Here at Hcsuk, we believe that one of the main barriers that prevent residents in care homes from receiving good and effective mouth care is a lack of availability of fit for purpose tools or products. We wanted to demonstrate that by introducing appropriate oral care products, significant improvements to peoples’ mouth care and overall health and well being can be achieved and can lead to more love and kisses to!
Background
We conducted a trial with Mr A who lives in a care home in Leicester with Advanced Parkinson’s Disease, with no swallow reflex and who is on a peg feed and is nil by mouth.
I met with Mr A to introduce myself and to ask him how we could help him, and he told me that all he wanted was to have a fresh feeling mouth, something that most of us take for granted, I’m sure.
Mr A’s mouth care was described as very poor by staff, as Mr A was not able to open his mouth very well and therefore access to his mouth to deliver effective oral care was limited, plus the staff were frightened 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
Mr A 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 met with Mr A:
Brushing twice a day with a normal toothbrush (large head) and standard toothpaste. This was intermittent due to the staff’s lack of confidence in the products and the risk of aspiration. Also, despite Mr A’s halitosis, staff would not use a mouth wash for additional fear of aspiration.
Our recommendations and rationale:
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 selected our Tepe Special Care Compact Toothbrush as it is very gentle with 12,000 extremely soft filaments and a small head which is more effective at reaching all parts of the mouth. This soft toothbrush was perfect for Mr A as it is recommended for patients with swelling and difficulty opening their mouths and its sturdy, ergonomically designed handle provides a comfortable and secure grip and can 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 residents who already have a dry mouth. Similarly, for those patients at risk of aspirating, a SLS free toothpaste could also be beneficial so as to reduce this risk as far as possible. We recommend that care homes provide non-foaming toothpastes (Sodium Lauryl Sulphate (SLS) free) for patients with a dry mouth or patients who are at risk of aspirating.
Providing dry mouth care - 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. There are different products available including gels, sprays and mouth rinses. We recommended Oralieve Moisturising Dry Mouth Gel which can be massaged into all areas of the mouth (cheeks, palate, tongue) in conjunction with an Mc3 (formerly MouthEze) oral cleanser before meals, to help with eating or before tooth brushing for very sore mouths. Dry mouth gel can be mixed with a couple of drops of water to make it more palatable to patients.
MC3 (formerly Moutheze oral cleansers) - provide gentle mouth cleansing without the choke or aspirating hazard of sponge swabs or the awkwardness of toothbrushes and also for the application of dry mouth products. We recommended this for Mr A to clean the soft tissues of his mouth and remove food debris and tenacious dried saliva.
The clinical results
The introduction of the Tepe small, soft headed toothbrush with angled head and the SLS free non foaming toothpaste, resulted in the staff being able to deliver regular mouth care 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.
As Mr A had a significant build up of dried secretions in his mouth and particularly on his tongue, the use of the dry mouth gel coupled with the MC3 (Moutheze oral cleanser) 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 has been really successful for lubricating Mr A’s dry lips and mouth and they have found the mouth area cleaner with less coating.
The carers’ have found that Mr A’s breath is much fresher and he is communicating more as his mouth is not so dry.
The social results
I went to visit Mr A a month after the trial began and he was a different person to the man I first met. He was much more confident and socialising more as a result of using the 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 visits every day and she has found that his breath seems much fresher especially when talking and he no longer has any signs of the bad breath he was suffering in the past. As a couple they are now able to be much more physically close and are kissing as a result of his improved oral hygiene.
Mr A and I exchanged a high five!
If you are interested in how you can improve oral care standards in your care home to meet the new CQC Quality Standard in oral care and demonstrates that your service is effective and responsive, we are running a course on Wednesday September 20th at Jury’s Inn, East Midlands Airport:
How to achieve CQC compliancy in oral care for adults in care homes
For more details and how to book, please visit our event page at
You can also watch the video of Jo talking about Mr A below
[embed]https://youtu.be/LCB0OBsUw0Y[/embed]
