Prevention at Individual and Population Level in Patients with Disabilities Flashcards
What is the purpose of having an MDT looking after the healthcare with a patient with a disability?
Encourages/facilitates the safe delivery of care
What can be done to help patients with oral care and prevention if they have disability but are capable of independent living?
Maximise existing skills
Establish routines
What can be done to help patients with oral care and prevention if they have disability and are dependent?
Engage carers
Provide appropriate education
Facilitate support
Which conditions may cause people to experience drooling?
Developmental disabilities
Cerebral palsy
Progressive neurological conditions
-> parkinsons
-> MND
What can be done to prevent drooling in patients?
- Head Positioning and Posture
- Speech and Language Therapy
- Behavioural techniques
- Medication and Surgery
What can cause dehydration, xerostomia and dysphagia in patients who are hospitalised?
oOxygen therapy
oMouth breathing
oSide-effects of medications
oReduced food and fluid intake
Which habits in patients who suffer from dysphagia can contribute to oral disease?
- Pouching
- Modification of consistency of foods and liquid- suggest swallowing issue
- Nutritional changes
- Sip Feeding- increased caries risk
- Risk of Aspiration
What is pouching, what can it cause, how can it be checked?
Keeping foods and medicines (iron tablets, alendronic acids can result in communications) in buccal sulcus
Can result in cervical and root caries
Check this to see if anything is being held- clear with gloved finger
What techniques can be helpful to aid oral care in those with dysphagia?
Get patient in upright position
Encourage patient to spit out toothpaste if they can
Use of suction toothbrush
Use of hand over hand technique
Adaptions to toothbrush handle
Using 2 toothbrushes- one to brush teeth, one to hold muscosa out of the way/mop mucous off tissues
Mouth guard/finger props
Why are foam sticks not recommended for OH in patients who have dysphagia?
Ineffective at removing plaque
Risk of aspiration and choking as the foam can become detached or be bitten off (especially if it is left soaking in liquid)
Why do patients who are PEG fed or nil by mouth still need oral hygiene?
Still need oral health care as they still get biofilm development or may still take food orally
Tissues must be kept moist
What are the issues with tasters? How can this be prevented?
Tend to be sweet (contain sugar) to help with dry mouth
Discuss with carers as this can cause caries
Knoppert tasters- non-cariogenic option
Which toothpastes may helpful for OH in patients with learning and disabilities?
Ora-nurse- unflavoured
SLS free/non-foaming- if swallowing issue
-> Sensodyne, oranurse, ultradex, biotene
How is the 2 toothbrush technique carried out?
- Thick handled rubber toothbrush
- Used between the occlusion as a prop
- Mop and Go-
Using gauze to wipe mucosa and teeth where mucus
has deposited - 2 Person approach:
-> 1 to support brushing -> 1 to support induviudal
What is open wide?
Programme for disabled people of middle age to improve oral hygiene
Broad- not specific to people with stroke, ASD etc
Aims to facilitate patients to look after their own mouths are far as possible
What are the different aspects of open wide programme?
Unit 1 – Core Oral Health Knowledge
-> educating patients about prevention, risk factors
Unit 2 – Practical Oral Care
-> OH, denture care, strategies to overcome barriers
Unit 3 – Oral Health Documentation
-> OHA, Oral care plan, daily oral care plan
What are action cards? Who are they used for?
Communication resource (similar to social stories) which explains task such as OH in steps
-> useful for people with ASD
Which adjuncts to communication can be helpful to aid consultation with patients with learning and physical disability?
Makaton
Picture boards
Letter boards
Wrist bands
Talking mats
Draw/write
Technology
How should a dentist communicate with patients who have learning and physical disability?
Smile
Be caring, calm, friendly
Speak clearly at appropriate pace
Use short sentences with certain words
Remain positive- do not show frustration
Make use of gentle touch if appropriate
What can be done to empower patients who have learning and physical disability when communicating?
Prompt
Encourage
Support
How should OH advice be given to patients with learning and physical disabilities?
Discuss at eye level with patient
Put pea sized amount on small headed toothbrush
Systematic approach
-> Outside surfaces
-> inside surfaces
-> chewing surfaces
-> mucosa
Encourage patient to spit toothpaste out (don’t rinse)
What can be done to make OH easier/more enjoyable for patient’s with learning and physical disability?
