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5.10 Oral health Issued: May 2008 Contents Good oral health means looking after the whole mouth Good oral care is important People with an intellectual disability need daily oral care and regular visits to the dentist Oral hygiene for people with swallowing problems Role of support staff How to brush someone else’s teeth How to clean dentures Annual oral health assessment Daily oral health care plan Resources Good oral health Good oral health means looking after the whole mouth including teeth, gums, means looking tongue and inside the cheeks. Even people who do not have teeth need daily oral after the whole care. mouth A person with good oral health has: • Moist lips without chapping • Pink, moist, uncoated tongue • Pink firm gums • Breath without offensive odour • Watery plentiful saliva • White unbroken teeth without cavities • No build up of food, tarter or plaque • No dental pain. Good oral care is important Good oral health is important because it can impact on a person’s: • ability to eat • physical appearance • comfort, cleanliness and wellbeing • breath, which may affect the person’s interaction with others • risk of chest infection. Aspiration pneumonia develops if food, drink or plaque from teeth is breathed into the air pipe instead of the food pipe. Poor oral hygiene can increase the risk of aspiration pneumonia in people with swallowing problems, regardless of whether they have teeth or dentures • overall health and quality of life People with an People with a disability have seven times more oral health problems than the intellectual general community. disability need It is important for staff to ensure that people have daily oral health care and daily oral care regular visits to the dentist because: and regular visits • poor or infrequent brushing results in high levels of plaque, tooth decay and to the dentist unhealthy gums • infrequent visits to the dentist reduces the opportunities for thorough dental cleaning, investigation and management. Oral hygiene for People who are fed by gastrostomy tube who do not eat or drink food by mouth people with because they are unable to swallow safely still require daily oral care. An oral swallowing hygiene plan needs to be developed in conjunction with the person’s problems dental professional so that the daily oral care does not lead to aspiration pneumonia. Discuss with the dental professional if it is appropriate to: • Use a face washer to wipe gums and remove food that has pocketed in the cheeks • Use suction toothbrushes (ask the dental professional to show staff how to do this) • Brush teeth and gums gently without toothpaste and very little fluid Role of support Support staff must ensure residents: staff • have an adequate fluid intake especially tap water • eat a healthy diet with minimal sugary drinks and confectionary • brush their teeth with fluoridated toothpaste or clean dentures at least twice a day • attend a routine dental check-up at least once a year, or as advised by the person’s dentist (see access to dental services under resource section of this practice instruction) • visit their dentist as soon as possible if dentures do not fit well. Support staff must: • complete an oral health assessment annually for each person using the form located in the resource section of this practice instruction • access appropriate medical or dental services as soon as possible if the oral health assessment indicates that mouth or teeth are in poor condition or if the person experiences dental pain • complete an individualised oral health care plan on the template included in the resource section of this practice instruction for each person to guide staff in the daily oral health care routine for each person • take both the oral health assessment form and the oral health care plan to any dental appointments and ask the dentist to review the plan. Include any additional oral health recommendations made by the dentist in the plan (e.g. use of recommended products). How to brush someone else’s Staff should assist the client to gather the following equipment teeth • Person’s toothbrush • A pea sized amount of toothpaste on the brush • Cup of fresh water • Towel • Hand basin or appropriate dish • Hand towel to be placed across client’s chest to protect clothing. Before you start oral care • Read the resident’s oral health care plan to familiarise yourself with their preferred routine • Disposable gloves should be worn by staff • Explain to the person what you are doing and show them the tools you are going to use. Let them familiarise themselves with the feel of the toothbrush on their hand or around the mouth before the routine starts • Wrap a face washer around the handle of the toothbrush Positioning • Ensure the resident is in a position that allows them to relax their mouth and jaws but also remain relatively upright • Position yourself so the resident can see you and be as close to their level as possible. Using a mirror can help both yourself and the resident • Assist the client from behind, the side or in front. This is dependent on the position of the client and the need to support and communicate with the client • Assistance is sometimes necessary to keep the head in a comfortable position Practical techniques and tips for cleaning teeth: • Force must not be used on any person who does not wish to have their teeth cleaned • If the person is resistant then