Oral Care for Older Adults

Oral care for Older Adults

• Some older patients may lack manual dexterity for oral hygiene and require assistance from family or in-home care providers
• Many older adults are edentulous (without teeth), which leads to disease or decay
• The periodontal membrane weakens with aging, making it more prone to infection. Periodontal disease predisposes older adults to systemic infection
• Dentures or partial plates do not always fit properly, causing pain and discomfort, which affects chewing, digestive processes, food enjoyment, and nutritional status
• Aging and some medications (e.g., antihypertensives, diuretics, anti-inflammatory medicines, and antidepressants) can cause dry mouth
• Changes in oral health and oral hygiene practices impact nutritional status, so reinforce the necessity of a healthy diet and teach patients how to select soft, nutritious foods
• Financial limitations and the belief that dentures eliminate the need for routine dental care are reasons older adults do not seek dental care

Oral Care for Patients Receiving Chemotherapy and Those with Artificial Airways

• Patients receiving chemotherapy frequently experience periodontal disease and need to visit the dentist every 3 to 4 months to clean their teeth up to four times a day and handle oral tissues gently with minimal trauma
• Xerostomia, bruxism, and dental caries may be present with patients who are methamphetamine users; cravings for sweets may cause decay and gum disease
• Patients may depend on their caregivers for oral care if they are unconscious or have an artificial airway (e.g., endotracheal or tracheal tubes), which increases their susceptibility to drying of salivary secretions if they cannot eat, drink, or swallow, or frequently breathe through the mouth.
• Pooling of salivary secretions in the back of the throat harbors microorganism growth, which can cause pneumonia if aspirated into the lungs

Common Bed Positions

• Fowler's position involves raising the head of the bed to an angle of 45 to 90 degrees for patient eating, during nasogastric tube insertion and nasotracheal suction, which promotes lung expansion and eases difficult breathing
• The semi-Fowler's position involves raising the head of the bed to 30 to 45 degrees with the foot of the bed raised at the knee; this position promotes lung expansion, especially with ventilator-assisted patients, and is used when patients receive oral care and gastric feedings to reduce regurgitation and aspiration risk
• Trendelenburg's: The entire bed frame is tilted with the head of the bed down; this is used for postural drainage and facilitates venous return in patients with poor peripheral perfusion
• Reverse Trendelenburg's is when the entire bed frame is tilted with the foot of bed down; this position is infrequently used, promotes gastric emptying, and prevents esophageal reflux

Denture Care

• Routine cleaning of dentures prevents gingival infection and irritation and is a regular basis for all patients whether or not they are disabled
• Dentures are a patient's personal property, therefore the the health care provider must consult with the health care provider to obtain topical or oral analgesics for pain control
• Soft-bristled toothbrush, denture toothpaste, denture adhesive, a glass of water, emesis basin, denture cup, 4x4 gauze, and clean gloves are needed to clean dentures
• Procedural steps:
  • Identify patient using two identifiers and agency policy
  • Assess the environment for safety
  • Determine patient's and caregiver's knowledge and health literacy
  • Perform hand hygiene
  • Ask questions about denture fit and about denture care and product preferences
  • Determine whether patience independently and needs dexterity
  • Lower the side rail and position patient sit up in bed
  • Position patient comfortably sitting up in bed or help patient walk from bed to chair placed in front of sink
  • Fill emesis basin or sink with tepid water lining with washcloth
  • Perform hand hygiene again and apply clean gloves
  • Ask patient to remove dentures and wrap denture gently with thumb and index finger wrapped in gauze. Then lift the lower denture from jaw and rotate one side downward to remove from patient's mouth. Place denture in emesis basin
  • Inspect oral cavity to see if their are any gum or mucus membrane tenderness or irritation
  • Inspect oral cavity, paying attention to gums, tongue, and upper palate
  • Brush the outside of dentures horizontally and use back and forth motions to clean, rinse in lukewarm water
  • If the water is too hot, dentures can crack if it is too hot
  • Apply a thin layer of adhesive to dentures before inserting
  • Insert cleaned upper dentures by holding jaw over their dentures. Ask if patient needs assistance and feel comfortable
  • Store dentures in a labeled denture cup when not in wear and keep denture cup labeled with patients name
  • Return patient to a comfortable position with side rails up, and dispose supplies
  • Lower bed to lowest position. Place the nurse's call system within the patient's reach. Place nurse call system within patient reach.
  • Record and report abnormal observations

Oral Hygiene

• Oral hygiene includes toothbrushing, flossing, and rinsing, this can be delegated to assistive personnel (AP). However, the nurse is responsible for assessing the patient's gag reflex.

• Types of changes in oral mucosa to report to nurse:

  • Reporting ulcerations, lesions, open sores, or bleeding of oral mucosa or gums
  • Patient report of pain

• Place paper towels on overbed table

• Maintain the patient's head of bed (HOB) raised 30-45 degrees to prevent excessive patient coughing, drooling, or choking

• Use soft bristle toothbrush, toothpaste, water, gloves, emesis basin or paper bag

• The first procedural steps:

  • Identify patient using two identifiers (e.g. name and birthday or medical record number) according to agency policy (TJC, 2021)
  • Review medical record and identify presence of common oral hygiene problems
  • Determine patient's or family caregiver's knowledge, experience, and health literacy

• Assess patient's oral hygiene practices such as frequency of brushing and flossing, type of toothpaste and mouthwash used, last dental visit

• Perform hand hygiene and apply clean gloves

• Using tongue depressor and penlight, inspect integrity of lips, teeth, buccal mucosa, gums, palate, and tongue

• Explain procedure to patient, discuss patient's preferences, assess patient's ability to grasp and manipulate toothbrush and willingness to help with oral care

• Move items that are nearby out of the patients way to make for easier reach

• Raise bed to comfortable working position. Raise side rail if needed

• Apply clean gloves. Apply enough toothpaste to brush to cover length of bristles. Hold toothbrush. Pour small amount of water over bristles

• Have patient hold toothbrush at 45-degree angle to gum line and brush surface cleaning teeth by moving bristles back and forth

• Allow patient to rinse mouth thoroughly with cool water and spit into emesis basin

• Return equipment

• Record and report any observations