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Mouth Care Matters

Mouth Care Matters Mouth Care Matters A guide for hospital healthcare professionals Developing people for health and healthcare Version control Version: V12. Date ratified: 11 November 2016 . Name and title of author Mili Doshi, Consultant in special care dentistry Date issued 11 November 2016 . Review date November 2017. 2016 Mouth Care Matters Contents A guide for health care professionals 1 Introduction 6 7 Dental decay (caries) 30. What is Mouth Care Matters in hospitals? 7 What is dental decay (caries)? 31. The Mouth Care Matters training programme 8 Signs of dental decay 31. Who is Mouth Care Matters training for? 8 Symptoms of dental decay 31. Mouth Care Matters team 8 Causes of dental decay 31. Prevention of dental decay 32. 2 Why do we need Mouth Care Matters training? 10 Management of dental decay in hospitalised patients 32.

Date ratified: 11 November 2016 Name and title of author Mili Doshi, Consultant in special care dentistry Date issued 11 November 2016 Review date November 2017 ... Occupational therapists (OT) Helping to advise and/or create aids for toothbrushes for patients with physical disabilities

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1 Mouth Care Matters Mouth Care Matters A guide for hospital healthcare professionals Developing people for health and healthcare Version control Version: V12. Date ratified: 11 November 2016 . Name and title of author Mili Doshi, Consultant in special care dentistry Date issued 11 November 2016 . Review date November 2017. 2016 Mouth Care Matters Contents A guide for health care professionals 1 Introduction 6 7 Dental decay (caries) 30. What is Mouth Care Matters in hospitals? 7 What is dental decay (caries)? 31. The Mouth Care Matters training programme 8 Signs of dental decay 31. Who is Mouth Care Matters training for? 8 Symptoms of dental decay 31. Mouth Care Matters team 8 Causes of dental decay 31. Prevention of dental decay 32. 2 Why do we need Mouth Care Matters training? 10 Management of dental decay in hospitalised patients 32.

2 What is the impact of hospitalisation on oral health? 11 8 Diet and oral health 33. We are a changing population 11 Effects of sugar in teeth 34. Our mouths are changing 11 Safe snacks 34. We are taking more medication 11 Sugar and medication 34. What are the barriers to providing good Mouth 9 Fluoride 35. care in hospitals? 11. What is fluoride? 36. References 12. How does fluoride work? 36. 3 Why is oral health important for How much fluoride is enough? 36. hospitalised patients? 14. References 36. Definition of oral health 15. Oral hygiene and oral health 15. 10 Tooth surface loss 37. What is tooth surface loss? 38. References 15. Signs of tooth surface loss 38. 4 Oral health and general health 17. Symptoms of tooth surface loss 38. Oral health links to systemic disease 18. Tooth erosion 38. Hospital-acquired infections linked Management of tooth erosion in hospitalised to poor oral hygiene 19.

3 Patients 38. Links to general health and Tooth abrasion 39. systemic disease 19. Management of tooth abrasion in hospitalised References 19. patients 39. 5 A healthy Mouth 21 Tooth attrition 40. Why Mouth Care Matters ' and not Management of tooth attrition in hospitalised Dental Care Matters '? 22 patients 40. What does a healthy Mouth look like? 22. 11 Periodontal (gum) disease 41. What could an unhealthy Mouth look like? 23. Definition of periodontal (gum) disease 42. When to seek medical/dental advice 24. Causes of gum disease 43. References 24. Signs of gum disease 43. 6 Dry Mouth (xerostomia) 25 Symptoms of gum disease 43. What is a dry Mouth ? 26 Management of gum disease in hospital . 43. What are the functions of saliva? 26. 12 Oral thrush (candida/fungal infection) 44. What are the signs and symptoms of What is oral thrush?

4 45. a dry Mouth ? 26. Causes of oral thrush 45. What are the causes of a dry Mouth ? 26. Signs of oral thrush 45. What is the impact of a dry Mouth on hospitalised patients? 26 Symptoms of oral thrush 45. Prevention 27 Management of oral thrush in hospitalised patients 46. Management of a dry Mouth for hospitalised patients 27 Antifungal medication 46. Saliva substitutes/moisturising agents 28 References 46. Mouth audit at East Surrey Hospital 29. References 29. Contents 13 Angular cheilitis 47 19 Having the right tools' for Mouth care What is angular cheilitis? 48 and assessment on the wards 67. Causes of angular cheilitis 48 Pen torches 68. Signs of angular cheilitis 48 Toothbrushes 68. Symptoms of angular cheilitis 48 Toothpastes 70. Management of angular cheilitis in hospital Foam swabs 70. patients 48 Finger guard 72.

