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Dental Hygiene Program for Long-term Geri Psychiatry
Kathy Lehmann, BSN, BA, MEd. Boston VA Health Care System Presented at 25th APNA Conf. at Anaheim, CA October 20-21, 2011
Some Startling Statistics
http://dentalwellness4u.com/dentaldisease/
90% suffers from some form of this disease.
30-50% has periodontal disease, the most destructive form of dental disease.
> 20 diseases whose early signs & symptoms show up first in mouth & adjacent tissue.
Increased levels of oral bacteria & carcinogens
Edentulous participants consumed fewer vegetables, less fiber & carotene & consumed
more cholesterol, saturated fat & calories than participants with 25 or more teeth.
Weakened immune system makes it more difficult to prevent & treat gum disease. This
creates a Catch-22 situation, where gum disease weakens the immune system, making
the body more vulnerable to infections & diseases, further weakening the immune
system & ultimately making it more difficult to treat gum disease. Whew!
If you have low bone density, or osteoporosis, you're at an 86% greater risk of having
gum disease, which is the major cause of tooth loss in those over 35.
Infection found in moderate to advanced gum disease involves numerous & very toxic
bacteria which have constant & direct access to blood stream & indirectly the lungs.
This allows access to blood & lungs 24/7 as long as infection is present.
Contemplation Stage
Research Issues
Interdisciplinary Team
MD/RNP approval
Teach staff
Identify supplies
Documentation Template
Establish dental cart
Teach patients
3-tier program:
Brush, Mouthwash, Floss
Weekly certificates
Hygienist visits scheduled
Who Do We Want to Help Change?
Males, age 45 - 65
Chronic institutionalization
Schizophrenic & Bipolar
Dental Health
Dentulous –w& w/o caries
Partial/Full Edentulous
Dentures
All had Risk Factors
Variable Teachability
Majority Motivated
Risks of Oral Disease
Diabetes
Digestive Disorders
Heart Disease
Osteoporosis
Respiratory Disease
Stroke
Severely stress the immune system?
Lower resistance to other infections?
Increase the severity of diabetes?
Contribute to respiratory disease?
Interfere with proper digestion?
Actually reduce life expectancy?
Preparation Stage
Reference poster – brush 6“ daily
House toothpaste & mouthwash
Dental care after each meal
Staff assess & reinforce teaching
Staff monitor supplies
Staff document participation
Action Stage
Add brand-name toothbrushes
Add prescribed GC MI Paste Plus
Add prescribed Peridex Oral Rinse
Coordinate with meals & meds
Staff member assigned to task
All three shifts
Maintenance Stage
Add use of staff-donated
battery-operated toothbrushes
Add Theramints 3x a day
Reinforce flossing
Patient Responses
Refuse
Brush excessively
Eat toothpaste/drink mouthwash
“Brush on my own” (not always true)
Non-compliance r/t psychiatric disease
Seek staff for dental care
Improved gum disease scores !!