Oral Health Program for the CNA

By:

Michaela Blessing

Janna Whitehead

Purpose • Improving personal oral hygiene efforts to better

care for the health of patients• Oral health is an indicator of patients health• Patients are keeping their teeth longer. Age is

not a factor.• Assisting patients with oral hygiene is an

important role of the CNA

Healthy Vs. Disease

• Pink tissues• No inflammation or swelling• No bleeding• Firm• No root exposure

• Red tissues• Inflammation and swelling• Bleed easily• Soft• Possible root exposure• Decay

Plaque

• Film of bacteria

• Sticky and colorless

• Adheres to the tooth surface

• Develops on: -Teeth -Gums -Tongue -Roots of teeth

Plaque Accumulation

• Factors influencing plaque accumulation:

-Crowded teeth

-Rough surfaces

-Difficult to clean areas (Wisdom teeth)

-Restorative work (Ex. Crowns)

• Plaque accumulation contributes to:-Unpleasant esthetic appearance -Cavity formation

-Bad breath -Tooth loss

-Calculus formation -Gum disease

-Breakdown of enamel

Calculus

• Calcified plaque• Plaque adheres to calculus• Must be professionally removed• Found:

-Above gum line

-Below gum line

-Attaches to tooth enamel and roots

How do I know if I have plaque?

• Everyone develops plaque

• Bacteria constantly forms in the mouth

• Ways to limit plaque formation: -Brushing

-Flossing

-Rinsing

-Routine dental exams

Disclosing Solution• Applied on teeth by a clinician• Color codes areas missed when brushing and flossing• Visual tool used to improve oral hygiene efforts• Blue= present more than 24 hrs• Pink= present less than 24 hrs

Toothbrush Selection• Soft Bristles• Small-Medium Head• Easy Grip Handle• Electric vs. Manual• Replace every 3-6 months• Tooth brush cover

Oral Hygiene Products

• ADA seal• Toothpaste purpose: -Cavities- (Crest, Crest Kid’s, Colgate Total) -Gum disease- (Colgate Total Advanced, Crest) -Stain-(Colgate Total Advanced Whitening) -Tartar-(Crest, Colgate Total Advanced) -Sensitivity-(Sensodyne) -Dry mouth- (Biotene)

Brushing Technique• Bass/Sulcular Method

• 45 Degree Angle

• Back and forth motion

• 2-3 teeth at a time

• Moderate Pressure

• 2 times daily

• Don’t forget to brush your tongue!

Disable Patients

• Have all items prepared

• Wash hands

• Wear gloves

• Tell patient what you are doing

• Drape towel/napkin over cloths

• Have patient in a supine position

• Help as needed

Modified Aids• Accommodate patients needs

• Easy use

• Comfortable for patient

• Ex. Parkinson’s Disease, Rheumatoid Arthritis, Cerebral Palsy

Modified Aids cont.

Bicycle Grip Tennis Ball Rubber Band

Velcro Electric Toothbrush

Remember!

• Oral health is directly related to overall health

• Ensure your patient is brushing 2 times a day. Morning and night

• Help your patient as needed this includes educating and skills

• Do not rush your patient• Make them feel comfortable• Develop a relationship

Michaela BlessingJanna Whitehead

Topics

• Types of Periodontal Diseases– Gingivitis– Periodontitis

• Flossing– Decreases plaque accumulation

Review

• What is plaque?

A. Food particles

B. A sticky film of bacteria

C. Calculus

D. Tartar

Review

• Calculus is calcified plaque. Calculus must be removed by a licensed professional.

A.Both statements are true.

B.Both statements are false.

C.The first statement is true; the second statement is false.

D.The first statement is false; the second statement is true.

Review

• When looking to purchase a dental product (toothpaste, mouthrinse, etc.) what is recommended to be on the product to ensure that it has been approved safe and effective by the American Dental Association?

ADA Seal

Review

• List some modified aids to help accommodate those patients who have disabilities.

Modified Aids• Bicycle Grip

• Tennis Ball

• Rubber Band

• Velcro

• Electronic Toothbrush

Review

• What is the recommended brushing method to effectively remove plaque both above and below the gumline?

