Oral Health America Webinar Series
Oral Hygiene: Caring for the Older Adult with Dementia
May 3, 2018
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CE Credit Available
ABOUT ORAL HEALTH AMERICA America’s leading national oral health nonprofit focused on the nation’s oral and overall health for 63 years, with particular emphasis on children and youth, older adults and Americans whose voices are not well-represented in oral healthcare conversations. OHA employs strategic partnerships and communications to connect the dots between oral and overall health
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Beatriz Hicks, MA, RDH
Clinical Associate Professor UT Health Science Center at San Antonio Dental Hygiene Division, Dept. of Periodontics
Carol Nguyen, RDH, MSDH
Associate Professor (tenured) UT Health Science Center at San Antonio Dental Hygiene Division, Dept. of Periodontics
Melanie Taverna, MSDH, RDH
Director of Dental Hygiene Online Graduate Programs Asst. Director of the South Texas Oral Health Network UT Health Science Center at San Antonio Dental Hygiene Division, Dept. of Periodontics
Oral Hygiene: Caring for the Older Adult with Dementia Beatriz Hicks, Carol Nguyen, Melanie Taverna UT Health San Antonio, TX Periodontics Dept. Division of Dental Hygiene
Learning Objectives After this webinar, the participant should be able to: 1. Demonstrate communication strategies used with dementia patients.
2. Identify caregiver/provider strategies and adaptive aids for oral hygiene care. 3. Recognize the signs and symptoms of oral conditions related to the dementia patient.
4. Access and utilize resources for the patient, family members, and health-care providers.
Types of Behavior Problems ➢
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Alterations in Activity Alterations in Perception Aggression or Agitation
Behavioral Variabilities ➢Nervousness
➢Feeling
powerless ➢Having a sense of impending danger, panic or doom ➢Increased heart rate ➢Breathing rapidly (hyperventilation) ➢Sweating ➢Trouble concentrating ➢Focusing on perceived threat, danger or fear
Interventions for Prevention of Behavioral Problems ✓ Decreasing Environmental Stressors ✓ Meeting Primary Self-Needs ✓ Increasing Quality and Quantity of
Social Interactions ✓ Balancing Inner Retreat and Active Times
Assisting Clients Non-Verbally Maintain eye contact Use a gentle touch Provide nurturing cues Allow the person to rest Provide a quiet environment if appropriate
Assisting Clients with Verbal Communication ➢
Take a deep breath and free your mind of distractions when dealing with each patient
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Identify yourself and use the persons name Use your normal voice diction
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Approach the patient slowly, low tone, and clearly Be patient- Especially with untrusting /uncooperative individuals.
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Repeat a question if necessary
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Eliminate choices
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Offer Precise Directions
Explain the procedure you are performing as you perform it. Use short words and simple sentences explaining what you will be doing ➢
To say “Let’s Brush your Teeth” is too vague
Instead (break into small steps or tasks): 1. 2. 3. 4.
“Hold the toothbrush” “Put toothpaste on the brush” “Put the brush in your mouth” “Now brush your teeth,” etc.…
Other Techniques: “Watch Me Technique” To begin, you may stand beside them or behind them: Text Title
01
Place your wn text here
Help the client get use to your touch by using gentle but firm Text Title pressure around the client’s02 face,Place lips and your own text outside of the mouth here (desensitization technique) Text Title
Place your own text 03 here Demonstrate the act of brushing their teeth to the client
If necessary, gently place your 04 hand over their hand to guide the toothbrush (hand over hand)
Other Techniques ➢ Find the patient’s dominant side and stand on that side ➢ Place your free hand gently, but firmly on the patient’s shoulder (on their dominant side) ➢ Holding the toothbrush in your hand, place the patient’s dominant hand over your hand ➢ Apply firm pressure to the patients dominant shoulder to serve as a distraction 2 ➢ Instructional video: https://www.youtube.com/watch?v=93ixNssks1c
Other Techniques ➢ ➢ ➢ ➢
Use praise and positive responses One provider can start the task then another will finish (rescuing) The presence of a someone who cares/family member is helpful If the client refuses oral hygiene then try again at a different time ➢ look for the best time of day, minimize wait time, etc..