introduce oral care slowly over time, starting gradually with some desensitization around the face • Remove food that has pocketed in cheeks prior to brushing with mouth swabs or a toothbrush • Ask the person to relax their lips and cheeks rather than open their mouth. The hand not holding the brush may be used to gently lift back the lips and cheeks to access the areas along the gum line of the teeth. A second brush may be used for this purpose. A bite block may be used for the client to bite on while the insides of the teeth are brushed • A cooperative client can be asked to open and close their mouth during the procedure as you move around the mouth. Having a wide open mouth throughout the whole procedure is not conducive to accessing many areas of the mouth • Introduce the brush at the corner of the mouth with mouth closed or slightly open • Work from the front of the mouth to the back, work on two teeth at a time • Gently brush all surfaces of the teeth and gums using a gentle, thorough and methodical approach • Look where you are going, and move around the mouth slowly to improve client comfort. You may need to stop at times to allow the client the opportunity to rest and relax before starting again • Cleaning the mouth includes both gums and teeth as well as food tucked under tongues or inside cheeks • Don’t avoid brushing if you see gums bleeding. Check that the bristles are soft and brush teeth and gums gently in circular movements • Excessive horizontal brushing is not recommended • Be aware of any loose teeth and brush with care • It is not necessary for the client to spit or rinse, sometimes it is better to leave the toothpaste in the mouth. Alternatively if it is safe to do so the resident can drink a glass of water following the routine. • Dry the lips and chin • Never place your fingers between the teeth of a resident Watch the 13 minute online video clip on practical oral care under the resource section of this practice instruction. Denture Care Residents who wear partial dentures are still susceptible to decay in their natural teeth so maintaining good standards of oral hygiene is still very important for denture wearers. People with full dentures still need to have their gums, tongue and mouth cleaned daily. • Dentures should be clearly and permanently labelled with the owner’s name either at the time of manufacture or to existing dentures at the person’s denture clinic • Dentures should be removed at night and cleaned to allow the mouth to rest and prevents fungal infections such as thrush. • Dentures should be stored in a labelled container of cold water in a safe but accessible place • Clean denture storage cases in warm soapy water • If the denture breaks or clasps are damaged, do not glue together or bend or modify clasps. Contact the person’s dentist Equipment • A hard denture brush • Denture toothpaste or mild soap • Do not use hot water, detergents, abrasives, bleaches, methylated sprits or antiseptics (unless instructed to do so). Before you get started • Where possible ask the client to remove their own dentures from their mouth in preparation for cleaning. • Check the person’s mouth for ulceration or ill-fitting dentures • Half fill a basin of water or place a handtowel in the basin in preparation for denture cleaning. This will prevent the denture being damaged if they are dropped. How to clean the dentures: • Clean over a hand basin half filled with water, or a soft towel • Carefully clean dentures with water, a denture brush and denture toothpaste or mild soap • Clean all surfaces of the dentures removing all plaque and food debris • Whenever possible, store dentures in a container of water overnight • To remove calculus or stains, soak plastic dentures overnight in a cup containing 1/3 cup white vinegar and 2/3 cup water • Note metal dentures should not be soaked in vinegar as they will corrode Watch the 5 minute online video clip on denture care under the resource section of this practice instruction. Annual oral Oral health assessment forms are designed to: Health • monitor the residents’ oral health assessment • evaluate oral hygiene care interventions • initiate a dental visit when required, • assist with residents’ individual oral hygiene care planning • prioritise residents’ dental needs. Staff must complete an oral health assessment form (located in the resource section of this practice instruction) for each resident in the week before the person’s annual dental review and take the completed form to the dental appointment. Daily oral health An individualised oral health care plan must be developed for each resident in care plan consultation with the resident and their family members (if appropriate), support staff and other professional staff such as the local dentist. Every client is an individual with different needs, skills, abilities and preferences therefore a ‘one size fits all approach to oral care will not be appropriate. The template for the oral health care plan is located in the resource section of this practice instruction. The oral health care plan must reflect: • Residents abilities to participate in their oral care routine e.g. what can they do for themselves and what do staff need to do to support them? • Environmental set up (including tools and products, positioning and physical set up of environment) • Timing and daily routine • Communication approaches • Specific management approaches (to overcome any behaviour