Provide written documentation of procedures accomplished.

Additional Considerations for Denture Patients
- Remove dentures and/or partial dentures after meals.  Rinse well and replace.
- If the resident is not using their dentures or partial dentures, record this in their chart and report.  Failure to wear dentures and partials may cause teeth to migrate and adversely affect the fit of the prosthesis.

Two-Month Maintenance

Every two months, use a flashlight to check all mouth tissues for changed in tissue color or texture.  Be especially aware of red or white areas.  If the resident is wearing partials or dentures, remove them prior to doing the examination.  After all areas have been checked, ask the resident if they are having any discomfort or pain, and if they are able to eat comfortably. 

Replace worn toothbrush with a new labeled toothbrush.

Every two months, dentures and partials should be cleaned in an ultra-sonic cleaner.
- Place rinsed dentures in a resealable plastic bag with water and denture cleanser.
- Place in ultra-sonic cleaner for five minutes.
- Rinse and scrub the denture with a denture brush.  Rinse well before returning to resident.
- Record and report any observations.

Tricks of the Trade

NEVER force open the mouth of a “mouth clencher".  Brush where you can reach.

NEVER place your fingers between the teeth of an uncooperative patient. 

A moist rolled-up wash cloth placed between the back teeth helps to comfortably keep the resident’s mouth open.

Use a cool, moist gauze – three or four times daily – to remove thick, crusty build up from the tongue and the roof of the mouth.

To relax a tight lower lip, have the patient smile, or hold the lip down with your thumb.

Watch for weight loss, or lack of appetite; this may be the first sign of dental problems.  Make sure your observations are reported.

Watch sweet treats for residents; they should be kept to a minimum or totally avoided.

A Word About “Dry-Mouth” (Xerostomia):

Saliva is very important in maintaining good oral health.  This is especially true in older individuals since a reduction in salivary flow is a normal part of the aging process.  Proper salivary flow helps to provide lubrication and protection of the oral tissue as well as buffering the acids that cause tooth decay.  Therefore, dry mouth may lead to some very serious dental conditions.  It may be caused by radiation therapy, vitamin deficiencies, stress, depression, diabetes, medications (both prescription and over-the-counter) and aging.  Mouth breathing will also cause xerostomia.

Symptoms of dry mouth include: lips stick to teeth, difficulty in swallowing, cracked or fissured tongue, difficulty/sore spots when wearing dentures and partials, inflamed gum tissue, bad breath. 

If you believe that a patient has xerostomia, arrange for the patient to be examined by a dentist to confirm this diagnosis.

Treatment choices: increase the fluid content of a resident’s diet, sugar free gum, salivary stimulus (suck on sugar free lemon candies), over-the-counter home care products (ex Biotene).

Prescription choices: daily fluoride, anti-plaque rinse (Chlorhexidine), saliva substitutes.

Many thanks to the North Carolina Dental Society and the Alliance of the North Carolina Dental Society for producing and sharing this guide.ADA.org.