May 11th 2015

1. LTC SMILES:
T H E J O U R N E Y O F
I M P L E M E N T I N G A N
O R A L H E A L T H P R O G R A M A T
P A R K R I D G E C E N T R E

2. The Journey Begins
2010 – Meeting at the Willows, Saskatoon

3. 2011 – Yearly treatments

4. Oral Health in Orientation to New Staff
Oral Health Education given to Existing
Staff

5. Oral Health Concerns in LTC:
Residents may have:
• Decreased saliva due to medications (dry
mouth)
• Medications given with sweet sticky substances
(Jam, jelled juice, applesauce , pudding )
• Few raw fruits and vegetables (self-cleansing)
• Lack of proper daily mouth care
• Cognitive issues that prevent entry into their
mouths

6. How does poor oral health happen?
Plaque (bacteria) builds up in the mouth on teeth, gums,
cheeks and tongue.
Approximately 40% of the tooth surface is “hidden”
between the teeth, and can’t be reached by a toothbrush.
Plaque is a thin sticky layer that can be brushed and flossed
away. Plaque is full of hundreds of types of bacteria.
When plaque hardens it becomes “tartar”. Tartar can form deep below the
gum line. Tartar needs to be removed by professional dental cleaning at
least once yearly. Brush at the gum line.

7. C O M PA R E

8. “ L O N G I N T H E TO O T H ”
Receding
gums
Tartar
Thinning
enamel
Tooth
decay

9. NOV 2012
WHY
RE-INVENT
THE WHEEL?

10. The oral health kit is based on the model used @ Deer Lodge Centre in Winnipeg.
Meetings with Material Management to bring products into our Stores
inventory.
EQUIPMENT

11. Oral Health Assessment Tool (OHAT)

15. ORAL HEALTH CARE
PLAN
(MIRROR CLINGS)
Dry erase
Reusable
At a glance

16. INITIAL VISIT TO PARKRIDGE
April & May 2014
 In one Parkridge Centre neighborhood, Saskatoon Health Region – Oral Health
Program dental health educators* (DHE’s) provided:
 Initial oral health assessments using the Oral Health Assessment Tool (OHAT)
 Plaque index scores for baseline data to determine an improvement or decline
in oral health
 Individualized daily oral care plans for each resident who had an OHAT
 Hands-on instruction/demonstration of how to provide daily oral care for various
residents
 Referral and follow up of oral lesions or any untreated oral conditions
 Referral to U of S DDS students for exams, complete treatment plans, hygiene,
restorative procedures, extractions and recall/follow up
.

17. E1 TEAM = OUR CHAMPIONS

19. JUNE 2014
Next Steps
 DHEs trained Clinical Nurse Educators (CNE) and one Speech
Language Pathologist (SLP) on how to perform the OHAT and daily
oral care.
 Provided hands-on demonstration of daily oral care on the
neighborhood with a variety of residents with varying dentitions
and behaviors.
 CNEs and neighborhood champions then trained Continuing Care
Aides (CCAs) on how to provide daily oral care.

20. Clinical Nurse Educators used a mannequin with teeth
and tongue to educate the staff and champions of each
NBHD

21. Tooth brushing
technique
in wheelchair
(video)
University of
Manitoba

22. 6 MONTH FOLLOW-UP VISIT
October 2014
 Residents who were assessed in April/May received their 6
month OHAT follow-up by dental health educators and the
neighborhood champions.
 Plaque indices for comparison data were completed on all
residents with natural teeth.
 Any reported lesion for follow-up/observation was re-assessed
for resolution and re-referred if resolution had not occurred.

24. 6 MONTH FOLLOW-UP VISIT
October 2014 – continued
 All individual oral care plans were updated and tooth
brushes and Perivex were replaced if required.
 Any resident who did not have a daily oral care plan on
their mirror was provided with one.
 Any toothettes or mouthwash found in resident’s oral kits
were removed.
 Any resident requiring follow-up for an oral lesion was
referred to CNE and Care Team Manager on the NBHD.

25. ONGOING IMPROVEMENTS:
Continuous adjustments are being made to policy,
processes, training and resources as required,
until everything flows well.
CNEs continued adding new neighborhoods and
training front-line staff, until daily oral care was
fully implemented at Parkridge Centre.
Each neighborhood has two or more dedicated
oral health champions depending on the number
of residents residing in each neighborhood.

26. WORK STANDARDS DEVELOPED
(BY PRC STAFF DEVELOPMENT AND SHR DENTAL
EDUCATORS)
1. Oral Care Routine Assessment:
Basic assessment process
2. Proper Oral Health in LTC:
Basic oral care for natural teeth
Basic oral care for the Edentulous resident
Oral care for a resident with dysphagia

27. PROPER ORAL HEALTH IN LTC:
WORK STANDARD
Special Considerations:
Wheelchair oral care
Lying down oral care
Oral care to Uncooperative residents
How to avoid being bitten
Good communication
Dry Mouth treatments
Appropriate and Inappropriate Foam Swab
usage
Lip Lubricant guidelines
Oral care for the unconscious resident

28. PRESENTLY AT PRC:
Oral care has now been implemented on
all NBHD’s, staff are practicing oral care
techniques. Education is ongoing.
Products have been assigned SKU numbers
and can been ordered through our SHR
Mat. Management (Stores) by the NBHD
clerks.

29. PRESENTLY AT PRC:
Staff are doing the care adequately,
consistency is a problem.
Re-assessments must be done, just in the
process of implementing this plan.
4th year Nursing Students from U of S for doing
follow-up education in Sept 2015 as part of
their health promotion practicum.

30. LESSONS LEARNED:
Patience:
Changing practice is a slow process
Have Managers and Nurses on Board:
Have a nurse (RN, RPN LPN) within the
NBHD team
Old Habits Die Hard!
Increased education and practice

32. Practice on
each other

33. LESSONS LEARNED:
Auditing/surveillance has to happen:
Check in with staff one month after initial
implementation / education.
Check kits in rooms (for mouth care only)
after one month.

35. LESSONS LEARNED:
Check resident’s teeth, communicate to staff
your findings. Takes a while to become a
habit.
Reminders:
Emphasize foam “toothettes” not for
cleaning
Post bouquets and reminders
Re-educate if needed
Have the champions report any issues

37. SMILE !