and cognitive issues) Following a clearly documented care plan will help to ensure consistency when multiple carers are responsible for a resident’s oral care. It is also a valuable resource for staff to communicate strategies that have been effective in supporting an individual in their dental hygiene routine. Resources Oral health assessment and care plan to be completed for each resident (links to forms) Watch the online video clip ‘practical oral care’ (13 minute video divided into 3 sections). This video was developed for aged care residential units but the information is relevant for disability services. Section 1 includes: • managing behaviour • dry mouth • the importance of oral care Section 2 includes • practical advice • task breakdown • bridging and chaining • denture care Section 3 includes • access to dental services Watch the online video clip ‘denture care’ (5 minutes) Read the written resource: • Preparing an oral health care plan • Dental products • Access to dental services in Victoria • Impact of medications on oral health Preparing an oral health care plan Issued: May 2008 Contents Determine the person’s abilities and support needs Environment and set up Timing and routine Communication Differences in people’s behaviour during oral health activities Determine the The process of brushing teeth has been broken down into step by step instructions person’s abilities in the resource section - task breakdown. Use this to identify which parts of the and support oral hygiene routine a person can do without help and which parts of the routine needs the person requires assistance. Environment and Oral care needs to be completed in an environment where the person is as relaxed set up and comfortable as possible. Oral hygiene is usually performed in the bathroom but consider whether another room (e.g. a person’s bedroom) might work better. Try to ensure the person is in a position that allows them to relax their mouth and jaws but also remain relatively upright. If appropriate, seat the person in a comfortable chair such as their favourite lounge chair. For some people it may be important to complete oral care in a quiet and distraction free space. • Noise • Distraction (e.g. shut the door) • Lighting (avoid harsh light shining into the person’s eyes). Consider a level of lighting that is adequate for the task but has a more relaxing quality (e.g. lamp). Practical ideas • Consider introducing relaxation activities such as aromatherapy, music or massage before starting the oral health program to calm and relax the person • Put up reminders to complete oral hygiene (use photos, brushing charts) • Involve people in choosing their own type and colour of toothbrush and paste • Lay out the oral hygiene tools in an order that enhances a person’s independence • Have a portable mirror that you can set up for the person to see themselves. Timing and Consider the best times to successfully complete a person’s oral hygiene routine routine and communicate this in the person’s oral care plan. For many people, routine will be important and it will be a good idea to try to complete the oral care routine at the same time and place each day. While it is ideal to complete oral care after meals and before bed it may not always be possible to achieve this. Find a suitable time when the person is relaxed and settled and staff have the time required to assist the person with their oral hygiene. Scheduling adequate support staff time to assist with oral care is important as some people may benefit from more time including time for rest breaks. For some people, having a second assistant available will be valuable. Practical ideas • Ensure that oral hygiene is included in the person’s plan or schedule Communication Effective communication is one of the key aspects of delivering oral health care to people with a disability. Strategies to support people with complex communication needs will be documented in their individual support plans. If individuals are able to gain an understanding of the reasons behind improving oral health routines, together with the consequences of poor oral health care practices, they are more likely to change their oral hygiene behaviour. The communication of oral health messages should occur at a level of understanding appropriate to the individual. These messages should also be delivered in an appropriate manner i.e. never rushed or in an aggressive tone but rather, calmly and at a relaxed pace. A gentle style of communication, using both verbal and non-verbal cues (such as written, visual, and touch), may assist the client to relax if they are feeling anxious about the situation. Use short simple sentences to explain the importance of oral health care. Breaking down the activity into step by step instructions, directions, and demonstrations, may assist the person to feel more comfortable during the activity. Depending on the individual, repeating instructions calmly may also be of benefit. As always, effective communication is more likely if both parties feel understood, so work to develop a rapport, and always be aware of individual differences such as preferred communication style, language use, and preference for the presence or absence of conversation during the activity. Practical ideas Some helpful tips for effective communication: • Begin each conversation by using the person’s name and introducing yourself (if necessary) in a friendly manner • Use