ADL’s – Activities of Daily Living – Oral Care
Lesson 1
Importance of Oral Hygiene
Good hygiene helps people to be healthy by preventing the spreading of germs and build-up of harmful bacteria that cause dental problems. Dental problems can cause discomfort. Infection from tooth decay can lead to serious health concerns if not prevented or properly treated.Strong, healthy teeth are needed to chew food into small pieces. Digestive problems can develop when a person is unable to chew food properly. Many choking accidents and deaths can be related to people being unable to properly chew their food. This can be due to poor fitting dentures or not wearing dentures. It can also be due to mouth pain or loose teeth from poor dental care. You will learn more about health issues and how to prevent or respond to them further on in the lesson. /
Smiling is fun when you have a healthy mouth and clean teeth.
Critical Aspects of Personal Care
· Respect the privacy and modesty of people.
· Respect and know personal preferences.
· Be aware of the person's comfort.
· Use your voice as well as your hands.
· Keep people safe.
Respect the privacy and modesty of people.
Always respect the privacy and modesty of each person as much as possible during routines. Oral care is something that some people are modest about and others will happily complete in front of others. Don't announce routines or problems with oral care in public places, including shared rooms. Be mindful of others needs in shared spaces. For example, even if a person is comfortable brushing in the living room or kitchen, others who share that space may not be comfortable with it.
Respect and know personal preferences.
Respect and know personal preferences for routines. This will include using preferred products, timing of routines, methods and frequency of completion, temperature of water, etc. In oral care, people often have strong preferences for types and flavor of toothpaste. Certain types of floss works better for some teeth and not others. Be familiar with these types of preferences.
Be aware of the person's comfort.
Be aware of the person at all times. The person is not a "chore" to be "completed." Check your hands for warmth before touching someone. Perfume or cologne is often placed on the wrist. If you use these products check to make sure they are not offensive to the person as your hands may be very close to his or her nose. Use a gentle but firm touch. Watch for tender spots or signs of infection or poor health. Pay attention to the person. Be aware of signs of discomfort at all times.
Use your voice as well as your hands.
Use your voice as well as your hands. Tell people before you touch them or start routines. Keep them posted along the way so they are not startled. Use a friendly, calm voice. Talk more if the person prefers. Talk less if they find it disturbing or irritating.
Keep people safe.
Keep people safe. You must know people's safety needs and take care to keep them safe. In oral hygiene, you may need to know proper positioning to prevent choking or gagging. It is very important that you take care to prevent transmission of disease between people by following the infection control tips in given in this lesson. Overall health is affected by poor oral hygiene. Take these tasks seriously as preventative measures to poor health.
Infection Control and Universal Precautions in Oral Care
Taking care to prevent the spread of disease is an important part of all personal care. It is especially important that direct support professionals take care during oral hygiene. This is because blood is more likely to be present during flossing and brushing than during other routine personal care.In addition, the mouth is a place where germs are able to enter a person's bodily systems. Much of the body has the protection of being covered by skin. However, the mouth easily absorbs many types of diseases. It's important to ensure that anything that enters a person's mouth is clean. It is also important not to share items used in oral hygiene.
Infection control procedures are covered in depth in the lesson on Universal Precautions and Infection Control in the College of Direct Support course on Safety at Home and in the Community. If you are not familiar with this information, you may want to review that lesson. /
The mouth is one of the places on the body where germs can enter vital systems
Infection Control and Universal Precautions
Infection control and Universal Precautions are used when assisting people with dental and oral care. On this page are several different ways in which infection control can be accomplished.
Universal Precautions
A standard set of procedures designed to protect individuals from coming into contact with contaminated blood or bodily fluids. Because anyone can be a carrier of these diseases and symptoms do not have to occur for a person to be contagious, universal precautions greatly reduce the chances of exposure because they require that all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.
Problems Due to Poor Oral Health
Poor oral care can lead to many health problems including those listed here:· Pain and illness due to cavities, gum disease, loose teeth, abscesses, and tooth loss.
· Mouth pain and irritation caused by conditions such as canker sores, cold sores, or thrush (candidiasis).
· The build up of plaque in the mouth due to lack of flossing has been linked to heart disease.
Mouth pain and tooth loss can cause people to avoid eating. It can keep them from correctly chewing food. Not only do they lose their enjoyment of food, they are more likely to choke. People may not eat enough or eat healthy foods due to these problems. For an elderly or frail person, not eating can be life-threatening /
Avoiding oral hygiene can lead to unnecessary pain.
Cavities
A breakdown of the tooth caused by bacteria, tooth decay or holes in the teeth caused by acid from the plaque bacteria.
Abscess
A collection of pus around an infection
Canker Sores
Canker sores are small ulcers inside the mouth. They are not contagious and usually recur. The exact cause of canker sores is not known. Canker sores can heal on their own, but can also be treated with over the counter medications. Spicy and acidic foods can often irritate and further inflame canker sores.
Cold Sores
Cold sores are also known as fever blisters and Herpes simplex. They are groups of painful, fluid-filled blisters. Cold sores are contagious and often recur. Cold sores often heal by themselves within approximately one week. They can also be treated with prescription medications
Candidiasis
Candidiasis is a fungal infection that is also know as thrush. This most often occurs in very young children and older adults who wear dentures. Good oral hygiene is essential to treating this, but prescription medication may also be necessary.