Counting and singing
Give meaning to toothbrush- Different coloured toothpaste for each segment
-> Patient associates certain parts of mouth
Timing- do at best time for patient, do at same time in same place to create routine
Make sure the lighting is adequate
Dignified environment
What head position should disabled patients with gag reflex and dysphagia be encouraged to be in when carrying out OH?
Forwards and downwards
What is the bridging technique? How can it be applied to tooth brushing for people with disabilities?
This helps to engage a person with the task through their senses and helps them to understand the task
Describe and show them the toothbrush, then mimic brushing your own teeth
Give another toothbrush to the individual. They may mirror your behaviour and brush their own teeth.
What is the chaining technique? How can it be applied to tooth brushing for people with disabilities?
This involves gently bringing the person’s hand to their mouth while describing the activity
-> The carer starts the activity and the individual finishes it
What is the hand over hand technique in brushing?
When the carer helps the patient by placing there hand over the patients and they gently brush together
What is the distraction technique? How can it be applied to tooth brushing for people with disabilities?
Distract the individual by placing a familiar item in their hand while you brush their teeth
Other distraction such as music may be helpful
What is the rescuing technique? How can it be applied to tooth brushing for people with disabilities?
If attempts are not going well, the carer can leave and a ‘rescuer’ comes in to take over
-> Bringing in someone else with a fresh approach may encourage the individual to cooperate
What can be done with patients who bite the toothbrush when the carer is trying to carry out OH with them?
Allow the person to continue biting the brush, use another toothbrush to provide oral care
What can be done with patients who thrust their tongue when the carer is trying to carry out OH?
Use a gauze square wrapped around your forefinger to gently retract or hold back the tongue or lip
How is OH carried out in tube fed individuals?
Aim to keep mucosa moist and lubricated- toothbrushing helps with this
Use non foaming toothpaste and upright position
-> prevents aspiration
What different brushes may be better tolerated by patients with learning and physical disability?
Small head
Soft/Silk brushes
Why is brushing and good oral hygiene important in terms of diet in people with physical and learning disability?
Better dentition leads to uptake of better quality more nutrient dense food
What can cause resistance to OH in patients with physical and learning disabilities?
Pain from dental source
Pain/stress from process
Stress from environment or person carrying out brushing with them
Which sensory aids can help with OH in patients with learning and physical disabilities?
- Power Suit- provides pressure sensation
- Use of sensory aid prior to brushing to de-stress and afterwards
- Desensitisation
- Counting
- Find a brush which is something they are interested in
- Warm water
- Stories or Books
What is the denture hygiene advice given to patients with learning and physical disabilities/carers?
- Dentures must be removed from the mouth at night
-> Reduces the risk of oral mucosal disease - Rinse dentures after every meal
- Clean dentures morning and night using a toothbrush and denture cream, or plain soap and water
- Do this over a filled basin or a soft surface to reduce the risk of breaking the dentures if you drop them
- Soak dentures in disinfecting solution for at least 20 minutes once a day
- Soak dentures overnight in plain water
What is positive and negative reinforcement when developing a routine?
Positive reinforcement- Refers to an increase in the rate of behaviour as a result of the presentation of a preferred event or stimulus
Negative reinforcement- refers to an increase in the rate of a behaviour as a result of the withdrawal (or prevention of occurrence) of a non-preferred stimulus or event.
What are the steps in the habit loop?
Cue/trigger
Routine- repetition
Reward
Which cues can be helpful for patients with learning and physical disabilities when completing oral care?
Time of day
Environment- associate bathroom with oral care
Person
Preceding behaviour
Objects
Which factors can be helpful when trying to facilitate behavioural change?
Supportive/stable environment
Piggyback- add new behaviour onto an already positive experience
Make it easy for patient
Use of unique personalised cues
Practice and repetition
When should an oral health assessment be carried out if patient has moved into residential care?
Within 48 hours
What is noted down in an oral health assessment?
Natural teeth
Dentures
Current oral problem list
Dental registration and attendance
Medicines and Smoking status
-> refer to dentist if required
What should be be included in the oral care plan?
Record of oral care required
Individual plan to meet the needs of each person- tailored
Highlight required support and techniques
Who completes and checks the daily oral care records?
Completed by carer each day
Checked by senior member of staff each week
-> after 4 weeks the assessment is reviewed again
What is the DisDAT?
Disability Distress Assessment Tool
-> enables distress cues to be identified
As per DisDAT what are the different features that may signify a disabled patient is distressed?
Facial appearance
Jaw movement
Eye appearance
Skin appearance
Vocal sounds/speech
Body posture
Habits/mannerisms
