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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Oral Care Gap Analysis
Organizational assessment tool to assist with implementation and evaluation of the RNAO Oral Health: Supporting Adults Who Require Assistance (2nd ed.) by comparing current practice to evidence-based practice.
Registered Nurses' Association of Ontario's. (2020). Oral health gap analysis. Toronto, ON: Long-Term Care Best Practices Program -
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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 table provides approaches and interventions that staff can use for providing oral care for residents with responsive behaviours, communication or functional impairment.
Scott, D., Van der Horst, M. L., & Bowes, D. (2007). Approaches of oral care: Interventions for residents in long-term care with responsive behaviours, communication or functional impairments. Retrieved from http://admin.rgpc.ca/uploads/documents/approaches%20for%20oral%20hygiene%20care%20reference%20tool.pdf Website http://www.rgpc.ca.
Copyright 2013.
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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://www.dal.ca/dept/hpi/community-reports/oral-care-uptake.html Web Address: http://www.dal.ca/dept/hpi/community-reports/oral-care-uptake.html
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A self directed learning tool that is designed to help familiarise the user with common oral health conditions experienced by the elderly. With use of photographs, the user is guided through 8 categories of oral health: lips, tongue, gums, saliva, natural teeth, dentures, oral cleanliness and dental pain. You are prompted to assess your knowledge by choosing if the oral health condition is, “healthy, changes or unhealthy” by clicking and submitting an answer.
South Australia Health. (n.d.). Common oral health conditions - self directed learning resource. Retrieved from http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/oral+health+care+for+older+people/oral+health+learning+quiz Source: Government of South Australia © 2012 SA Health
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This downloadable Power Point presentation discusses the relation between diabetes and oral health, how to decrease the risks to oral health and care planning. You must accept the download prompt in order to view this document.
Halton Region. (2012). Diabetes and Oral Health. [Power Point slides]. Retrieved from http://www.halton.ca/cms/one.aspx?portalId=8310&pageId=29689. Copyright Halton Region.
Website www.halton.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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Ce guide fournit des recommandations fondées sur des preuves pour IA et IAA sur les meilleures pratiques en matière de soins buccodentaires de soins infirmiers. Ce guide met l'accent sur les recommandations pour l'évaluation de la santé buccodentaire et stratégies et interventions de soins liés à l'oral.
Registered Nurses' Association of Ontario (2008). Santé bucco-dentaire : Soins infirmiers évaluation et Intervention. Toronto, Ontario: auteur. Récupéré de https://rnao.ca/sites/rnao-ca/files/BPG_Oral_Health_French.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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This fact sheet describes various useful dental tools that can be used to assist with the oral care of people who have challenges.
University of Manitoba - Rady Faculty of Health Sciences. (n.d.). Mouth care helpers for caregivers. Retrieved from http://umanitoba.ca/faculties/health_sciences/dentistry/ccoh/media/Helpers-p-1-2-2018.pdf Web Address: http://umanitoba.ca/faculties/health_sciences/dentistry/ccoh/longterm-care-facts.html
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This link takes you to the website of the University of Manitoba Rady Faculty of Health Sciences' collection of long term care fact sheets and video clips which can be used to support mouth care training for caregivers.
University of Manitoba: Rady Faculty of Health Science. (n.d.). Mouthcare resources for caregivers: Fact sheets and video clips. Retrieved from http://umanitoba.ca/faculties/health_sciences/dentistry/ccoh/longterm-care-facts.html © 2019 University of Manitoba.
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Cet outile est la version Français/traduite de l’OHAT. Un outil d’évaluation fiable, valide et normalisé pour effectuer l’évaluation de la santé buccodentaire initiale et continue. L'outil décrit les 8 catégories à évaluer.
The oral health assessment tool (OHAT) for long-term care. This version is based on modifications from the Halton Region’s Health Department (2007). 2008 September modified with permission from Dr. Chalmers
Centre d'Apprentissage de Recherche et d'Innovation, Bruyère - Résidence Saint-Louis, & La Cité Collégiale. (n.d.). Outil d’évaluation de l’état de santé buccodentaire pour les professionnels qui ne sont pas spécialisés en soins dentaires. Retrieved from https://clri-ltc.ca/files/2017/04/20170427_OHAT_FR_Translation-Accessible-CORRECTED-1.pdf Source: © 2018 Ontario Centres for Learning, Research and Innovation in Long-Term Care
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This online educational resource on seniors' oral heath is intended to support professional caregivers and health care providers with learning about oral health care delivery to residents in long-term care. The course uses audio narration and video clips to enhance learning and is divided into two modules: 1) Good oral health, and 2) Daily mouth care.
Created by the British Columbia Dental Association (BCDA) who has shared it with the Ontario Dental Association
British Columbia Dental Association. (n.d.). Online educational resources: Seniors' oral health care. Retrieved from https://www.youroralhealth.ca/Seniors-Oral-Health-Public/seniors-module/presentation_html5.html -
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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://www.youtube.com/watch?v=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://www.youtube.com/watch?v=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 downloadable Power Point presentation discusses the various techniques that can be used by care givers throughout the stages of dementia. You must accept the download prompt in order to view this document.