Bass/Sulcular Method

• 45 degree angle

• Moderate Pressure

• 2-3 teeth at a time

Periodontal Diseases

• Diseases that affect the supporting structures of the teeth: gums and bone

• 2 types– Gingivitis– Periodontitis

Gingivitis• Infection of the gums

•Caused by plaque (bacteria)

•Reversible!

•Symptoms:•Red, swollen, inflamed tissues•Gums bleed easily•Can sometimes be painless

Periodontitis• Infection of the soft tissue and bone that supports the teeth

• Caused by plaque (bacteria) and the body’s response to infection

•Irreversible!

•Symptoms:• Red, swollen, bleeding gums•Receding gums•Loose, mobile teeth•Bad breath

Reduction in Bone Level

Gingivitis vs. Periodontitis

Factors that can increase your risk of periodontal disease:

• Poor oral health habits- none/poor brushing and flossing• Tobacco Use• Poor nutrition• Certain medications• Hormonal changes, specifically those related to

pregnancy (seen in gingivitis)• Decreased immunity/Systemic Diseases:

– HIV/AIDS– Leukemia– Poorly controlled diabetes– Etc.

How to Prevent Gingivitis & Periodontitis• Removing plaque is the most

important step!

• Brush 2x daily

• Use an anti-gingivitis and anti-plaque toothpaste:

-helps kill harmful bacteria that cause plaque and

gingivitis

• Floss daily

• Rinse after brushing:

– effective at fighting plaque, gingivitis, and bad breath

• Visit the dentist regularly

Flossing• Removes plaque and food particles from in between teeth and under the gumline

• Approximately 18”

• Use thumbs and index fingers

• Gently guide floss between the teeth

• ‘C’ shape around the side of the tooth

• Slide floss up and down against the tooth surface and underneath the gumline

•Rotate floss so as to not transfer bacteria

Types of Floss

Flossing Aids

Proxy Brush

Floss Holder

Super Floss

Floss Threader

Remember!

• Brushing without flossing is like washing only 65% of your body while the other 35% remains dirty!

Lesson 3Lesson 3

Michaela BlessingJanna Whitehead

Topics• Caries

• Fluoride

• Xylitol

• Nutrition

• Xerostomia

Review• Which of the following is a reversible

infection of the gums caused by plaque?

A.Caries

B.Periodontitis

C.Xerostomia

D.Gingivitis

Review• True or False?

Periodontitis is reversible; once bone is lost it can be regained.

Review

A. Quickly snap the floss between the teeth using an up and down stroke

B. Gently glide the floss between the teeth and below the gumline in a ‘C’ shape against the tooth

C. Flossing is not important and should only be done when food particles gets stuck in between the teeth

D. None of the above

Which of the following demonstrates the proper flossing technique?

Flossing• ‘C’ Shape

• Use thumbs and index fingers

• Gently guide floss between the teeth

• Removes plaque and food particles from in between teeth and under the gumline

• Approximately 18”

Caries

• Cavity/Caries = a hole in the tooth

• Caused by acid produced by bacteria

Caries

• Caries can be found on the:

• Crown (Enamel)• Root (Cementum)

• Can be recurrent

Caries Process• Tooth decay involves 3 major factors:

• Food/Beverages consumed (sugar)• Bacteria/Plaque• Teeth

Process

1. Bacteria in our mouth digest fermentable carbs and sugars that we eat

2. Once digested, the bacteria secrete an acid on the tooth

3. The acidic byproducts eat away at our enamel causing the tooth to demineralize or breakdown

4. These acid attacks generally start in the enamel and can spread to the softer inner layer of the tooth (dentin)

pH Scale• pH scale-

demineralization begins at a pH of 5.5, water is neutral 7.0

Caries Prevention

• Plaque Control

• Brushing twice daily and flossing• Rinse (recommended ACT mouthwash)• Visit a dentist regularly

