Washington Dental Service Foundation - Home Care … Health for Caregivers...Thanks to Washington Dental Service Foundation for ... make a note in your client'sservice/care plan AND

Slide 1: Oral Health for Caregivers

Thanks to Washington Dental Service Foundation for developing this program.

Washington Dental Service Foundation

Mission: Eliminating oral disease in order to improve overall health for all

Focus on prevention and early treatment of oral disease

Some of the Foundation's projects include

Community woter fluoridation

Engaging dentists in caring for young children

Engaging physicians and other professionals in preventive oral health

Improved oral health for seniors

Increased dental treatment for the underserved

Improving oral health saves money for everyone, enables children to do betterin school and later in life, and helps adults live healthier and longer lives.

Thanks to Professional Registry of Nursing and Bellingham Technical Collegefor their pilot testing of this curriculum.

Trainer - OH Slides & Notes - Script 2·1

The Caregiver Helps PreventOral Disease-~ the oral heolrh core.

MOnitor client's mouth for changes.

" Educate client about oral health Information.

Refer problems to supervisor or case manager.

Overview

Slide 2: The Caregiver Helps Prevent Oral Disease

Prompt, assist, or perform the oral health care for client.

Allow your client as much independence as possible, but rememberthat s/he may need assistance in one or more oral care routines.

Monitor client's mouth for changes.

You may be the first person to spot an unusual condition or changein your client's oral health.

Caregivers CANNOT make a diagnosis, but CAN report changesor unusual conditions.

We do not expect you to become an expert or to make any kind ofdiagnosis, but you can be a caring observer.

Educate client about oral health information.

Be willing to share your knowledge and help your client make betteroral health decisions.

Refer problems to supervisor or case manager.

If you notice signs of oral disease in the mouth tissues, lips, tongue,or teeth, make a note in your client's service/care plan AND reportto your supervisor or your client's case manager.

Traine.r - OH Slides <5. Notes - Scnpt 2·2

Slide 3: Oral Health-Overall Health Connection

"Yau cannot be healthy without oral health."

Surgeon General's Report on Oral Health

-May 2000

Oral health and overall health are related. What happens in the mouth isoften a reflection of what is happening elsewhere in the body

We cannot view the mouth as an isolated area, disconnected from the restof the body.

Often the first signs of a medical condition may show in the mouth.

Example 1: An undiagnosed or uncontrolled diabetic may have gumproblems or difficulty healing because the blood sugar is notregulated properly.

Example 2: People with gum disease often have heart problems aswell. The exact relationship is not fully understood, whether onecauses the other or exactly how they are associated.

Trainer Note: If you do not present the "Why Oral Health?" sect(onseparately, include some of that information here. Choose thoseitems most relevant for your audience.

Trainer - OH Shdes & Nates - Script 2 - 3

Slide 4: Today's Topics

We will cover basic information in all of these areas today.

As we go through the material, be sure to ask questions as they come toyou.

If you wait until the end, you probably will forget what you wanted to ask.

What's Normal?

What are the characteristics of a normal healthy mouth")

Your Clients May Be at Risk For...

Things we should notice when assisting with or performing oral care

Daily Routine

Tips for performing daily oral care

Oral Health Aids

Devices to make oral care easier

Professional Care

Professional care is an important part of overall dental health.

Trainer - OH Slides &. Notes - SCript 2·4

J "Oral Health Photo Guide"i and "Tip Sheet"-

• How do you fit todoy's new Informotlon mtoyour rout ine")

., Whot do you do when you notice somethingunusuol In your client's mouth")

" Photos ond descriptions will gUIde you.

Slide 5: "Oral Health Photo Guide" and "Tip Sheet"

In your packet you will find the sheet, What's Normal? What's Not? WhenDo I Refer? An Oral Health Photo Guide. The photos are the ones you willsee in today's program. The card is for reference as you inspect yourclient's mouth.

In the Resources section #2 of this workbook you will find the OralConditions Tip Sheet that provides quick information on common problemsand ways you may be able to help your clients.

How do you fit today's new information into your routine?You can be the "watchdog" for changes in your client's oral health.

You can observe the mouth, lips, teeth, and tongue every day.

You might see something family members or others may not notice.

You can share information from this course with your client andyour client's family and get them interested in oral health.

What do you do when you notice something unusual in your client'smouth?

Note observations in the service/care plan; report to yoursupervisor or your client's case manager.

Caregivers are not expected to make a diagnosis, but can observeand report unusual conditions.

Photos and descriptions will guide you.

These photos or descriptions do not include all conditions, but offera guide for comparing normal and abnormal.

Trainer - OH Shdes & Nates - Script 2 - 5

•What's Normal?What's Not?

" Tongue & LipsNo lumps. bumps. orsores

MOIsture

No dry mouthAll surfaces In themouth shouldappear mOIst

-'1 Teeth "I Gums

Cleon . no food. Cleon - rIO food orplaque. or tartar plaque next to gumsNo untreated decoy PInk. not red

No swelling orbleedingTight ogolnst teeth

Slide 6: What's Normal?

Let's take a look at what makes a mouth "healthy" or "normaL"

This is a list of what we should look for.

Teeth

Clean - no food, plaque, or tartar deposits

No untreated decay or broken teeth

Gums

Clean - no food or plaque next to gums

Pink - no red or white areas

No swelling or bleeding

Tight against teeth

Moisture Level

No Dry Mouth

AII surfaces in the mouth should appear moist

Tongue & Lips

No lumps, bumps, or sores

TrOlner - OH Slides & Notes - Script 2 - 6

Slide 7: Normal, Healthy Mouth

Photo 1 - Healthy Mouth: (Point out the features on photos.)

Teeth:

Clean, with no food between the teeth or near the gums, no plaque,and no tartar. Your client's teeth may not be perfectly straight,but they can and should be clean.

No untreated decay. People may have fillings, crowns, or appliances,but the important thing is that we do not see untreated cavities,broken teeth, or broken fillings.

Gums (gingiva):

Clean, with no food, plaque, or tartar next to the gums.

Light to medium pink, not red or inflamed, and no white areas.

No swelling or redness of the gums (gingivitis), no bleeding, notenderness.

Gum tissue fits closely against the teeth.

Photo 2 - Healthy Tongue:

The tongue should appear moist, slightly rough, mostly pink with awhitish sheen. There should be no significant lumps, bumps, or sores.

Photo 3 - Healthy Palate (Roof of the Mouth):

The roof of the mouth may appear somewhat ridged or bony, butshould be pink with no significant lumps, bumps, or sores.

Trainer - OH Slides & Nates - Script 2·7

Slide 8: Your Clients May Be at Risk For ...

There are six major oral health problem areas that may affect yourclients. We will not cover every possible situation, but will give youinformation on the ones of most concern to most people.

Gum Disease

Tooth Decay (Cavities, Caries)

Denture Problems

Dry Mouth

Poor Nutrition

Oral Cancer

Today we will look at these areas to learn how problems get started andhow to prevent them, how to recognize the problems, and what happens ifyou don't take care of the problems. We will help you to understand whenand how to report a problem and when your client should see a dentalprofessional.