Tactile Techniques ➢ Jaw techniques and control of the jaw in order to access the oral cavity: - Hold the mandible (lower jaw) steady - Place pointer finger at chin to help open and manipulate jaw - Use smooth movements to move jaw
➢ Ways to manage a gag reflex in hypersensitive patients: -With finger use firm but gentle pressure on the outside of the lips/face
-Pressure can be applied to the front of the half of the tongue with a toothbrush
Do not place fingers in the mouth or toothbrush too far back in the mouth!
Tactile Techniques ➢Slide the back of a toothbrush against the cheek; this will will break perioral muscle spasms ➢For Tardive Dyskinetic movements, apply firm pressure to cheeks, lips, chin, face
Controlling an Active Tongue ➢ Use jaw control ➢ Firm pressure on front ½ tongue • Use mirror, tongue depressors, or bite blocks (open wide bite blocks)
➢ Ask the individual to swallow •
This helps relax and refocus the muscles
Strategies & Adaptive Aids
Multidisciplinary Team: Baseline Assessment for New Clients
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Assess level of assistance required to maintain oral hygiene ➢ ➢ ➢
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Independent Some assistance Fully dependent
Assess for pain/discomfort on eating/talking ➢
Excellent Questionable Poor
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Inquire if client has a dental home?
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Inquire date of last dental cleaning & exam Does patient wear a partial or denture?
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Is the denture/partial labeled on top & bottom?
Physical limitation categories to determine assistance with oral hygiene
Physical Limitations-great pic! - Independent - Some assistance - Fully dependent
Adaptive Aids
Brush for 2 minutes 2 X per day [AM/PM]
Collis Curve Toothbrush
Note: Electric dental equipment may confuse a person with severe Alzheimer’s or Dementia. 1
Electric Brush
Open Wide Mouth Rest
Bedside Adaptive Aids: Swab plus toothbrush
Swab
Interdental Brushes
Assistive Devices
DENTURE CARE…
Removable Partial Denture, RPD Partial
Denture
Healthy Edentulous Tissues
Gums Pink & Firm
Infected Denture (white spots)
Maintenance of Dentures
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Thoroughly rinse with cold tap water after cleaning or soaking with a denture solution
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When reinserting the denture make sure it is moist
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Visually ensure they are seated comfortably
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Remove denture/partial daily while sleeping or during waking hours
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Clean daily before meals and after storage with a denture brush and denture toothpaste/ mild liquid soap
Maintaining Family/Caregiver Alliance ➢ Health Team/Advocates collaborate with dentist ➢ Provide individualized care focused on: ➢ Communication ➢ Consistency
➢ Surveillance of mental/physical status ➢ Respect patients' needs and rights
Impact of Poor Oral Hygiene ➢
Negatively affect a person’s behavior
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Leads to fungal infections, tooth decay, tooth loss, and gum disease aka periodontitis
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Weight loss
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Can lead to systemic health complications ➢ malnutrition, respiratory infections, diabetes, cardiovascular diseases, and even premature death (e.g., due to aspiration pneumonia)
Recognize Oral Conditions and when to Refer Adapted: Administration on Aging (ADA 2016)
Xerostomia (Salivary Hypofunction)
Challacombe Scale of Clinical Dryness (CODS)
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Management Options for Dry Mouth
Oral lubricants: (OTC) ➢
Saliva substitutes and gels, toothpaste, Example: Biotene, Oasis, Xyli-melts
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Sugar-free xylitol chewing gum/lozenges
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Ice cubes/water
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Vitamin E Chapstick for lips
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Referral to MD if severe: Sjögrens Syndrome
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Salivary stimulants (RX): ➢ Prilocarpine (Salagen) ➢ Cevimeline (Evoxac) Significant side effects
Periodontal Disease
46
Decay: crown or root surfaces
Decay Prevention
Rx by DDS
Stomatitis ▪ ▪ ▪
Any inflammatory process affecting the mucous membranes of the mouth and lips May have many different causes May have many different appearances
Candida
Herpetic Lesions
Apthous Ulcers
Resources for the patient, family members, and health-care providers
Smiles For Life : CE’s http://www.smilesforlifeoralhealth.org/buildcontent.aspx?tut=555&pageke y=62948&cbreceipt=0
American Dental Association: https://www.mouthhealthy.org/en/adults-over-60
Colgate: http://www.colgate.com/en/us/oc/oral-health/life-stages/oral-care-age-55up/article/oral-health-for-seniors
Association of State and Territorial Directors (ASTDD): http://www.smilesforlifeoralhealth.org/buildcontent.aspx?tut=555&pageke y=http://www.astdd.org/healthy-aging-committee/
Morningside Ministries mmLearn: ** www.mmlearn.org • http://training.mmlearn.org/video-library/topic/oral-care Sign in required
DVD Mouthcare without a Battle: ** http://www.mouthcarewithoutabattle.org/
uestions? Questions?
