1
Competency:
*Demonstrate proper tooth brushing on the dentulous resident
*Demonstrate proper flossing on the dentulous resident
*Demonstrate proper swabbing for the edentulous resident
*Identify residents who need assistance with daily care
*Infection control
Competency:
*Demonstrate proper denture cleaning, storage and labeling
*Demonstrate proper denture insertion technique
Competency:
*Identify common oral health lesions
*Describe abscess/symptoms of infection
*Poorly fitting dentures
*Caring for a NPO patient
Competency:
*Communicate institutional policies related to personal care including mouth and teeth care
*How to report an emergency according to facility policy
FLOSS: " Facilitating Long-term Oral health ServiceS "
The purpose of FLOSS is to improve the general understanding of oral health care.
These modules are designed to enhance the knowledge, technique, and skills of Certified Nursing Assistants in caring for geriatric patients.
Who to Assist?
Denture Care
- People that may forget to brush i.e. Alzheimer's/ dementia patients
- Conditions that may alter motor control i.e. arthritis, Parkinson's
- Other: elderly, physically weak
Cleaning & Storage
1. Soak dentures in a correctly labeled denture container over night in cool to warm water with cleansing tab.
- cleansing tab kills 99.9% of bacteria and important for infection control
2. It's important for dentures to remain moist at all times to prevent dentures from changing shape and no longer fitting patient.
3. Make sure to rinse dentures in the morning before having patient place back in mouth.
4. Dentures should be out at least 4 hours for every 24 hours.
Make sure to not place dentures in napkins so they are not accidentally thrown out
Infection Control
Denture Instructions
Labeling
1. Patient's name or some form of unique identification can be placed in dentures when they are made (some denture storage cup also have identification).
2.Important so that dentures are not confused between patients.
3. Dentures labeled inside the material does not weaken or make dentures less esthetic.
Oral Problems
- Personal Protective Equipment (PPE):
- Gloves are recommended
- Wash hands thoroughly before and after attending a patient
- Use new, sterilized, or pre-packaged oral-care products
- Follow your facilities protocol for proper PPE
Denture Techniques
Let's take a closer look...
Brushing
Swabbing
Flossing
- It is very important to remove dentures at night to give the gums a rest
- After removing dentures, gently brush tongue in a back-to-front motion with a soft-bristled tooth brush. Use a gloved finger or oral swab with foam head to swab the gums, roof of mouth, and inside of cheeks.
- Let individual rinse with lukewarm salt water to help clean gums
- If the person wears a partial denture make sure to clean/floss around the clasp
- Use a soft bristled toothbrush
- Brush outer surface of upper & lower teeth with small, circular strokes by tilting the toothbrush at a slight angle
- Brush chewing surfaces of upper and lower teeth
- Brush inner surface of upper and lower teeth and gently under gum line
- Turn your toothbrush sideways and gently brush tongue by sweeping in a back-to-front motion
- If the toothbrush bristles are splayed out, you're brushing too hard!
- Break off ~18in. of floss and wrap most of it around one of your middle fingers. Wind the rest on your other middle finger.
- Guide the floss gently between the individual's teeth to the gum line and shape it into the letter "C" against the side of the tooth.
- Slide the floss up and down away from the gum to remove the debris. Repeat for the other side of the tooth.
- Use fresh part of floss as you repeat the steps for the rest of teeth.
- Don't forget the back side of the very last teeth
Tooth Decay
Loss of tooth structure due to a bacteria and sugar
Abscess
A swollen area within tissue containing pus
Gum Disease
Infection of the gums that can lead to bone loss and eventually tooth loss
Symptoms
-Swelling
-Not eating
-Fever
-Unusual drooling
-Foul odor
-Combative behavior (patient stops oral hygiene due to pain)
Key identifiers:
- Redness
- Swelling
- Puffiness
- Bleeding
Removal
Insertion
Oral Lesions
Oral Cancer
1. Always place upper dentures first. Apply adhesive to dentures. Place 3-4 pea size dots along upper denture making sure to include roof of denture. Place about 3 pea size drops evenly along lower denture.
2. Place dentures in mouth and press firmly for proper seal.
1. Upper dentures: place fingers in cheek area along top of dentures near gums and gently pull down to remove denture.
2. Lower dentures: place fingers on each side of denture and slowly rock out of mouth.
Uncontrollable cell growth
Signs:
- White, red, or speckled velvet textured patch
- Unexplained numbness
- Difficulty speaking or swallowing
Common Locations:
- Lip
- Tongue
- Floor of mouth
Common Oral Lesions include:
- Tooth Decay
- Gum Irritation or swelling
- Thrush
- Oral Cancer
Proper Oral Hygiene
Thrush
Fungal infection that is white in appearance with red, raw corners of mouth
Torus
Bony growth that does not change quickly with time
- Possible locations:
- Roof of mouth
- Floor of mouth
Oral Health
Indications of Poorly
Fitting Dentures
Caring for NPO (nothing by mouth) patients
Things to Remember!
