Dental Hygiene Program for Long-term Geri Psychiatry

Kathy Lehmann, BSN, BA, MEd. Boston VA Health Care System Presented at 25th APNA Conf. at Anaheim, CA October 20-21, 2011

Periodontal Disease

Some Startling Statistics

http://dentalwellness4u.com/dentaldisease/

90% suffers from some form of this disease.

30-50% has periodontal disease, the most destructive form of dental disease.

> 20 diseases whose early signs & symptoms show up first in mouth & adjacent tissue.

Increased levels of oral bacteria & carcinogens

Edentulous participants consumed fewer vegetables, less fiber & carotene & consumed

more cholesterol, saturated fat & calories than participants with 25 or more teeth.

Weakened immune system makes it more difficult to prevent & treat gum disease. This

creates a Catch-22 situation, where gum disease weakens the immune system, making

the body more vulnerable to infections & diseases, further weakening the immune

system & ultimately making it more difficult to treat gum disease. Whew!

If you have low bone density, or osteoporosis, you're at an 86% greater risk of having

gum disease, which is the major cause of tooth loss in those over 35.

Infection found in moderate to advanced gum disease involves numerous & very toxic

bacteria which have constant & direct access to blood stream & indirectly the lungs.

This allows access to blood & lungs 24/7 as long as infection is present.

Improving Smiles ~ Adding Smiles

Prochaska’s Stages of Change

Contemplation Stage

Research Issues

Interdisciplinary Team

MD/RNP approval

Teach staff

Identify supplies

Documentation Template

Establish dental cart

Teach patients

3-tier program:

Brush, Mouthwash, Floss

Weekly certificates

Hygienist visits scheduled

Who Do We Want to Help Change?

Males, age 45 - 65

Chronic institutionalization

Schizophrenic & Bipolar

Dental Health

Dentulous –w& w/o caries

Partial/Full Edentulous

Dentures

All had Risk Factors

Variable Teachability

Majority Motivated

Risks of Oral Disease

Diabetes

Digestive Disorders

Heart Disease

Osteoporosis

Respiratory Disease

Stroke

Severely stress the immune system?

Lower resistance to other infections?

Increase the severity of diabetes?

Contribute to respiratory disease?

Interfere with proper digestion?

Actually reduce life expectancy?

Preparation Stage

Reference poster – brush 6“ daily

House toothpaste & mouthwash

Dental care after each meal

Staff assess & reinforce teaching

Staff monitor supplies

Staff document participation

Action Stage

Add brand-name toothbrushes

Add prescribed GC MI Paste Plus

Add prescribed Peridex Oral Rinse

Coordinate with meals & meds

Staff member assigned to task

All three shifts

Maintenance Stage

Add use of staff-donated

battery-operated toothbrushes

Add Theramints 3x a day

Reinforce flossing

Patient Responses

Refuse

Brush excessively

Eat toothpaste/drink mouthwash

“Brush on my own” (not always true)

Non-compliance r/t psychiatric disease

Seek staff for dental care

Improved gum disease scores !!

Working to Prevent Relapse