Trainer - OH Slides & Notes - Script 2 - 8

Slide 9: Gum Problems: Gingivitis & Periodontal Disease

Bacterial Infections

Germs clump together on our teeth and under the gums to form"plaque:' which irritates the gum tissues.

Gingivitis: Red. Puffy or Bleeding Gums

The first signs of gum problems might be red. swollen. or bleeding gumtissue. This condition is called gingivitis.

Many people avoid brushing and flossing if the gums bleed. thinking theyneed to "leave it alone" so it can heal.

Brushing and flossing. even if it makes the gums uncomfortable for afew days. will help to improve the gums in the early stages of gingivitis.

Periodontal Disease: Bone Loss. Tooth Loss. Bad Taste or Odor

If not treated or controlled. the gingivitis will get worse. The plaquewill harden into a crusty material called calculus or tartar, and the boneholding the teeth in place will begin to dissolve. This condition is calledperiodontal disease.

As the disease progresses. there may be a bad taste or odor, and theteeth may become so loose that they need to be removed.

The early stages of periodontal disease often go unnoticed becausethere is little or no pain. Your client may not be aware of anyproblems.


Slide 10: Gum Problems

Diabetes and Smoking - Higher Risk for Periodontal Disease

Uncontrolled diabetics may have gum problems, even without muchplaque on the teeth. Blood sugar control is critical for keeping gumtissue healthy. Daily oral hygiene care is critical.

Smokers also are more likely to have periodontal disease.

Prevention: Plaque Removal, Professional Treatments

Daily plaque removal by brushing and flossing keeps gum tissuehealthy.

Professional cleanings on a regular basis also may be needed to keepgum tissues healthy.

Trainer - OH SlIdes.& Notes - Script 2 - 10

Slide 11: Gum Problems - Photos

Photo 4 - Gingivitis:

Gums are red and swollen and may bleed easily.Brushing and flossing can help improve this condition, or

professional care may be needed.

If plaque remains on the teeth, it hardens to form tartar orcalculus, which irritates the gums. The tartar or calculus cannotbe removed by brushing. Eventually, the gums detach and pullaway (recede) along the length of the teeth.

Tartar on the teeth may need to be removed (by having the teethcleaned) before the gingivitis will improve.

Photo 5 - Periodontal Disease:

If the gingivitis is not treated or controlled, it can progress to amore serious condition, periodontal disease, where the boneholding the teeth in place is destroyed.

Eventually, the gums may pull away from their original position,exposing the roots of the teeth. This allows decay and infectioninto tooth roots and also into the bone that supports the teeth.

AS the bone dissolves, the teeth will become loose.

The loose teeth may become so painful that eating becomesdifficult and severe infections may develop.

The disease may be treatable or may require the teeth to beremoved.

These teeth have been partially cleaned, but tartar deposits remainvisible.

Trainer - OH Slides & Nates - Script 2 - 11

•Gum Problems - Prevention-" Clean the teeth and gums daily.

Caregiver~ theoral health care for dents.Brush, floss, other olds

., Avoid tobacco.• SmokIng and Msmokeless" (c.hcw,rgr.r SPll ~ct;occo)

" Schedule routine dental care.

,.

Slide 12: Gum Problems - Prevention

Clean the teeth and gums daily.

Caregiver prompts. assists. or performs the oral health carefor clients.

If your client is able, s/he may need only a reminder to take care oforal health. However, you should still monitor self-care for quality.

The client's service/care plan may indicate that you will need toperform the oral care for your client.

Brush, floss, other aids

The brush cleans the areas we can see: Tongue and cheek sides ofthe teeth, biting surfaces.

Floss cleans between the teeth where the brush can't reach.

Toothpicks, specialized brushes or cleaners, or other products areavailable to help you clean if you have trouble using a brush or floss.These will be discussed in more detail later

Avoid tobacco products.

Smoking increases the risk of developing gum problems.

Smokeless tobacco causes gingivitis, gum recession, bone loss, toothdecay.

Schedule routine dental care

Professional care is important in controlling gum problems.


Slide 13: Gum Problems - Treatment

This is general information to help you understand some of thetreatments that your client may receive at the dental office.

Oral health instruction

Brushing, flossing. and other aids to keep teeth and gums in goodcondition.

Thorough cleaning of the teeth

The dental hygienist or dentist can remove the calculus deposits toimprove tissue health and to make home care easier.

Anti - bacterial rinses

The dentist may prescribe anti-bacterial rinses to control theplaque. It is important to follow the doctor's instructions exactly.

Surgery to correct problems

Sometimes cleaning and home care are not enough to control theproblems, and surgery may be needed to reshape the gum tissue oreliminate the deeper areas of infection.


Slide 14: Activity: Check Your Mouth

Using a hand mirror, look at your gums, teeth, and tongue.

What do you see?

Does it look normal or not normal?

Do you see anything unusual?

Note to trainer: Students may be uncomfortable in publicly displayingtheir own teeth or mouths, and may not want to participate. The purposeof this exercise is to help students become more comfortable looking attheir own teeth, gums, and tongue before they attempt extended oralcare with their clients.

Take a lO-minute break before moving to the next section.

TraIner - OH Slides & Notes - Scnpt 2 - 14

Slide 15: Tooth Decay (Cavities or Caries) All words mean the same thing.

Like gum disease, tooth decay is caused by germs in our plaque.

Germs (bacteria) make acid from our food.

The tooth decay germs love the same things we do-sweet, sticky, orstarchy foods like candy, cake, cookies, soda, or chips, crackers, andpretzels. (Refined sugars and flours.)

"Diet" or "sugar-free" foods are better for our teeth because they don'tprovide food for the germs. However, diet sodas contain acids that canalso dissolve our teeth. (Citric acid, phosphoric acid)

Liquid medications often contain large amounts of sugar.

Each time we eat, the acid remains for about 20 minutes. ("Acid Attacks")

If we sip on a soda, nibble on crackers or cookies, or suck on sugaredcandies we will have many acid attacks in a day.

That's why we should eat Just a few times per day, eat sweets ordesserts with our meals (not as a separate event), and clean our mouthsafter eating.

The acid makes holes called decay, cavities, or caries.

More acid attacks per day = greater chance for new cavities.

Our teeth need time to "rest and rebuild" between acid attacks.

The acid weakens or "demineralizes" our teeth, but allowing our teeth torest between attacks can help the tooth rebuild or "remineralize"

Trainer - OH SlIdes & Notes - Script 2 - 15

Slide 16: Tooth Decay (Cavities, Caries)

Untreated cavities can lead to pain, infections, and tooth loss.

Teeth may be sensitive to cold, hot, or Sweet foods; becomepoinful: develop serious infections (abscesses); or need to beremoved.

Prevention: Plaque control, diet, fluoride

We will look at prevention later in the program.

Trainer - OH Slides & Notes - ScrIpt 2· 16

Slide 17: Tooth Decay-Process

Here is another way to understand the steps in getting tooth decay:

Germs + Refined Carbohydrates = AcidAcid Attacks + Tooth = Decay

Untreated Decay 7 Infection, Abscess, Loss of Tooth

Decay begins with acids attacking the tooth enamel (the outer portion ofthe tooth.)Teeth can be kept healthy with daily oral hygiene, healthy diet, and theuse of fluoride in drinking water, toothpaste, mouth rinses, andprofessionally-applied gel or varnish.

