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Mouth Care Decision Tree Document
Oral Health Framework for Continuing Care
We are witnessing a paradigm shift in oral health for seniors in care. Evidence shows these seniors are especially vulnerable to a lack of mouth care – increasing their risk of dental disease and general health problems. No longer is daily mouth care a “grooming activity” but rather an infection prevention measure. Current best practice indicates an oral care plan is essential for each resident to improve their oral health, and reduce the impact of oral infections on general health and well being.
The three key elements of the framework are:
1. oral assessment and care planning2. daily mouth care3. referral to dental professionals as required
The AHS Oral Health Framework builds competency of continuing care staff by outlining the knowledge, skills and abilities needed to implement the three elements and to problem solve unique challenges. Regulated and non- regulated staff work together as a team to support the resident’s daily oral health and to watch for oral health changes that may signal the need for further assessment and intervention. This document outlines the mouth care tools developed to support staff in delivering resident centred care.
AHS dental hygienists serve as content experts, providing oral health information, staff training and resources and tools to assist staff in providing mouth care for even the most challenging of residents.
Mouth Care Planning with RAI Outcome Scales and The Chewing and Mouth Pain Assessment Decision Trees
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3. Select mouth care protocol based on choking risk• See: Guidelines for Mouth Care Protocol (page 5&6)• Include denture care protocol as required
1. Use ADL and CPS scores to select level of staff support• See: Mouth Care Planning with RAI Tool (page 3&4)• If care reactive/responsive behaviours are present consider what
care-techniques could be used to benefit resident and care provider
B. Develop a Mouth Care Plan using the followingcomponents to address RAI findings.
5. State plan to address identified oral health status triggers from AHS Chewing and Mouth Pain Assessment Algorithm (9-16)
• Facilitate referral as indicated to MD, Dentist, Denturist,or Dental Hygienist
Goal: Every Resident has a Mouth Care Plan to address their current level of independence and oral status needsFollowing each RAI Assessment, use the resident’s RAI data and outcome scales to develop an individualized mouth care plan for the residents care plan
and communicate this with the caregivers performing the daily mouth care
A. Gather required information forMouth Care Planning
RAI Results:1. Activities of Daily Living Self Performance scale (ADL)2. Cognitive Performance Scale (CPS)3. Oral Concerns4. Levels of Consciousness
Ask care staff or family:Are there challenges to providing mouth care?
a. Availability and/or condition of mouth care suppliesb. Food pocketing after snacks and meal timesc. Swallowing or choking concernsc. Care-responsive behaviour during mouth care ormeal timesd. Other
THEN
FIRST
2. Determine frequency of re-checking mouth for debris and bleeding gums• Check for food pocketing after snacks and meals times• Check for debris at bedtime and /or bleeding gums with brushing
every 2 weeks
4. Consider resident safety when recommending mouth and denture careproducts and choosing storage location
• See: Guidelines for Mouth and Denture Care Product Selectionand Storage (page 7&8)Diagram 1
Mouth Care Planning with RAI Outcome Scales and The Chewing and Mouth Pain Assessment Decision Trees
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Select the resident’s highest either the ADL or CPS score. Start with this level of mouth care for care plan. Adjust as required to meet other clinical factors.
ADLCPS
0
Level 1 Resident is able to perform mouth care on their own and successfully remove all debris and plaque. May require one or more of the following:
• No intervention for daily mouthoral care or
• Mouth care tools and products tobe set out for resident use –toothbrush or denture brush,toothpaste
ADL CPS
1
2
Level 2 Resident removes most debris and plaque, but needs supervision and set up assistance to complete the task. May require one or more of the following:
• Verbal prompts to perform dailymouth care
• Assistance with dispensing toothpaste• Oral hygiene tools to be passed• Simple modifications to oral hygiene
care tools for better grasp
ADL CPS
3
4
Level 3 Resident is unable to remove most of the debris and plaque on their own. Resident is:
• Able to start or participate inbrushing procedure.
• Requires additional support like“hand over hand” assistance tocomplete mouth care tasks
ADL CPS
5
6
Level 4 Resident is unable to remove any debris or plaque independently.
• Requires daily mouth care to beperformed by care staff
• Some residents may be able toparticipate by giving feedback
Note: Care-resistant behavior may require more than one provider to perform mouth care.
Mouth Care Planning Tool Interventions
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No
Yes
Is there a confirmed swallowing problem?