simple sentences • Avoid asking too many questions • Speak clearly and calmly • Ask one question at a time, and leave time for the answer. If needed, repeat your question in your normal voice • Stand in front of, or beside, the person • Don’t speak when behind the person • Maintain eye contact • Move slowly and calmly • Be aware of your non-verbal communication, and use it to connect with the person • Provide caring, nurturing cues. Smile, and use gentle touch • Use praise and positive reinforcement • Maintain patience and reassurance • Involve the person in the activity Differences in The skills and strategies used by support staff when working with people with people’s disabilities can have an enormous impact on the success of oral health treatment behaviour during and the uptake of oral health routines by individuals. Some people may be easy to oral health work with, while others may be more difficult. activities Behaviours that may impede support staff in assisting people with oral health care may include: • Refusal to partake in oral health care – such as refusing to open mouth • Biting the toothbrush • Being unable to rinse or participate in brushing • Resistance to participate given lack of understanding the reasons behind intervention • Aggression (which may be caused by anxiety/fear/uncertainty) Practical Ideas to handle these challenging situations include: • Verbal prompts: Redirect the person back to the task of oral hygiene • Distracting: The use of singing, music, holding items, gentle touch and talking to distract the person from a distressing situation • Bridging: To improve sensory connection and task focus by having the person hold the same object as the support worker while the support worker carries out an activity e.g. a toothbrush • Hand-over-hand The support worker’s hand is placed over the person’s hand to guide the person • Chaining: The support worker starts the activity, and the person completes it. • Rescuing: A second support worker enters a situation and tells the first support worker to leave so the second support worker can ‘help’ his or her friend Resources Task breakdown Use the brushing teeth task break down list link in the next page to assess which parts of the task the person: • Can do independently • Needs some assistances • Needs full assistance TASK BREAK DOWN – BRUSHING TEETH Can do all Needs Unable to do parts of assistance with any part of task for some aspect of task by self self tasks (Verbal (Full (Independe prompts, assistance nt-needs physical required) no help) assistance) What you will need Soft toothbrush Water Fluoride toothpaste Towel Cup for rinsing, Bowl (if required) Getting started Gather items for toothbrushing Position yourself in front of basin (with mirror) or with bowl in front of you Set up items Pick up the toothbrush Turn on tap Wet the toothbrush with water Turn off the tap Remove the cap of the toothpaste Squeeze a pea sized amount of toothpaste onto the bristles of the toothbrush Close toothpaste tube Put toothpaste tube back in toothpaste holder Brushing top teeth Place the toothbrush on the front tooth of your top teeth where the teeth and gums meet Using a circular motion brush the outside surface of the top teeth and gums Using a circular motion brush the inside surface of the top teeth and gums Brush the biting surface of the top teeth using a back and forth motion Remove toothbrush from mouth Spit out the toothpaste Brushing bottom teeth Place the toothbrush on the front tooth of your bottom teeth where the teeth and gums meet. Using a circular motion brush the outside surface of the bottom teeth and gums Using a circular motion brush the inside surface of the bottom teeth and gums Brush the biting surface of the bottom teeth using a back and forth motion Remove toothbrush from mouth Spit out the toothpaste Turn on tap Rinse toothbrush Turn off tap Put toothbrush back in toothbrush holder Rinse Grasp cup Turn on tap Fill cup with water Turn off tap Rinse your mouth with water Spit out water Wipe mouth with towel Replace cup in the holder Finishing off Put away toothbrush, toothpaste and rinsing cup Put towel away Oral health assessment & care plan Part A: Oral health assessment Person’s name: …………………………………………………………………………………………………………………… Last updated on: …………………………………………………………………………………………………………………… Instruction: Complete the oral health assessment table below in the week before the person’s annual dental review and take to the dental appointment. For each resident, tick either the ‘healthy description’, the ‘unhealthy description’ or the ‘don’t know’ section (if you are unsure) for each category of oral health. Category Healthy Unhealthy Don’t know Does the person have daily oral □ Regular daily oral care □ Regularly refuses/misses □ health care? daily oral care Are the person’s lips… □ Moist □ Chapped □ Is the person’s tongue… □ Pink □ Red □ □ Moist □ Dry □ Are the person’s □ Pink □ Red □ gums… □ Firm □ Spongy □ □ Ulceration □ Is the person’s □ OK □ Bad □ breath… Is the person’s saliva… □ Plentiful □ Dry □ □ Watery □ Sticky/frothy □ Describe the □ No decay □ Decay □ person’s natural teeth. (If applicable) □ No broken teeth □ Broken teeth □ □ All firm □ Some loose □ Describe the □ Intact □ Missing □ person’s dentures (If applicable) □ Well fitting □ Broken □ □ Loose □ Describe the □ No food particles □ Food particles □ person’s oral cleanliness □ No tarter □ Tarter □ □ Minimal plaque □ Thick plaque □ Category Healthy Unhealthy Don’t know Does the person □ No behavioural signs □ Behavioural signs □ have dental pain? □ No verbal signs □ Verbal signs □ □ No physical signs □ Ulcerations, swelling, decay □ Other comments: Oral health assessment & care plan Part B: Oral health care plan Oral health care plan Every resident should have a completed oral health care plan that describes oral health care specific to that person. Include information so that all staff members will know how to support this person to complete oral care each day. Every resident should be assisted to brush their natural teeth (if present), gums, inside the cheeks and tongue twice daily using a pea sized amount of fluoride containing toothpaste. If the resident has dentures they are to be removed and cleaned daily. Take this plan to any dental appointments to show the dentist and write down add any further instructions made by the dentist. 1a. What parts of the oral health care routine can the person do for themselves? 1b. What do staff need to do to support the person in their oral health care routine? 2. Environmental set up: • what tools are used (electric toothbrush, bent toothbrush) • positioning (seated or standing) • what products are used ( low frothing toothpaste, floss, denture cleaning products, products recommended by the dentist) 3. Preferred timing and daily routine • time e.g. after meals, before bed • place where the person is relaxed and comfortable e.g. bathroom or bedroom, favourite chair 4. Communication approaches 5. Specific management approaches to overcome behaviour and cognitive issues Resources If you are unfamiliar with supporting a person in oral health care: • watch the video clip ‘practical oral care’ linked to resource section 5.10 residential services practice manual) • watch the video clip ‘denture care’ linked to resource section 5.10 residential services practice manual • read the resource information linked to section 5.10 residential services practice manual Dental products Issued: May 2008 Contents Individualize care for each resident Standard toothbrushes Electric toothbrushes Dental Floss Toothpaste Products for dry mouth Mouthwashes Antimicrobials Other useful products Individualize care As part of individualizing care for residents it will be important to identify and for each resident document which products and tools are most appropriate for each individual resident in the person’s oral health care plan. Standard toothbrushes A toothbrush with a small head and soft bristles is best for natural teeth. Encourage the resident to choose their own toothbrush (colour, type, brand). Small adaptations to toothbrushes can enhance a resident’s independence: • put a larger grip on the toothbrush handle • change the angle of the toothbrush by gently bending the head of the toothbrush. Immerse the neck of the toothbrush in hot water to assist in achieving the required bend. • try a children’s toothbrush. Electric Electric toothbrushes have been shown to be beneficial for clients with fine motor toothbrushes issues and assist in maintaining independence. However, electric toothbrushes will not be appropriate for all clients due to the noise and vibration issues Trialling an When trialling an electric toothbrush do so in a careful and controlled way that is in electric line with the resident comfort level and at their own pace: toothbrush • Resident holds electric toothbrush while it is turned off • Carer holds it while it is turned on so resident can hear the noise it makes • Once resident is comfortable with the noise ask resident to hold it while it is turned on • Let resident feel the sensation of the electric toothbrush on their arm or palm to get used to the vibration of the brush. • Once the resident is entirely comfortable with the noise and vibration you can begin to brush teeth. • Some residents may prefer a standard toothbrush. Using an electric Read the instruction leaflet included in your electric toothbrush packaging before toothbrush use. Remember to be gentle on the gums. In general: • Place a pea-sized amount of toothpaste on the brush head • Guide the brush head to teeth before switching it on • Turn brush on • Gently guide the brush head slowly from tooth to tooth, following the curve of the gum and the shape of each tooth, as shown, before proceeding to next tooth • Guide the brush head over gums but do not press too hard or scrub them • Let the brush do the work • Refer to the leaflet within the toothbrush packaging for specific cleaning directions. Dental Floss A range of flossing products are available at supermarkets and chemists. Using standard floss may not be appropriate given the difficultly and potential safety hazards when flossing back teeth. It is important not to place your hands inside a resident’s mouth. Flossing handles may be an alternate option that aid carers when flossing a resident’s teeth. Only use dental floss, floss holders or ‘Interdens’ to clean between teeth, do not use wooden toothpicks, they can damage the sensitive gum tissue between the teeth. Toothpaste Fluoride toothpastes and gels are recommended Use low foaming toothpaste where possible Try a range of toothpastes to find the one the resident likes best Toothpaste is not essential if the taste is difficult for the person to tolerate. Products for Dry The types of products that are used for relief of dry mouth are called ‘saliva Mouth substitutes’. These products can be used before meals or when the resident reports a dry mouth. Below are some additional products that can be helpful in managing dry mouth. Product Where to Uses How to use find Biotene Pharmacy, Very helpful in Apply gel onto tongue, oral dentist relieving itching, directly to affected balance gel burning, pain and areas or under swallowing dentures as needed difficulties associated throughout day and with dry mouth. night Works under dentures to help with retention. Can provide relief of dry mouth for up to 8 hours Biotene dry Pharmacy Helps to kill bacteria, Twice/day to brush mouth reduce inflammation teeth, spitting out toothpaste and tooth sensitivity excess for patients with dry mouth Biotene Pharmacy Alcohol-free Use approx. 