Implementing and sustaining evidence-based practices in long-term care.

Oral Care

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    This best practice guideline (BPG) Oral Health: Supporting Adults Who Require Assistance Second Edition replaces the RNAO BPG Oral Health: Nursing Assessment and Intervention, which was released in 2008. The purpose of this next edition BPG is to provide nurses, the interprofessional team and caregivers with evidence-based recommendations for the provision of oral care for adults (18 years of age and older) that will: (a) promote an interprofessional approach to providing oral care, (b) enhance the delivery of oral care interventions, and (c) ultimately lead to positive oral health outcomes for persons. 

    The BPG focuses on providing oral care across health settings to adults who require assistance with oral care in a continuum that ranges from the set-up of oral care supplies to full physical assistance with oral care. This BPG provides recommendations to support the delivery of oral care—including appropriate supervision, prompting and assistance—while still advocating for the person’s independence and autonomy. 

    Registered Nurses’ Association of Ontario (2020). Oral Health: Supporting Adults Who Require Assistance. (2nd ed.). Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/bpg/RNAO_Oral_Health_Supporting_Adults_Who_Require_Assistance_Second_Edition_final.pdf 

    This work is funded by the Government of Ontario.

     

     

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    A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

    Registered Nurses Association of Ontario (2022) Gap Analysis -Oral Health Supporting Adults Who Require Assistance. Toronto, ON.

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    An algorithm to guide oral assessment and intervention. The algorithm summarizes the recommendations to help oral care teams to understand how to implement them into practice.

    Registered Nurses’ Association of Ontario. (2020). Appendix F of Oral Health: Supporting Adults Who Require Assistance (2nd ed.). Toronto, Canada: Author.  (page 110). Retrieved from https://rnao.ca/sites/rnao-ca/files/bpg/RNAO_Oral_Health_Supporting_Adults_Who_Require_Assistance_Second_Edition_final.pdf

     

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    This website from Dalhousie University focuses on oral health care resources as a result of oral health activities in long term care homes. Resources include a manual, education videos, oral care tool kits, assessment and care planning tools and guidelines for organizationally mapping oral care.

    Dalhousie University. (n.d.). Population Health Institute: Brushing up on mouth care.  Retrieved from http://brushingup.ca/

     

     

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    This fact sheet provides signs and symptoms of dry mouth and treatment options. Topics covered include: how saliva functions, causes, risk factors, prevention, treatment and maintenance interventions.

    Ontario Dental Hygienists’ Association. (n.d.). Dry Mouth. [Fact sheet]. Retrieved from https://odha.on.ca/wp-content/uploads/2016/08/Dry-Mouth-fact-sheet.v2.pdf
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    This fact sheet from the Ontario Dental Hygienists' Association provides signs of poor oral care and gives clear instructions for how a caregiver can give oral care to another person.

    Ontario Dental Hygienists' Association. (n.d.). For caregivers – A guide to providing oral care. Retrieved from https://odha.on.ca/wp-content/uploads/2016/08/CaregiversNewFactSheet.pdf

     

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    This website offers a workbook with 10 accompanying videos to help long-term care home staff to learn techniques to provide better oral care to their residents. 

    Minnesota Dental Association. (n.d.). Growing old with a smile: Oral health for older adults in long-term care. Retrieved from https://www.mndental.org/public/oral-health/seniors-and-oral-health/

     

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    L'objectif de cette prochaine édition de la ligne directrice sur les pratiques exemplaires (LDPE) est de fournir aux infirmières, à l'équipe interprofessionnelle et aux soignants des recommandations fondées sur des données probantes pour la prestation de soins bucco-dentaires aux adultes (18 ans et plus) qui : (a) favoriseront une approche interprofessionnelle de la prestation soins bucco-dentaires, (b) améliorer la prestation des interventions de soins bucco-dentaires, et (c) conduire finalement à des résultats positifs en matière de santé bucco-dentaire pour les personnes.

    Le BPG se concentre sur la prestation de soins bucco-dentaires dans tous les établissements de santé aux adultes qui ont besoin d'aide pour les soins bucco-dentaires dans un continuum qui va de la mise en place de fournitures de soins bucco-dentaires à une assistance physique complète pour les soins bucco-dentaires. Cette LDPE fournit des recommandations pour soutenir la prestation de soins bucco-dentaires, y compris une supervision, une incitation et une assistance appropriées, tout en préconisant l'indépendance et l'autonomie de la personne.

