1. Oral Care

2. Aims By the end of the session the participant will:  Be familiar with the structures within and around the mouth  Be aware of the negative impact on general health which can occur due to poor oral health  Know the correct equipment to use when carrying out oral care

4. Oral Care  Poor oral hygiene is a common cause of distress for patients and families  Poor care may be due to lack of training, knowledge, inconsistent care  Not always a high priority  Essential for patient comfort

5. Risk Factors for Oral Complications  Systemically ill, terminal illness, unconscious patient, tracheostomy  Oxygen therapy, mouth breathing, nil by mouth.  Naso – gastric/peg feeding  Chemotherapy/radiotherapy, drug therapy  Ill fitting dentures  Diabetes  Dementia

6. Consequences of poor oral care  Pneumonia  Septicaemia  Endocarditis  Pain  Xerostomia (dry mouth)  Halitosis  Difficulty eating and drinking  Withdrawal  Low mood

7. Good Oral Care  Frequent inspection important using a pen torch, tongue depressor and gloved finger  Have an understanding of the possible risk factors  Examine in and outside the mouth  Early detection/reporting of problems  Need instruction on specific requirements for that patient

8. Dentate Patients (own teeth)  Brush teeth at least twice per day with toothbrush and fluoride toothpaste  Moisturise lips if necessary with a water based lubricating gel  ONLY use foam swabs soaked in water if using a toothbrush is too painful or impossible,

9. Care of Dentures  Remove and brush with a toothbrush and water after every meal  Rinse mouth with water to remove debris  Moisturise lips if necessary with water based lubricating gel  Remove and soak overnight in water  If oral infection is present, e.g. candida, dentures should be soaked in 1% sodium hypochlorite solution 2ml mixed with 160ml of tap water. If they have metal parts – soak in chlorhexidine 0.2%

10. Oral Problems  Candida (thrush)  Bacterial infections  Xerostomia(dry mouth)  Mucositis  Cold sores  Ulcers  Angular cheilitis

11. Candida

12. Dry mouth  What causes a dry mouth?  What problems can a dry mouth cause?

13. Causes   Drugs – lots of them  Radiotherapy  Oxygen  Mouth breathing

14. Complications of dry mouth  Decay  Gum recession and loss of teeth  Difficulty eating  Difficulty speaking  Trauma of mucosa  Halitosis

15. Dry Mouth (Xerostomia)  Continue brushing teeth twice per day with fluoride toothpaste  Sips of and rinsing with tap water  Artificial saliva – Avoid glandosane in patients with their own teeth Saliva Orthana has a porcine extract so is not suitable for some patients due to culture  Oral balance gel  Sugar free chewing gum  Review of medication

16. Cold sore

17. Aphthous ulcer

18. Angular cheilitis

19. Treatment of Painful Mouths  Some patients may need pain relief such as co- codamol or even morphine in severe cases  Avoid strong, acidic mouthwashes e.g. brand makes  Benzydamine (Difflam) mouth wash has local anaesthetic. It can be diluted 1:1 if stinging  Topical steroid for ulcers such as hydrocortisone pellets

20. Practical Session…