• Diet Control• Less sugar intake

• Fluoride

• Xylitol

• Treatment of Xerostomia

Fluoride • Fluoride

– mineral that occurs naturally in food and water

• Purpose – helps remineralize areas in the enamel that have broken down due to acid

production– helps the tooth become more resistant to acid attacks– Is capable of reversing early signs of tooth decay (white spots)– Helps with sensitivity (fluoride varnish)

• Fluoride is most important for individuals at a high risk for cavities such as: - Dry mouth due to medications- Periodontal disease- History of cavities (many restorations)- History of frequent cavities- Children

Forms fluoride is available

• Public:- Food, community water, toothpaste, mouth rinses, floss

• Dental office:- Contain higher amounts of Fluoride

o Fluoride gel- painted on or uses a mouth trayo Fluoride foam- painted on or uses a mouth trayo Fluoride varnish- painted onto the teeth (children and sensitivity)

Fluoride Applications

Fluoride Varnish

Xylitol• A sugar substitute

• Helps in the prevention of cavity formation

• Recommended:– Chew xylitol gum after a meal

– Helps to buffer and stimulate saliva

– Helps neutralize pH

• Variety of forms available:– Gum

– Lozenge

– Mint

– Spray

– Sugar Packets

Nutrition• Poor nutrition

• Unhealthy eating habits = leading cause of death in U.S.

• Quality of life reduced• Life threatening diseases:

• Diabetes• Obesity• Role in cavity formation

• Excellent Nutrition

• Prevents cavity formation• Take caution when eating

foods high in sugar (sticky)• Limit snacking between

meals• Drink water• Chew gum or firm foods

(meat, fruits)

Xerostomia• Dry mouth• Higher risk of caries

development• Causes:

- Certain medications

- Dehydration

- Salivary gland damage (head and neck radiation)

• Ways to help with xerostomia:- Consume water

-Chew gum

-Products- Biotene

Patient with Sjogren’s

Fissured Tongue

Questions?

Lesson 4Lesson 4

Michaela BlessingJanna Whitehead

Topics

Oral Cancer Screening

• Purpose• Importance

Denture Care

• Proper Care

Review

• True or False?

Caries (also known as a cavity) is a hole in tooth caused by acid produced by bacteria.

Review

• Which of the following is NOT required to be in the oral cavity for the caries process to begin?

A.Tooth

B.Sugar/Food

C.Xylitol

D.Bacteria

C. XylitolCaries Process

• 1. Bacteria in our mouth digest fermentable carbs and sugars that we eat

• 2. Once digested, the bacteria secrete an acid on the tooth

• 3. The acidic byproducts eat away at our enamel causing the tooth to demineralize or breakdown

• 4. These acid attacks generally start in the enamel and can spread to the softer inner layer of the tooth (dentin)

Review

• Which of the following is a mineral that occurs naturally in food and water and helps to remineralize areas in the enamel that have broken down due to acid production?

A. Xerostomia

B. Fluoride

C.Xylitol

D.Caries

B. Fluoride• Helps the tooth become more resistant to acid attacks• Is capable of reversing early signs of tooth decay (white spots)

Review• What is xylitol and what is its purpose?

A. A hole in the tooth

Caused by acid produced by bacteria

B. A naturally occuring mineral

Helps remineralize the enamel

C. It’s a condition

Caused by dry mouth

D. A sugar substitute

Helps in the prevention of cavity formation

Xylitol

• Recommended:– Chew xylitol gum after a meal

– Helps to buffer and stimulate saliva

– Helps neutralize pH

• Variety of forms available:– Gum

– Lozenge

– Mint

– Spray

– Sugar Packets

Review

• Define xerostomia

Oral Cancer Screening

Purpose:• Detect unusual/abnormal findings • Potentially put individual at risk • Should be reported

Importance• Early detection of oral cancer• CNA should be familiar with oral cavity• Notice when abnormal lesion is present.