    Association des infirmières et infirmiers autorisés de l’Ontario (AIIAO). Santé buccodentaire : Soutenir les adultes qui ont besoin d’aide. 2e  édition. Toronto (Ont.) : RNAO 2020
    https://rnao.ca/sites/rnao-ca/files/bpg/translations/Oral_Health_FR.pdf 

    Ce travail est financé par le Ministère de la Santé et des Soins de longue durée.

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    This resource lists medications that can have an impact on oral health.

    South West: Best Practice Coordinators in Long-Term Care Initiative. (n.d.). Medications that impact oral health. Retrieved from https://admin.rgpc.ca/uploads/documents/8%20medications%20that%20impact%20oral%20health%20primary%20care.pdf

      

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    Ontario Regulation 246/22 was made under The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector April 11, 2022.

    Government of Ontario (2022) Ontario Regulation 246/22. Toronto ( ON) retrieved from O. Reg. 246/22: GENERAL (ontario.ca)

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    This YouTube webinar from the Registered Nurses Association of Ontario Oral Care Community of Practice describes options for giving oral care to residents who have expressive behaviours.  It provides a background on the meaning of behaviours and practical ways to approach oral care.

    Thoma, J., & Kurchinski, K. (2016). Oral Care Approaches when Residents have Expressive Behaviours [Video file]. Retrieved from https://youtu.be/ntcCpfOZBPE
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    This is a comprehensive collection of audits to review oral care in long term care. It contains instructions and audits on: dental equipment; Denture and denture supplies; Oral care supplies in residents’ care caddie; Oral care practices; POC/Flowsheet; Actual Resident Assessment of oral care; Admission Process; Levels of assistance and behaviours; Annual Assessment; Quarterly Assessment; Annual evaluation of oral care education; and Resident and Family Information.

    MacDonald, I. (2016). Oral Care Auditing Tool. Toronto, ON: Registered Nurses Association of Ontario - Oral Care Community of Practice 2015-16.

     

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    This RNAO-sponsored webinar is 34 minutes long, with a focus on dementia oral care.

    Kurchinski, K., & Woodbeck, H. (2016). Oral care best practices for residents with responsive behaviour: Approaches and strategies [Video file]. Retrieved from https://youtu.be/oFS1c-qpCeE

     

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    This booklet is a group of tools that long term care or other health care organizations can use to collect baseline data on the status of oral care. Tools included are: RAI-MDS indicators; audits for oral supplies and care on charts; and an oral health knowledge survey.

    MacDonald, I. (2015). Oral care community of practice data collection tools. Toronto, ON: Registered Nurses Association of Ontario.

     

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    This is a link to a series of six videos that discusses why oral care is important and demonstrates appropriate oral care techniques for the various stages of dementia.  A DVD of these videos, Oral Hygiene for Residents with Dementia is available for purchase at the RNAO Online Store: https://shop.rnao.ca/node/113.

    Registered Nurses’ Association of Ontario (December 2009). Oral care for residents with dementia. [Video series]. Retrieved from https://youtu.be/MP576ht84Fg

     

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    This is a link to a series of six videos that describes the specialized oral care required for patients with the challenges of xerostoma (dry mouth), dysphasia (difficulty swallowing) and mucositis (inflamed oral tissues). A DVD of these videos, Oral Care for Xerostomia, Dysphagia and Mucositis is available for purchase at the RNAO Online Store: https://shop.rnao.ca/node/115.

    Registered Nurses’ Association of Ontario (December 2009). Oral care for xerostomia, dysphagia, and mucositis. [Video series]. Retrieved from https://youtu.be/D5_m5PYRd_g

     

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    This document is a sample policy and procedure on oral care. The policy was created by the RNAO Long-Term Care Best Practices Program Oral Care Toolkit Team to support LTC Homes.

     Registered Nurses' Association of Ontario. (2016). Oral care sample policy and procedure. Toronto, ON: Author 

     

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    This is a link to webinar series on thirteen different oral health topics that can be used for staff education. These include topics on oral health such as: diabetes, dementia, dry mouth, stroke, palliative care, bad breath, care planning, infection control, dentures, 2-toothbrush technique, tools, and oral assessment (OHAT).