If decoy progresses, it creates a cavity or hole in the tooth.If a person has a cavity but doesn't have the tooth repaired, and doesn;tchange the conditions in the mouth, the decay will continue to destroy thetooth. That tooth may become infected or abscessed .

. Untreated decay and/or an untreated abscess may result in a toothneeding to be removed (extracted).In more serious cases, an untreated abscess can lead to seriouswidespread infection, often resulting in swelling of the face, andsometimes resulting in swelling of the brain or even death.

People who are in a weakened immune state may have difficulty recoveringfrom a dental abscess.


Slide 18: The Progression of Plaque

The red staining indicates areas where plaque exists. After 3 days of nobrushing. plaque has almost completely covered the cheek-side surfacesof the top teeth as well as infected the gum line and areas in between theteeth. Without the staining. it may be difficult to see how much plaqueexists on un-brushed teeth.

Trolner - OH Slides & Notes - Script 2 - 18

Slide 19: Tooth DecayPhoto 6 - Caries (Cavity, Tooth Decay):

When a tooth decays, its enamel surface breaks down and allowsacids and bacteria to enter the softer areas inside the tooth.Usually, decay begins as a small whitish area that, if left untreated,grows and darkens. Decay often occurs between the teeth wherefood particles are more difficult to remove. How many areas ofdecay do you see on this photo? (At least 7.)

Photo 7 - Abscessed Teeth:In photo 7, untreated decay has allowed infection to enter theteeth and move into the teeth r09ts. Swelling on the gum abovethese teeth (arrows) indicates infection (abscess) from the teeththat is draining into the mouth.

Photo 8 - Facial Swelling from Abscess:

If the infection isn't treated, the person's face may begin to swellas the infection spreads from the tooth to the surrounding area inthe face or neck.

Widespread infection can make people extremely ill.This is a matter that needs immediate attention.Often the dentist (or physician) will treat the infection withantibiotics first, then repair the tooth.Treatment could include placing a filling or crown, root canaltreatment (the nerve chamber is cleaned and sealed), or extraction(removal) of the tooth.


Slide 20: Tube-Fed Clients Need Brushing Too

Even though this patient is tube-fed and does not typically receive foodor beverages in his mouth, plaque and calculus (a hard deposit of plaqueknown as tartar) have built up on his teeth and cleaning is still needed.


Slide 21: Tooth Decay - Prevention

If you have a toothbrush like this, buy a new one!

Remove bacteria (plaque) every day

Brush, floss, and other aidsLimit sweet, sticky, or sugary foods and drinks

(Refer to prior discussion of snacks & acid attacks.)Choose sugar substitutes

The germs that cause tooth decay cannot use sugar substitutes tomake acid, so these products help prevent decay.Use moderation when eating "dietetic" candies sweetened withsugar substitutes. These sweeteners have a laxative effect andcan create gastric distress or cause diarrhea.

Xylitol (another sugar substitute) not only prevents decay, but also canhelp teeth rebuild themselves (remineralization)

Name-brand products that contain xylitol:

Carefree Koolerz gumSome of the Trident gum varieties

Some of the Tom's of Maine toothpastes; Orajel toothpasteBiotene rinses, toothpaste, gum (also used to relieve dry mouth)

Some of the Starbucks "after-coffee" mints or gum

Check ingredient labels; look for xylitol as first or secondingredient

For the greatest benefit, we need to chew the gum or eat the mints 3-5times per day, for about 5 minutes, especially after meals and snacks.This amount will not create gastric distress for most people.


Slide 22: Tooth Decay - Prevention

Fluoride:

Using toothpaste with fluoride or drinking fluoridated water protect againstdecay for people of all ages. This is especially important for many people whomay have gum recession and exposed root surfaces that decay more easily.

ToothpasteChoose one with the" ADA Seol of Approvol" to get the proper fluoride content.

Choose 0 flovor thot your client likes and will use. Some taste too "hot" or ·spicy."

Use just enough toothpaste to cover the bristles.

Fluoridated WaterFluoridated water supplies protect everyone:

1. As children's teeth develop, the fluoride strengthens the teeth from within.

2. Children and adults: Teeth are bathed in fluoride every time we drink water.

Home water filters ("Brita" type filters or those attached to the kitchenfaucet) do not remove fluoride.

Whole-house reverse osmosis filters will remove fluoride.

Fluoridated Bottled WaterMost bottled drinking water does NOT contain fluoride. (Check labels.)

Crystal Springs makes fluoridated water available for home delivery, and Sparklettsand Dannon offer smaller bottles of fluoridated water for sale in stores..

Fluoride rinses, gels, or varnishOver-the-counter fluoride rinse can be used at bedtime to give extra fluorideprotection, especially for those with new decay. (ACT or Fluorigard Rinses)

Dentists may prescribe brush-on fluoride gel for people with dry mouth, new decay, orthose receiving chemotherapy and radiation treatments.

Dentists or physicians (or staff members) may apply fluoride gel or varnish duringoffice visits.

Photo 9 - Fluoride varnish is painted on the teeth to help prevent new cavities.

Trainer - OH Slides & Notes - ScripT 2 - 22

23: Tooth Decay - Treatment

1. Keep natural teeth

Repair cavities while they are small.Problems treated early are easier and less expensive to correct.

Silver or white fillingsSmaller areas can be restored with silver or tooth-colored fillingmaterials.

Crowns or capsWhen a large area of the tooth is decayed, a crown or cap may beneeded to restore the tooth. Crowns may be tooth-colored ormetal.

2. Missing teeth can be replaced with:

Bridges or partial denturesA bridge is a non-removable replacement for one or more missingteeth, usually requiring crowns on the teeth next to the missingtooth.

A partial denture is a removable replacement for one or moremissing teeth.

DenturesA full denture is a removable replacement for all of the upper orlower teeth.

Implants

An implant is a permanent replacement for a missing tooth or teeth.A metal anchor is placed in the jawbone and a replacement tooth isattached to the anchor.

Trainer - OH Slides & NOTes - Script 2· 23

Slide 24: Dental Treatments

These are examples of various dental treatments.

Silver (or white) fillings can be placed in teeth with small cavities.

Crowns are used for larger areas of decay or broken teeth.

Bridges replace missing teeth and are permanently cemented in place.

Partial denture (not shown) has caused tissue irritation.

Implants are anchored into the Jawbone under the gums, and a crown isattached.


Slide 25: Daily Oral Health Routine

Personal Health ActivityMouth care is a very personal and sensitive activity that you can performcaringly and confidently.

You might have a client who is uncooperative or who refuses to allow you toperform your duties. Other clients may not be able to keep their mouths openvery well. With practice and patience you will learn to perform daily care.

Protect Yourself and Your ClientConsider your safety when working with your clients.

Practice good body mechanics to decrease the chances of injuringyourself.Infection Control Issues·Universal Precautions should be followed when performing oral care toensure that you and your client are protected against crosscontamination.·Wash hands before and after oral care.·Wear gloves and other protective gear appropriate for your client'scondition. (May include mask, gown, safety goggles.)

·Do not allow any of the oral health items to touch dirty surfaces likecountertops or sinks.·Do not contaminate faucets, drawer handles, or other surfaces bytouching with dirty gloves.

