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Part 1 – How to Perform an Oral Assessment in Long-Term Care: The Normal
Mouth
Presenters: Paige Henry and Amanda Monette Algonquin College Dental Hygiene Students
Originally recorded on March 17, 2015
AcknowledgementsThis presentation was created through a partnership between the
RNAO Long-Term Care Best Practices Program (LTC BPP) Coordinators working within the Champlain and North West LHINs and the Dental Hygiene Program at Algonquin College.
Funding used to support the development of this Oral Health Assessment Series was from the LTC BPP through the Ministry of Health and Long-Term Care and from an Algonquin College Innovation Funding grant.
The following dental hygiene students: Paige Henry, Brieanna Duffy, Yingke Zhang, Kelci Cape, Amanda Monette and Ashley Hartin developed this presentation as part of DEN4466 - Community Health Outreach, with support and direction from Professor Tonia Peachman-Faust, and LTC BP Coordinators - Heather Woodbeck and Ibo MacDonald.
We would like to recognize Angela Nuelle, Full Time Faculty in the Dental Hygiene Program at Algonquin College for her leadership and coordination of this Oral Care Partnership 2
Objectives• To demonstrate an approach to oral
health status assessment in residents
• To illustrate normal changes in oral health status associated with aging
Required equipment: Gloves and a maskTongue depressor• Helps to control the tongue
Gauze• Helps with holding the tongue (when able)• May be used to remove debris
Light source
Optional equipment: Hand-held disposable oral mirror• Helps to effectively examine tissues/teeth at the back of the mouth
Head lamp
Oral Health Status Assessment
During the Exam• Introduce yourself • Explain what you’re going to do• Get resident’s consent• Seek feedback continuously • Monitor for body language, visual and verbal cues• Stop if the resident no longer cooperates
Oral Health Status Assessment Video
Image: Canterino and Katsman Dentistry
Image: Soda Head
Image: Mead Family Dental
Debris Is NOT normal and must be removed. It is important to recognize the many variations:
Plaque - bacterial debris in the mouth - it can be seen on all oral tissues.
Food debris – seen in between teeth
**Both of these should be removed daily by brushing**
Calculus is hardened plaque build-up which can only be removed during a dental visit
- it appears chalky white, stained brown, or grey/black.
Examples:
Image: Oral Care
Debris (cont’d)
Image: Oral Care
Image: Oral Care
Image: EPPLEY Plastic Surgery
Image: DermNet NZ
LipsNormal age related changes:• More wrinkles• Thinner lips
At rest, lips should be touchingFailure to close may cause
dry mouth May be moist, dry, or cracked Lesions associated with aging
Although frequently benign, these findings should be recorded and monitored for changes
Image: MedicineNet.com
Image: Smiles By Design
Image: Smiles By Design
Image: Mouths Matter
Image: NYC dentist
Image: Sarkissiandds
Image: South Charlotte Dentistry
TeethNormal age related changes: Generally even in color
but different shades of white/yellow- Staining is normal
Recession or seeing exposed root surfaces
Missing teeth/no teeth Teeth may be straight,
appear crowded, tilted, or rotated
Heavily restored teeth – i.e. fillings
Signs of wear (attrition)
Image: Easy Notecards (Chapter 7 Flashcards)
Gums (gingiva)
Image: Oral Health Patient Information, Gum Disease
Normal age related changes:
Pink, firm, moistIdeally pointed to fill
interdental spacesOften blunted and/or cratered (missing) in an aged mouth Variation of normal:
Pigmentation Image: Oral Health Buzz
Image: National Institute of Dental and Craniofacial Research
Linea Alba
Tissue trauma
Canker sores
Variations of normal
If any lesion remains after 2 weeks it must be looked at by a physician or dentist
Normal: Pink and moist
Oral Tissues
Image:Maher Dental Specialty Clinic
Image: Study Blue
Image: StarBrite Dental
o .
