1. Oral Health Program for the CNA By: Michaela Blessing Janna Whitehead

2. Purpose Improving personal oral hygiene efforts to better care for the health of patients Oral health is an indicator of patients health Patients are keeping their teeth longer. Age is not a factor. Assisting patients with oral hygiene is an important role of the CNA

4. Healthy Vs. Disease Pink tissues No inflammation or swelling No bleeding Firm No root exposure Red tissues Inflammation and swelling Bleed easily Soft Possible root exposure Decay

5. Plaque Film of bacteria Sticky and colorless Adheres to the tooth surface Develops on: - Teeth -Gums -Tongue -Roots of teeth

6. Plaque Accumulation Factors influencing plaque accumulation: - Crowded teeth -Rough surfaces -Difficult to clean areas (Wisdom teeth) -Restorative work (Ex. Crowns) Plaque accumulation contributes to: -Unpleasant esthetic appearance -Cavity formation -Bad breath -Tooth loss -Calculus formation -Gum disease -Breakdown of enamel

7. Calculus Calcified plaque Plaque adheres to calculus Must be professionally removed Found: - Above gum line -Below gum line -Attaches to tooth enamel and roots

8. How do I know if I have plaque? Everyone develops plaque Bacteria constantly forms in the mouth Ways to limit plaque formation: -Brushing -Flossing -Rinsing -Routine dental exams

9. Disclosing Solution Applied on teeth by a clinician Color codes areas missed when brushing and flossing Visual tool used to improve oral hygiene efforts Blue= present more than 24 hrs Pink= present less than 24 hrs

10. Toothbrush Selection Soft Bristles Small-Medium Head Easy Grip Handle Electric vs. Manual Replace every 3-6 months Tooth brush cover

11. Oral Hygiene Products ADA seal Toothpaste purpose: -Cavities- (Crest, Crest Kid’s, Colgate Total) -Gum disease- (Colgate Total Advanced, Crest) -Stain-(Colgate Total Advanced Whitening) -Tartar-(Crest, Colgate Total Advanced) -Sensitivity-(Sensodyne) -Dry mouth- (Biotene)

12. Brushing Technique Bass/Sulcular Method 45 Degree Angle Back and forth motion 2-3 teeth at a time Moderate Pressure 2 times daily Don’t forget to brush your tongue!

14. Disable Patients Have all items prepared Wash hands Wear gloves Tell patient what you are doing Drape towel/napkin over cloths Have patient in a supine position Help as needed

15. Modified Aids Accommodate patients needs Easy use Comfortable for patient Ex. Parkinson’s Disease, Rheumatoid Arthritis, Cerebral Palsy

16. Modified Aids cont. Bicycle GripTennis BallRubber Band Velcro Electric Toothbrush

17. Remember! Oral health is directly related to overall health Ensure your patient is brushing 2 times a day. Morning and night Help your patient as needed this includes educating and skills Do not rush your patient Make them feel comfortable Develop a relationship

18. Michaela Blessing Janna Whitehead

19. Topics Types of Periodontal Diseases –Gingivitis –Periodontitis Flossing –Decreases plaque accumulation

20. Review What is plaque? A. Food particles B. A sticky film of bacteria C. Calculus D. Tartar

21. Review Calculus is calcified plaque. Calculus must be removed by a licensed professional. A.Both statements are true. B.Both statements are false. C.The first statement is true; the second statement is false. D.The first statement is false; the second statement is true.

22. Review When looking to purchase a dental product (toothpaste, mouthrinse, etc.) what is recommended to be on the product to ensure that it has been approved safe and effective by the American Dental Association?

23. ADA Seal

24. Review List some modified aids to help accommodate those patients who have disabilities.

25. Modified Aids Bicycle Grip Tennis Ball Rubber Band Velcro Electronic Toothbrush

26. Review What is the recommended brushing method to effectively remove plaque both above and below the gumline?

27. Bass/Sulcular Method 45 degree angle Moderate Pressure 2-3 teeth at a time

28. Periodontal Diseases Diseases that affect the supporting structures of the teeth: gums and bone 2 types –Gingivitis –Periodontitis

29. Gingivitis Infection of the gums Caused by plaque (bacteria) Reversible! Symptoms: Red, swollen, inflamed tissues Gums bleed easily Can sometimes be painless

30. Periodontitis Infection of the soft tissue and bone that supports the teeth Caused by plaque (bacteria) and the body’s response to infection Irreversible! Symptoms: Red, swollen, bleeding gums Receding gums Loose, mobile teeth Bad breath

31. Reduction in Bone Level

32. Gingivitis vs. Periodontitis

33. Factors that can increase your risk of periodontal disease: Poor oral health habits- none/poor brushing and flossing Tobacco Use Poor nutrition Certain medications Hormonal changes, specifically those related to pregnancy (seen in gingivitis) Decreased immunity/Systemic Diseases: –HIV/AIDS –Leukemia –Poorly controlled diabetes –Etc.