See "Hands-on" Section (Unit 3) for additional information.

Trainer - OH Sltdes & Notes - Script 2·25

Slide 26: Daily Oral Health RoutineBrush

Twice per day; 2 minutes minimumBedtime brushing is most important

We must clean our mouths at the end of the day so that food and plaque are notin the mouth overnight.

Choose a soft brush and use a gentle circular motionPlace the brIStles where the gums and teeth meet, make short brush strokes(circles, 'jiggle or wiggle"), count to 5 in each area.Work," a pot tern so you don't miss any areas.

Remember to brush the tongue!Floss

Once per dayCleans between teeth where the brush misses

Gently sltp the floss between teethhPull the floss tight against one tooth, scrapethe plaque from around and under t e gums.It is 'okay" to use waxed floss, floss holders, or other aids.

Caution: If your client has not flossed before. the gums may bleed when you try tofloss. If sine has heavy calculus or tartar deposits on the teeth. you may hovedifficulty getting the floss between the teeth. This is a situation oeyond yourscope of practice and you should record and report. Professional cleaning andinstructions in oral hygiene techniques by the dentist or hygienist probabfy will beneeded.

FluorideToothpaste. mouth rinse, water supply

You only need to cover the bristles of the toothbrush with Q fluoride toothpaste.Fluoride rinses (ACT from Johnson & Johnson or Fluorogard from Colgate) mayhelp clients at risk for new covities.Drink fluorIdated water if possible.

Hands-on Practice: Brush & Floss using models,

Tramer - OH Slides & Notes - Script 2 - 26

Slide 27: The Power of Brushing

Good brushing technique removes more plaque and germs from the teethand gums.

The red staining indicates areas where plaque exists. In the first set ofphotos (top left) the left side of the mouth went without brushing for 5days, while the right was not brushed for 3 days.

The second set of photos (top right) shows how much plaque (and redstain) is removed if the teeth are brushed with a horizontal, back andforth motion. As you can see, only the flat surface areas of teeth wereadequately cleaned. Areas in between teeth and near the gum line stillcontain plaque. This is not the best way to brush.

The bottom photo shows a clean mouth in which the plaque (and red stain)have been removed through proper brushing technique - small circularmotions with the toothbrush angled at 45 degrees toward the gum line.


Slide 28: Bleeding May Occur

The gums of a patient with gingivitis or periodontal disease may bleedwhen brushed or flossed - this is a symptom of the oral disease. Gentlebrushing usually helps reverse mild bleeding or early gingivitis.

Caution: If your client has not flossed before, the gums may bleedwhen you try to floss. If slhe has heavy calculus or tartar depositson the teeth, you may have difficulty getting the floss between theteeth. This is a situation beyond your scope of practice and youshould record and report. Professional cleaning and instructions inoral hygiene techniques by the dentist or hygienist probably will beneeded.


f,Maintenance Routine-., Ask Doily:

· Are you able TO eat comfortably?

· Are you having any pam or discomfort?

Momtor teeth, gums, tongue, lips monthly· Use a floshhght to check for red or white

areas, sores, or other abnormalities

"I Record unusual findings and~ to yoursupervisor.

Slide 29: Maintenance Routine

Ask Daily:

-Are you able to eat comfortably?

-Are you having any pain or discomfort?

Monitor teeth, gums, tongue, lips every month

Use a flashlight covered with plastic wrap or a sandwich bag tocheck for red or white areas, sores, or other abnormalities

You may be the only person to inspect your client's mouth.

Pick a date to inspect each month. Mark on the calendar l

This is in addition to the observations you make every day during oralcare.

Follow the same pattern that you use in brushing and flossing

(Example: Start on the upper right outside, work around all of theoutside areas, then move to the inside of the upper, working back tothe upper right. Follow the same routine for the lower teeth. Checkthe tongue.)

Record your observations and report any problems to your supervisor orclient's case manager. Continue to monitor. If a sore area remainsafter 2 weeks, refer your client to a dentist or physician.

Trainer - OH Slides & Notes - Script 2· 29

Non-verbal signs of oral problems-'! Behavior change without other reason

, Refusing to eat or change In foodpreference

, Touching cheek/mouth more often

" Swelling, uneven faCial features

Worm, puffy cheeks or chin

'I RefUSing to uSe dentures/partials orremoving them to eat

Slide 30: Non-verbal signs of oral problems

In addition to looking in and around the mouth, identifying oralproblems can occur by paying attention to clients' behaviors.

Behavior change without any other know cause or reason may be relatedto dental pain.

Other signs may be:

'Refusal to eat or a new preference for soft foods or foods of a certaintemperature.

'More frequent touching of the cheek or mouth

'Swelling or uneven facial features

'Warm, puffy cheeks or chin

,Or refusal to use dentures and removing them to eat,

Trainer - OH Slides & Nates - Script 2 . 30

Slide 31: "Monitor & Document" Exercise

Refer to "Hands-on Section." p. 3-13 for "Monitor & Document"exercises.

Using the "Oral Health Photo Guide." choose one photo and pretendthat you notice something unusual in your client's mouth whenperforming your monthly monitoring.

Use the form to write what you would report in the service/care plan.

Note to trainer: Option 1: This activity can be done as a solo exercisewith individuals completing the form and reporting to the group. Assigneach student or small group a photo, have them complete the form, reportto group.

Option 2: This can be done as an oral exercise with the class contributingideas on what they see (using photo guide or slides projected on screen).with the trainer prompting things to consider (size, color, shape, etc.)according to the form.

TraIner - OH Slides & Nates - Script 2 - 31

Assessing Client's Abilities-"I Abilities con ronge from:Highly able· but ltkely r,eeds~ andObSCI"'/otlon to ensure adequate cleanmg

Moderately oble· needs aSSiSTance (eg nOr'd or.hondo or coregwcr completes biush,r.g/floss,ng)

Very limIted· coreglver muST~ Ihebrush,r_g/floss'ng for dent

Allow The ,lien 10 (orcuct as mucn of the t05~ as she ecr,

Slide 32: Assessing Client's Abilities

Due to phySical or cognitive limitations, clients will have a varying abilityto take care of their teeth and gums.

Some clients will be highly able. But they will likely still need you toprompt them (e.g. put toothpaste on brush, encouragements) and youshould always monitor their skills to ensure they are brushing correctlyand thoroughly.

Some clients will be moderately able. They will need assistance withbrushing and/or flossing. They may need you to place your hand on theirsto guide the activity. Or they may begin the task but need you tocomplete it.

Very limited: Some clients will not be able to brush/floss their teeth. Youwill need to do this for them - we will discuss strategies for this in a fewminutes.

Remember to allow the client to do as much as they are able to on theirown.


Assessing Client's Levelof Cooperation-", Clean teeth and gums dally

, No absolutes l

Acceptance can range from:Cooperative - opens mouth easily

Needs encouragement - clenches teeth.purses lips. will open \'JITh coaxing

Continually reSISTive - hands pulling orsWinging. attempts To biTe, sc.reams, kIcks,head moving back ar.d forTh

i

I

Slide 33: Assessing client's level of cooperation

Assessing your client's level of acceptance of care will help you todetermine a strategy of approach and how best to protect yourself,

There are no absolutes!

