By Loretta J. Seidl, RDH, MHS, ECP
Staff members in nursing homes assume responsibility for oral health assessments.
It's been 155 years since the pioneers of Kansas came to search for unknown territories and create new lives for their families. Kansans have always been strong, hardworking folks who want to do the right thing for their neighbors for the right reasons. So it's not surprising that I, a Kansas dental hygienist, and some nursing home administrators, initiated pioneering oral health care in the states' long-term care facilities.
Many Kansas nursing homes have had great success with the BLISS Oral Health Training Program© (BLISS OHTP). During the past 19 years I have developed, implemented, and monitored the BLISS OHTP, including yearly follow-up visits. Joan Loehr, DDS, my extended care (ECP) supervising dentist, assisted with the program. The staff members, known as the BLISS Oral Health Team, are responsible for providing oral health assessments and referrals as needed. In addition, the BLISS OHTP's web-based electronic program tracks the oral health of each resident, from the time they enter the facility until the time they leave.
Sixteen years ago, Teresa Achilles, administrator of the Cheney Golden Age Home in Cheney, Kansas, was one of the pioneers willing to provide comprehensive oral health for her residents. The BLISS Oral Health Team at the Cheney Golden Age Home assesses each new resident upon admission using the BLISS OHTP protocol. This allows them to determine the level of assistance the resident will need to maintain optimum daily oral care. This optimum oral care for each resident provides freedom from discomfort and pain, and the ability to enjoy eating and socializing without embarrassment, which increases each resident's self-esteem.
Oral problems experienced by older adults are preventable, can often be detected early, and are not the direct result of aging. Dental caries and periodontal disease are plaque-related oral diseases. Although these diseases are generally not life-threatening, nor do they seriously impair most older adults, they can have an effect on the management of medical conditions, general health, nutrition, and quality of life (Blanco-Johnson, 2012). Remember, an infection in the gum tissue can create an open route to the body's bloodstream. Oral infection can also lead to aspirated bacteria into the respiratory system. These routes of infection can clearly compromise a nursing home resident's overall health.
There are other conditions and diseases that can affect a resident's ability to maintain his or her own oral health. These include arthritis, dementia, diabetes, hypertension, stroke, visual changes, and xerostomia. For example, xerostomia is a common side effect of over 400 medications, many of which are prescribed for nursing home residents. Dry mouth can lead to gum disease, tooth decay, and eventually tooth loss. Medications can also cause taste alterations, which make food less tasty.
With dry mouth there is less saliva, which is necessary to aid in chewing, swallowing, and speaking. Saliva also neutralizes the acids produced by bacterial plaque, helps food particles slide off teeth, and lubricates the soft tissues. Because saliva acts as a sealant between the gums and teeth, dry mouth can make it harder for those who wear dentures to keep them clean and in place. In some cases, artificial saliva is used to assist these folks. Without adequate saliva buffering, decay can become rampant.
In addition to providing assessments and referrals, the long-term care staff members are taught to be aware of the individual needs of each resident, which helps in maintaining optimum oral health. For example, many residents will exhibit gum recession, which exposes the dentin. Due to the dentin's porous nature, it decays much faster than the enamel, and in the presence of xerostomia, root decay can rapidly spread and cause pain, abscess, and even tooth loss.
Additionally, when a resident has exposed dentin that's sensitive to hot and cold drinks, it's important to serve room temperature water and not ice cold water for both drinking and rinsing the mouth after brushing. Residents suffering from dehydration will drink more water if room temperature water is provided.
Maintaining good oral health has provided an amazing array of successes for nursing home residents. Some BLISS OHTP testimonials include: 1) Fewer hospital admittances due to respiratory problems 2) Less frequent behavioral problems 3) Improvement in overall self-esteem 4) Enhanced quality of life, especially when oral cancer is detected early
Cheney Golden Age Home's administrator commented, "As a result of the BLISS OHTP, oral health problems in residents are found in the early stages, which means the costs are lower when our residents visit a dentist. In addition, it's a great marketing tool for the facility because we can say that we offer an excellent oral health program for residents."
Maintaining optimum oral health for seniors is the need of the time! It is vital to the overall health and well-being of a population that is so often forgotten. The Kansas Health Care Association continues to make oral health care a priority. It is an important part of their quality care initiatives. As many Kansans say, "It's the right thing to do!"
A computer program tracks the oral health of nursing home residents for the duration of their stay at the facility.
Adopt a nursing home
Please take the time to adopt a nursing home near you and provide semiannual oral health in-services for the staff. You will not only help the staff feel more competent and comfortable when they provide care to their residents, but you will also help them understand their and their families' oral health needs. Additionally, long-term care residents will enjoy having you visit with them. Residents, and sometimes family members, sit in on my in-service presentations and ask questions. This is an opportunity for staff members to learn what concerns family members have regarding their loved ones' oral health needs.
Once you adopt a nursing home, the benefits are immense.
- You will increase oral health knowledge and care for the residents, staff members, and their families.
- You will enable staff members to feel more competent and comfortable in providing oral care for their residents by showing them how to use certain oral aids, for example, the Open Wide bite block and Collis curve toothbrush.
- You will assist with new-staff training, which means at least two oral health in-services per year due to high staff turnover in nursing homes.
- You will increase public awareness of our profession.
- You will increase public awareness of your dental office.
An added bonus: In some states, in-service training may count as continuing education credit for dental hygiene licensure requirements.
Loretta (Letty) J. Seidl, RDH, MHS, is the current president of BLISS & Associates LLC and the Serendipity Foundation Inc., which supports oral health training in long-term care facilities. Through the BLISS Oral Health Training Program (OHTP), she provides daily oral care to residents and referrals to dentists as needed. Working in nursing homes for 24 years, she has provided comprehensive oral health care, in-services, and staff training. She also presents oral health awareness seminars for state surveyors. Her approach to planning for the future needs of our aging population has been innovative and balanced, with a holistic view of their physical, mental, and emotional needs. She is a former assistant professor in the department of dental hygiene at Wichita State University.
1. Blanco Johnson V. (2012) Oral Hygiene Care for Functionally Dependent and Cognitively Impaired Older Adults. Journal of Gerontological Nursing. Volume 38 - Issue 11:11-19.
2. BLISS & Associates, LLC. (1996) BLISS Oral Health Training Program.