OR Is resident on a
mechanically altered diet or thickened fluids?
Basic mouth care protocol• Toothbrush 2 times daily• Apply water-based moisturizer to lips before each
episode of care• Use a grain-of-rice to a pea-size amount of
fluoridated toothpaste to protect teeth from decay• Encourage resident to spit out excess saliva,
debris and toothpaste• For maximum benefit, do not rinse mouth or drink
immediately after toothpaste• Apply water-based moisturizer to lips and/or
mouth after each episode of care• Rinse toothbrush thoroughly and stand brush side
up in cup to air dry
Guidelines for Mouth Care Protocol
Modified mouth care protocol To reduce risk of choking and aspiration risk
• Position resident as upright as possible• Apply water-based moisturizer to lips before each episode of care• Toothbrush 2 times daily with a moist toothbrush (shake out excess
water) to clean teeth/ mouth• Use mop-as-you-go technique to remove saliva and debris• After cleaning teeth, apply a rice-size amount of non-foaming
fluoride toothpaste to all natural teeth for protection from decay• Use mop-as-you-go technique to remove saliva and excess
toothpaste• For maximum benefit, do not rinse mouth or drink immediately after
toothpaste• Apply water-based moisturizer to lips and/or mouth after each
episode of care• Rinse toothbrush thoroughly and stand brush side up in cup to air
dry
Diagram 2
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Product Important Features Recommended Products Indications for Use Toothbrush • Soft or Ultra Soft bristled toothbrush
• Straight, evenly cut bristles • Compact, narrow head – may be more effective at
reaching difficult spacesPalliative Care • Ultra-soft toothbrush
Note: Medium or hard bristles can cause damage to oral mucosa
Family purchased: • Oral B compact 30 or 35• Colgate Floss Tip, Slim Soft• Sunstar GUM soft or ultra-soft• Sensodyne Ultra-soft• Youth or child size when few teeth remain• Collis Curve Toothbrush 1-956-546-4818 ask
for FionaFacility purchased: • SAGE Ultra-Soft Reorder – Sage #6082
• For use with residents with or without teeth(edentulous residents) to clean teeth, gums, tongueand tissues 2 times per day; remove debris frommouth; apply moisture to tissues in the mouth
• Powered toothbrushes may be tolerated by someresidents with good swallowing control and highcognitive function
Caution: Power brushes removable head may be a choking risk as it can be pulled off, bitten/ broken or swallowed
Toothpaste General Recommendations• Approved by the Canadian Dental Association• Contain fluoride to protect teeth from tooth decay• Contains sodium bicarbonate to help maintain
healthy pH levels and assist with dissolving mucousin the oral cavity.
Residents with Choking Risk • Choose non-foaming toothpaste (i.e. does not
contain sodium lauryl sulfate)Residents with Reduced Saliva, Dry Mouth or Cavities Choose products that contain fluoride, calcium and phosphate to boost re-mineralization for residents with dry mouths and natural teeth
Toothpastes for Residents Note: ~ Products that do not contain sodium lauryl sulphate for residents with choking risks ** Products that contain fluoride, calcium and phosphates for residents with dry mouth, reduced saliva or cavities • Biotene ~** Palliative Care• Sensodyne ProNamel ~ Palliative Care• Sensodyne Repair **• 3M Clinpro 5000** (higher content of fluoride
than regular toothpaste)• Prevident 5000 (higher content of fluoride
than regular toothpaste)
• Residents with natural teeth should includetoothpaste with fluoride as part of the daily mouthcare
• Use toothpaste with brushing for residents that aresafe to take thin liquids and can expectorateeffectively
• For residents with swallowing problems or chokingrisk, apply rice to pea size amount at end ofbrushing to receive full benefit
• Choose a toothpaste that suits resident’s dentalhealth needs
Palliative Care • If toothpaste is not tolerated for brushing 2 times a
day, use water or mouth moisturizer for comfort
Oral Rinse • Antibacterial• Non-alcohol preferred.Note: Mouthwash containing alcohol or glycerin should be avoided, due to their drying action on the oral mucosa. • Chlorhexidine assists with plaque removal, has broad
spectrum antimicrobial properties, must be prescribedby the dentist. Can result in discoloration of the teeth Fluorides reduce the effect of chlorhexidine
when used at the same time.• Club Soda: Sodium bicarbonate is an effective method
of dissolving mucous in the oral cavity.• Eliminates mouth odors
• Water• Club soda• Oral B Fluorinse• Biotene Moisturizing Mouthwash• Listerine Zero• Prescription Chlorhexidine mouth rinse
Note: Mouth rinses should not be used for swish and spit with residents with known swallowing or choking risks or who can’t spit.