Cooperation by your client when approached for daily oral hygiene isrelative. Some clients may be cooperative with one caregiver and veryresistive with another. Behaviors may change from day to day or evenhour to hour.

Acceptance can vary;

A cooperative client will open mouth easily and not resist,

Some clients will show resistance at first (clenching teeth, pursing lips)but with patience and coaxing will eventually allow care

Some clients will be continually resistive and show combative behaviors.

They may pull your hands away from their mouth, swing their arms at you,attempt to bite your fingers, scream, kick, or move their head back andforth,

Trainer - OH Slides & Notes - Scnpt 2 - 33

Slide 34: Levels of Cooperation Cont.

Some clients will show even more obstructive behavior by moving awayfrom you - sitting on floor or leaving room, throwing up, screaming,spitting.

Trainer - OH SlIdes & NOles - Script 2 - 34

Slide 35: Levels of Acceptance, Cont

Also, some clients may use self injurious behavior. This may be due tostress or be an outlet for communication. The client may bite or hitherself, or pick at her skin in or around her mouth.

Trainer - OH Slides & Notes - Scripf 2 - 35

Gaining Cooperation- Clean teeth and gums dOIlySelect Q good time of doy and locatIonRefrome the task:

7 have a present for you, let's see If ,f "ts"7 sec somethmgon your tooth, let's see If I cantoke the sugar bug out·

Compliment often, •Great helper'Ask for their aSSISTance·

7 need your help, thiS IS a speclol brush"~You are really helping me to learn 10 do thISrlghr W

Slide 36: Gaining Cooperation

Select a good time of day

For both the caregiver (time when she is less rushed) and client (timewhen he tends to be in positive or more cognitive state)

Select a good locationBe flexible - oral care doesn't have to happen at sink. Bring supplies toclient in bed or wheelchair. Use towel on chest/shoulder to catch run-offof saliva/toothpaste.

Reframe the taskIf needed, use words other than - "time to brush your teeth" Instead,try "I have a present for you - it's a red toothbrush. Let's see if it fits."Or, "I see something on your tooth, let's see if I can get the sugar bugoff."

Use compliments often"You're a great helper!" or "You're doing a great job!"

Ask for assistance from the client"I need your help, this is a special brush, help me see if it works""You are really helping me learn how to do this right"


Gaining Cooperation Cont.- Explain procedure wI brush on teeth:-How does this fee/when I massage yourteeth'>"

75 If better oller here'""Am I domg good?"

" Sing songs. count

" Place something In clients hands

"

Slide 37: Gaining Cooperation Cont.

Explain the procedure with the brush on the teeth

"How does this feel when I massage your teeth?" move brush in circles.

"Is it better over here?" "Am I doing good?"

Sing songs, count

Helps client to relax, get client in on the game

Place something in clients hands

This will help to occupy them.

Trainer - OH Slides & Notes - Script 2·37

Slide 38: Oral Health Aids

It's "okay" to use other aids beyond standard brushes and dental floss,depending on the client's situation, abilities, and service/care plan. Showexamples & allow students to examine them.

Automatic brushes

Limited mobility clients

Easier for people with arthritis or other disabilities.

Effective for plaque removal

Most people spend about 30 seconds brushing their teeth and oftenleave over half the plaque on their teeth.

Automatic brushes clean more effectively for the time spent.

Timers

Brushes with timers help people brush long enough.

Floss holders or mini-brushes

Easier access for cleaning between teeth

For large fingers or limited mobility

Holders make i.t easier for you to do the flossing.

Mini-brushes work well if there are large spaces between teeth.

Toothpicks or wooden tooth sticks also work well for some people.

Adapters

To extend length or increase width of oral health aids

Simple items can be used to construct adapters: tennis balls, racquetballs, bicycle grips, washcloths, 12-inch rulers.

See "Resources" section for a list of product suppliers.


Slide 39: Adapting the Toothbrush

A regular, soft-bristled toothbrush is a good tool for brushing. Run the"neck" of the to'Othbrush under warm water and bend the "head" back 45degrees. When placed in the patient's mouth, the toothbrush will nowpush the cheek away from the teeth enabling a better view for thecaregiver.

Toothbrush attachments may make brushing easier for patients who havedifficulty holding the small handle of a toothbrush. Simple items can beused extend the length or increase the width of the toothbrush: tennisballs, racquet balls, bicycle grips, washcloths, 12-inch rulers. A list ofsuppliers is included on your CD.


Importance ofProfessional Dental Care-" Chents need exams and professIOnal care

an a regular basIs.DOlly home care IS Important. but not theonly focI or In good oral heollh. .

, Dental VISitS 'nclude ~,~• ExamInation of teeth and gums~~

Oral cancer screening

Early detection and treaTment of problems

Slide 40: Importance of Professional Dental Care

Clients need exams and professional care on a regular basis.

Daily home care is important, but not the only factor in goodoral health.

Clients should receive dental care on an interval based on theirdental risk factors

Example: Clients with new cavities or gum problems should be seenmore frequently. Clients with diabetes should be seen morefrequently. The time interval between appointments is based onthe dentist's or dental hygienist's recommendation.

Dental visits include

Examination of teeth and gums

X-rays may need to be taken to check for decay between the teethor under old fillings and to check for bone loss.

Gum tissue will be examined for periodontal disease.

A treatment plan will be developed if problems are detected.


Early cancer detection is critical to a successful outcome. Oralcancer screenings take just a few minutes.

Early detection and treatment of problems

It is easier to treat a problem while it is small, rather than waitinguntil it becomes larger or painful.

Trainer - OH Slides & Noles - Smpl 2 - 40

Slide 41: Where to Find Dental Care

Finding dental care often is a problem for seniors and disabled adults.

Medicare does not include dental treatment, and Medicaid adult dentalbenefits are limited.

Most seniors lose their dental insurance when they retire.

You may be able to help your clients find care.

Referral Services

Most counties and some communities provide referral services that canhelp you find dental care for your client and for yourself These areoften sponsored by health districts or departments, dentalorganizations, housing authorities, area agencies on aging, andcommunity clinics.

Community Clinics

Community clinics offer a low-cost option for dental care. They usuallyaccept Medicaid or charge fees on a sliding scale.

Dental Professional Schools

The UW School of Dentistry and several dental hygiene programs anddental assistant vocational schools around the state offer limitedaccess to dental care.

A Community Clinics list is included in the 'Resources' (#3) section of yourworkbook which contains contact information for local dental care providers.Also check with your client's case manager.

5-hour class: Depending how quickly you have moved along, this may bethe place for a 30-minute lunch break or wait until after slide # 45.


Slide 42: Denture Problems

If all of the teeth in the upper or lower jaw are missing, they may bereplaced with a removable denture.

New denture users will have to learn how to successfully wear theirdentures, which may take practice and patience.

Upper dentures are held in place by suction between the roof of themouth and the denture.

Lower dentures are held in place by gravity and proper design Somepeople use denture adhesives to hold the dentures in place.

Having dentures does not mean that the person will never have future"dental problems," such as:

Poor fit

The denture doesn't change, but the tissue or underlying bone canshrink, resulting in a poor fit.