Plaque
A layer of bacteria on the teeth that causes tooth decay and gum disease
Preventing Plaque Build-Up
Decay and gum disease are caused by plaque. Plaque is an invisible bacterium that lives in the mouth all the time. When sugar from food is present in the mouth, plaque produces acid. This acid eats away at the teeth. This causes a cavity. If left without treatment the tooth can be lost. Worse, infection can set in and cause serious problems. Tooth or ear pain can be a sign of serious cavities and infection. However, early detection of cavities that are not yet painful is part of a regular dental visit.
A build-up of plaque also irritates and destroys the gums. An early form of gum disease is gingivitis. Early stages of gum disease can be reversed through improved oral hygiene and a professional cleaning. If left untreated, gingivitis can progress to periodontitis. This form of gum disease is more serious and can cause tooth loss and pain. The signs of gingivitis include red, swollen, painful, or bleeding gums.
The four elements of oral health described later in the lesson reduce the opportunity for plaque to build up on teeth. These also help when plaque that does build up is removed before teeth and gums are permanently damaged
Gingivitis
· The mildest form of Periodontal Disease. This is a disease involving the gums, that can result in a person losing their teeth. The disease is caused by a bacteria that is in plaque, a substance that forms on your teeth.
· Gingivitis is an early form of gum disease. It is usually not painful. Symptoms include red, swollen or soft gums that bleed easily. If left without treatment and care, more serious gum disease (periodontitis) can occur.
Periodontitis
A serious gum disease caused by poor oral hygiene. The symptoms include inflamed, bleeding gums, loose teeth, and mouth pain. Professional dental treatment should be sought if any of these symptoms occur. Preventive care and treatment can reverse some of the problems caused by this disease. Without treatment and daily oral hygiene the condition will get worse.
Increased Risk and Obstacles to Oral Health
People who need support and help with daily oral hygiene are at increased risk for poor oral health. This varies from person to person. However, there are three primary reasons for this additional risk
Lack of Information or Understanding:
Many people with and without disabilities do not understand the consequences of poor oral care. It may be that they have never been taught. It may be that they cannot understand the information.
A related problem includes family care-givers or other direct support providers do not understand the risks. In these cases, the person may not get enough support. They may not be provided enough regular help to stay healthy. It's important that direct support professionals understand the risks and help effectively with this critical area of health. It's also important that direct support professionals can work within a family care-giver situation to support and help with this.
Limited Physical Ability or Different Physical Needs:
Some people may not be able to perform oral hygiene tasks. This may be because they cannot control their own arms or hands. They may lack the fine motor skills to reach all parts of their teeth. They may not have the physical energy to complete the routine. In these cases, the direct support professional will need to provide physical assistance to help the person to do these tasks. The amount of physical assistance will depend on the needs of the person. In addition, there are modified toothbrushes and other adaptive equipment that can make it easier for the person.
People who need support often are more likely to use medications. Side effects of some of these medications may increase gum or tooth sensitivity. They may weaken teeth or encourage gum growth over the tooth. They may make the person more susceptible to gum disease. DSPs should know if the person they support has these concerns.
Fear or Dislike of Oral Care:
Sometimes a person can complete oral care but does not want to do it. They may be resistive to the attempts to help them. When a person understands the risks and chooses not to complete oral care, this is his or her choice. When the person does not understand the risks of avoiding oral care, the direct support professional will need to spend time assessing the situation. The direct support professional will need to support the person in understanding and managing the risks as possible. In the case where it is unlikely that the person will ever comprehend the risks, the direct support professional will work to make oral hygiene as pleasant as possible so that the person is more apt to participate.
Overcoming Obstacles to Good Oral Health
To understand why there is resistance, it is important to involve the person directly. Let the person know you are concerned about comfort and health. Remind the person of the basics of good oral hygiene (which you will learn later in the lesson.) Ask if there is something you can do to improve the situation.
In some case, you may need to present accurate information in an alternative format to help the person fully understand the risks of poor oral health. This may include pictures. It may include demonstrations, or other methods. You may have to repeat this information many times before the person understands it.
If the person has limited communication skills, you will need to consider the person's behavior. Look at possible environmental and other causes, such as pain, or dislike of the flavor of the toothpaste. This can be done through observation. Reading a person's medical history or background and discussing with other direct support professionals who help this person can be helpful to figuring out why the person is resistive. In some cases, a formal functional assessment may be necessary.
Functional Assessment
Methods and strategies used in the person's daily environment that help us understand the antecedent(s) that predict challenging behaviors and the consequences that maintain challenging behaviors. Using a definition of the behavior that is observable and measurable, functional assessment seeks to discover the function the behavior serves (that is, what the person obtains or avoids) by looking at: 1) When, where, and with whom are the behaviors are most and least likely to occur; and 2) What consequences maintain these behaviors. The results of a functional assessment are used to develop a hypothesis statement, which in turn is used to develop a behavior support plan. The hypothesis statement can be further tested through functional analysis if needed.
Handling Resistance to Oral Care
For some people, experiences with oral hygiene have been very bad. If the person also has cognitive impairments or problems with impulse control, he or she may become extremely resistive to oral care. If you are working with someone who has such issues, it's important to be sensitive and caring, but it's also important not to just give up on oral health. The person's quality of life and life span can be greatly reduced if this area is neglected. If resistance is sudden and serious, get the person to a dental professional to check for pain or infection.