Poor oral health is associated with malnutrition, dehydration, brain abscesses, valvular heart disease, joint infections, cardiovascular disease, pneumonia, aspiration pneumonia, and poor glycemic control in type I and II diabetes.  Oral health also affects nutritional status, ability to speak, self-esteem, mental wellness, and overall well-being.  Many oral diseases are not part of the natural aging process but side effects of medical treatment and medications.

ORAL HEALTHCARE IN AGING

Nursing Standard of Practice Protocol: Providing Oral Health Care to Older Adults

Updated July 2012

Linda J. O’Connor

Reprinted with permission from Springer Publishing Company. Evidence-Based Geriatric Nursing Protocols for Best Practice, 4th Edition, © Springer Publishing Company, LLC. These protocols were revised and tested in NICHE hospitals. The text is available here.

I. Overview: The promotion of oral health through good oral hygiene is an essential of nursing care. The RN or designee provides regular oral care for functionally dependent and cognitively impaired older adults.

II. Background

A. Oral hygiene is directly linked with systemic infections, cardiac disease, CVA, acute MI, glucose control in diabetes, nutritional intake, comfort, ability to speak, and a patient’s self-esteem and overall well-being.

B. Definitions

1. Oral: refers to the mouth (natural teeth, gingival and supporting tissues, hard and soft palate, mucosal lining of the mouth and throat, tongue, salivary glands, chewing muscles, upper and lower jaw, lips).

2. Oral cavity: includes cheeks, hard and soft palate.

3. Oral hygiene: the prevention of plaque-related disease, the destruction of plaque through the mechanical action of tooth brushing and flossing or use of other oral hygiene aides.

4. Edentulous: natural teeth removed.

III. Patient Assessment

A. An RN conducts an oral assessment/evaluation on admission and every shift.

A nurse assesses the condition of:

1. The oral cavity (lips, oral mucosa, and tongue): The oral cavity should be pink, moist, and intact.

2. The presence or absence of natural teeth and/or dentures: Natural teeth should be intact and dentures (partial or full) should fit comfortably and not be moving when the older adult is speaking.

3. Ability to function with or without natural teeth and/or dentures.

4. Patient’s ability to speak, chew, and swallow.

5. Any abnormal findings, such as dryness, swelling, sores, ulcers, bleeding, white patches, broken or decayed teeth, halitosis, ill-fitting dentures, difficulty swallowing, signs of aspiration, and pain are documented by the nurse and the health care team is informed.

B. Assessment Tool: The Oral Health Assessment Tool (OHAT). See the Resources for information about this tool.

IV. Nursing-Care Strategies

A. Oral Hygiene Plan of Care: Dependent Mouth Care of the Edentulous Patient

1. Oral care is provided during morning care, evening care, and PRN.

2. Wash hands and don gloves.

3. Remove dentures.

4. Brush dentures with toothbrush/toothpaste using up and down motion.

5. Clean the grooved area, which fits against the gum with the toothbrush. Rinse with cool water.

6. Brush the patient’s tongue.

7. Reinsert dentures.

8. Apply lip moisturizer.

B. Dependent Mouth Care: Patient with Teeth or Partial Dentures

1. Oral care is provided during morning care, evening care, and PRN.

2. Wash hands and don gloves.

3. Place soft toothbrush at an angle against the gum line. Gently brush teeth in an up and down motion with short strokes using the toothbrush.

4. Brush the patient’s tongue.

5. Apply lip moisturizer.

For partial dentures, follow procedure for full denture cleaning and insertion.

C. Assisted/Supervised Care

1. Oral care is provided during morning care, evening care, and PRN.

2. Assess what a patient can do and provide assistance as needed.

3. Set up necessary items.

V. Evaluation of Expected Outcomes

A. Patient

1. Will receive oral hygiene a minimum of once every 8 hours while in the acute-care, long-term-care, or home setting.

2. Patients and families will be referred to dental services for follow-up treatment.

3. Patients and families will be educated on the importance of good oral hygiene and follow-up dental services.

B. Professional Caregiver/RN will:

1. Conduct an assessment/evaluation of the oral cavity on admission and every shift.

2. Notify the physician and dentist of any abnormalities present in the oral cavity.

3. Assess what each a patient can do independently.

4. Observe aspiration precautions while providing care.

5. Provide oral care and dental care education to patients and families.

C. Institution

1. Will provide access to dental services as appropriate.

2. Will provide ongoing education to health care providers.

3. Will provide a yearly oral health and dental care in-service to health care providers.

Journal Articles

Coleman, P. (2002). Improving oral health care for the frail elderly: A review of widespread problems and best practices. Geriatric Nursing, 23(4), 189-199.

Coleman, P. (2005). Opportunities for nursing-dental collaboration: addressing oral health needs among the elderly. Nursing Outlook, 53(1), 33-45.

Fowler, E.B. (2001). Peridontal disease and its association with systemic disease.MilitaryMedicine, 166(1), 85-89.

Rawlins, C. & Coupland, J. (2001). Effective mouth care for seriously ill patients.Profession l Nurse, 16(4), 1025-1028.

Scannapieco, F.A. (1999). Role of bacteria in respiratory infection. Journal of Periodontology,70(7), 793-802.

Schwartz, M. (2000). The oral health of the long-term care patient. Annals of Long-Term Care, 8(12), 41-46.

Ship, J. (2002). Improving oral health in older people. JAGS, 50, 1454-55.

Ship, J.A., Pillemer, S.R. & Baum, B.J. (2002). Xerostomia and the geriatric patient. JAGS,50(3), 535-543.

Taylor, G.W., Loesche, W.J., & Terpenning, M.S. (2000). Impact of oral diseases on systemic health in the elderly: diabetes mellitus and aspiration pneumonia.Journal of PublicHealth Dentistry, 60(4), 313-320.

U.S. Department of Health and Human Services. (2000). Oral Health in America: A report ofThe Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health.

Walton, J., Miler, J. & Tordeala, L. (2001). Elder oral assessment and care.MedSurg Nursing, 10(1), 31-44.

Last updated - September 2005