Interesting Facts

• 2x as common in men than women

• Average age of diagnosis = 62

• 2/3 of individuals with oral cancer - over age 55

Risk factors associated with oral cancer•Tobacco use

o Depends on amount and frequency of use

• Alcohol useo Heavy alcohol drinkerso Risk rises with individuals who use tobacco and alcohol in combination

• Sun exposure o Common cause - lip cancer

• Poor nutritiono Diets low in fruits and vegetables

• Some genetic syndromes • HPV• Immune system suppression

Normal, Healthy Oral Cavity

Abnormal Findings

Fissured Tongue

Linea Alba

Smoker’s Palate

Abnormal Findings

Exostosis

Mandibular Tori

Oral Cancer

Border of tongue

Underneath tongue

On the lip

Performing an Oral Cancer Screening1. Observe face and neck

– Swellings, skin abnormalities, discolorations, moles, asymmetry

2. Lips and corners of the lips– Changes in color, texture

3. Palpate the lymph nodes

4. Remove partials and dentures for the intraoral screening

5. Examine, palpate the palate, – Look in tonsils area and back of throat

6. Move, palpate the lips

7. Examine, palpate cheek tissues

8. Examine, palpate tongue – Changes in color, texture, symmetry, mobility

– Be sure to look at ALL surfaces of tongue

– Hold tip of tongue to view side surfaces

9. Have patients lift tongue up– Examine, palpate floor of mouth

Performing an Oral Cancer Screening

What to Report• Charge nurse• Dentist

• Pain• Loss of feeling• Sores • Blisters• Ulcers• Swellings• Growths or lumps• Discolorations of red or white areas• Broken or decayed teeth • Dry mouth • Spots or crusting of the lips• Unexplained bleeding in the mouth• Difficulty chewing or swallowing

Open Discussion

• Discuss the importance of the Certified Nursing Aide’s duty in providing an oral cancer screening.

Denture Care• Denture

o A removable plate or frame holding one or more artificial teeth

• Importance of cleaning dentureso Denture cleaning

• Part of daily oral hygieneo Cleaning the patient’s dentures

• Prevents unnecessary exposure to microbes• Could lead to oral and systemic disease• Malodor and fungal infections

Dentures

Denture Stomatitis• A yeast infection of the mouth

• Most common denture infection

• Will appear on the hard palate with red and inflamed tissues

• Causes:• Poor oral hygiene efforts • Continuous wear of dentures

How to care for a denture• Dentures and partials should be cleaned on a daily basis!

• Place towel in sink, fill the sink with warm water Never put dentures directly over sink without a towel If you drop the denture it could easily break

• Wear gloves, bring denture over sink using a denture container or cup for transportation

• Hold dentures in palm of hand over sink

• Inspect denture– Cracks

– Breaks

– Sharp edges

– Missing teeth

– Bring to charge nurses attention if damage is noticed

• Apply denture paste to denture brush Do not use tooth paste because it is to abrasive for the dentures

• Scrub denture on all surfaces using a denture brush

• Rinse denture completely

• Return to patient – Transport in cup or container

How to care for a denture

Wear gloves!

Remember!• Dentures should be removed, cleaned, and soaked every night

• Soaking dentures overnight will eliminate 99.9% of denture germs

• Be sure to soak dentures in a denture solution (denture tablets and water)

• Do not soak dentures in Listerine, this will cause staining

How to label a denture

• Purposeo Prevent loss of the denture o Prevent cross contamination among residents

• Supplieso Gloveso Fine-tipped indelible markero Paper towelo Clear acrylic nail polisho Disposable emery boardo Disposable brusho Glass of watero Gauze

How to label a denture1. Be sure denture has been thoroughly cleaned2. Wash hands, wear gloves3. Locate rear area of denture

• Side toward cheek• Avoid area that fits in the palate

4. Use disposable emery board• File a small area until rough and porous• Area needs to be no longer than a finger nail

5. Use gloved hand or gauze• Brush away powdery substance (residue) - results from filing• Dispose of emery board

6. Use fine tipped permanent sharpie• Mark denture with initials of patient • First initial and last name

7. Allow marker to dry8. Use disposable brush

• Paint marked area with acrylic clear nail polish• Sally Hansen’s Hard-As-Nails is effective• Do not use brush that comes with polish

9. Allow polish to dry

Be cautious to not cross contaminate between patients

Questions?