Here at Hcsuk, we believe that one of the main barriers that prevent residents in care homes from receiving good and effective mouth care is a lack of availability of fit for purpose tools or products. We wanted to demonstrate that by introducing appropriate oral care products, significant improvements to peoples’ mouth care and overall health and well being can be achieved and can lead to more love and kisses to!
We conducted a trial with Mr A who lives in a care home in Leicester with Advanced Parkinson’s Disease, with no swallow reflex and who is on a peg feed and is nil by mouth.
I met with Mr A to introduce myself and to ask him how we could help him, and he told me that all he wanted was to have a fresh feeling mouth, something that most of us take for granted, I’m sure.
Mr A’s mouth care was described as very poor by staff, as Mr A was not able to open his mouth very well and therefore access to his mouth to deliver effective oral care was limited, plus the staff were frightened of Mr A swallowing or aspirating on the oral care products which were in use.
Mr A had severe halitosis and a substantial build up of debris on his tongue as a result of intermittent cleaning results
Mr A had his own teeth and didn’t have any particular issues with these at the time of the trial
The oral care regime that was in place when I met with Mr A:
Brushing twice a day with a normal toothbrush (large head) and standard toothpaste. This was intermittent due to the staff’s lack of confidence in the products and the risk of aspiration. Also, despite Mr A’s halitosis, staff would not use a mouth wash for additional fear of aspiration.
Our recommendations and rationale:
We know that a toothbrush used properly is the only tool that will successfully remove bacterial plaque from the teeth and mouth.
For tooth brushing - we selected our Tepe Special Care Compact Toothbrush as it is very gentle with 12,000 extremely soft filaments and a small head which is more effective at reaching all parts of the mouth. This soft toothbrush was perfect for Mr A as it is recommended for patients with swelling and difficulty opening their mouths and its sturdy, ergonomically designed handle provides a comfortable and secure grip and can easily be angled for better access to all areas of the mouth.
Toothpaste – As Mr A was at risk of aspiration we recommended our Oralieve Mild Mint SLS free Non Foaming Toothpaste. Sodium Lauryl Sulphate (SLS) is the ingredient added to many toothpastes that makes them foam. This can have a drying effect on the oral tissues and therefore should be avoided in residents who already have a dry mouth. Similarly, for those patients at risk of aspirating, a SLS free toothpaste could also be beneficial so as to reduce this risk as far as possible. We recommend that care homes provide non-foaming toothpastes (Sodium Lauryl Sulphate (SLS) free) for patients with a dry mouth or patients who are at risk of aspirating.
Providing dry mouth care - Dry mouth moisturising products provide long lasting relief for a severe dry mouth and can be used to soften dried secretions so that they can be removed more readily. There are different products available including gels, sprays and mouth rinses. We recommended Oralieve Moisturising Dry Mouth Gel which can be massaged into all areas of the mouth (cheeks, palate, tongue) in conjunction with an Mc3 (formerly MouthEze) oral cleanser before meals, to help with eating or before tooth brushing for very sore mouths. Dry mouth gel can be mixed with a couple of drops of water to make it more palatable to patients.
MC3 (formerly Moutheze oral cleansers) - provide gentle mouth cleansing without the choke or aspirating hazard of sponge swabs or the awkwardness of toothbrushes and also for the application of dry mouth products. We recommended this for Mr A to clean the soft tissues of his mouth and remove food debris and tenacious dried saliva.
The clinical results
The introduction of the Tepe small, soft headed toothbrush with angled head and the SLS free non foaming toothpaste, resulted in the staff being able to deliver regular mouth care with confidence that the risk of aspiration was minimal and being able to access all areas of Mr A’s mouth for cleaning, easily and thoroughly.
As Mr A had a significant build up of dried secretions in his mouth and particularly on his tongue, the use of the dry mouth gel coupled with the MC3 (Moutheze oral cleanser) enabled the staff over a period of time to work on reducing the build up and to restore Mr A’s tongue to a pink and healthy state.
The nurses commented that the dry mouth gel has been really successful for lubricating Mr A’s dry lips and mouth and they have found the mouth area cleaner with less coating.