• Mouth rinse can be used in place of water formoistening the toothbrush during mouth care,providing a pleasant taste.
• It is a choice for the residents to use mouth rinseas a ‘swish and spit’.
Palliative Care • Club soda or water can be used every two hours to
keep the mouth moist. Dispense a small amountinto a paper cup; apply club soda or water with amoist foam swab or toothbrush; discard cup andfoam swab after each use.
• Club soda can be used to remove dried mucus anddebris on the tissues in the mouth.
Lip Moisturizer
• Water-based• Non-petroleumNote: Vaseline and other petroleum – based moisturizers should not be used on the oral cavity or lips, as they dry tissue, may cause lip inflammation and are not recommended for patients on oxygen
• Muko-gel, K-Y Jelly,• Biotene Oral Balance• E0S, Burt’s Bees• SAGE #6083 Mouth Moisturizer
Note: Read the labels for products that are petroleum-free and paraben-free
• Use lip moisturizer to keep dry lips moist and intact• Moisten lips before and after mouth care for
comfort and to reduce cracking of lipsPalliative Care • Apply every 2 hours or as needed for comfort and
to prevent or treat dry, cracked, painful lips
Guidelines for Mouth and Denture Care Products Selection and Storage Before choosing any product consider the resident’s capacity to rinse and spit; follow directions; and know swallowing and choking risks.
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Product Important Features Recommended Products Indications for Use Mouth Moisturizer
• Water-based• Alcohol- free• Liquid, spray or gel• Xylitol : Reduces decay by interfering with the growth
of cavity causing bacteria (Approved by the FDA)
• Water• Club Soda• Biotene Oral Balance• Mouth Kote• Moi-Stir Spray (on the Formulary)• SAGE #5210 Oral Moisturizer Spray
• Encourage frequent sips of water throughout theday and discourage frequent sips of drinkscontaining sugar
• For Palliative Care and residents with Xerostomia(dry mouth) resulting from medications, oxygen useor mouth breathing leading to dried mucussecretions, use mouth moisturizers to loosenmucous every 2 hours.
Swabs • Single use ONLYNote: DO NOT USE to perform mouth cleaning. • Not solid enough for removing gross debris.• INEFFECTIVE for removing plaque (bacteria) from
teeth and oral tissuesCaution: Can be a choking risk - swab can come off with over use • Choose a soft toothbrush to perform mouth cleaning
• Regular foam swabs
Note: DO NOT USE Lemon Glycerin Swabs o Dry and irritates soft tissueo Painful on open soreso Cause softening and erosion of the tooth
enamelo Increase risk of bacterial and fungal
infections
• Use to moisten tissue• Use to apply solutions to oral tissue• For residents with swallowing problems or choking
risks, remove excess water before using in mouthPalliative Care • Every 2 hours, use foam swabs with water, mouth
moisturiser or club soda to moisten tissue• Substitute, use an ultra-soft toothbrush
Denture Care *optionalproducts
Denture brush • Dentures require cleaning with a denture brush to
remove all debris and bacteria.• Alternative: regular toothbrush can be used but may
not be as effective*Denture paste• Use to clean, freshen and remove stains from the
dentureNote: Toothpaste is not recommended as it is abrasive and will scratch the finish off the denture and may increase amount of bacteria and stain Denture cup (container) • To hold denture(s) in solution at night*Denture cleansing tablets• To soak and disinfect dentures over night*Denture adhesive• To assist in keeping dentures from moving around in
the mouth during eating and speaking
Alternative: dish soap and water with a good denture brush is effective for cleaning dentures.
*Denture pastes:• PolidentDentu-Creme Cleanser Paste
*Denture tablets:• Polident Denture Cleanser Tablets – variety
of types for dentures and partials• Efferdent Denture Cleanser – variety of
types• Generic brands
*Denture adhesives: comes in paste, powder oradhesive strips and wafers • Fixodent – variety of types• Poli-Grip denture adhesive creams, powders
and strips• Werner’s Denture Powder• Seabond Denture adhesive wafers
• Dentures need to be soaked in cool water whenoutside of the mouth (over night).
