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Mouth Care Decision Tree Document

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Page 1: Mouth Care Decision Tree Documentextcontent.covenanthealth.ca/Policy/VII-C-110 Mouth Care Decision... · • Listerine Zero • Prescription Chlorhexidine mouth rinse. Note: Mouth

Mouth Care Decision Tree Document

Page 2: Mouth Care Decision Tree Documentextcontent.covenanthealth.ca/Policy/VII-C-110 Mouth Care Decision... · • Listerine Zero • Prescription Chlorhexidine mouth rinse. Note: Mouth
Page 3: Mouth Care Decision Tree Documentextcontent.covenanthealth.ca/Policy/VII-C-110 Mouth Care Decision... · • Listerine Zero • Prescription Chlorhexidine mouth rinse. Note: Mouth

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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