Sore spots

If the denture moves when chewing or rubs against tissues, itcreates sore spots.

Broken teeth; sharp edges or cracks

Broken dentures should NOT be worn.

A sharp or broken edge may cause in lury to the soft tissues ortongue.

Do NOT attempt home repairs!

Improper repairs may cause sore spots or difficulty chewing.

Trainer - OH Slides & Nates - Script 2 - 42

Slide 43: Denture Problems

Photo 10 - Irritation from Partial Denture: (Point out the features onthe photo.)

Denture irritation often appears as redness on the palate (roof ofthe mouth) or on the gums where the appliance rests. Sometimes adistinct "sore spot" or open sore can be seen.

This photo shows the mark (redness) created by a partial denture.The soreness may be caused by irritation when the denture remainsin the mouth for long periods of time, or it could be caused by anallergic reaction to the metal in the partial.

To reduce the risk of irritation, dentures should be kept clean(brushed daily), and should be removed from the mouth (andsoaked) at night to allow the tissues to "rest." (Think of how yourfeet would look or feel if you left your shoes on all the time.)

Note: Some people like to sleep with their dentures in theirmouths. In some cases, a dentist may even recommend this.

This is okay IF dentures are cleaned thoroughly before bed.Additional daytime cleanings or even a one- or two-hour daytimesoak could help make up for the lack of overnight soaking.

Note: This photo also shows a gold crown, two fillings, and a row ofmetal crowns with porcelain veneers (the white portion that you seeon the front of the crowns).

Trainer - OH Slides & Notes - Script 2 • 43

Tissue exam

Importance ofProfessional Dental Care-'0 Clients with dentures need yearly exams.

.&", "71

Comfort and fIt of dentures .~~

Chec.k for broken Teeth or sharp edges I.-, \

Oral cancer screeOlng

Slide 44: Importance of Professional Dental Care

People who have dentures can still have "dental" problems and should bechecked yearly.

Clients with dentures need yearly exams.

Tissue exam

Dentures can create sore spots around or under the denture.

Usually the dentures can be adjusted sa they can be worncomfortably.

Comfort and fit of dentures

The dentist can check to see if the dentures are becoming looseand make necessary adjustments.

Broken teeth or sharp edges

Dentures with cracks or sharp edges should NOT be worn.

They can cut or injure the tissues.


Early cancer detection is critical to a successful outcome. Oralcancer screenings take just a few minutes.

Clients who use tobacco or alcohol are more likely to develop oralcancer.

Trainer - OH Slides & Notes - Script 2 • 44

Slide 45: Denture CareInfection control policies apply to denture care. Avoid placing the denture orbrush on any unclean surface such as a countertop or sink.Use care in handling dentures. They can be very slippery and are easily brokenif dropped. Replacing broken dentures can be very expensive-many hundredsof dollars per denture. Placing a washcloth or towel in the sink may cushion thedenture in case of on unexpected drop.

Dentures collect plaque, hard calculus or tartar deposits, and stains-thesame as our natural teeth.

If food debris is not removed from the denture, the tissue under thedenture can become sore, tender, and inflamed.Dentures and partials should be removed and rinsed (preferably brushed)after meals.

Brush daily with a denture brush.Soak overnight, using commercial products like Polident or Efferdent.Never soak dirty (unbrushed) dentures!

Do not use bleachl Bleach can remove the pink coloring, can discolor themetal on a partial denture, or create a "metallic taste."Liquid soap can be used in place of denture toothpaste, but it must berinsed completely before inserting denture.

Check for cracks, sharp edges, or broken teeth.Gently brush the gums, roof of the mouth, and the tongue beforereinserting the denture.Practice denture care. Refer to Hands-on Section for more information.Take a lunch break if you did not do so after Slide # 41.

Tro;ner - OH Slides & NOles - Script 2 - 45

Slide 46: Dry Mouth

Many people are likely to develop "dry mouth," a serious condition that cancause maJor problems in the mouth, This is a condition beyond thenormal drying of tissues that happens as we age. Dry mouth has manypossible causes, including:

Medication side-effects

M.edications used to treat high blood pressure, allergies,depression, and many other conditions can cause dry mouth.

About 400 medications have dry mouth as a possible side effect.

Many people take at least one of these medications, and your clientmay be taking several.

Chemotherapy or radiation treatments

These cancer treatments damage or destroy mouth tissues.

Dental care should be completed before treatments begin.

Saliva glands do not work properly

Certain medical conditions may create problems with the salivaglands.


The Wonders of Saliva-., SalivaCleanses the mouthKills bacTeriaNeutralizes aCidsRemlnerallzes teethMOIstens the mouth, makmg It eaSter 10 eot,toste, swallow, and speak.

•, Without enough saliva, oral problems candevelop qUickly.

Slide 47: The Wonders of Saliva

Saliva plays several important roles in protecting oral health:

Saliva helps keep the mouth clean by washing away food particles.

Saliva helps kill bacteria in the mouth that can cause infection andit neutralizes the acids that cause tooth decay.

Saliva contains minerals like calcium and fluoride that help hardenand repair the teeth.

Saliva lubricates the mouth, making it easier to eat, taste, swallow,and speak. This lubrication also helps defend the whole bodyagainst infection.

When there is not enough saliva in the mouth, problems can developquickly. There might be new decay (especially on exposed rootsurfaces), fungal infections, or mouth pain.


Slide 48: Dry Mouth - Side Effects & Photos

Photo 11 - Root Decay (Cavities, Caries):

See how the decay progresses from #1 to #6:

1. A tooth without caries.

2. The beginning stage of tooth decay, the "white spot." Properprevention can halt the decay from progressing further.

3. The enamel surface has broken down. (Note also the red gumtissue.)

4. A filling was placed, but the disease has not been stopped andnew decay surrounds the filling.

5. The decay process continues and breaks down more of the tooth.

6. The tooth has fractured - the effect of a process which couldhave been stopped at an early stage l

Photo 12 - Cracks on Corners of Lips

Cracks on the corners of the mouth may have a number of causes,including fungal infections and simple irritation, but often they arerelated to dry mouth. Caregivers should alert their supervisor or theirclient's case manager if they observe this condition.

Photo 13 - Dry, Painful Tongue (Also note cracks at corner of lips):

A dry tongue often appears smooth, red, and slightly swollen. A drytongue can make speaking, tasting, and swallowing difficult.

Photo 14 - Possible fungal Infection on Tongue:

Some medical cond'itions may result in a fungal (yeast) infection thatoften affects the tongue. The heavy white coating is a possibleindication that this type of infection is present. Alert your supervisor.


Dry Mouth - Management-" PhysIcian may change medications.

" Drink extra water. !Jm" Protect teeth with fluoride. ..!Il ..-" Use a saliva substitute. :~ IJ,I" AVOId:

Sugary snacks or drinksBeverages with caffeine or alcoholMouthwashes with alcoholTobacco

"

Slide 49: Dry Mouth - ManagementAlert physician.

The physician may be able to change your client's medication.

Drink extra water throughout the day. especially fluoridated water.Sipping water throughout the day helps maintain moisture and protect teeth.

Taking small sips of water during meals helps with swallowing food.

Keeping a gloss of water at bedside is goad for nighttime sipping, but may increasenighttime trips to the bathroom.

