Oral Hygiene for People with Dementia

Assignment 1

Evidence based practice

"Oral Hygiene for adults with Dementia"

-Introduction-

The purpose of this essay is to discuss a clinical skill or nursing action by referring to the nursing and allied health literature to explain and support evidence based practice. The skill I wish to examine is the practice of oral hygiene for adults with dementia in residential aged care facilities. In this essay I aim to provide the reader with adequate references to support the best practice for oral hygiene for people with dementia.

-Evidence based practice -

Good oral health is important for a person's sense of well being and quality of life (Fiske, 2001). Inadequate oral hygiene can lead to pain, tooth loss, oral disease, dehydration and speech impediments. It can also affect self-esteem and the ability to eat and talk comfortably (Chalmers, Carter & Spencer, 2004). Behavioural problems in people with dementia can be caused by dental pain and problems (Chalmers, Carter & Spencer, 2004).

In concern with oral hygiene, as dementia progresses it may:

* Reduce a person's oral hygiene care abilities.

* Reduce their ability to communicate dental pain and problems to others.

* Increase barriers to accessing dental treatment, including transportation, financial, and communication barriers.

* Decrease older adults' and caregivers' recognition of the significance and consequences of dental pain.

* Decrease older adults' and caregivers' perception of need for dental treatment.

* Increase the use of medications for behaviour management (JBI, 2004).

According to a report released by the Australian Institute of Health and Welfare (AIHW) the oral health of older adults with dementia is considerably worse than those of the non-dementia counterparts (AIHW, 2005). At the beginning of the study they found that tooth decay was present in just under half of the dementia sufferers compared to 15.5% for the rest of the population (AIHW, 2005) This went up to 60% in the group to 28.5% in the non dementia group one year later (AIHW, 2005).

This report also found that many more dementia sufferers needed help with their oral hygiene and many persons exhibited resistive or combative behaviour during the care giving process, with one third refusing to open their mouths (AIHW, 2005). Other concerns included the decreased use of fluoride from sources such as toothpastes (AIHW, 2005).

Professor Spencer, from AIHW Dental Statistics and Research unit, considers that 'carers need training and support to improve the oral hygiene care for older adults with dementia' (AIHW, 2005).

-Assessment, Hygiene and Treatment-

Three key oral health components in residential age care setting have been identified (JBI, 2004). These are oral assessment, oral hygiene and dental treatment (JBI, 2004).

The need of assessment is vital to promote and maintain adequate oral hygiene (JBI, 2004). Generally assessment is dependent

upon a person's ability to report signs and symptoms and to remain co-operative throughout a dental examination (JBI, 2004, vol.8). Whereas assessment of a person with dementia can be a challenge, the resident may not be able to state any pain, symptoms or problems (JBI, 2004). They may also become agitated and restless and will not allow anyone to complete a full assessment on them (JBI, 2004).

There are several assessments tools available one of these is the Brief Oral Health Status Examination (BOHSE), which has been tested on cognitively impaired and unimpaired elderly. It has been modified and utilized on a population of cognitively impaired elderly and found to be useful when used by Certified Nurses The BOHSE contains a measurement column that provides the nurse with a description of how to assess the item directly on the form. The BOHSE is an instrument used for screening purposes only. It is not a diagnostic tool and does not replace the need for a periodic examination by a professional dentist. Prior to using the BOHSE, staff should receive in-service education from a professional dentist or dental hygienist, School of Dentistry faculty, dentists in private practice or dentists contracted to provide services to a nursing home.

Another assessment tool is the Oral Health Assessment tool and is a condensed alteration of the BOHSE. It can be completed before implementing an individualized oral hygiene care plan. Completing this assessment will help the health care professional assess the patients current oral status and factors, which can contribute to their risk for oral disease. This makes it possible to put into practice the most appropriate care, plan for the residents needs.

There is only a small amount of literature providing quality evidence based on the use of a successful oral health assessment tool for people with dementia (JBI, 2004). There is no published evidence to this date that has directly linked the use of the assessment tool and the standard of oral hygiene and care given within residential aged care facilities (JBI, 2004). For successful assessment of the residents with dementia the assessment should be undertaken by trained staff and on admission the assessment should also involve a dentist (JBI, 2004). Assessment should be done on a regular basis, at least every 8 weeks (JBI, 2004).

Research has shown that staff training in oral hygiene and the use of an individualised Oral Hygiene Care Plan is beneficial to the resident and also the nurse and will allow appropriate care (National Guideline Clearing house [NGC], 2003).

The Oral hygiene care plan should contain information about the residents current oral status including the level of assistance, the type of care necessary, and the type of hygiene instruments required (type of toothbrushes, whether or not dentures are in place, type of toothpaste) (NGC, 2003). Also noted in the care plan are problems that could be encountered with the resident and strategies that can be enforced if needed (NGC, 2003).

By identifying the persons self care ability, the provider can determine at what level care is necessary - whether just reminding, assisting, full assist or palliative care is needed (NCG, 2003) The nurse