Mouth Bit

Mouth Bit

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Client Care Tips For Your CNAs - Mouth Care

 Do the CNAs at your workplace know how crucial this routine task is to their clients? Are they aware that a person's oral health is a good indicator of his or her overall physical condition? By sharing the following information and tips at your next CNA inservice meeting, you may give your aides a renewed motivation for performing mouth care.

Open Wide

Imagine this...your client, Mr. Smith, eats three meals plus three snacks every day. He hardly ever brushes his teeth and he has never learned how to floss. Here's what's happening inside Mr. Smith's mouth:

 

• Every time he eats, bacteria band together and form something called plaque.
• This plaque sticks to the enamel of Mr. Smith's teeth, especially where the teeth meet the gums.
• As the plaque builds up, Mr. Smith's gums become red and swollen. They are also sore and tend to bleed.
• Mr. Smith also gets cavities in several teeth, as bacteria eats away the enamel on his teeth.
• Before long, Mr. Smith's gums begin to pull away from his teeth, forming little "pockets".
• Bits of food and plaque fall into these pockets, destroying the nearby tissue and bone.
• Mr. Smith complains of tooth pain when he eats.
• Mr. Smith's jaw bone and tissue continue to be destroyed by bacteria. His teeth become loose. Many fall out. The rest are being rotted out by cavities.

 

Sounds awful, doesn't it?

You Can Help!!

Remember...it's never too late to begin good mouth care. Even Mr. Smith could be helped by learning new habits or by having you do his mouth care for him.

All your clients can benefit from improving the way they take care of their mouths and teeth (or dentures). Having a healthy mouth helps clients feel better, have a heartier appetite and eat a more balanced diet. You can use your knowledge of mouth care to give your clients brighter smiles and healthier mouths.

Who Is at Risk for Mouth Problems?

All your clients need good mouth care, but some are at higher risk for mouth problems. These include:

 

• People who smoke cigarettes, pipes or cigars. Smokers are five times more likely to get gum disease than nonsmokers. They are also at risk for oral cancer.
• Clients with poorly fitting dentures which may cause inflammation or sores.
• Clients who are intubated-with a tube down their throats to give oxygen to the lungs. These clients are at risk for mouth ulcers, bleeding and oral infections. And, having a tube in their mouths makes performing mouth care a real challenge!
• Clients who take medications that have bad effects on the mouth. These include antihistamines, dilantin, certain antibiotics and anticancer chemotherapy.
• Anyone on oxygen. Breathing in oxygen from a tank tends to dry out the tongue and the oral mucosa.
• People with diabetes. They have less circulation to their oral tissues. If they do get a mouth lesion, it will probably be slow to heal. Their breath may also smell "fruity" which is a serious problem. (Report fruity-smelling breath right away!)
• Clients who breathe mostly through their mouths instead of their noses. Mouth breathing tends to reduce the circulation of blood in oral tissues.
• Clients with cancer. Their immune systems are weak and they are prone to mouth infections from chemotherapy and radiation.
• People who have AIDS because they tend to get oral infections and lesions.
• Clients who have an NPO diet order (nothing by mouth). Their mouths get very dry and their lips may get chapped.
• People with renal disease. They may get mouth ulcers, bleeding gums or breath that smells like ammonia.
• Elderly clients, since age often causes reduced saliva production and increased gingivitis (gum irritation).
• Anyone who consumes a lot of sugary foods and/or beverages, including alcohol.
• People who are too confused or too weak to perform their own mouth care.
• People who have poor mouth care habits such as rarely brushing their teeth, flossing or visiting a dentist.

 

Miscellaneous Mouth Care Tips

Remember that persistent bad breath can be a warning sign of a number of different conditions. It can be caused by dental problems, indigestion or a respiratory infection. Many diseases can also alter the breath. For example, diabetes can produce a "fruity-smelling" bad breath. If a client has a sudden "bout" of bad breath or a change in the way the breath smells, be sure to report it to your supervisor.

When someone has a dry mouth, it means there is less saliva available to wash away food and neutralize plaque. This can lead to an increase in tooth decay and gum disease and can make dentures uncomfortable to wear. To avoid dry mouth, have your clients take frequent sips of water and/or suck on ice chips; chew sugar-free gum to stimulate saliva production; and avoid caffeine which can further dry the mouth.

Swallowing problems due to medical conditions, including stroke, Alzheimer's disease, Parkinson's disease and cerebral palsy can cause drooling. So can certain medications. Clients who drool may need to be fully upright before eating or drinking to prevent inhaling saliva, food or fluids into the lungs. Report any new onset of drooling to your supervisor.

Dentures can loosen with age and if a client loses weight. In general, dentures should be adjusted and/or changed every three to five years.

People who wear dentures should chew food on both sides of the mouth to even out the pressure on their gums.

It's important to gently brush the gums and tongue of denture-wearers daily-before the dentures are placed in the mouth. Use a very soft toothbrush or a washcloth. This removes plaque and stimulates the gums.

More Tips for a Healthy Mouth

Remind your clients that they can restore lost calcium by eating fruits and vegetables high in calcium, such as dark leafy greens. These foods will also help protect tooth enamel by lowering the acid buildup in saliva.

If a client has mouth pain from irritation or lesions, offer foods that are warm-not hot. Rough and/or spicy foods may need to be avoided. Crushed ice may relieve pain. Your clients may also have a prescription spray or mouthwash to help with this problem.

Toothbrushes should be replaced at least every three months or when the bristles look frayed and worn out.

You can clean the gums of people without teeth (infants or adults) by rubbing them gently with gauze.

It's common for older people to be sensitive about having their mouths and/or heads touched. When approaching them for mouth care, move slowly and explain what you are going to do. Speak in a soft, soothing, friendly voice to put them at ease.

Glycerin and lemon swabs are often used to moisturize dry lips and mouths. However, both of these swabs can cause the mouth to dry out even more! Plain swabs made out of sponge-and dipped in water-can be used to clean the mouth.

Let your clients know that chewing on ice can cause gum injuries or even broken teeth. And, using a toothpick too aggressively can damage tooth enamel or cut the gums.

If you ever hear clicking, popping or snapping noises when clients move their jaws, be sure to let your supervisor know. Also, watch out for clients who aren't able to open their mouths very widely. They may be suffering from a painful joint condition called TMJ syndrome which requires professional dental care.

Linda H. Leekley BS, RN
President, In the Know, Inc.
http://www.knowingmore.com

Do you struggle to provide your nursing assistants with high quality continuing education? With more than 120 in service topics, In the Know has the solution to nearly any problem facing your nurse aides. (For a more thorough discussion of mouth care, check out our Performing Mouth Care inservice.) Using our inservices ensures that your CNAs will learn more-and achieve more. As a result, their client care will improve dramatically! And, we stand by the superior quality of our teaching materials with a 60-day money back guarantee. Please visit my website at http://www.knowingmore.com to download a FREE Inservice Topic.

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Pain - Shut Your Mouth 8-Bit

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