Halton Region. (2012). Oral care for individuals with dementia. [Power Point slides]. Retrieved from http://www.halton.ca/cms/one.aspx?portalId=8310&pageId=29689. Copyright Halton Region. Website www.halton.ca.
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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://www.youtube.com/watch?v=MP576ht84Fg&list=PLrvqQwvIXI-cj_QUq1BQD_8g0-tjvrGwl -
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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 http://www.youtube.com/playlist?list=PLF2FDDE6CFB15B0D5&feature=plcp. -
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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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The link takes you to the oral care section 34 of the Ontario Regulation 79/10 made under the Long-Term Care Homes Act, 2007, Government of Ontario.
Long-Term Care Homes Act. (2007). The Ontario Gazette, Ontario Regulation 79/10, Section 34. Retrieved from https://www.ontario.ca/laws/regulation/r10079 -
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The OHAT, also known as the Modified Brief Oral Health Status Examination provides a systematic way to assess the oral cavity. It categorizes findings into three categories – Healthy, Changes and Unhealthy.
Registered Nurses’ Association of Ontario (2008). Appendix E of Oral Health: Nursing Assessment and Intervention. Toronto, Canada: Author. p. 69. Retrieved from https://rnao.ca/sites/rnao-ca/files/Oral_Health_-_Nursing_Assessment_and_Interventions.pdf -
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This is a sample of the oral health assessment tool (OHAT) for long-term care. The OHAT will download automatically as a PDF file.
Halton Region. (2007). Oral health assessment tool (OHAT) for long-term care. Retrieved from http://www.halton.ca/common/pages/UserFile.aspx?fileId=15348 Modified with permission from Dr. Chalmers (2014)
Source: Halton Region. www.halton.ca.
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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/fa2b610047d74c29a03da5fc651ee2b2/BOHRC_Professional_Portfolio_OHC_Planning_Guidelines%5B1%5D.pdf?MOD=AJPERES&CACHEID=fa2b610047d74c29a03da5fc651ee2b2 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 document is an example of an oral hygiene care plan for long-term care.
Halton Region. (2007). Oral hygiene care plan for long-term care. Retrieved from www.halton.ca/common/pages/UserFile.aspx?fileId=15346. Copyright. Website www.halton.ca.
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This is a 12-question test that can be used to verify staff's level of oral hygiene knowledge. Answers are also provided in the toolkit (See Oral hygiene knowledge test - answers).
Regional Geriatric Program Central (n.d.). Oral Hygiene Knowledge Test - 12 Questions. Retrieved from https://admin.rgpc.ca/uploads/documents/oral%20hygiene%20knowledge%20test.pdf -
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Responses to the Oral hygiene knowledge test - 12 questions.
Regional Geriatric Program Central (n.d.). Oral Hygiene Knowledge Test - answers. Retrieved from http://admin.rgpc.ca/uploads/documents/oral%20hygiene%20knowledge%20test-answers.pdf
Copyright 2013 www.rgpc.ca
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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 http://www.yourdentalhealth.ca/Assets/Oral%20Inspection%20Tips%20for%20Caregivers%20(Seniors)_YDH.pdf -
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This Power Point presentation discusses the common oral health problems in palliative care and treatment options.
Halton Region. (2012). Palliative care: Managing oral care at life’s end stages. [Power Point slides]. Retrieved from http://www.halton.ca/cms/one.aspx?portalId=8310&pageId=29689. Copyright Halton Region. Website www.halton.ca.
Follow these steps to access the resources on the website - Halton Region » Living in Halton » Parents, Youth & Seniors » Seniors » Oral Health for Seniors
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This 25-minute YouTube video is Part 1 of the RNAO Long-Term Care Best Practices Program - Oral Health Assessment Series (3 parts). It discusses available oral assessment tools and demonstrates a method for performing an oral assessment. Pictures of variations of normal findings, how to check denture fit and challenges in oral care are presented.
MacDonald, I. & Peachman-Faust, T. (2015). Part 1 - How to perform an oral assessment in long-term care: The normal mouth. [Video file]. Retrieved from https://www.youtube.com/watch?v=sgFlgumtbJE -
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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 pocket guide was developed by the National Initiative for the Care of the Elderly (NICE). It describes the signs and symptoms of periodontal disease and gives practical tips on how to provide oral care for people with dementia.
National Initiative for the Care of the Elderly. (2012). Periodontal disease and older adults. Retrieved from http://www.nicenet.ca/files/U_of_T_Nice_193448_Expert_Dental_Tool-4.pdf -
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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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The South Australia Health website provides information on a variety of clinical topics including Oral Health for Older People. It is an in-depth toolkit aimed at improving oral care in residential care (long term care). Resources include brochures on caring for natural teeth, caring for dentures and partials, dental care for people with diabetes and oral assessment.
Government of South Australia (n.d.). South Australia Health – Oral Health for Older People. Retrieved from http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/oral+health+care+for+older+people/oral+health+care+for+older+people Source: Government of South Australia © 2012 SA Health
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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.