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Oral and Dental Care Work Instruction

1         Scope

This work Instruction applies to all mobility staff who provide oral and dental care to clients.

Good oral health is fundamental to overall health and wellbeing (COAG 2015). Without it, a person’s general quality of life and the ability to eat, speak and socialise is compromised, resulting in pain, discomfort and embarrassment.

Oral health refers to the condition of a person’s teeth and gums, as well as the health of the muscles and bones in their mouth (AHMAC 2017). Poor oral health—mainly tooth decay, gum disease and tooth loss—affects many Australian children and adults and contributed 4.5% of all the burden that non-fatal burden diseases placed on the community in 2015. Oral health generally deteriorates over a person’s lifetime.

The most common oral diseases affect the teeth (tooth decay, called ‘caries’) and gums (periodontal disease). Oral disease can destroy the tissues in the mouth, leading to lasting physical and psychological disability (NACDH 2012). Tooth loss can reduce the functionality of the mouth, making chewing and swallowing more challenging, which in turn can compromise nutrition. Poor nutrition can impair general health and exacerbate existing health conditions (NACDH 2012). Poor oral health is also associated with a number of chronic diseases, including stroke and cardiovascular disease (DHSV 2011) [i]

2         Definitions

3         Work Instruction

It is important to support the independence of clients and clients by assisting them to do as much of their daily living care as they can. If clients are unable to manage their own daily oral hygiene care, they may need assistance.

3.1.1    NATURAL TEETH

• Wash hands and apply PPE
• Explain the procedure and seek consent. (If the client or client is cognitively impaired show the toothbrush and/or swab stick (if being used) as part of the explanation of the procedure).
• Ask the client or client to remove any partial or full dentures (if applicable) or assist in this process if needed. Place dentures in a container.
• Stand behind the client or client (cuddle position) when possible or standing in front position with client sitting.
• Protect clothing with a towel placed across the front of chest/neck.
• Perform an oral assessment
• Oral Assessment: assess the appearance of the oral cavity – gums, teeth, tongue, breath, and report any changes to the Care Manager.
• Assisting the client or client (within their capability) use a soft toothbrush and a small amount of fluoride toothpaste commence at back lower jaw.
• Place brush at 45-degree angle at junction of teeth and gums.
• Apply gentle pressure and move brush in circular (jiggling) motion, spend 10 seconds on each tooth.
• Brush the lower teeth from left to right on outer and inner surfaces.
• Repeat with upper teeth with the bristles angled toward the gum.
• Use a back-and-forth action to brush the biting surfaces of upper and lower teeth.
• Scrape the tongue carefully from back to front with toothbrush.
• Encourage client to spit excess toothpaste foam and not rinse out mouth after brushing to enable fluoride to soak into teeth.
• Rinse the toothbrush under running water.
• Remove excess water from the brush and store brush uncovered in a dry place.
• It is recommended to replace toothbrushes when the bristles become shaggy, or after illness (e.g., chest infection) and with the change of the seasons (every 3 months).
• Use water-based lip moisturisers to help lubricate the lips.
• Where the client or client is unable to brush their own teeth, consider using a dental solution moistened swab stick to gently clean each area of the person’s mouth with separate swab sticks, discarding after each use.
• Assist the client or client to use floss between their teeth.

3.1.2    DENTURES

Remove dentures after each meal and rinse mouth and denture with water or encourage drinking water after meals to help keep mouth clean. Toothpaste is not recommended for cleaning dentures as it is abrasive and can scratch the surfaces and lead to staining.

• Place a face washer in the base of the sink or use a basin of water to prevent breakage if denture slips
• Remove full or partial dentures
• Hold dentures carefully and brush all surfaces with a soft toothbrush or soft nailbrush and hand soap (not toothpaste)
• Rinse with running water
• Brush gums and any remaining teeth
• Oral Assessment: assess the appearance of the oral cavity – gums, teeth, tongue, breath, and report any changes to the Care Manager
• Encourage the client or client to remove and replace dentures
• If assistance is required replace upper denture first, then lower denture
• It is recommended that dentures are removed from the mouth overnight, brushed and soaked in water with or without denture cleanser tablet
• Disinfect dentures weekly and as directed if being treated for fungal infection – e.g., oral thrush. Use of chlorhexidine is recommended
• Plaque can form on any appliance worn in the mouth and if left can turn into calculus. Use full strength white vinegar to soak dentures for 8 hours. Scrub using a denture brush to remove the build-up and/or loosen the calculus. This is only recommended for use in full plastic dentures.
• For heavily stained dentures or partial dentures refer to dental professional

3.1.3 MOUTH WASH

Equipment Required

• 1 tooth mug
• 1 tooth bowl
• 1 towel
• Solution as recommended by a pharmacist or other health professional
• Gloves

 Procedure

• Wash and dry hands and apply PPE
• Sit client upright if possible
• Protect the clothing with a towel
• Remove any dentures and clean as per procedure above
• Instruct the client to rinse mouth with solution, swish around mouth then spit out and to repeat this until mouth feels clean
• Wipe mouth and chin
• Replace cleaned dentures (if applicable)
• Remove the towel
• Discard used solution and clean equipment
• Remove PPE and rewash hands.

3.1.4 MOUTH TOILET

Equipment Required

• 1 large bowl
• 1 small bowl
• Mouth swabs
• Solution as recommended by a health professional in a glass
• Rubbish bags
• Gloves
• 1 towel
• Water based lip moisturiser
• Denture container

Procedure

• Wash and dry hands and apply PPE
• Explain procedure to the client
• Protect the clothing with the towel
• Remove and dentures and place them in the container
• Place a bag for soiled mouth swabs nearby
• Moisten a dressed mouth swab in solution
• Gently clean each area of the client’s or client’s mouth with separate mouth swabs wiping over teeth, gums and tongue (use a one-way swipe then discard swab technique)
• Clean the dentures and reinsert them
• Put moisturiser on the lips if required
• Remove the towel
• Discard the bag of soil probes
• Remove PPE and wash hands

[i] Oral health and dental care in Australia, Introduction – Australian Institute of Health and Welfare (aihw.gov.au)

Document History
Reviewed by:          Clinical and Risk Specialist
Authorised by:         CEO
Date Adopted:
Next Review Due:
 

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