1. The risk of poor oral health increases as people become less able to self-manage due to issues of functional dependence, physical frailty, medical co-morbidity, poly-pharmacy and cognitive impairment.
2. Increasing numbers of people are retaining at least some of their natural teeth. As their ability to self-manage oral hygiene decreases, their risk of oral disease and infection increases.
3. Oral disease impacts on other areas of health and quality of life.
4. Oral Health Assessment is essential for the identification of issues and implementation of management strategies.
5. Simple oral health strategies involving a multi-disciplinary approach can assist with promoting and maintaining good oral health.

Continence

Poor oral health affects food selection in particular the ability to chew foods with high fibre content. This can affect continence management.

Delirium

Chronic infection from poor oral health can compromise the immune system and contribute to a systemic inflammatory response. This in conjunction with oral pain can exacerbate a change in behaviour especially for older people with dementia.

Dementia

Older people with dementia are particularly at risk of developing complex oral disease and conditions. Dementia compromises their ability to reliably report their experience of oral health problems and dental pain. In addition, older people with dementia can sometimes behave in ways that make it difficult to provide oral health care.

Depression

Poor oral health may cause pain and discomfort, bad breath, impact on people’s ability to speak, sleep well, socialise and feel happy with their appearance.

Medication

Polypharmacy can impact on oral health by causing dry mouth (xerostomia). Drug classes that especially contribute to dry mouth are those with anticholinergic effects such as ACE inhibitors and diuretics. For further information contact the Therapeutic Advice and Information Service.

Mobility

As a consequence of poor oral health, nutritional status may suffer and have an impact on maintaining weight, muscle mass and strength.

Nutrition

Tooth loss, poorly fitting dentures and oral infections affect appetite, food enjoyment and ability to chew which impacts on food intake and food selection.

Skin integrity

As a consequence of poor oral health, nutritional status may suffer and have an impact on skin integrity and wound healing.

Oral health is linked to general health, and oral conditions involving teeth, gums and dentures can significantly affect overall well-being and the ability to age positively.

For example:

• Oral pain and difficulty with eating can affect nutritional intake and body weight and therefore skin integrity, strength and mobility, and continence.
• Oral pain may also affect mood and behaviour, especially for people with cognitive impairment who find it difficult to self report their pain and discomfort.
• Poor oral health is linked to increased risk of cardiovascular disease, stroke and aspiration pneumonia. Aspiration pneumonia is a major cause of morbidity and mortality for hospitalised and institutionalised frail older people.
• Chronic oral infection can complicate the medical management of general illnesses such as diabetes, chronic heart failure and respiratory diseases.
• Poor oral health results in bad breath and affects people’s ability to speak, socialise and feel happy with their appearance.
• Medications taken by older people or people with mental health conditions often cause dry mouth (xerostomia) which affects speaking, eating and also increases the levels of oral bacteria and infection.

Check for and report or follow up on signs of the following oral health conditions

• soreness and cracks at corners of the mouth
• sore, swollen or inflamed or coated areas on the tongue
• red swollen mouth
• bad breath
• dry oral tissues
• saliva which is thick, stringy or rope-like
• swollen red gums that bleed easily when brushed
• loose or broken teeth or exposed tooth roots
• oral pain or tooth sensitivity
• difficulty eating and or speaking
• changed behaviour and refusing to open mouth
• poor oral cleanliness and food left in the mouth
• chipped or broken teeth on the denture
• chipped or broken acrylic areas on the denture
• bent or broken mental wires or clips on a partial denture
• check for a name on the denture.

It is recommended that an appropriate health professional such as a registered nurse or doctor perform an Oral Health Assessment using the Oral Health Assessment Tool (OHAT) on admission and repeat as required

A ‘healthy’ or ‘changes’ assessment can be managed using the Oral Health Care Planning Guidelines.

An ‘unhealthy’ assessment indicates a referral to a dental professional is recommended. As most referrals are likely to be of a non-urgent nature, this information should be included in discharge planning advice and correspondence.

Management principals should be based on a Model of Oral Health Care which integrates four key oral health processes into general care

1. oral health assessment
2. oral health care planning
3. assistance with daily oral hygiene
4. referral for dental treatment.

For healthy teeth and gums follow these simple steps

• use a soft toothbrush
• clean your teeth or dentures twice a day
• use a fluoride toothpaste
• drink water when you are thirsty
• sip water if your mouth is dry
• eat a healthy diet
• avoid sweets and sugary drinks between meals
• visit your dentist for a regular check-up.