A/Prof Ivan Darby Melbourne Dental School

  What is the situation?

  Why is good oral hygiene important?

  What has been and can be done?

  How effective is it?

  Hospitalised patients

◦  Oral health affects quality of life & personal dignity

◦  Contributes to an increased incidence of hospital-acquired infection esp. RTI & VAP

◦  Negative effect on nutritional status

◦  Oral health can deteriorate in hospital

  Residential aged care facilities

◦  Significant risk group

◦  Cumulative and complex

◦  Declining edentulism

◦  Large amounts of plaque & calculus

◦  Periodontal disease prevalent ◦  Poor oral health increased risk of aspiration pneumonia &

bacteraemia

  Reduces risk of VAP & pneumonia

  Reduces risk of periodontal disease

  Reduces risk of caries

  Will improve quality of life

  Will improve nutrition

  May reduce/minimise risk of systemic upset

  OH & OHI

  Dental visits ◦  Practice ◦  Domicillary

  Education ◦  Residents/Patients ◦  Carers ◦  Nursing staff ◦  Family

  ICU or intubated can’t clean their own teeth

  In nursing homes in Victoria ◦  Less than 1/3 cleaned their own teeth twice a day ◦  More than ½ once a day ◦  1/3 had some assistance ◦  Dementia required help ◦  When assistance required 30% had their teeth

cleaned only once or twice a week (Hopcraft et al. 2012)

  Residents often cannot go to a dental practice

  11% visited within previous 12 months

  Clean the mouth thoroughly before they go into care or hospital? ◦  May be a bit difficult if they have an emergency

admission?

  Treat dental problems before entry into residential homes………A maintainable dentition?

Only a small amount of time spent in residential homes

  It’s a bit difficult to get an unconscious person to brush their teeth!!

  Will improve OHI but: ◦  Elderly may have trouble with dexterity/grip   Bigger brush handles   Powered brushes ◦  May not remember the instruction ◦  Needs reinforcement

  YES!!

  Dental care providers are not a common source of education

  Most information from journals, books, AV media, in-house training run by other staff or during their training

  1/3 did not receive any information at all (Hopcraft et al. 2008)

  Barriers ◦  Lack of education ◦  No reinforcement ◦  Low priority ◦  Fear of causing pain & injury ◦  Perception that oral care does not provide

significant benefits ◦  Patients’ resistive behaviour/lack of cooperation ◦  Inadequate nursing staff ◦  Lack of supplies ◦  Lack of time

  Seems to be overlooked

  Interested in looking after resident/patient?

  Are there relatives?

  Where are do they live?

  Buy oral hygiene products?

  (Pack of 10) Soft, flavored, oral stimulators. A must for dysphagia programs. Soft, peppermint-flavored foam heads provide a safe means to move pocketed food from inside the cheek, or to clean the tongue. Sponge material stimulates intra-oral structures for sensory stimulation, tongue lateralization and mobility, and coordination. Disposable Toothettes are individually wrapped and sold in packages of 10 or 250.

  This is an hygiene product and cannot be returned.

  USD 3.47

Needleman et al 2011 Terezakis et al 2011

Hospital won’t buy toothbrushes for patients!

Unrealistic time commitment?

Where’s the government?

Should the dental profession be doing more and not relying on the nursing staff?

  Oral health is a huge problem   Gets worse in hospital/residential care   Oral hygiene important   Mechanical plaque removal – powered

brushes   Education & involvement of carers/nurses   Use dental hygienists   Lobby the government to fund oral health

care better

Thank you for your attention. What questions have you? Thank you to Oral B for sponsoring my presentation and allowing me to say what I wished I’d like to dedicate this lecture to Dr Rain Papli, periodontist, who sadly passed away in August.