Parkwood Healthcare CommunityGeriatric Oral HealthcareIn-Service

Tammy Fisher RDH BSJuly 24, 2015

Introduction: Parkwood Healthcare

Located in Bedford, Texas near DFW Airport

Conveniently located adjacent to Texas Health

Harris Methodist HEB hospital

Managed by Life Care Services in Dallas,

Texas

Serves the urban senior population group

of Dallas-Ft. Worth

A for-profit facility

107 beds available

87 current residents1

Introduction: Services Available

Independent living

Memory care

Assisted-living

Skilled nursing

Rehabilitation

Introduction: Amenities AvailableNutritious mealsPrivate roomsLaundry servicesHousekeepingBeauty salonSpiritual servicesTransportationSocial ActivitiesWi-Fi Services1

Introduction: Professional StaffTerrie Brummett- Executive DirectorDaisy Sarmiento RN-Director of NursingCertified Nursing AssistantsLicensed Vocational NursesOn-Site Medical DirectorOn-Site Physical TherapistOccupational TherapistSpeech TherapistAdvising Physicians1

Introduction: Care ProvidedOncology recoveryDiabetic carePain managementMobile X-raySecure Alzheimer’s careIV Antibiotic therapyRespiratory care managementHospice services1

Introduction: Parkwood Principles

1. We serve the customer first and foremost.

2. We deal honestly and fairly, with integrity and openness.

3. We maintain a long term perspective.

4. We are diligent and persevering.

5. We are interconnected and independent.3

Goals By the end of this in-service, the nursing

staff will be able to honestly and fairly provide the residents with adequate daily oral hygiene with an understanding of the long-term implications for overall health.

Objectives After completing the video, each participant in this in-service will

describe to a partner three physical conditions adversely affected by poor oral hygiene.

Following the lecture, the Parkwood nursing staff will list, with a partner, three benefits to maintaining natural teeth for a lifetime.

Following the video, lecture and hands-on practice on a typodont, each participant in this in-service will demonstrate proper toothbrushing technique to the instructor.

Following the video, lecture and participation exercises, the in-service participant will value the benefit of providing oral health care to the Parkwood residents.

At the conclusion of this in-service, each participant will take a post-test and score at least 75%

Target AudienceParkwood Healthcare nursing staffCertified Nursing AssistantsLicensed Vocational NursesMost are women with 5% being maleAttitudes about oral health care include

apathy, repulsion, fear, unwillingness, personal dental phobias7

May consider oral health care to be elective

Target Audience: Reasons cited for lack of provision of oral health care

Lack of clear guidelinesFearful of damaging teeth and prostheticsFear of being bittenLack of dentist supervisionUnwillingness of residentsTime constraintsInadequate training5

Contenthttps://www.youtube.com/watch?v=gMSx63csAwY

Content: Physical Conditions Impacted by Oral Hygiene

DiabetesCardiovascular HealthStrokePneumoniaPossibly Alzheimer’s diseaseRespiratory infectionsDementiaPoor nutrition

Content: Toothbrushing First inspect the mouth for infection or lesions If infection is present, discard used oral preventive aids Oral health care should be provided two times per day All oral aids should be labeled with resident’s name A soft toothbrush with a small head and large handle is best Handles may be modified if needed Use a small pea-sized amount of fluoridated toothpaste Use positive, encouraging words to cue the resident May use the hand-over-hand technique May use the two toothbrush technique May need a care partner to hold resident’s hands and speak softly If resident is in a wheelchair, may need to stand to the side and

behind

Content: Dentures Dentures should be removed and cleaned twice daily Line the sink with a towel before cleaning dentures to prevent

breakage should a drop occur Use a denture brush, not a soft toothbrush to clean dentures Use a soft cloth to clean tongue, palate, cheeks and alveolar

ridge Remove dentures overnight If patient wants to wear dentures at night, remove for 2-3 hours

after mealtime Place in liquid in labeled container A small ultrasonic cleaner may be used safely for cleaning Only place fingers inside lips and cheeks to avoid being bitten Adhesive should be used sparingly All dentures should be labeled with resident’s name

Content: Advanced RestorationsImplant Denture

Content: Advanced RestorationsSingle Implant

Content: Advanced RestorationsPorcelain Crowns

Content: Advanced Restorations Porcelain Bridge

Content: Advanced Restorations Porcelain Veneers

Content: Oral Health Aids

Content: Oral Health Aids

Content: Oral Health Aids

Content: Denture Aids

Content: Modified Toothbrushes

Content: Products for Xerostomia

Post-Test1. Name three physical conditions affected by poor oral hygiene.2. List two characteristics of an appropriate toothbrush.3. Why is it important for dentures and personal oral hygiene aids to

be properly labeled?4. What can you do to prevent being bitten?5. What preventive measures can you use to avoid breaking a

denture?6. List two alternative oral hygiene aids.7. Describe two advanced dental restorations.8. List two effects of losing all natural teeth.9. List three benefits of maintaining natural teeth for a lifetime.10. Ideally, how often should oral care be provided for the residents?

ConclusionProviding daily oral hygiene care for the elderly may be difficult at times; however, it is an important task that must be diligently and faithfully attempted in order for the resident to enjoy optimum overall health. Self-esteem, proper diction, socialization, the maintenance of facial features and improved overall health are benefits that may be enjoyed by those who keep their natural teeth for a lifetime.

References1. Parkwood Healthcare Center; 2015. Available from: www.parkwoodcarelcs.com 2. U.S. News & World Report. Health rankings and advice; 2015. Available from:

http://health.usnews.com/best-nursing-homes/area/tx/parkwood-healthcare-community-675565 3. Life Care Services. Leading with integrity; 2015. Available from:

http://mydigimag.rrd.com/publication/?i=211053 4. Life Care Services. A Passion to serve: A matter of principles; 2015. Available from:

http://mydigimag.rrd.com/publication/?i=209016 5. Forsell M, Sjogren P, Kullberg E, Johansson O, Wedel P, Herbst B, Hoogstraate J. Attitudes and perceptions

towards oral hygiene tasks among geriatric nursing home staff. International Journal of Dental Hygiene 2011; 9(3): 199-203.

6. Dickinson C, Beatty CF, Marshall D. A pilot study: are dental hygienists in Texas ready for the elderly population explosion? International Journal of Dental Hygiene 2012; 10(2): 128-137.

7. Lindquist L, Seleskog B, Wardh I, von Bultzingslowen I. Oral care perspectives of professionals in nursing homes for the elderly. International Journal of Dental Hygiene 2013; 11(4): 298-305.

8. De Visschere L, de Baat C, De Meyer L, van der Putten GJ, Peeters B, Soderfelt B, Vanobbergen J. The integration of oral health care into day-to-day care in nursing homes: a qualitative study. Gerodontology 2015; 32(2): 115-122.

9. McKeown LL, Woodbeck HH, Lloyd M. A journey to improve oral care with best practices in long-term care. Canadian Journal of Dental Hygiene 2014; 48(2): 57-62.

10. Konno R, Kang H, Makimoto K. A best evidence review of intervention studies for minimizing resistance-to care behaviours for older adults with dementia in nursing homes. Journal of Advanced Nursing 2014; 70(10): 2167-2180. 

11. Columbia University College of Medicine. (2013). Daily oral care for the nursing home resident with dementia for cnas. Retrieved from https://www.youtube.com/watch?v=gMSx63csAwY