1 mouthwash mouthwash which tablespoon as needed, soothes and rinse or spray around moistens dry, mouth sensitive oral tissues and neutralizes bad breath Biotene Pharmacy Used to stimulate Chew 1 or 2 pieces as chewing saliva flow in dry required to relieve dry gum mouth sufferers, mouth & throat, fight bad breath and especially after meals protect teeth (It is important to between brushing. ensure that a resident Will not stick to is able to safely dentures manage chewing gum from a swallowing and choking perspective before considering its use.) Mouthwashes Mouthwash can assist in cleaning the mouth but is not a substitute for tooth brushing. Most supermarket mouthwashes contain alcohol and are not usually appropriate for clients because they cause a dry mouth. Only use the mouthwash which has been recommended for that specific client. Antimicrobials Special products containing the ingredient chlorhexidine gluconate help reduce the growth of oral bacteria which cause tooth decay and gum disease. It is important to consult with a dentist prior to and while using the products listed below. Other useful products Product Where to find Uses How to use Regular Supermarkets, Protects teeth Twice/day to brush toothpaste e.g. pharmacy and gums teeth, spitting out Colgate Total, against bacteria excess Macleans and the Protect formation of holes Toothpaste for Supermarkets, Has special Twice/day to brush sensitive teeth pharmacy ingredients teeth when sensitive, e.g. Sensodyne which protect spitting out excess teeth and help relieve sensitivity Colgate Pharmacy Strongest Brush once or NeutraFluor available twice/day, spitting our 5000 Plus toothpaste with excess extra fluoride, (needs to be used for those more under the guidance of prone to tooth a dental professional) decay Colgate Supermarkets, Used if unable to 10ml once/day rinsed NeutraFluor 220 Pharmacy brush teeth at all or sprayed around mouth rinse with toothpaste mouth (needs to be used under the guidance of a dental professional) Colgate Pharmacy Used if unable to 10ml once/week rinsed NeutraFluor 900 brush teeth or sprayed around mouth rinse adequately with mouth toothpaste every (needs to be used day under the guidance of a dental professional) Colgate Pharmacy Home use for Once/day brushed or NeutraFluor gel patients whose swabbed onto teeth teeth cannot be (needs to be used brushed with under the guidance of toothpaste a dental professional) GC Tooth Only available Excellent for Squeeze small amount Mousse through strengthening onto finger or cotton dentists teeth and offers swab and apply protection from directly to teeth. Leave tooth decay in for 3 minutes, spit out high risk patients excess Access to dental services Issued: May 2008 Contents Regular dental visits are essential Working with local dental professionals Public Dental Services in Victoria DAS residents do not have priority access to public dental services Expected waiting times for public dental services may vary People from DAS are exempt from fees Inform the dental service about the person’s circumstances What to do if staff have concerns about public dental care Specialised services for people with special needs Treatment Provided by Special needs clinic Eligibility Access to special needs dental service Referral Requirement for special needs dental service Cost of special needs dental service Resources Regular dental People with disabilities have 7 times more oral health problems than the general visits are community. Regular dental visits are important to assist in early detection of dental essential problems. People should visit the dentist for a regular check and professional teeth clean. Working with local dental If the person does not already have a local dentist professionals • Establish contact and introduce yourself and the residents in your care to the local dentist • Familiarisation visits may be useful • Be aware if the individual resident has private dental insurance to cover access to private dental care. • Be aware of individual residents’ eligibility for public dental care Public Dental Public dental services are funded by the government and are provided through Services in community dental clinics in community health services and rural hospitals. On Victoria some occasions clients will be given a voucher to go to a private dentist. Dental Health Services Victoria (DHSV) provides a range of public dental care services for adults throughout Victoria. Information regarding these services is detailed below. Service Directory Type of Who is eligible? Where is it How much do I service available? pay? * Youth Dental Dependants or Community dental Free to health care Program holders of a health clinics across