TongueNormal:
Pink in colour and covered with different sized taste buds
Image: Introduction to Preliminary Diagnosis of Oral Lesions
Image: Maria Tigner – Introduction to preliminary Diagnosis of Oral Lesions
Coated Tongueo Results from debris,
bacteria and dead cells getting caught between the taste buds
Geographic Tongueo Red patches with white
borders o Exacerbated by stressFissured Tongueo Deep fissures or grooves
on the top of the tongue
Tongue – Variations of Normal
Images: Maria Tigner - Introduction to Preliminary Diagnosis of Oral Lesions
Images: Maria Tigner - Introduction to Preliminary Diagnosis of Oral Lesions
Must note:• Presence/amount of saliva – light, medium,
abundant • Consistency of saliva – on a continuum from watery
to thick*The ideal finding is medium - abundant,
watery saliva*
Saliva
Image: WikiHow
Abundant & watery
Image: Indian Journal of Palliative Care
Light & thick
Challenges to Oral Exam
• Resident won’t open mouth - try stroking the cheek• Prioritize- Do as much as you can, - Focus should be on RAI-MDS section L
- Debris present in mouth prior to going to bed at night
- Has dentures or removable bridges- Some or all natural teeth lost – does not have or
does not use dentures or partial plates- Broken, loose, or carious teeth- Inflamed gums, swollen or bleeding gums,
oral abscesses, ulcers or rashes
Bruch, J., & Treister, N. (2010). Clinical oral medicine and pathology. New York: Humana Press Canterino and Katsman Dentistry. [on-line image]. Retrieved February 18, 2015, from www.jacantennodds.comDermNet NZ. [on-line image]. Retrieved February 18th, 2015 from http://www.dermnetnz.org/lesions/labial-melanosis.htmlEasy Notecards (Print Chapter 7 Pictures flashcards). [on-line image]. Retrieved March 16, 2015, from http://www.easynotecards.com/print_list/6167EPPLEY Plastic Surgery. [on-line image]. Retrieved February 18th, 2015 from http://www.exploreplasticsurgery.com/tag/lip-wrinkles/Ibsen, O., & Andersen Phelan, J. (2014). Oral pathology for the dental hygienist (6th ed.). St. Louis: Saunders Elsevier.Indian Journal of Palliative Care. [on-line image]. Retrieved February 18th, 2015 from http://www.jpalliativecare.com/article.asp?issn=0973-1075;year=2010;volume=16;issue=2;spage=74;epage=78;aulast=MolJohnson, T. (2014, October 29). Yeast Infections (Candidiasis) in Men and Women. Retrieved February 11, 2015 from http://www.webmd.com/skin-problems-and-treatments/guide/candidiasis-yeast-infectionKummer, A. (n.d.). The ASHA Leader. Retrieved February 24, 2015 from http://www.asha.org/publications/leader/2005/051227a.htm Madden, R. (n.d.). Tra-oral Examination: Intra-oral Examination: Normal Anatomy Normal Anatomy. Retrieved February 24, 2015 from http://student.ahc.umn.edu/dental/2012/5121/PEI-Intraoral_anat_2009.pdfMaher Dental Specialty Clinic [on-line image] Retrieved March 15, 2015, from http://dentistrajkot.com.Mead Family Dental [on-line image]. Retrieved February 18, 2015, from http://meadfamilydental.com/2011/11/plaque-vs-biofilm- and-the-research-that-could-change-dentistry-as-we-know-it/MedicineNet. [on-line image]. Retrieved March 14th, 2015 from http://www.medicinenet.com/image-collection/venous_lakes_picture/picture.htmMouths Matter [on-line image] retrieved on March 03, 2015 from http://www.mouthmattersbook.com/mrsdalloway/wp- content/gallery/book-images/gum_recession.jpgNational Institute of Dental and Craniofacial Research. [on-line image]. Retrieved March 15, 2015, from http://www.nidcr.nih.gov.Neild-Gehrig, J.S. (2010). Oral Examination. Patient Assessment Tutorials: A step-by-step guide for the dental hygienist (2nd ed., pp. 465- 473). Philadelphia, PA: Lippincott, Williams, & Wilkins NYC Dentist [on-line image] retrieved on March 03, 2015 from http://www.nycdentist.com/blog/2008/12/page/2/Oral Care. [on-line image]. Retrieved February 18th, 2015 from www.oralcare.comOral Health Buzz. [on-line image]. Retrieved March 16, 2015, from http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/ColgateNewandNow/Personal/2013/April/article/SW
-281474979063347.cvspOral Health Patient Information | Gum Disease. [on-line image]. Retrieved March 16, 2015, from http://www.mypil.net/gumdisease.htm
References
Sarkissiandds [on-line image] retrieved on March 03, 2015 from http://sarkissiandds.com/articles/amalgam/7-galvanism-3.jpgSmiles By Design [on-line image] retrieved on March 03, 2015 from http://www.smilesbd.com/SmileGallery.htmlSoda Head. [on-line image]. Retrieved February 18, 2015 from www.sodahead.comSouth Charlotte Dentisry [On-line Image] Retrieved on March 03, 2015 from http://south-charlotte-dentistry.com/wp- content/uploads/2011/05/ground-teeth2.jpg StarBrite Dental. [on-line image]. Retrieved March 15, 2015, from http://eastbaydentist.com.Study Blue. [on-line image]. Retrieved March 15, 2015, from https://www.studyblue.com.Tigner, M. (Fall, 2013). Introduction to preliminary diagnosis of oral lesions [Powerpoint presentation slides]. Retrieved from https://blackboard.algonquincollege.com/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_179912_1%26url%3DWikiHow. [on-line image]. Retrieved on February 18th, 2015 from http://www.wikihow.com/Blow-Saliva-BubblesWilkins, E. M. (2013). Extraoral and intraoral examination. Clinical Practice of the Dental Hygienist E4(11th ed., pp. 146-149). Philadelphia, PA: Lippincott, Williams, & Wilkins Wyatt Jr., A. (2014, June 23). Bad Breath Causes, Treatments, and Prevention. Retrieved February 11, 2015 from
http://www.webmd.com/oral-health/guide/bad-breath
References (cont’d)