- Discomfort
- Loose fit
- Speech problems
- Difficulty eating
- Swelling & Ulcers
- Fungal Infection
- Swab the patient's mouth and use lip balm often
- If using a toothbrush limit the amount of toothpaste or only use a wet toothbrush
- If the mouth opening is small use a child size tooth brush
- Don't forget to look for signs of thrush, dry mouth, and cavities all of which are common in NPO patients
Oral health affects your overall physical health
Competency:
*Describe how oral health affects overall physical health
*Identify/describe behaviors that impact oral health
*Identify common diseases/conditions that affect oral health
*Describe oral health related to systemic diseases and medications
Signs of A Dental Emergency
Diseases & Conditions affecting oral health
Institutional Policies
- Severe toothache
- Broken tooth
- Head/neck swelling
- Defective fillings
- Soft tissue injuries
- Trauma
- Intraoral soreness or swellings
Viruses
- HIV
- AIDS
- Shingles
- Herpes
Age-Related Disorders
Often times these viruses show signs in the mouth first. This is why daily checkups are encouraged.
Behaviors impacting oral health
- Alzheimer's
- Dementia
- Arthritis
- Osteoporosis
- Cataracts
- Parkinson's
Stress
These are also people that may need additional assistance with oral hygiene.
Other
Diseases that Affect Entire Body
- Stress impairs the body's natural healing process
- Alters hormone levels which could increase swelling and bacterial load
- Stress can also present itself in the form of mouth sores
Poor diet
Dealing With
Combative Patients
- Mental illness
- Cancer
- Xerostomia "dry mouth"
- Medications
Good
- Pneumonia
- Diabetes
- Cardiovascular
- Asthma
- Kidney failure
- Liver disease
- High sugar foods promote cavities
- Frequent snacking provides favorable environment for cavity causing bacteria
- Fruits and vegetables contain high levels of antioxidants which promote healing
- Consider Xylitol products (chewing gum, mints, etc.)
- Stay calm and do not raise your voice
- Be understanding and figure out the problem
- Bring in a third party
- Walk away
- Proper dental hygiene combined with routine dental visits
- Balanced diet
- Saliva flow
- Fluoridated water
Many cancer treatments and medications can cause dry mouth, which increases the risk for cavities. Saliva or spit is the body's natural protection against mouth germs.
Don't forget oral health is linked to the overall health of your entire body. Pneumonia is the leading cause of death in nursing homes. Poor oral care can be linked with pneumonia.
Helpful Tips
Tobacco
If any dental emergencies are present call your facility dentist and then follow your facility procedures for emergency protocols
Day shift duties:
Brush teeth
Floss
Insert dentures
Night shift duties:
Denture care
Brush & Floss
Swab
Weekly checkups help to improve communication
and goals for the patient
Alcohol
- Make sure to change toothbrush every 3-4 months
- Use water and toothpaste with fluoride (note: bottled water may not contain fluoride)
- For dry mouth products are available such as Biotene mouthwash, Oasis mouth spray, or Orajel moisturizing gel
- Recommended to use alcohol FREE mouthwash across the whole facility
- Bad breath
- Staining of teeth
- Swelling
- Decreased rate of healing
- Increased risk of oral cancer
- It is important to look for signs of oral cancer from previous smoking or tobacco abuse. A lump or sore that does not heal after 14 days is unusual and could be cancerous. Common sites are sides of tongue and under the tongue, but can be found anywhere in the mouth. Refer to dentist if such a sore is noticed.
- Combined with smoking can lead to an increased risk of oral cancer
- Remember it is important to look for signs of oral cancer from previous alcohol abuse. Refer to slide about tobacco for instruction.
All Affect Oral Health
Practicum Component
At the completion of the competencies, CNA's should be able to demonstrate how to brush teeth using the supplied materials. It is recommended to evaluate staff on a satisfactory/unsatisfactory scale. See Proper Oral Hygiene competency for the brushing video to assess staff.
Assessment & Credits
2. Which of the following diseases is most
likely to lead to poorer oral health in the elderly
a. Diabetes
b. Cardiovascular
c. Kidney failure
d. HIV/AIDS
e. All of the above
3. Which of the following are signs of a dental emergency?
a. Resident is not eating
b. Resident’s breath has a foul odor
c. Resident has swelling in and/or around mouth
d. Resident is drooling more than usual
e. All of the above
1. Which of the following statements is true regarding the oral health of residents in long term care facilities?
a. Reminding residents to brush their teeth every day is enough to keep their mouths and teeth healthy.
b. Since they have challenges with performing self-care activities, they are at risk for poor oral health unless caregivers help them brush their teeth each day.
c. If a resident has dentures, there is no need to clean out the mouth.
4. Which of the following statements is true for residents with dentures.
a. As long as they are brushed, they can remain in the mouth overnight
b. A denture can be wrapped in a napkin for storage when out of the mouth.
c. Dentures need to be brushed and then placed in a labeled denture container with water and cleansing tablet over night.
5. What are the most common oral problems
a. Tooth Decay
b. Gum Infections
c. Oral Cancer
d. All of the above
Flossy Lyrics
I'm flossy
I'm the first girl to pull off the plaque
I switched up the curic-cu-lum
That's right I put all your teeth in the jar
And that's right I'm one who's taking care of your mom
I'm flossy
I'm the CNA ya love to hate
I'm the chick that's raised the stakes
I told old Eleanor she should switch to paste
I'm back here to educate cause I'm flossy
Ooh let me slow it down so you can catch the show (catch the show)
Use the floss, make it go extra slow (extra slow)
Real nurses like to floss real slow (like to floss real slow)
Ooh I showed you how to clean the gums
I do it like a pro
I floss the teeth like a daughter would, I'm so good
Ooh from the residents up in Harvest Health
The fabulous flossing families on the island
Don't mess up our plan
We gon' keep flossing while we educate and bossing
Dentures in my mouth, de-dentures on gums
Dentures in my mouth, de-dentures on my gums