34. How to Prevent Gingivitis & Periodontitis Removing plaque is the most important step! Brush 2x daily Use an anti-gingivitis and anti- plaque toothpaste: -helps kill harmful bacteria that cause plaque and gingivitis Floss daily Rinse after brushing: –effective at fighting plaque, gingivitis, and bad breath Visit the dentist regularly

35. Flossing Removes plaque and food particles from in between teeth and under the gumline Approximately 18” Use thumbs and index fingers Gently guide floss between the teeth ‘C’ shape around the side of the tooth Slide floss up and down against the tooth surface and underneath the gumline Rotate floss so as to not transfer bacteria

36. Types of Floss

37. Flossing Aids Proxy Brush Floss Holder Super Floss Floss Threader

38. Remember! Brushing without flossing is like washing only 65% of your body while the other 35% remains dirty!

39. Lesson 3 Michaela Blessing Janna Whitehead

40. Topics Caries Fluoride Xylitol Nutrition Xerostomia

41. Review Which of the following is a reversible infection of the gums caused by plaque? A.Caries B.Periodontitis C.Xerostomia D.Gingivitis

42. Review True or False?  Periodontitis is reversible; once bone is lost it can be regained.

43. Review A.Quickly snap the floss between the teeth using an up and down stroke B.Gently glide the floss between the teeth and below the gumline in a ‘C’ shape against the tooth C.Flossing is not important and should only be done when food particles gets stuck in between the teeth D.None of the above Which of the following demonstrates the proper flossing technique?

44. Flossing ‘ C’ Shape Use thumbs and index fingers Gently guide floss between the teeth Removes plaque and food particles from in between teeth and under the gumline Approximately 18”

45. Caries Cavity/Caries = a hole in the tooth Caused by acid produced by bacteria

46. Caries Caries can be found on the: Crown (Enamel) Root (Cementum) Can be recurrent

47. Caries Process Tooth decay involves 3 major factors: Food/Beverages consumed (sugar) Bacteria/Plaque Teeth Process 1. Bacteria in our mouth digest fermentable carbs and sugars that we eat 2. Once digested, the bacteria secrete an acid on the tooth 3. The acidic byproducts eat away at our enamel causing the tooth to demineralize or breakdown 4. These acid attacks generally start in the enamel and can spread to the softer inner layer of the tooth (dentin)

48. pH Scale pH scale- demineralization begins at a pH of 5.5, water is neutral 7.0

49. Caries Prevention Plaque Control Brushing twice daily and flossing Rinse (recommended ACT mouthwash) Visit a dentist regularly Diet Control Less sugar intake Fluoride Xylitol Treatment of Xerostomia

50. Fluoride –mineral that occurs naturally in food and water Purpose –helps remineralize areas in the enamel that have broken down due to acid production –helps the tooth become more resistant to acid attacks –Is capable of reversing early signs of tooth decay (white spots) –Helps with sensitivity (fluoride varnish) Fluoride is most important for individuals at a high risk for cavities such as: -Dry mouth due to medications -Periodontal disease -History of cavities (many restorations) -History of frequent cavities -Children

51. Forms fluoride is available Public: - Food, community water, toothpaste, mouth rinses, floss Dental office: - Contain higher amounts of Fluoride o Fluoride gel- painted on or uses a mouth tray o Fluoride foam- painted on or uses a mouth tray o Fluoride varnish- painted onto the teeth (children and sensitivity)

52. Fluoride Applications Fluoride Varnish

53. Xylitol A sugar substitute Helps in the prevention of cavity formation Recommended: –Chew xylitol gum after a meal –Helps to buffer and stimulate saliva –Helps neutralize pH Variety of forms available: –Gum –Lozenge –Mint –Spray –Sugar Packets

54. Nutrition Poor nutrition Unhealthy eating habits = leading cause of death in U.S. Quality of life reduced Life threatening diseases: Diabetes Obesity Role in cavity formation Excellent Nutrition Prevents cavity formation Take caution when eating foods high in sugar (sticky) Limit snacking between meals Drink water Chew gum or firm foods (meat, fruits)

55. Xerostomia Dry mouth Higher risk of caries development Causes: - Certain medications - Dehydration - Salivary gland damage ( head and neck radiation ) Ways to help with xerostomia: - Consume water -Chew gum -Products -Biotene Patient with Sjogren’s Fissured Tongue

56. Questions?

57. Lesson 4 Michaela Blessing Janna Whitehead

58. Topics Oral Cancer Screening Purpose Importance Denture Care Proper Care

59. Review True or False? Caries (also known as a cavity) is a hole in tooth caused by acid produced by bacteria.

60. Review Which of the following is NOT required to be in the oral cavity for the caries process to begin? A.Tooth B.Sugar/Food C.Xylitol D.Bacteria

61. C. Xylitol Caries Process 1. Bacteria in our mouth digest fermentable carbs and sugars that we eat 2. Once digested, the bacteria secrete an acid on the tooth 3. The acidic byproducts eat away at our enamel causing the tooth to demineralize or breakdown 4. These acid attacks generally start in the enamel and can spread to the softer inner layer of the tooth (dentin)

62. Review Which of the following is a mineral that occurs naturally in food and water and helps to remineralize areas in the enamel that have broken down due to acid production? A.Xerostomia B.Fluoride C.Xylitol D.Caries