5 14 Mouth ulcers 49 Prescribed/on the advice of a dentist/doctor 72. What is a Mouth ulcer? 50 References 72. Causes of Mouth ulcers 50 20 Recording Mouth care for hospitalised Signs of a Mouth ulcer 50 patients The Mouth Care Pack 73. Symptoms of a Mouth ulcer 50 Why do we need to record Mouth care? . 74. Management of Mouth ulcers in hospital . 51 The tool - Mouth Care Pack 74. Guide for completing the Mouth 15 Excessive drooling 53. Care Pack 74. Why do some patients drool? 54. Completing the Mouth care screening sheet 75. Signs of drooling 54. Notes on the Mouth care screening sheet . 75. Symptoms of drooling 54. Level of support 75. Management of drooling in Mouth care assessment (middle pages of the hospitalised patients 54. Mouth care pack) 77. 16 Mucositis 55 Daily recording sheet 79. What is mucositis? 56 References 79.

6 Signs of mucositis 56. 21 Assisting patients with Mouth care 81. Symptoms of mucositis 56. How to distinguish between independent and Management of mucositis in dependent patients? 82. hospitalised patients 56. Different types of assistance 82. 17 Oral cancer 57 Cross infection control 83. What is oral cancer? 58 Key messages in steps 84. What are the signs and symptoms of 22 Denture care 85. oral cancer? 58. Changes in denture demographics 86. Management of suspected oral cancer in hospital 58 Types of dentures 86. Importance of denture hygiene 87. 18 Patients with increased oral health risk factors 59 Denture fixative 87. Why are some patients more at risk from Mouth Removing and replacing dentures in the Mouth 87. care problems? 60 Lost dentures 87. Signs of Mouth related problems in vulnerable Cleaning dentures 88.

7 Patients 60 The denture sunflower 90. Dementia and oral health 60. 23 Dental referrals 91. Mental Capacity Act 61. Urgent and non-urgent referrals 92. Learning disabilities and oral health 62. Mental health conditions and oral health . 62 24 Drugs that cause dry Mouth (xerostomia) 93. Intensive care ventilated patients and oral health 62 25 MOUTHS 95. Head and neck cancer treatment and What is MOUTHS? 96. oral health 63. 26 Contact 97. Stroke, dysphagia and oral health 63. Physical disability and oral health 63. End of life care and oral health 64. References 64. 1 Introduction Key messages MCM is a training initiative to improve the oral health of hospitalised patients MCM training comes in various formats MCM training is not just for nurses but a range of health care professionals Introduction What is Mouth Care Matters in hospitals?

8 Observations of Mouth care being carried out on patients on the wards. Mouth Care Matters (MCM) is a training initiative aimed at improving the oral health (health of the Mouth ) of Mouth Care Matters is based on four key themes, hospital hospitalised adult patients in Kent, Surrey and Sussex. staff require the: This guide complements the Mouth Care Matters Knowledge of the importance of Mouth care and training that is currently being delivered in hospitals. The good oral health and the links to general health information to the best of our knowledge, is up-to-date and well-being and evidence-based. The programme was developed and piloted at East Surrey Skills gained through training on how to carry out Hospital, an acute hospital with approximately 650 beds. Mouth care and assessment of the Mouth From a comprehensive review of the current literature, we Tools' needed to provide good Mouth care believe the findings at East Surrey Hospital, with regards to Mouth care, are representative of hospitals up and down Support when necessary from doctors/dentists/.

9 The country. For this reason this guide includes findings Mouth care team from focus groups, clinical audits, patient cases and direct About Mouth Care Matters ' posters Poster to help identify a healthy & unhealthy Mouth 7. A guide for health care professionals The Mouth Care Matters training Mouth Care Matters team programme As part of the Mouth Care Matters training programme, Factoring in time for additional training for busy health Surrey and Sussex Health Care Trust recruited a Mouth care care professionals can be difficult, therefore MCM training team. This team is responsible for: comes in various formats and includes: Ward-based training Small group classroom teaching sessions Classroom training Ward-based, hands-on training Supporting staff and carers with Mouth care in challenging situations Sessions tailored to specific groups, for example the speech and language team, palliative care, Liaising when urgent dental referrals are needed chemotherapy, oncology, doctors, dieticians and during an inpatient stay pharmaceutical team Signposting patients to appropriate dental services on discharge E-Learning Supporting the hospital with Mouth care policies MCM guide and audit MCM resources (posters, newsletters etc.)

10 Mouth Care Matter promotional and social media work MCM website Mouth Care Matters supports the need for every hospital to have a dedicated Mouth care lead. Who is Mouth Care Matters training for? MCM is not only about training the nursing staff in a hospital; oral health promotion is also important for other health care professionals involved in the care of hospitalised patients including doctors, speech and language therapists, dieticians, occupational therapists and pharmacists. Working together we can form a more holistic approach to patient care, including Mouth care. Roles of health care professionals in Mouth care Health Care Professional Roles in Mouth care and oral health may include: Doctors Diagnosing and prescribing for oral conditions such as ulcers and oral thrush Nursing staff Carrying out Mouth care assessments and assisting or providing Mouth care Speech and language therapist (SALT) Providing Mouth care advice for high risk dysphagia patients Dietetics team Nutritional advice taking into account oral health Occupational therapists (OT) Helping to advise and/or create aids for toothbrushes for patients with physical disabilities Pharmacists Advising patients/carers on drug related oral problems including dry Mouth Physiotherapists Role can involve looking in the Mouth and make other teams aware of poor oral conditions 8.


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