Journal of Gerontological Nursing

CLINICAL OUTLOOK 

Interventions to Improve Oral Care: The Nursing Assistant's Role

Gail P Winkley, RDH, MS; Jessie O Brown, RDH, MHE; Troy Stone, RDH, MHE

Abstract

Medical and sociologie problems associated with aging are compounded by poor oral and dental health. Although there have been advances in dental knowledge and technology, a large segment of the older population and their caregivers view oral health with common misconceptions or obsolete information (Logan, 1991). The caregiver should monitor the assessment and prevention of oral health problems (Danielson, 1988). When an elderly person is hampered by physical or psychologic disabilities, it is necessary for the caregiver to perform these tasks.

Bedbound patients are at risk for developing oral problems due to the following factors:

* Diets that primarily consist of soft or liquid food. This reduces chewing, which no longer stimulates muscle tone and the condition of oral tissues. Sugar is retained in the mouth for a longer time, which promotes dental caries;

* Medications that can alter saliva production. This can lead to retention of food debris in the mouth and digestive problems. Frequent use of antibiotics can lead to fungal infections;

* Circulatory problems that can contribute to the swelling and bleeding of oral tissues;

* Mouth breathing, weakness of the tongue, and dry and cracked lips, which result in patient discomfort, loss of chewing ability, drooling, or a dry throat with a persistent cough;

* Decrease of social interaction due to difficulty in eating, speaking, swallowing, mouth odor, and general discomfort; and

* Increase in root caries and peridontal disease, which can cause pain, bleeding, swelling, and tooth loss.

Daily cleanliness of the mouth and teeth helps to prevent coating of the tongue, and reduces odors and sores in and around the mouth. Oral plaque removal also helps the patient gain greater emotional security. The nursing assistant in a long-term care facility is responsible for the resident's individualized health care (Fisk, 1984). Many elderly residents must rely on others for assistance with oral services that they can no longer perform. Because dental health is a vital part of total health, this service should not be overlooked (USDHHS, 1990).

Plaque Removal

Many patients will need only a gentle reminder or limited daily assistance to help with oral care. When this is the case, the nursing assistant needs only to supervise daily plaque removal with a soft bristle multituf ted toothbrush and a fluoride dentrifice. A brushing of the sulcus is necessary to effectively remove oral debris (Figure).

Nursing Implications

Nationwide, the expectations for quality total health care, including oral health, have been augmented. The nursing assistant can have a profound effect by providing essential daily oral care services within the overall health care treatment plan (Woolfork, 1989). Consultation with dental professionals and participation in dental inservice educational programs will strengthen the quality of geriatric patients in long-term care facilities.

TABLE…

Medical and sociologie problems associated with aging are compounded by poor oral and dental health. Although there have been advances in dental knowledge and technology, a large segment of the older population and their caregivers view oral health with common misconceptions or obsolete information (Logan, 1991). The caregiver should monitor the assessment and prevention of oral health problems (Danielson, 1988). When an elderly person is hampered by physical or psychologic disabilities, it is necessary for the caregiver to perform these tasks.

Bedbound patients are at risk for developing oral problems due to the following factors:

* Diets that primarily consist of soft or liquid food. This reduces chewing, which no longer stimulates muscle tone and the condition of oral tissues. Sugar is retained in the mouth for a longer time, which promotes dental caries;

* Medications that can alter saliva production. This can lead to retention of food debris in the mouth and digestive problems. Frequent use of antibiotics can lead to fungal infections;

* Circulatory problems that can contribute to the swelling and bleeding of oral tissues;

* Mouth breathing, weakness of the tongue, and dry and cracked lips, which result in patient discomfort, loss of chewing ability, drooling, or a dry throat with a persistent cough;

* Decrease of social interaction due to difficulty in eating, speaking, swallowing, mouth odor, and general discomfort; and

* Increase in root caries and peridontal disease, which can cause pain, bleeding, swelling, and tooth loss.

Daily cleanliness of the mouth and teeth helps to prevent coating of the tongue, and reduces odors and sores in and around the mouth. Oral plaque removal also helps the patient gain greater emotional security. The nursing assistant in a long-term care facility is responsible for the resident's individualized health care (Fisk, 1984). Many elderly residents must rely on others for assistance with oral services that they can no longer perform. Because dental health is a vital part of total health, this service should not be overlooked (USDHHS, 1990).

Plaque Removal

Many patients will need only a gentle reminder or limited daily assistance to help with oral care. When this is the case, the nursing assistant needs only to supervise daily plaque removal with a soft bristle multituf ted toothbrush and a fluoride dentrifice. A brushing of the sulcus is necessary to effectively remove oral debris (Figure).

Figure. To clean the inside surfaces of the front teeth, hold the brush vertically and use up and down strokes.

Figure. To clean the inside surfaces of the front teeth, hold the brush vertically and use up and down strokes.

When the patient is bedbound or disabled, the nursing assistant must provide daily oral hygiene care procedures (Table). It is helpful to gather all appropriate supplies together, including disposable gloves; lubricant for lips; toothbrush with soft bristles; cup of water or diluted mouthwash; emesis basin; straw; towel; gauze; and toothpaste (do not use on an unconscious patient, as it is difficult to remove without a mechanical evacuation system). The basic procedures for completing this task may be modified to meet the needs of each individual.

Dentures, like natural teeth, must be kept clean and free of deposits. This prevents offensive mouth odors and preserves health by reducing the amount of bacterial and fungal organisms. Denture brushes are designed with bristles that are stiffer than those of a toothbrush. Artificial dentures should be brushed with a cleaning agent and rinsed under running water. The mouth should be rinsed thoroughly upon rising, after each meal, and before retiring (Papas, 1991).

Periodic Assessment

A dentist or dental hygienist should attend periodic staff meetings and conduct inservice programs to reinforce oral health care techniques. Oral manifestations should be discussed, and strategies and modification for care written into the health plan. This ensures that changing dental needs are met (Quinn, 1988).

Table

TABLE

TABLE

Nursing Implications

Nationwide, the expectations for quality total health care, including oral health, have been augmented. The nursing assistant can have a profound effect by providing essential daily oral care services within the overall health care treatment plan (Woolfork, 1989). Consultation with dental professionals and participation in dental inservice educational programs will strengthen the quality of geriatric patients in long-term care facilities.

REFERENCES

  • Danielson, K.H. Oral care and older adults. Journal of Gerontological Nursing 1988; 14(11):6-10.
  • Fisk, V.R. When nurses' aides care. Journal of Gerontological Nursing 1984; 10(3):1 19-127.
  • Lebel, J.O. Health needs of the elderly. Dent Clin North Am 1989; 33:1.
  • Logan, H.L., Ettinger, R., McLeran, H., Casko, R. Common misconceptions about oral health in the older adult: Nursing practices. Special Care in Dentistry 1991; 11(6):243-247.
  • Papas, A.S., Niessen, L.C., Howard, H.C. Geriatric Dentistry, Aging, and Oral Health. St. Louis: Mosby-Year Book, 1991, pp. 309-330.
  • Quinn, M.J. Establishing a preventive dentistry program in a long-term health care institution. J Gerontol 1988; 4.165-167.
  • US Department of Health and Human Services (USDHHS). Health people 2000: National health promotion and disease prevention objectives (DHHS Publication No. [PHS] 9150213). Washington, DC: US Government Printing Office, 1990:359.
  • Woolfork, C.H. What can you expect of nurses' aides? Geriatric Nursing 1989; 10(4):178-180.

TABLE

10.3928/0098-9134-19931101-14

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