Using a saliva substitute before bed and a humidifier during the night also may helpprevent nighttime dry mouth.

Protect teeth with fluoride.Extra fluoride may be needed to protect teeth when the mouth is dry. Fluoridetoothpaste, rinses, and prescription gels con provide this protection.

Fluoride varnish may be applied at the dental or medical office.

Use a saliva substitute.Saliva substitutes replace missing moisture. (More info on the next slide.)

Avoid:Sugary snacks or drinks

Sipping on sugary drinks or juices contributes to tooth decoy.

Sucking on sugary candies or mints increases the chances of decoy.

Beverages with caffeine or alcoholCaffeine and alcohol increase dryness.

Mouthwashes with alcoholMost mouthwashes contain high levels of olcohol which increose dryness.

(Listerine contains about 25"10 alcohol: Scope about 10% alcohol. Check labels.)

Tobacco productsTobacco increases dryness and increases the risk for developing oral cancer, gumdisease. and fungol infections.

Tra,ner - OH Slides & Notes - Script 2 - 49

Dry Mouth - Aids-'j Saliva Substitutes

Increase mOisture and comfortBlorer,e or OroJel Produc.ts

Qlnse. geL toothpaste, gum

• XylitalSugar substitutePre'IenTs decoy: repOIrs early decoyGum. mintS, dry mouth products

Slide 50: Dry Mouth - Aids

Saliva Substitutes

To increase moisture and comfort

Increases moisture. decreases bacteria

Use during the day and before bedtime

Biotene and Orajel Dry Mouth Products

Enzymes to increase moisture

Xylitol to prevent decay

Rinse, toothpaste, gum

Show product displays.

Xylitol

Sugar substitute

Prevents decay; repairs early decay (remineralization)

Gum, mints, dry mouth products

Biotene, Carefree Koolerz gum, some flavors of Trident gum,Tom's of Maine toothpaste and rinse, Orajel products

Show product displays.

Trainer - OH Slides <I Notes - Script 2 - 50

Poor Nutrition - Resulting From ..-, Inadequate MealsFading appetite; too much botherAltered toste, especlolly In senIors

Helf os mcny Joste buds at Qge 7~ 0'; ct Qgc 30

Poor quoloty or small quonlily meals: sofT d,elFlnanclol concernS

., Disabilities that affect meal preparation.~ Arthntls; limited movement; VISion or hearIng... problems: mental healTh problems: OThers.

'"Slide 51: Poor Nutrition - Resulting From..

Several factors could put your client at risk for poor nutrition:

Inadequate meals

Failing appetite; too much botherNot interested in preparing or eating nutritious meals.

Altered taste, particularly in seniors

Only half of our taste buds remain at age 75, so the ability totaste food is decreased. This may make eating less appealing.Chemotherapy, medications, medical conditions also change taste.

Poor quality or small quantity; soft dietClient eats smoller amounts of food or poor-quality food.

A soft diet restricts the variety of food choices.

Financial concerns .Limited or low income restricts choices.Higher-quality foods sometimes cost more.

Disabilities may affect meal preparation and oral healthArthritis; limited movement; vision or hearing problems; mentalhealth problems; other conditions

These all contribute to the poor nutrition/poor oral health cycle.These same disabilities may make it more difficult for your clientto do simple oral health routines.

(Examples: Can't lift arms high enough to floss or brush; can'tsee well enough to watch in a mirror while flossing; can't hear wellenough to understand directions on "how to.")


Poor Nutrition andOral Health-

." Poor nutrition can result In poor oral health.Walch for Crccks at (or~er of mouth or sore tOl'l(jue

Food resIdue on teeth thOT (on lead 10 decoy

" Oral health problems can result In poornutntlon.

Mlss,r-g broker.. cecoyed teeth make eaTing d.fflcult

Dry mouTh con meke ot ddf.cult TO tosTe or.d <.iV/oIIOII!

'.,

Slide 52: Poor Nutrition and Oral Health

Poor nutrition can affect a person's overall health, as well as oral health.

This is a two-sided issue:

1. Poor nutrition can result in oral health problems.

Examples: Certain vitamin or mineral deficiencies may result inmouth problems, like a sore tongue or cracks at the corners of themouth.

Food residue on teeth can lead to decay.

Soft diets can result in food remaining on the teeth, leading todecay.

2. Oral health problems can result in poor nutrition.

Examples: Missing, broken, or decayed teeth can make it difficultto eat a balanced diet or a variety of foods.

Chewing may become painful with decayed, broken, or loose teeth.

Dry mouth can make it difficult to taste and swallow.

Trainer - OH SlIdes & Notes - Script 2 . 52

Slide 53: Nutrient Deficiencies

Photo 15 - Sore Tongue: (Point out the features on the photo.)

A vitamin or mineral deficiency may cause a smooth, red, or soretongue.

Nutrient deficiencies also may cause sores or cracks around thelips. (Arrows.)

Other causes can also produce problems that look like these.

It is not your responsibility to diagnose a condition. You areresponsible to record and report unusual findings.

Note in your client's service/care plan and report to your supervisoror client's case manager.

Your client may need referral to professional care if these do notgo away within two weeks.

Tra;ner - OH Slides & Notes - Script 2 - 53

Preventing Nutrition Problems-, Caregivers may be Involved In mealplanning. shopping. and preparing.

Help your clients make smart foodchoices. within diet restrictions.

FruITs and vegetobles. whole grams. proteins. Limit sweeTS. fots, or Junk foods. ,

Slide 54: Preventing Nutrition Problems

Caregivers can be involved in meal planning, shopping, and preparing.

As a caregiver involved in meal planning and preparation, you may beable to influence your client's food choices.

Choosing wisely can improve your client's oral health and overallhealth.

Tip: Look through the "sale" ads in the newspaper with your client.

This helps create an appetite and your client will be happy tofind things "on sale." The client gets to choose, but you helpsteer toward better choices.

Help your clients make smart food choices, within established dietrestrictions.

Choose a variety of fruits and vegetables, whole grains,proteins.

Limit sweets, fats, and nutrient-poor foods or snacks Uunkfood)

Be sure to follow diet restrictions listed in the client's service/careplan.

Note: Some diabetics are advised to eat a number of smallprotein-rich or vegetable snacks throughout the day to maintainsugar levels. Caregivers should refer to the client's service/careplan.

Small, frequent meals are often recommended for clientswith acid reflux, Parkinson's or Alzheimer's diseases.


Best Practices-" L'mlt sweet or sticky snacks and drinks.

" Eat full meals Instead of sipping,nibbling, or grazing.

" Drink fluoridated water Instead of .dillJUice or soda. ~~,

.- ......n.

Slide 55: Best Practices

Inappropriate choices can result in decreased oral health.

Limit sweet or sticky snacks and drinks.

"Refined" carbohydrates like sugar, white flour, or highlyprocessed foods stick to the teeth.

High-carbohydrate diet: A source of food for oral bacteria;carbohydrates are converted to acids that damage teeth.

Sticky foods: Dried fruit (raisins, cranberries, etc.), whilenutritious choices, stick to the teeth more than fresh fruits.

