1. Oral Care

2. Aims By the end of the session the participant will: • Be familiar with the structures within and around the mouth • Be aware of the negative impact on general health which can occur due to poor oral health • Know the correct equipment to use when carrying out oral care

4. Oral Care • Poor oral hygiene is a common cause of distress for patients and families • Poor care may be due to lack of training, knowledge, inconsistent care • Not always a high priority • Essential for patient comfort

5. Risk Factors for Oral Complications • Systemically ill, terminal illness, unconscious patient, tracheostomy • Oxygen therapy, mouth breathing, nil by mouth. • Naso – gastric/peg feeding • Chemotherapy/radiotherapy, drug therapy • Ill fitting dentures • Diabetes • Dementia

6. Consequences of poor oral care • Pneumonia • Septicaemia • Endocarditis • Pain • Xerostomia (dry mouth) • Halitosis • Difficulty eating and drinking • Withdrawal • Low mood

7. Good Oral Care • Frequent inspection important using a pen torch, tongue depressor and gloved finger • Have an understanding of the possible risk factors • Examine in and outside the mouth • Early detection/reporting of problems • Need instruction on specific requirements for that patient

8. Dentate Patients (own teeth) • Brush teeth at least twice per day with toothbrush and fluoride toothpaste • Moisturise lips if necessary with a water based lubricating gel • ONLY use foam swabs soaked in water if using a toothbrush is too painful or impossible,

9. Care of Dentures • Remove and brush with a toothbrush and water after every meal • Rinse mouth with water to remove debris • Moisturise lips if necessary with water based lubricating gel • Remove and soak overnight in water • If oral infection is present, e.g. candida, dentures should be soaked in 1% sodium hypochlorite solution 2ml mixed with 160ml of tap water. If they have metal parts – soak in chlorhexidine 0.2%

10. Oral Problems • Candida (thrush) • Bacterial infections • Xerostomia(dry mouth) • Mucositis • Cold sores • Ulcers • Angular cheilitis

11. Candida

12. Dry mouth • What causes a dry mouth? • What problems can a dry mouth cause?

13. Drugs – lots of them Radiotherapy Oxygen Mouth breathing Causes

14. Complications of dry mouth • Decay • Gum recession and loss of teeth • Difficulty eating • Difficulty speaking • Trauma of mucosa • Halitosis

15. Dry Mouth (Xerostomia) • Continue brushing teeth twice per day with fluoride toothpaste • Sips of and rinsing with tap water • Artificial saliva – Avoid glandosane in patients with their own teeth Saliva Orthana has a porcine extract so is not suitable for some patients due to culture • Oral balance gel • Sugar free chewing gum • Review of medication

16. Cold sore

17. Aphthous ulcer

18. Angular cheilitis

19. Treatment of Painful Mouths • Some patients may need pain relief such as co-codamol or even morphine in severe cases • Avoid strong, acidic mouthwashes e.g. brand makes • Benzydamine (Difflam) mouth wash has local anaesthetic. It can be diluted 1:1 if stinging • Topical steroid for ulcers such as hydrocortisone pellets

20. Practical Session…