Oral CareOral Care

AimsAims

By the end of the session the participant will:By the end of the session the participant will:

Be familiar with the structures within and Be familiar with the structures within and around the moutharound the mouth

Be aware of the negative impact on general Be aware of the negative impact on general health which can occur due to poor oral health which can occur due to poor oral healthhealth

Know the correct equipment to use when Know the correct equipment to use when carrying out oral carecarrying out oral care

Oral CareOral Care

Poor oral hygiene is a common cause of Poor oral hygiene is a common cause of distress for patients and familiesdistress for patients and families

Poor care may be due to lack of training, Poor care may be due to lack of training, knowledge, inconsistent careknowledge, inconsistent care

Not always a high priorityNot always a high priority Essential for patient comfortEssential for patient comfort

Risk Factors Risk Factors forfor Oral Oral ComplicationsComplications

Systemically ill, terminal illness, unconscious Systemically ill, terminal illness, unconscious patient, tracheostomypatient, tracheostomy

Oxygen therapy, mouth breathing, nil by mouth.Oxygen therapy, mouth breathing, nil by mouth. Naso – gastric/peg feedingNaso – gastric/peg feeding Chemotherapy/radiotherapy, drug therapy Chemotherapy/radiotherapy, drug therapy Ill fitting denturesIll fitting dentures DiabetesDiabetes DementiaDementia

Consequences of poor oral Consequences of poor oral carecare

PneumoniaPneumonia SepticaemiaSepticaemia EndocarditisEndocarditis PainPain Xerostomia (dry mouth)Xerostomia (dry mouth) HalitosisHalitosis Difficulty eating and drinkingDifficulty eating and drinking WithdrawalWithdrawal Low moodLow mood

Good Oral CareGood Oral Care

Frequent inspection important using a pen Frequent inspection important using a pen torch, tongue depressor and gloved fingertorch, tongue depressor and gloved finger

Have an understanding of the possible risk Have an understanding of the possible risk factorsfactors

Examine in and outside the mouth Examine in and outside the mouth Early detection/reporting of problemsEarly detection/reporting of problems Need instruction on specific requirements Need instruction on specific requirements

for that patientfor that patient

Dentate Patients (own teeth)Dentate Patients (own teeth)

Brush teeth at least twice per day with Brush teeth at least twice per day with toothbrush and fluoride toothpastetoothbrush and fluoride toothpaste

Moisturise lips if necessary with a water Moisturise lips if necessary with a water based lubricating gelbased lubricating gel

ONLYONLY use foam swabs soaked in water use foam swabs soaked in water

if using a toothbrush is too painful or if using a toothbrush is too painful or impossible, impossible,

Care of DenturesCare of Dentures Remove and brush with a toothbrush and water Remove and brush with a toothbrush and water

after every mealafter every meal Rinse mouth with water to remove debrisRinse mouth with water to remove debris Moisturise lips if necessary with water based Moisturise lips if necessary with water based

lubricating gellubricating gel Remove and soak overnight in water Remove and soak overnight in water If oral infection is present, e.g. candida, dentures If oral infection is present, e.g. candida, dentures

should be soaked in 1% sodium hypochlorite should be soaked in 1% sodium hypochlorite solution 2ml mixed with 160ml of tap water. If solution 2ml mixed with 160ml of tap water. If they have metal parts – soak in chlorhexidine they have metal parts – soak in chlorhexidine 0.2%0.2%

Oral ProblemsOral Problems

Candida Candida (thrush)(thrush) Bacterial infectionsBacterial infections XerostomiaXerostomia(dry mouth) (dry mouth) MucositisMucositis Cold soresCold sores UlcersUlcers Angular cheilitisAngular cheilitis

CandidaCandida

Dry mouthDry mouth

What causes a dry mouth?What causes a dry mouth? What problems can a dry mouth cause?What problems can a dry mouth cause?

CausesCauses

Drugs – lots of themDrugs – lots of them RadiotherapyRadiotherapy OxygenOxygen Mouth breathingMouth breathing

Complications of dry mouthComplications of dry mouth

DecayDecay Gum recession and loss of teethGum recession and loss of teeth Difficulty eatingDifficulty eating Difficulty speakingDifficulty speaking Trauma of mucosaTrauma of mucosa HalitosisHalitosis

Dry MouthDry Mouth ( (XerostomiaXerostomia))

Continue brushing teeth twice per day with fluoride Continue brushing teeth twice per day with fluoride toothpastetoothpaste

Sips of and rinsing with tap waterSips of and rinsing with tap water Artificial saliva – Avoid glandosane in patients with Artificial saliva – Avoid glandosane in patients with

their own teeththeir own teethSaliva Orthana has a porcine extract so is not Saliva Orthana has a porcine extract so is not suitable for some patients due to culturesuitable for some patients due to culture

Oral balance gelOral balance gel Sugar free chewing gumSugar free chewing gum Review of medicationReview of medication

Cold soreCold sore

                            

Aphthous ulcerAphthous ulcer

Angular cheilitisAngular cheilitis

Treatment of Painful MouthsTreatment of Painful Mouths

Some patients may need pain relief such as co-Some patients may need pain relief such as co-codamol or even morphine in severe casescodamol or even morphine in severe cases

Avoid strong, acidic mouthwashes e.g. brand Avoid strong, acidic mouthwashes e.g. brand makesmakes

Benzydamine (Difflam) mouth wash has local Benzydamine (Difflam) mouth wash has local anaesthetic. It can be diluted 1:1 if stinginganaesthetic. It can be diluted 1:1 if stinging

Topical steroid for ulcers such as hydrocortisone Topical steroid for ulcers such as hydrocortisone pelletspellets

Practical Session…Practical Session…