• *Dentures tablets may be added to the water if desired.
Note: Hot water can distort the denture fit. Caution for product use: *Denture tablets• Use tablets and solution with caution to avoid
accidental ingestion by residents*Denture adhesive• Use sparingly; use only as much as is required to
hold denture in. Consider having denture relined orremade if increasing the amount of dentureadhesive used every day
• Use adhesive strips and wafers with caution as itmay pose a choking or aspiration risk wheninserting or removing denture from the mouth
Palliative Care • Respect residents choice to wear dentures
Care and Storage
1. Toothbrushes and denture brushes 1. Label mouth care items with resident’s name2. Use running water to clean brush bristles3. Storage cup
1. Thoroughly rinse to remove toothpaste and debris2. Store in a cup with the bristles pointing up3. Air dry bristles between use to kill bacteria
2. Many mouth care products can be choking andswallowing risk to residents and may be a hazardousif consumed by frail seniors
1. Pastes: toothpaste, denture pastes andadhesives
2. Denture cleansing tablets3. Mouth rinses containing alcohol
1. To reduce risk of accidental consumption byambulatory cognitively impaired residents, storemouth care items in a secure location in theresident’s bathroom or nursing station
Before choosing any product consider the resident’s capacity to rinse and spit; follow directions; and know swallowing and choking risks.
Guidelines for Mouth and Denture Care Products Selection and Storage
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Chewing and Mouth Pain Assessment Decision Trees Long Term Care Staff commonly use decision trees (or algorithms) to decide on appropriate care for residents. Provincial Seniors Oral Health Working Group developed these Mouth Care Decision Trees in collaboration with Long Term Care Facilities from each Zone in Alberta.
The decision trees 1) Identify a trigger 2) Determine questions to ask 3) Propose a referral or action to manage the condition
Possible Oral Health TriggersObservation of changes in resident by care staff (RN/ LPN/ HCA) includes:• Visual changes of the face and mouth• Verbal complaint by resident• Physiological changes in general health• Behaviour changes during mouth care
and eating
Decision Points
Questions to navigate Professional Staff through oral health
assessment
Referral to appropriate dental or medical
professional
Action to manage any identified oral health
issues
Note: For some LTC the decision trees can be incorporated into the Electronic Health Record to generate an interactive patient record.
1) 2) 3)
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Investigate other physiological factors
Consult Interdisciplinary team members:
MD, OT SLP, Dietary, Dysphagia team
Yes or Unsure
Is the origin of chewing problem or mouth pain related to
oral health?
No
No
If resident is missing teeth and has no
dentures, assess for resident’s desire for
dentures (new or replacement)See pg 16 diagram D
Assessing for oral health origins for Chewing Problems and/or Mouth Pain
during RAI Assessment
No
Diagram 3
No
Then
Yes
Chewing Problem: Observable Triggers• Failure to chew food leading to choking• Swallowing without chewing food• Eating mechanically altered diet• Dry mouth• Avoidance of certain foods• Not eating• Weight loss
Mouth Pain: Observable TriggersPhysiological Changes• Loss of weight• Localized swelling of face or neck• Localized swelling of gums• Thrush (candidiasis)• Sinus infection• Increased stress• Malaise
Verbal complaintStatement or crying out in pain with :
• Chewing or eating• Eating hot or cold foods or drinks• Ear ache• Daily mouth care• Sitting at rest• During the night
Change in behaviour• Pulling face away while receiving mouth care or
eating• Pulling or rubbing of face or jaw• Aggressive behaviour during mouth care or eating• Chewing lip• Teeth grinding• Refusal to eat
No oral health findings for
chewing problems or mouth pain found in
assessment of teeth,
soft tissues or dentures
Related to natural teeth?