The carers’ have found that Mr A’s breath is much fresher and he is communicating more as his mouth is not so dry.
The social results
I went to visit Mr A a month after the trial began and he was a different person to the man I first met. He was much more confident and socialising more as a result of using the products and he told me that his mouth felt much fresher and cleaner and that it didn’t feel so dry.
Mr A’s wife visits every day and she has found that his breath seems much fresher especially when talking and he no longer has any signs of the bad breath he was suffering in the past. As a couple they are now able to be much more physically close and are kissing as a result of his improved oral hygiene.
Mr A and I exchanged a high five!
If you are interested in how you can improve oral care standards in your care home to meet the new CQC Quality Standard in oral care and demonstrates that your service is effective and responsive, we are running a course on Wednesday September 20th at Jury’s Inn, East Midlands Airport:
How to achieve CQC compliancy in oral care for adults in care homes
For more details and how to book, please visit our event page at
You can also watch the video of Jo talking about Mr A below[embed]https://youtu.be/LCB0OBsUw0Y[/embed]
On 7th June 2017, NICE Quality Standard 'Oral Care in Care Homes' was published. It recommends that residents in care homes have their oral health needs assessed on admission and recorded in their personal care plans, and are supported to clean their teeth twice a day and/or their dentures daily.
The Care Quality Commission (CQC) expects care managers to take account of the nationally recognised guidance, including CQC Guidance from NICE, in essence, CQC want to see care homes prioritizing oral care. Also, being able to evidence how you support residents to maintain good oral health will help you to demonstrate that your service is both effective and responsive.
Included in the guide below are the tools to help you make those improvements:
We know that many of you social care managers and your staff out there know what is expected of you when it comes to supporting your residents with oral care, but due to a lack of available training, fit for purpose oral care product solutions, tools and resources, are unaware of the best practices and how to implement these.
Here at Hcsuk, we really want to help and support you to achieve compliancy, and are therefore really proud and excited to announce that we have teamed up with Jane Peterson, RDH, BSc, Dental and Healthcare Professional and founder of oral health training company Oral Health Matters, to host:
Our First CPD Accredited Seminar
Wednesday 20th September 2017
8.30 a.m. - 12.30 p.m.
Jury’s Inn, East Midlands Airport
£99 per person
Including refreshments, networking opportunities, car parking and buffet lunch
To book this course now, please go to https://hcsuk-oral-health.eventbrite.co.uk
As well as teaching you best practice in assisting and supporting your residents on oral health matters, these best practices will demonstrate to your stakeholders that you prioritise oral care.
Who should attend this course?
This oral care seminar is designed for all staff who are involved in the personal care of residents, senior care staff including care managers, oral champions, learning and development leads and trainers.
What are the course objectives?
To raise awareness of the importance of daily mouth care for older people in residential care and to provide practical advice on oral care techniques. Carers will be provided with the knowledge and ability to plan and deliver daily mouth care within residential and nursing care homes. This course combines the practical and theoretical aspects of our basic and advanced level courses to deliver a complete guide to oral care provision for the elderly in care homes.
Which topics does the course cover?
What are the expected learning outcomes for you and your staff?
On successful completion of this course delegates will be able to:
Meet Jane, our trainer for the day
Jane Peterson RDH, BSc
Jane has completed a Bachelor of Science degree in Oral Health Promotion, which highlighted to her the need for Oral Health Promotion in Care Homes and enabled Jane to reflect on oral health status and develop preventive strategies for care staff and the elderly in care homes. Jane carries out oral healthcare visits in a number of care homes and because of her experience she understands the challenges some residents pose with daily oral care. Jane currently works in General Practice 1 day a week, the rest of her time is dedicated to teaching and speaking at group meetings and seminars nationally to Dental and Healthcare Professionals.
We have limited spaces available and we are expecting a high level of demand for this event so we recommend that you book your places today to avoid disappointment!
So here’s that link again: https://hcsuk-oral-health.eventbrite.co.uk
We look forward to sharing our knowledge with you on the day.
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