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>> Narator: This is a video demonstration of an oral health assessment in a residential
aged care facility. To do an assessment you'll need a torch or
a planet light, a tongue depressor or a bent toothbrush, and
an oral health assessment form which you can download from this CD.
You may also find it useful to have someone assist you with completing the form while
you do the assessment. Eight categories of oral health: lips, tongue,
gums and oral tissue, saliva, natural teeth, dentures, oral cleanliness,
and dental pain, are assessed as healthy changes or unhealthy.
The self directed learning section of the CD will help you get familiar with these.
It is important to initially introduce yourself to the resident and explain the purpose of
the assessment. This should be considered the first step of
the assessment process. The assessment is then conducted via a series
of logical steps. Begin by examining the lips. They should be
pink, moist and smooth. Observe for dryness, red corners, swelling,
lumps or ulcerated patches. Now move on to examine the tongue. It should
be moist and pink. If it appears patchy, coated, fissured, ulcerated,
or swollen, these are indications that the mouth is too
dry or has been colonised by fungi or bacteria. The next stage is examining the gums and oral
tissue. Like the lips, they should be pink, moist and smooth,
with no visible signs of bleeding. Here again, dryness, red swollen or inflamed mucosa, the
presence of ulcers, white or red patches, indicates an unhealthy
state requiring corrective intervention. Notice here saliva should be present in the
mouth. It should appear free flowing and clear. Dry sticky mucosa, absence of saliva, or if
the resident reports having a dry mouth, is an indication of problems with saliva production
or flow, and corrective action is required. The next step is to examine the teeth. Be
aware that increasing numbers of residents have their own teeth.
This puts frail and dependent residents at high risk of poor oral health if their daily
oral hygiene is not adequately maintained. To gain better access and vision, try supporting
the resident's chin with your index finger and thumb.
This is sometimes referred to as a pistol grip. The thumb holding the chin can be used
to roll down and hold the lower lip. A backward bent toothbrush can also be used
as a retractor to help you see more of the mouth.
When assessing natural teeth, there should be no decayed or broken teeth or roots.
If the teeth are excessively worn down, or there are signs of decay or broken teeth or
roots, treatment and referral to a dentist should arranged.
If the resident has either full or partial dentures, the denture must be removed and
inspected. There should be no broken or rough areas on
the denture. It should be clean, clearly labelled with
the resident's name, and the resident should indicate that they wear the denture for the
majority of the day. If the denture is rough or damaged, a referral
to a dental professional is recommended. It is also important to check their gums and
oral tissue that are usually covered by the denture.
While in the process of investigating the teeth, gums, and surrounding mucosa, oral
cleanliness can be assessed. The mouth should be clean and moist, with
no evidence of food particles or tartar buildup on either teeth or dentures.
The last category to be assessed is the presence of dental pain.
It is important throughout the process to talk with the resident.
There should be no verbal report, behavioural or physical signs or symptoms of dental pain.
Indications of dental pain may include pulling at the face, chewing lips, not eating or changed
behaviour. If there is dental pain, analgesia and a dental
referral are advised. In closing, the key points to remember are
An oral health assessment consists of eight categories of oral health
lips, tongue, gums and oral tissue, saliva, natural teeth, dentures, oral cleanliness,
and dental pain, are assessed as health changes or unhealthy.
A healthy or changes assessment can be managed by using the oral health care planning guidelines
in the professional portfolio. An unhealthy assessment generally indicates
the need for dental referral. Information about dental referral protocols
is also included in the professional portfolio, and relevant forms can be printed from this
CD. It is recommended a resident should have an
oral health assessment performed by the GP or RN on admission, and subsequently on a
regular basis and as the need arises, or example, following an acute incident.
An oral health assessment should only take a few minutes to do, and it can easily be
integrated into a general health assessment.