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Oral Health in Care Homes - Coggle Diagram

- - - - Daily OH - following the theme of assisted living, carreid out by the CHR themself where possible, and by the care home staff were not.
        
        Toothbrushing
        
        An electric or manual toothbrush, once in the evening before bed and one other time, modified bass technique for 2 minutes, 'spit don't rinse' afterwards, medium/soft tufted, changed ever 6mth
        
        Toothpaste - The toothpaste used should contain 1350ppm fluoride, and if the resident is at high risk of caries e.g. due to polypharmacy casing xerostomia, then a 2800pmm or 5000ppm can be prescribe as well.
        
        Mouthwash - so long as the CHR has the capacity not to swallow the mouth rinse, it can be used as an adjunct (fluroataed or not) to aid oral hygyine; to be used at anotehr time to briushing e.g. after lunch
        
        ID Brushing - small spaces = floss tape or floss picks/electric flossers if dexterity is an issue
        
        Denture care
        
        As many CHR of an older generation are more likley to have dentures, it is important they are properly labeled, cleaned every day and removed and stored in water at night. Due to the massive physical and psychological benefits dentures provide, should any resident's denture become ill-fitting or lost, it is then paramount a new set be manufactured for the resident as soon as possible as well.
      - TFV - as elderly CHRs are more likely to be taking medication, it is possible they may also suffer from xerostomia (REF). TFV applied 2-4 times a year is a recommended adjunct to help protect against root caries.
      - To discuss with GP and Pharmacist
        
        Apart from daily oral health care, another essential component of the MCP would be discussing with the CHR's GP and pharmacist common risk factors that could be addressed that would also benefit their oral health.
        
        Key interventions include diet advice and attempting to swap to sugar-free medications where available to reduce sugar consumption, providing smoking and alcohol cessation advice, and providing support in managing any other health conditions that can also affect oral health e.g. diabetes (BSP, 2017).
      - Carers should have some training and awareness of different oral diseases and their symptoms, such that they can help detect, refer and manage e.g. caries, gingivitis, periodontitis, oral cancer, oral infection, dry mouth, ill-fitting dentures or just of any oral pain.
  - - - For residents who suffer from capacity issues, it is expected they would be in a specific care home with trained staff who would also be able to assist with their MCP.
        Should treatment at the dentist be necessary, it may be advisable to liaise and organise the their treatment with a special care dentist who would be able to provide a better treatment experience for the patient, including domicillary care.
    - - Small modifications could be made to e.g. electric toothbrush handles to allow for as much self care as possible, however if it cannot be performed to a sufficient quality by the resident themselves, then the assistance by care home staff will be more necessary
    - - Visits to the care home would be prohibited, and routine dental care has been suspended. Therefore prevention via the MCPs is even more vital, and information such as useful guidelines, other educational resources and updated treatment access pathways should be communicated to the care home staff and residents.
      - MCPs should be carried out independently where possible. Small changes may be made e.g. switching to a manual toothbrush to reduce droplets and splatter.
        For CHRs who require aid with their MCP, staff can assist so long as they have appropriate PPE (TURAS Learn, 2020).
    - - Organise members of the dental team to go into the care home to provide training sessions to the care home staff, making use of available educational resources, guidelines and factsheets. They could train a few seinor care home managers or even elect an Oral Health Champoin wwho could then train other staff members.
    - - The practice could possibly liaise with sales reps to provide free or cheaper bulk-bought supplies of e.g. denture cleaners, toothbrushes, toothpaste etc...