See pg 11 Diagram A
Related to soft tissues? See pg 12-14
Diagrams B1,2&3
Related to dentures for fit and function
See pg 15 Diagram C
Refer to dental
professional
Investigate
Yes
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Visual assessment of teeth with flashlight
• Broken tooth with jagged, sharp edges,• Tooth broken off at gumline• New space between teeth• Visible decay (brown/black holes) in
teeth• Decay along gumline of teeth• Teeth that move with brushing or eating• Loose bridges or crowns• Localized tongue ulcerations
Ask resident, care staff and family about these behaviour changes• Indicates dental pain when asked• Pain with brushing• Refusal of mouth care• Grinding• Increased tongue thrusting activity• Rubbing/pulling of face/cheek• Fingers in mouth• Crying out in pain• Loss of appetite• Decrease food intake• Refusal to eat• Avoids sweets or acidic foods• Reaction to food temperatures:
hot or cold
Notes for conversations with familyEarly detection and referral for dental treatment can:• Improve quality of life• Reduce risk of discomfort that can lead to weight loss• Reduce risk of aspiration pneumonia• Reduce risk of further tooth loss due to decay and
gum disease• Prevent aspiration of loose or broken-off teeth• Reduce risk of dental abscesses• Allow for conservative treatment options, i.e. fillings
versus extractions• Decrease treatment costs• Become more challenging as residents health
declines and medical, cognitive and physiologicalbarriers increase
Funding for low income seniors is available through Alberta’s Dental and Optical Assistance for Seniors Program http://www.health.alberta.ca/seniors/dental-optical-assistance.html
Referral to Dentist for treatment
Consult with MD to provide management for
pain and infection
Yes
No
A. Assess teeth for source of mouth pain and/or chewing problems
Yes
No
Yes
Discuss dental treatment needs with resident or alternate
decision maker . Agree to proceed?
For chewing problems provide nutritional
management
Consult MD re:1. Interim management for pain and infection
2. Does general health support visit to dentist at
this time?
Diagram A
Continue daily mouth care
plan
Continue daily mouth care
plan
And
And
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Referral for dental treatment: Dentist or
Dental Hygienist
Visual assessment of gums with flashlight
• Bleeding gums when brushing• Gingival (gum) swelling and redness• Heavy debris or hard deposits on teeth• Halitosis (bad breath)
Yes
Gingivitis/ Periodontal Disease1. Increase assistance for resident's mouth care2. Ensure mouth care thoroughly two times daily3. Reassess tissue for bleeding and debris in two weeks
Yes
2 weeks later
Is there stillbleeding with
brushing?
Continue daily mouth care
planNo Are there
hard deposits?
Yes
No
B1. Assess gums for signs bleeding (gingivitis)
Discuss dental treatment needs with
resident or alternate decision maker . Agree to
proceed?
Consult MD re: does general health support visit to dentist or
hygienist at this time?
Consult with MD to provide management for pain and infection
Yes Yes
No
And
Then assess for:B2. Signs of infection or dental abscessB3. Signs of sores, lumps and bumps
No
No
Diagram B1
Notes for conversations with family
Early detection and referral for a professional dental cleaning to improve the heath of the gums may:
• Result in easier daily brushing• Assist in maintaining good blood glucose levels for diabetics• Reduce risk of tooth loss due to gum disease• Reduce the risk of heart disease or stroke
Funding for low income seniors is available through Alberta’s Dental and Optical Assistance for Seniors program http://www.health.alberta.ca/seniors/dental-optical-assistance.html And
Continue daily mouth care
plan
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Referral to Dentist for treatment
Visual assessment with flashlight • Gum are swollen, tender and infected around
broken or decayed teeth• Intra-oral gum-boil with or without pus• Halitosis (bad breath)• Extra-oral facial fistula (draining abscess)• Swelling of face or neck
Ask care staff about any of the following: Physiological observations
• Signs of localized pain in mouth when eating orduring mouth care
• Malaise• Appetite loss• Fever (>37.5) with facial swelling• Signs and symptoms of systemic septicaemia
Behaviour Changes• Avoidance of food: sweets, acidic• Reaction to food temperatures: hot, cold• Touching/pulling of face/cheek• Crying out in pain• Increased tongue thrusting activity• Grinding
Yes
Immediately consult MD re:
1. Interim management for painand infection
2. Does general health support visit to dentist at
this time?
Yes
Consult with MD to provide ongoing
management for pain and infection
No
B2. Assess the face, neck and mouth for signs of dental infection or abscess
Yes
No
Discuss dental treatment needs with
resident or alternate decision maker. Agree to
proceed?