card holders, their care card aged Victoria. dependents and under 18 or in dependants of school years 9 - education 12. maintenance allowance recipients. General Victorian health General dental $22.50 per visit dental care care card holders care is available at capped at $90 for (Non and their community agency a course of care for emergency – dependants. dental clinics health care card such as fillings, across Victoria. holders. etc) Emergency All Victorians are The Royal Dental $22.50 for health dental care eligible to access Hospital of care card holders. emergency care at Melbourne $100 pre payment the Royal Dental for non-health care Hospital of card holders, with Melbourne. total cost based on treatment need. Denture care Victorian health The Royal Dental Up to $108 for a care card holders Hospital of full (top and and their Melbourne; bottom) acrylic dependants. Community dental denture and clinics across approximately $51 Victoria. for partial dentures. Specialist Victorian health The Royal Dental Dependent on care care card holders Hospital of treatment needs. (by referral and their Melbourne. This will be only) dependants (by discussed at your referral only). appointment. For more information please visit www.dhsv.org.au or call the Community Dental Information Line on 1300 360 054. *Fees are subject to annual review and may change. Visit the locations page to find your nearest clinic. Some people may not be suitable for dental care in a community clinic. For example if a person requires a general anaesthetic or has severe behaviours of concern they may be referred to the special needs clinics located at the Royal Dental Hospital of Melbourne and community sites. DAS residents do The current dental policy does not provide priority access for people residing in not have priority disability accommodation services to public dental services. access to public dental services Expected waiting Emergency clients (patients experiencing pain, dental trauma, discomfort or times for public infection) are assessed within 24 hours and seen within 2 weeks with the actual dental services time depending on clinical need. Clients who do not require urgent care are placed may vary on a waiting list. Some DAS People residing in disability accommodation services with health care cards or residents are disability pension cards are exempt from fees for public dental care. exempt from fees Inform the dental When making a dental appointment support staff should: service about the • indicate that the client is from disability accommodation services person’s • highlight any specific requirements of the patient circumstances • provide the dental team with the information for health professionals letter found under the resource section. What to do if If support staff have concerns about the dental care provided to DAS residents there are discuss the issue with: concerns with • the complaints or practice manager at the community dental clinic public dental care • your line manager. If the matter is still unresolved ask your regional DAS manager to contact Catherine James, Manager of Dental Health at DHS. Catherine will need to know: • the name of the person experiencing the problem • their date of birth • the dental agency involved • details of the problem experienced. Specialised The Special Needs Service is part of the Integrated Special Needs Department at services for the Royal Dental Hospital of Melbourne. It provides Dental treatment to adults people with with physical, intellectual and psychological disabilities who require more complex special needs care that could not be provided in a general dental community setting. Treatment The Special Needs Dentistry Unit can provide a wide range of treatments including Provided by examinations, scaling and cleaning, restorations, extractions, and denture work. Special Needs Both emergency and general dental treatment is provided to eligible patients. clinic Patients are encouraged to seek regular recall, rather than rely on emergency visits to maintain their oral health. The special needs dental service is available for people who hold a current Eligibility for government concession card. These include: special needs • Pensioner Concession Card dental service • Health Care Card Referral Access to the special needs dental service can be obtained by referral. The general requirement for dentist would need to complete the “Specialist Referral Form”. A completed special needs Special Needs Application Form for Dental Examination and Treatment is also dental service required. These can be obtained by contacting the: Dental Hospital on Ph (03) 9341 1261, or mail request to Special Needs Dentistry Unit Royal Dental Hospital of Melbourne 720 Swanston St, Carlton, 3053 Cost of special Co-payment fees are applicable for this service. Some exemptions may be applied needs dental to patients with a mental illness and/or intellectual disability. A completed Co- service payment Exemption forms accompanied by supporting evidence needs to be submitted. Once approved, co-payment exemption is applicable for one course of care only. Resources For more information on public dental services in Victoria visit the Dental Health Services Victoria website A letter for support staff to take to appointments with health professionals can be found in the residential services practice manual section 5.3 under resources.
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