63. B. Fluoride Helps the tooth become more resistant to acid attacks Is capable of reversing early signs of tooth decay (white spots)

64. Review What is xylitol and what is its purpose? A.A hole in the tooth Caused by acid produced by bacteria B. A naturally occuring mineral Helps remineralize the enamel C.It’s a condition Caused by dry mouth D.A sugar substitute Helps in the prevention of cavity formation

65. Xylitol Recommended: –Chew xylitol gum after a meal –Helps to buffer and stimulate saliva –Helps neutralize pH Variety of forms available: –Gum –Lozenge –Mint –Spray –Sugar Packets

66. Review Define xerostomia

67. Oral Cancer Screening Purpose: Detect unusual/abnormal findings Potentially put individual at risk Should be reported Importance Early detection of oral cancer CNA should be familiar with oral cavity Notice when abnormal lesion is present.

68. Interesting Facts 2x as common in men than women Average age of diagnosis = 62 2/3 of individuals with oral cancer - over age 55

69. Risk factors associated with oral cancer Tobacco use o Depends on amount and frequency of use Alcohol use o Heavy alcohol drinkers o Risk rises with individuals who use tobacco and alcohol in combination Sun exposure o Common cause - lip cancer Poor nutrition o Diets low in fruits and vegetables Some genetic syndromes HPV Immune system suppression

70. Normal, Healthy Oral Cavity

71. Abnormal Findings Fissured Tongue Linea Alba Smoker’s Palate

72. Abnormal Findings Exostosis Mandibular Tori

73. Oral Cancer Border of tongue Underneath tongue On the lip

74. Performing an Oral Cancer Screening 1. Observe face and neck –Swellings, skin abnormalities, discolorations, moles, asymmetry 2. Lips and corners of the lips –Changes in color, texture 3. Palpate the lymph nodes 4. Remove partials and dentures for the intraoral screening 5. Examine, palpate the palate, –Look in tonsils area and back of throat 6. Move, palpate the lips 7. Examine, palpate cheek tissues 8. Examine, palpate tongue –Changes in color, texture, symmetry, mobility –Be sure to look at ALL surfaces of tongue –Hold tip of tongue to view side surfaces 9. Have patients lift tongue up –Examine, palpate floor of mouth

75. Performing an Oral Cancer Screening

76. What to Report Charge nurse Dentist Pain Loss of feeling Sores Blisters Ulcers Swellings Growths or lumps Discolorations of red or white areas Broken or decayed teeth Dry mouth Spots or crusting of the lips Unexplained bleeding in the mouth Difficulty chewing or swallowing

77. Open Discussion Discuss the importance of the Certified Nursing Aide’s duty in providing an oral cancer screening.

78. Denture Care Denture o A removable plate or frame holding one or more artificial teeth Importance of cleaning dentures o Denture cleaning Part of daily oral hygiene o Cleaning the patient’s dentures Prevents unnecessary exposure to microbes Could lead to oral and systemic disease Malodor and fungal infections

79. Dentures

80. Denture Stomatitis A yeast infection of the mouth Most common denture infection Will appear on the hard palate with red and inflamed tissues Causes: Poor oral hygiene efforts Continuous wear of dentures

81. How to care for a denture Dentures and partials should be cleaned on a daily basis! Place towel in sink, fill the sink with warm water  Never put dentures directly over sink without a towel  If you drop the denture it could easily break Wear gloves, bring denture over sink using a denture container or cup for transportation Hold dentures in palm of hand over sink Inspect denture – Cracks – Breaks – Sharp edges – Missing teeth – Bring to charge nurses attention if damage is noticed Apply denture paste to denture brush  Do not use tooth paste because it is to abrasive for the dentures Scrub denture on all surfaces using a denture brush Rinse denture completely Return to patient – Transport in cup or container

82. How to care for a denture Wear gloves!

83. Remember! Dentures should be removed, cleaned, and soaked every night Soaking dentures overnight will eliminate 99.9% of denture germs Be sure to soak dentures in a denture solution (denture tablets and water) Do not soak dentures in Listerine, this will cause staining

84. How to label a denture Purpose o Prevent loss of the denture o Prevent cross contamination among residents Supplies o Gloves o Fine-tipped indelible marker o Paper towel o Clear acrylic nail polish o Disposable emery board o Disposable brush o Glass of water o Gauze

85. How to label a denture 1. Be sure denture has been thoroughly cleaned 2. Wash hands, wear gloves 3. Locate rear area of denture Side toward cheek Avoid area that fits in the palate 4. Use disposable emery board File a small area until rough and porous Area needs to be no longer than a finger nail 5. Use gloved hand or gauze Brush away powdery substance (residue) - results from filing Dispose of emery board 6. Use fine tipped permanent sharpie Mark denture with initials of patient First initial and last name 7. Allow marker to dry 8. Use disposable brush Paint marked area with acrylic clear nail polish Sally Hansen’s Hard-As-Nails is effective Do not use brush that comes with polish 9. Allow polish to dry  Be cautious to not cross contaminate between patients

86. Questions?