Then assess for:B3. Signs of sores, lumps
and bumps
No
Diagram B2
Continue daily mouth care plan
And
Care team determine need for
“Managed Risk NegotiatedAgreement”
And
Notes for conversations with family
Early detection and referral for dental infections and abscesses may:
• Reduce the risk of infection spreadingto other areas of the head and neck• Reduce the risk of a systemic infection(septicaemia)
Funding for low income seniors is available through Alberta’s Dental and Optical Assistance for Seniors program http://www.health.alberta.ca/seniors/dental-optical-assistance.html
Continue daily mouth care plan
And
Referral to Dentist for treatment
Visual assessment with flashlight • Gum are swollen, tender and infected around
broken or decayed teeth• Intra-oral gum-boil with or without pus• Halitosis (bad breath)• Extra-oral facial fistula (draining abscess)• Swelling of face or neck
Ask care staff about any of the following: Physiological observations
• Signs of localized pain in mouth when eating orduring mouth care
• Malaise• Appetite loss• Fever (>37.5) with facial swelling• Signs and symptoms of systemic septicaemia
Behaviour Changes• Avoidance of food: sweets, acidic• Reaction to food temperatures: hot, cold• Touching/pulling of face/cheek• Crying out in pain• Increased tongue thrusting activity• Grinding
Immediately consult MD re:
1. Interim management for pain and infection
2. Does general health support visit to dentist at
this time?
Consult with MD to provide ongoing
management for pain and infection
Discuss dental treatment needs with
resident or alternate decision maker. Agree to
proceed?
Care team determine need for
“Managed Risk NegotiatedAgreement”
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Visual assessment with a flashlight • Lumps and bumps• Reddening of facial skin (rash) around mouth• Cracking of lips and corners of mouth• Dry, cracked tongue• Coating on tongue and oral mucosa• White or red pressure sores on soft tissues• Thrush• Tongue ulcer• Rashes
Consult Medical Doctoror Dentist for management
B3. Assess inside and outside the mouth for signs of coating, sores, and lumps
Yes
Then assess:C: Dentures
No
Diagram B3
Continue daily mouth care
planAnd
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Assess for presence of denturesResident has dentures and routinely wears them• Denture could be complete or full denture
(resident is missing all their natural teeth in the arch and denture replaces all teeth)
• Dentures could be partial plates/dentures(resident has some natural teeth and denture replaces missing teeth in the arch)
Assess dentures for:Dentures should be comfortable and not move around during speaking or eating. Loose dentures can be a swallowing or choking risk.• Poor Fit – Dentures should not be so loose that they
move easily in mouth or fall down with speaking and eating
• Poor Function – dentures should not interfere withability to speak, chew or swallow
• Hard deposits or stain (increases bacteria retentionand can cause ulcers or pressure sores)
• Broken clasps (metal hooks), broken edges, ormissing denture teeth
• Label with resident's name
C. Assessment of dentures for source of mouth pain and/or chewing problems
Then
Include daily denture care along with mouth care 2x daily in care plan
Referral to Dentist or Denturist for
adjustment, repair or construction of
dentures
Yes
Discuss denture treatment needs with resident or alternate
decision maker. Agree to proceed?
Yes
No
No
Diagram C
And
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Assess mouth with flashlight for observable triggers• Resident is missing all their natural teeth = edentulous
+Resident does not have or does not routinely wear full dentures
• Resident has gaps of missing teeth in either arch+
Resident does not have or does not routinely wear a partial denture
D. Assessment for need of dentures(new or replacement)
Yes
Yes
Referral to Dentist or Denturist for further
assessment and construction of
dentures
Yes
Include daily mouth care 2x
daily in care plan
Discuss denture treatment needs and success factors with resident or alternate
decision maker . Agree toproceed?
No
Diagram D
Ask resident if they
want new dentures?
No
Notes for conversations with family #1 factor for success - Does resident want new dentures?
Reasons people like denturesDentures can improve:
a. Ability to chew (however many individuals with missing teeth eat well and maintain healthy body weight without dentures)b. Ability to speak more clearlyc. Feeling more comfortable in social settingsd. Feeling less self-conscious with family and friends
Reasons people avoid dentures a. Feelings of choking or gaggingb. Trouble with fit and stability: people with less “gum ridge” have more
trouble keeping dentures in placec. Dementia (depends on severity of condition)d. Resident’s general health and ability to tolerate denture making
procedures (could be 4-6 appointments)e. Cost of dentures (could range from $1500-2500 per denture)
Funding for low income seniors is available through Alberta’s Dental and Optical Assistance for Seniors program http://www.health.alberta.ca/seniors/dental-optical-assistance.html
And
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