The first action not accomplished is the patient’s initial oral assessment upon moving into a care facility of any type. In most situations, there has been little, if any, formal education about recognizing or diagnosing a patient’s dental condition, what kind of diseases or conditions can occur and what action can be taken in the best interest of the patient’s oral health. When I interface with the nursing staff professions—RNs, CNAs, and LPNs—I continually find enormous opportunities for oral health care instruction. Educating the staff responsible for this initial assessment is one of my primary goals, as it is a critical step in being aware of conditions present and how that can be treated.
I offer a brief instructive seminar for various nursing staff; the training takes 30-45 minutes and the goal is to teach how to assess the mouth in half that time. It starts with a penlight to illuminate the oral cavity and continues through basic diagnosis and tooth/gum brushing. The staff work on one another as practice at first. One of the biggest impacts for all of them is to gain personal appreciation of the resident’s experience. And they appreciate how private we all can be about our mouths with someone “pokin’ around in there.” One key aspect of my seminars is increasing the basic knowledge of the effect of oral infection on the rest of the body. Also, a thorough knowledge of different cultural concerns or lack of concerns about dental health is essential if this educational information is going to cause caregivers to sit up and take notice.
The second action not being taken is the daily oral care that is or is not provided by the caregivers. The routine tasks of bathing, feeding and medications that must be met daily for each resident often allows for the omission of daily oral care. Or at best, daily oral care becomes a task that is performed too quickly with little thought being given to quality. In residential care, caregivers must ask permission to brush patients’ teeth. The resident has rights that protect them from doing things they may not wish to do regardless of the health outcome. Often a resident will refuse a request because they think they can do the job themselves or they do not understand the need. They may be in stages of dementia and may not like anyone to be around their face. They may also be in pain, not know how to express this and avoid the discomfort of having someone to brush their teeth.
All health care professionals walk a fine and precise legal line regarding how much a caregiver is able to do and what care they will deliver. There are also challenges from aggression among the elderly and mentally handicapped. I’ve learned to avoid those “left punches” and not take anything personally when dealing with advanced Alzheimer’s and other conditions of the infirm. I believe the primary challenge AND opportunity for a Licensed Access Permit Hygienist is to show value on both a professional and personal level that can then be transferred to those in one’s care.
The horror of seeing a mouth of a resident in dementia care who has not had partials even removed for many months, let alone cleaned, with just the front teeth brushed, is hard to believe. The odor from these mouths that normally only comes from a sewer is a red flag for the dental community that our elders need oral care.
Families and facilities find it difficult to locate dental health care providers that will take the time to understand the residents’ needs. With tens of thousands in residential care here in our local area and more to come as the population ages, this growing need for dental services for the elderly in distress and pain needs attention. I truly believe everyone deserves a healthy smile!
Sandy Nelson, BS, RDS, LAP is a 35-year ADHA member. Sandy will be teaching a class titled “Setting Up a Limited Access Permit Dental Hygiene Business” in March 2003 at OHSU-Dept. of Dentistry Continuing Education. She is also owner of Smiles All Around, (503) 631-7994, fax (503) 631-7924, cowgirlrising@msn.com.