As part of Parkinson’s Awareness week we wanted to share with you how, by using our empathy for a gentleman living with advanced Parkinson’s, and our knowledge of the condition, we were able to gain a good understanding of his needs and advise on and recommend specialist oral care product solutions for him.
This has proved to be life changing for Mr A and has led to a more loving and fulfilling relationship with his wife. J
‘All I want is to be able to feel that my mouth is fresh and clean every day’
This is what Mr A told me when I first met him and asked him how I could help improve his oral care.
I was genuinely moved by his simple wish, and it made me realise that this was something that I completely took for granted – I would never dream of leaving the house without feeling that my teeth are squeaky clean and my breath sweet.
And it also made me absolutely determined to do everything within my power to help make Mr A’s wishes happen.
Background to oral care case study
We were asked to conduct a trial with Mr A living in a care home in Leicester with Advanced Parkinson’s Disease. I had met one of his nurses at a workshop where I had been giving a presentation ‘How to brush up on oral care in care homes’ and the nurse had approached me afterwards for help as they were at a loss as to how to improve this gentleman’s oral care.
Mr A had no swallow reflex was on a peg feed and was nil by mouth. His mouth care was described as very poor by staff, as he wasn’t able to open his mouth very well. Therefore access to his mouth to deliver effective oral care was limited. Added to this the staff were frightened of the possibility of Mr A swallowing or aspirating on the oral care products which were in use.
Mr A had severe halitosis and a substantial build up of debris on his tongue as a result of intermittent cleaning results. He had his own teeth and didn’t have any particular issues with these at the time of the trial.
The oral care regime that was in place when I first met Mr A:
Mr A’s oral care plan stated brushing twice a day with a normal toothbrush (large head) and standard toothpaste. This was only happening intermittently due to the staff’s lack of confidence in the products provided and the risk of aspiration. Also, despite Mr A’s halitosis, staff would not use a mouthwash for additional fear of aspiration.
What we recommended and why:
We know that a toothbrush used properly is the only tool that will successfully remove bacterial plaque from the teeth and mouth.
For tooth brushing - we advised on using our Tepe Special Care Compact Toothbrush as it is very gentle with a small head which is less invasive and more effective at reaching all parts of the mouth. This soft toothbrush was perfect for Mr A as it is recommended for people with swelling and difficulty opening their mouths and its sturdy, ergonomically designed handle provides a comfortable and secure grip. It can also easily be angled for better access to all areas of the mouth.
Toothpaste – As Mr A was at risk of aspiration we recommended our Oralieve Mild Mint SLS free Non Foaming Toothpaste. Sodium Lauryl Sulphate (SLS) is the ingredient added to many toothpastes that makes them foam. This can have a drying effect on the oral tissues and therefore should be avoided in people who already have a dry mouth. Similarly, for those patients at risk of aspirating, an SLS free toothpaste could also be beneficial so as to reduce this risk as far as possible.
Providing dry mouth care - As Mr A had a significant build up of dried secretions in his mouth and particularly on his tongue, we recommended the use of Oralieve Moisturising Dry Mouth Gel to be massaged into all areas of the mouth (cheeks, palate, tongue) coupled with the Moutheze oral cleanser. Dry mouth moisturising products provide long lasting relief for a severe dry mouth and can be used to soften dried secretions so that they can be removed more readily. Dry mouth gel can be mixed with a couple of drops of water to make it more palatable to patients.
Mouth Cleansing - We recommended Moutheze oral cleansers for Mr A to help clean the soft tissues of his mouth and remove food debris and tenacious dried saliva. Moutheze provide gentle mouth cleansing without the choke or aspirating hazard of sponge swabs or the awkwardness of toothbrushes.
What happened clinically?
The introduction of the soft headed toothbrush with angled head and the SLS free non foaming toothpaste, resulted in the staff being able to deliver regular mouth care. They could now do this with confidence that the risk of aspiration was minimal and being able to access all areas of Mr A’s mouth for cleaning, easily and thoroughly.
The use of dry mouth gel and the Moutheze enabled the staff over a period of time to work on reducing the build up and to restore Mr A’s tongue to a pink and healthy state. The nurses commented that the dry mouth gel had proved really successful for lubricating Mr A’s dry lips and mouth and his mouth area was cleaner with less coating.
The carers found that Mr A’s breath was much fresher and he was communicating more as his mouth was not so dry.
What happened socially?
I went to visit Mr A a month later and hardly recognised the person that stood before me, to the man I first met. He was smiling, confident and was socialising much more as a result of using our products, and he told me that his mouth felt much fresher and cleaner and that it didn’t feel so dry.
Mr A’s wife visited him every day and she found that his breath seemed much fresher especially when talking and he no longer had any signs of the bad breath he had been experiencing in the past. As a couple they were now able to be much more physically close than previously and were enjoying kissing again as a result of his improved oral hygiene.
Mr A and I exchanged a high five and I was absolutely delighted that we had been able to help give back to Mr A his fresh feeling mouth, his confidence and more kisses with his wife.
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