Oral health

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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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