Email us at: hicksb@uthscsa.edu; nguyenc@uthscsa.edu; taverna@uthscsa.edu
Adaptive Aids Information ▪ ▪ ▪
▪ ▪
http://colliscurve.com/ https://specializedcare.com/products/mouth-rests https://sage-products.co.uk/product-oral-hygiene/ https://www.medline.com/product/SecurityToothbrushes/Z05-PF06372 http://www.medicaleshop.com/headrests-necksupports.html
References: "Dental Care | Alzheimer's & Dementia | Alzheimer's Association. N.p., n.d. Web. 09 Jan. 2015. Chalmers JM. Behavior management and communication strategies for dental professionals when caring for patients with dementia. Spec Care Dentist 2000 July-August;20(4): 174-154. PMID: 11203891 Hall GR, Buckwalter KC. Progressively lowered stress threshold: a conceptual model for care of adults with Alzheimer‘s disease. Psych Nurs 1:399-406,1987 Nurs Health 1487-95,1991. https://www.cdc.gov/chronicdisease/resources/publications/aag/alzheimers.htm Taverna, M. V., Nguyen, C. A., & Hicks, B. M. (2016). Oral hygiene and self-care in older adults with dementia. Generations, 40(3), 43-48.
References Snow, Teepa. ""How to Help a Person with Dementia Brush Their Teeth" with Teepa Snow." YouTube. YouTube, 12 Dec. 2012. Web. 09 Jan. 2015. Harms, R. W., Berge, K. G., Hagen, P. T., Litin, S. C., Sheps, S. G., & Edwards, B. S. (Eds.). (2014, August 15). Anxiety-Symptoms. Retrieved December 26, 2014, from Mayo Clinic website: http://www.mayoclinic.org/diseases-conditions/anxiety/basics/symptoms/con-20026282 Felton D, Cooper L, Duqum I, Minsley G, Guckes A, Haug S, Meredith P, Solie C, Avery D, and Chandler ND,. Evidence-Based Guidelines for the Care and Maintenance of Complete Dentures: A Publication of the American College of Prosthodontists, J. Prosth. 2011; Vol 20 (Supplement s1) pgs. S1-12. http://onlinelibrary.wiley.com/doi/10.1111/j.1532849X.2010.00683.x Clinical Dryness Scale https://www.google.com/search?q=Challacombe+Scale+of+Clinical+Dryness+(CODES)&tbm =isch&tbo=u&source=univ&sa=X&ved=0ahUKEwjg76CvdPaAhUFSq0KHbT8BjUQsAQIQw&biw=1024&bih=434
Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes. • Write your questions in your control panel on the upper right hand of your screen. • Submit questions at any time.
CE Credit Available
Contact Information • Beatriz Hicks • hicksb@uthscsa.edu • Carol Nguyen • nguyenc@uthscsa.edu • Melanie Taverna • taverna@uthscsa.edu • Eamari Bell • eamari.bell@oha-chi.org