    Terry Kirkpatrick. (2013).  Oral health care. [Video series].  Retrieved on October 8, 2013 from http://www.youtube.com/user/TerryKirkpatrick1/videos?sort=dd&live_view=500&flow=list&view=0.

     Sponsored by the Seniors Health Knowledge Network's Oral Health Community of Practice.  

    Website http://seniorshealthknowledgenetwork.com/community/oral-health-community-practice.

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    This oral health care planning guideline provides information on a standard protective care regimen, additional oral care treatment, oral care and changed behaviour and palliative care considerations. An Oral Health Care Plan guide is included.

    Government of South Australia. (2008). Better oral health care in residential: Oral health care planning guidelines. Retrieved from https://www.sahealth.sa.gov.au/wps/wcm/connect/77fd7a004b3323958834ade79043faf0/BOHRC_Professional_Portfolio_Full_Version%5B1%5D.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-77fd7a004b3323958834ade79043faf0-nwm-H7C

    Source: Government of South Australia © 2012 SA Health

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    This tool was developed for use during resident admissions. Its aims is to have conversations with residents and/or family about oral/dental history along with preferences for oral care.

    MacDonald, I. (2016). Admission oral health history and preferences tool. Toronto, ON: Registered Nurses Association of Ontario.

     

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    This fact sheet from the British Columbia Dental Association provides a succinct description on how to do an oral exam, along with clear pictures of common oral problems.  It is available in Farsi, Chinese, Tagalog, and Punjabi. There are also video resources connected to this fact sheet.

    British Columbia Dental Association. (n.d.).  Oral Inspection Tips for Caregivers.  Retrieved from https://www.oda.ca/wp-content/uploads/2021/03/2019June_Oral-Inspection-Tips-for-Caregivers_FINAL.pdf

     

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    This 25-minute video shows a range of unhealthy changes and common abnormalities that can be found during oral assessments of residents living in long term care homes. How to do an oral assessment is reviewed. It is Part 2 of the RNAO Long-Term Care Best Practices Program - Oral Health Assessment Series (3 parts).

    MacDonald, I. & Peachman-Faust, T. (2015). Part 2 - Oral assessment in LTC: Unhealthy changes and common abnormalities. [Video file]. Retrieved from  https://www.youtube.com/watch?v=fsQF-ElrwZk

     

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    This 30-minute video demonstrates how to brush another persons teeth and describes interventions for various oral care problems found in residents in long term care. It is Part 3 of the RNAO Long-Term Care Best Practices Program - Oral Assessment Series (3 parts).

    MacDonald, I. & Peachman-Faust, T. (2016). Part 3 - Best practices for oral care interventions in long term care. [Video file]. Retrieved from https://www.youtube.com/watch?v=fp5oXYNHQp4

     

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    This document is a sample of the holistic and reliable Oral assessment tool (THROAT) oral health assessment tool.

    Registered Nurses’ Association of Ontario (2008). Appendix E – Sample 2 of Oral Health: Nursing Assessment and Intervention. Toronto, Canada: Author. p. 70.

    Reference: Dickinson, H., Watkins, C. & Leathley, M. (2001). The Development of the THROAT: The Holistic and Reliable Oral Assessment Tool. Clinical Effectiveness in Nursing. 5, 106-110.

    This work is funded by the Ontario Ministry of Health and Long-Term Care. 

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    This document provides two examples of oral care plans for long-term care. 

    Registered Nurses’ Association of Ontario. (2020). Appendix K of Oral Health: Supporting Adults Who Require Assistance (2nd ed.). Toronto, Canada: Author.  (pages 120-121). Retrieved from https://rnao.ca/sites/rnao-ca/files/bpg/RNAO_Oral_Health_Supporting_Adults_Who_Require_Assistance_Second_Edition_final.pdf

     

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    This document offers talking points on the connection between oral and overall health. Oral health can influence other body systems, while therapies for chronic diseases can have an impact on the oral cavity and nurses can use this fact sheet while talking to residents and families about the importance of oral hygiene.  

    The Canadian Dental Hygienist Association. (2015). Talking points – whole body health requires oral health. [Fact sheet]. Retrieved from https://files.cdha.ca/profession/resources/FactSheet_WholeBody_printerFriendly_final2.pdf

    Source: Canadian Dental Hygienists Association www.cdha.ca.