Poor oral hygiene in long-term care.
ABSTRACT The poor oral care given to vulnerable patients in long-term care settings can have serious consequences, including increased risk of stroke, heart disease, and pneumonia. Nurses can take action by making sure supplies are in place, promoting oral care to all direct care staff and administrators, and making evidence-based recommendations during resident care conferences.
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ABSTRACT: OBJECTIVES: To develop and test a person-centered, evidence-based mouth care program in nursing homes. DESIGN: Pre-post assessment, with an 8-week intervention period and a pilot 6-month extension at one site. SETTING: Three North Carolina nursing homes. PARTICIPANTS: Ninety-seven residents and six certified nursing assistants (CNAs). INTERVENTION: CNAs already working in the facilities were trained as dedicated mouth care aides. A psychologist and dental hygienist provided didactic and hands-on training in evidence-based mouth care products and techniques and in person-centered behavioral care. MEASUREMENTS: Primary outcome measures for natural teeth were the Plaque Index for Long-Term Care (PI-LTC) and Gingival Index for Long-Term Care(GI-LTC) and for dentures the Denture Plaque Index (DPI); a dentist unmasked to study design obtained measures. Secondary outcomes included quantity and quality of care provided. RESULTS: Outcome scores significantly improved (P < .001 for PI-LTC and GI-LTC; P = .04 for DPI). Coding of videotaped care episodes indicated that care was more thorough (P < .001-P = .03) but took more time (P < .001) after training. Consistency of care appeared to be more important for natural teeth than dentures. CONCLUSION: As little as 8 weeks of mouth care can significantly improve oral hygiene outcomes. Given the consequences of poor oral hygiene, greater attention to mouth care education and provision are merited. The dedicated worker model is controversial, and future work should assess whether other models of care are equally beneficial.Journal of the American Geriatrics Society 06/2013; · 3.98 Impact Factor
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ABSTRACT: Two important factors contribute to a higher chance of a deterioration of oral health status in frail and disabled elderly people. First, advances in oral health care and treatment have resulted in a reduced number of edentulous individuals and the proportion of adults who retain their teeth until late in life has increased substantially. Second, neglected self-care and/or professional care have led to reduced oral health care utilization. This review reports the consequences of having a poor oral health status and its impact on general health of frail elderly people and gives an overview of the important enabling and disabling factors regarding the provision of oral health care to frail older persons. Impaired cognitive and functional ability, medication-induced hyposalivation, reduced saliva buffer capacity and high saliva acidity, diabetes mellitus, the number of exposed root surfaces due to gingival recession, poor oral hygiene, high frequency of sugar consumption, and poor socio-economic conditions are the major predisposing conditions for the upsurge of caries in older population groups. Poor oral hygiene, tobacco smoking, and excessive alcohol consumption together with some systemic diseases, such as metabolic syndrome, rheumatoid arthritis, diabetes mellitus and post-menopausal osteoporosis are reported to be important risk factors for periodontal disease and later on peri-implantitis. Although during recent years increasing attention has been given to improving oral health care for frail old people, there is ample evidence showing that the oral health of elderly people, in particular of care home residents is (still) poor. The introduction of innovative care pathways to improve oral health care of elderly people by implementing new guidelines or health care models appears to be a complex process. Therefore, a poor oral health status might be regarded as a new geriatric giant in frail elderly people, which deserves urgent attention of scientists, health care providers and policymakers.European geriatric medicine 07/2013; 4:339-344. · 0.63 Impact Factor