Think about the frequency & consistency of foods

How many snacks each day? (Frequency)

Are the snacks sweet, sticky, or starchy choices that willcling to the teeth? (Consistency)

Eat full.meals instead of sipping, nibbling, or grazing.

Snacks can be a constant source of "acid attacks."

Acid levels in the mouth are highest just after eating, especiallyafter eating sweet or starchy foods. These times are oftenreferred to as "acid attacks" Frequent snacking means frequentacid attacks. Repeated exposure to these acids can destroy theteeth (cavities or decay).

Drink fluoridated water instead of juice or soda.

Fluoridated water provides tooth-strengthening minerals everytime we drink.


Slide 56: Reading Nutrition Labels - DEMONSTRAnON

Many products contain large amounts of "hidden" sugar. Learning to readthe nutrition labels can help you identify those foods.

1. Find the line where sugars are listed. The number is in GRAMS.

2. Does anyone know how large a gram is') (Is it big or little?)3. A gram is very small. There are about 4 grams in a teaspoon of sugar.

4. Since we aren't as familiar with grams, let's convert the number tosomething we know better, teaspoons.

5. Divide the number of grams by 4. This will give the number ofteaspoons. For our chocolate milk example, 28 divided by 4 =7.

6. There are 7 teaspoons of sugar PER SERVING of chocolate milk.7. How many servings in this container? f.,8. Multiply 7 teaspoons by 2. This gives the total amount of sugar in the

carton of chocolate milk. = 14 teaspoons.9. How does that compare with some other foods or drinks')

10. Let's look at a can of soda. Coke or Pepsi usually has about 40-44 gramsper 12-oz can, so 40 or 44 divided by 4 : 10 or 11 teaspoons. The sodahas less sugar than the chocolate milk!

11. Which has better nutrition? (Chocolate milk - calcium & protein.)12. What would be other better choices? (Plain milk, fluoridated water.)

Have other product packages available to compare sugar' content, such asdifferent brands of yogurt, cottage cheese, "nutrition" bars, sodas,cookies or snack foods.

Have students compare total grams or convert to teaspoons.Discuss excess sugar consumption in relation to overall health or obesity.

Trainer - OH SlIdes & Notes - Script 2· 56

Oral Cancer-" 30.000 new caseS per year" 6.000 deaths per year'I Tobacco and alcohol uSers hove a greater

chonce of developing cancer." Painless in the early stages.

Report Symptoms:Sores thot do nol heal \fIlThln 2 weekslumps. bumps. or swelling. Red or whiTe potches

Difficulty chewing or swoIlOl·Jl(".g

Slide 57: Oral CancerCancer can appear anywhere in the mouth: Tongue, lips, cheeks, gums,roof or floor of the mouth, throat.Tobacco and alcohol' increase risks. When both are used, the chance ofdeveloping cancer increases dramatically.Early oral C(lncer is often painless, so warning signs are sometimes ignoreduntil the cancer has progressed.Survival rates for oral cancer are poor. Only about half of those who arediagnosed with oral cancer are alive 5 years later.

30,000 new cases per year8,000 deaths per yearTobacco and alcohol are risk factorsPainless in the early stagesOlder adults are more likely to be diagnosed with oral cancer

Report Symptoms/ Refer for Evaluation:Sores that do not heal within 2 weeksLumps, bumps, or swellingRed or white patches in the mouthDifficulty chewing or swallowing

It is extremely important to have anything that doesn't heal within 2weeks checked by a physician or dentist!

Tra,ner - OH Slides & Notes - Script 2 . 57

Slide 58: Unidentified Lesions or Sores

Photo 16 - Unidentified Lip Sore:

A sore on the lip may have many causes. It might be a cold sore (herpes).but it could be something very serious. If any sore does not heal withintwo weeks, professional care is needed to determine the cause.

A cold sore typically appears as a weeping and/or crusty sore on the lip,face, nose, or other area, but usually will heal within 10-14 days. Theherpes virus is easily passed from one person to another. Avoid touchingany open sores with bare (ungloved) hands because you could infectyourself with the virus.Lip cancer often appears as a crusty sore on the lip that never completelyheals. People who spend much time outdoors, smoke, or chew tobacco aremost vulnerable to oral cancer. Use of alcohol may make a person moresusceptible to oral cancer.We can't tell if a sore is cancerous just by looking at it. A biopsy isneeded to determine if cancer cells are present. The lesion in this photowas later found to be cancerous.

Photo 17 - Unidentified Oral Lesion:Normally, a sore or cut in the mouth will heal quickly. Anything that lastsmore than 2 weeks should be checked by a physician or dentist.This sore is on a tongue. There could be many possible causes, such aschronic biting of the tongue, a rough or broken tooth or filling, or oralcancer.

Remember to record your observations in your client's servicelcare planand report to your supervisor or client's case manager. Refer as needed.


~ Cancer Treatmentand Oral Health-, Surgery

Chemotherapy or Radiation TreatmentsOral sIde effects:

Dry moutnTooth decoyIdccrlonsChange.n tOSTe:

Check your dent's mouth DAILY for soresor other changes. Record and~.

Slide 59: Cancer Treatment and Oral Health

Treatment for oral cancer can include surgery, chemotherapy or radiationtherapy, or a combination of treatments.

Often chemotherapy or radiation therapy used to treat cancer in otherareas of the body can affect the mouth as well.

Surgery

Surgery for oral cancer may include removing the cancerous area,plus additional tissue surrounding the cancer.

Oral cancer can spread quickly from one area to another.

Chemotherapy or Radiation Treatments

Treatments can create problems for the teeth or gums, othermouth tissues, or saliva glands.

Cancer pati"ents should have dental exams before starting chemo orradiation so that any dental problems can be treated first.

Oral side effects of chemo or radiation:

Dry mouth

Tooth decay

Infections

Change in taste

Check your client's mouth DAILY for sores or changes. This iscritical during treatment. Changes can happen quickly.

Record your observations and report to your supervisor or yourclient's case manager.

Trainer - QH Slides & Notes - Script 2 - 59

Caregivers Can ImproveOral Healthl- "" ..., "

~.'.'

"~ the oral health care

'I Mamtar client's mouth for changes.

Educate client about oral health mformatlon.

"1 Refer problems to supervisor or case manager.

Conclusion

Slide 60: The Caregiver Helps Prevent Oral Disease

Prompt, assist, or perform the oral health care for client.Allow your client as much independence as possible, but rememberthat s/he may need assistance in one or more oral care routines.

Monitor client's mouth for changes.

You may be the first person to spot an unusual condition or changein your client's oral health.Caregivers CANNOT make a diagnosis, but CAN report changesor unusual conditions.We do not expect you to become an expert or to make any kind ofdiagnosis, but you can be a caring observer.

Educate client about oral health information.Be willing to share your knowledge and help your client make betteroral health decisions.

Refer problems to supervisor or case manager.If you notice signs of oral disease in the mouth tissues, lips, tongue,or teeth, make a note in your client's service/care plan AND reportto your supervisor or your client's case manager.

lO-minute break. Resume by answering any questions, discussing the"Practical Applications" section. Finish with the quiz, evaluations, andcertificates.


Documents

Washington Dental Service Foundation - Home Care … Health for Caregivers...Thanks to Washington Dental Service Foundation for ... make a note in your client'sservice/care plan AND