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 Oral Health Basics, Part 1

Dental hygienists train staff to administer daily dental care for residents who need assistance.

 

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It has been more than 150 years since the great pioneers journeyed to Kansas in search of unknown territory and new lives for their families. Kansans have always been strong and hard-working folks wanting to do the right thing for their neighbors, for the right reason.
 
So it’s not surprising that the folks from Kansas have been some of the first pioneers to initiate oral health programs into their long term care facilities.
 
Some Kansas nursing homes have had great success with the BLISS Oral Health Training Program (OHTP) that has been in use over the past 14 years (BLISS, 2007). The program has been copyrighted, and a patent is pending for the software version.

Program Boosts Quality Care

The OHTP provides and monitors training for nursing home staff by a registered dental hygienist (RDH) who assists them in providing oral care for their residents. At each facility, an RDH trains a team of staff, known as the oral health team. The team is responsible for providing oral health assessments and referrals as needed. The OHTP includes: initial and quarterly oral health assessments; referrals to dentists as needed; identification of dentures; staff oral health in-service presentations; and, most important of all, maintenance of daily oral care for residents who find it difficult or impossible to provide it for themselves.
 
Fourteen years ago, Teresa Achilles, administrator at the Cheney Golden Age Home, was one of the first pioneers to take the challenge of providing a comprehensive oral health program to residents.
 

OHTP trainingThe oral health team at Cheney assesses each new resident upon admission using the OHTP protocol. This determines the level of assistance a resident will need to maintain optimal daily oral care. The staff then provide the required support specific to each resident, dependent on the functional or cognitive restrictions of the individual.
 
When there is a change in the functional or cognitive condition of the resident, the level of assistance will also change accordingly.

Prevention Improves Outcomes

There are numerous benefits to daily oral health for residents, including freedom from discomfort and pain and the ability to enjoy eating and socializing without embarrassment, all of which serve to improve residents’ self-esteem.
 
Maintenance of daily oral health involves removal of dental plaque, which is a natural bacterial biofilm composed of various micro-organisms tenaciously attached to teeth and other oral surfaces (Harris, Garcia-Godoy, & Nathe, 2009). Plaque-related oral diseases are dental caries (tooth decay) and periodontal disease (gum disease). These diseases are not caused by a single pathogenic microorganism. The accumulation of numerous bacterial species makes up dental plaque (Harris et al., 2009).
 
Oral problems experienced by older adults are preventable and can often be detected early. They are not the direct result of aging. Dental caries and periodontal disease are plaque-related, preventable oral diseases. Although these diseases are generally not life-threatening or seriously impairing for most older adults, they can have an effect on the management of medical conditions, general health, nutrition, and quality of life (Blanco-Johnson, 2012).
 
It is important to remember that infections in the gum tissue create an open route to the body’s bloodstream. Oral infection can also lead to aspirated bacteria into the respiratory system. These routes of infection can clearly compromise a resident’s overall health.
 
There are other conditions and diseases that can affect residents’ ability to maintain their own oral health. These include: arthritis, dementia, diabetes, hypertension, stroke, visual changes, and xerostomia (dry mouth). For example, xerostomia is a common side effect of more than 400 medications—many of which are often prescribed for nursing home residents. With dry mouth, there is less saliva, which is necessary to lubricate the soft tissues and aid in chewing, swallowing, and speaking.
 
Saliva also neutralizes the acids produced by bacterial plaque. Without adequate saliva buffering, decay can become rampant. Therefore, if there is inadequate saliva, plaque readily sticks to the teeth, dentures, and partials, making it easier for decay to occur and compromising normal oral function.

Individual Needs Should Be Met

In addition to providing assessments and referrals, staff at Cheney Golden Age Home are taught to be aware of the individual needs of each resident, which helps in maintaining optimum oral health. For example, many residents will exhibit gum recession, which exposes the dentin, a portion of the tooth root. The dentin is much softer than the enamel, which is the hard, mineralized outer covering of the tooth. Due to the dentin’s porous nature, it decays much faster than the enamel.
 
In the presence of xerostomia, root decay can rapidly spread, causing pain, abscess, and even tooth loss. Additionally, dentin is sensitive to hot and cold drinks. Many residents are likely to drink more water if it is served to them at room temperature instead of ice cold. In addition, it’s more comfortable to rinse the mouth, after brushing, with room temperature or warm water.
 
Residents who are suffering from dehydration will respond to drinking more water if this simple formula is used: Provide room-temperature water for their use.
 
Maintaining good oral health for residents has provided an amazing array of successes for nursing home residents. Some OHTP testimonies include the following: fewer hospital admittances due to respiratory problems, less-frequent behavioral problems, improvement in overall self-esteem, and enhanced quality of life, especially when oral cancer is detected early.
 
Kansans will continue to be pioneers in the field of oral health. They are well aware that the baby boomers are a population who value maintaining optimum oral health. Once they enter a nursing home, they will expect, and appreciate, the dedicated staff who assist their neighbor with maintaining oral health.
 
“As a result of the OHTP, Cheney has less expense with the purchase of supplements, and since the oral health problems are found in the early stages, less cost once a resident goes to the dentist,” says Achilles. “In addition, it is a great marketing tool for the facility because we are able to say that we offer an excellent oral health program for our residents.”
 
And as many Kansans are fond of saying, “It’s the right thing to do!”

READ MORE: Paying For Dental Work
 
Loretta J. Seidl, RDH, MHS, is president of BLISS & Associates and an oral health consultant for the Kansas Health Care Association and Oral Health Kansas.
 
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