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At least 19 recordsLinked to original sources
PubMedDate not supplied

The costs and consequences of neglected medically necessary oral care.

Oral diseases and conditions may adversely affect general health, and certain medical conditions may have a negative effect on oral health. However, little attention has been given to assessing the economic costs and consequences associated with care that is a direct result of, or has a direct impact on, an underlying medical condition and/or its resulting therapy. The costs can be significant for patients; their families; third-party payers such as insurance companies, Medicare, and Medicaid; and society. The health consequences of such conditions may dramatically affect function, morbidity, quality of life, and survival. This paper reviews one possible approach for identifying and measuring the costs and consequences associated with medically necessary oral health care and presents a framework for evaluating medically necessary oral health care. The paper also describes the cost components of care and the dimensions of health consequences. Finally, an example illustrates this approach. The summary information presented here is meant to offer concepts and ideas important in assessing the costs and health consequences associated with medically necessary oral health care. Individuals interested in a more detailed discussion of economic evaluation of health care programs and outcomes assessment are referred elsewhere. 10-23

Cost of Illness↗
PubMed2003

Oral health education for nursing personnel; experiences among specially trained oral care aides: one-year follow-up interviews with oral care aides at a nursing facility.

The improved dental health in most industrialized countries is not apparent among elderly and long-term care patients. Oral healthcare has been found to have low priority in nursing care. To create lasting positive effects in oral healthcare education, a new educational model was tested in an oral healthcare project. After approval from ethical committee, nursing assistant and nurses' aides took part in a dental auscultation period at a dental clinic to serve as oral care aides additional to traditional oral healthcare education. Following this period, the aides were given responsibility for the oral healthcare at their ward. After serving as oral care aides for 1 year, interviews were made and analysed based on the Grounded Theory methodology. The aim was to investigate how the oral care aides had experienced their new duties regarding oral healthcare. The results indicated that, despite several environmental changes, reluctant residents and occasional lack of commitment from colleagues, the oral care aides felt responsible for the oral healthcare provision. The oral care aides expressed courage, the capacity to cope with reality, confirmation and empathy, characteristics that propelled them from novices to oral care aides with an expert competence.

Adaptation, Psychological↗
PubMed2006

Effects of daily oral care with 0.12% chlorhexidine gluconate and a standard oral care protocol on the development of nosocomial pneumonia in intubated patients: a pilot study.

PURPOSE: The purpose of this pilot study was to determine if a difference existed between nosocomial pneumonia rates for intubated critical care unit (CCU) patients who received twice-daily oral hygiene care with 0.12% chlorhexidine gluconate and those who received the standard oral care. METHODS: Over seven months (February to August), CCU patients were identified through screening and informed consent procedures, and randomized into 1 of 2 groups. Over the 7 months, due to the critically ill nature of the patients, only 5 subjects were enrolled. While in the study, twice-daily oral hygiene care consisted of brushing the cheeks, teeth, and endotracheal tube with a suctioning toothbrush using an FDA-approved 0.12% chlorhexidine gluconate antimicrobial agent with the experimental group (2 intubated patients in the CCU). The control group (3 intubated patients in the CCU) received the standard oral care 6 times per day utilizing a soft foam swab and half strength hydrogen peroxide. All oral care was performed by the nursing staff. The number of persons developing nosocomial pneumonia was monitored until hospital discharge. RESULTS: Results revealed that 1 person out of 3 in the control group was discharged from the hospital with a diagnosis of nosocomial (aspiration) pneumonia. Neither of the 2 subjects in the experimental group was diagnosed with nosocomial pneumonia. Preliminary findings suggest that twice-daily oral hygiene care with 0.12% chlorhexidine gluconate may reduce the risk of nosocomial pneumonia in intubated patients more than the 6-times daily standard oral care protocol. The standard oral care protocol does not include the use of an FDA-approved antimicrobial solution. However, the small size of the sample makes this finding inconclusive. CONCLUSION: Twice-daily oral hygiene care with 0.12% chlorhexidine gluconate may hold promise as a nosocomial pneumonia reduction strategy within hospital CCUs; however, its application requires further testing.

Adult↗
PubMed2004

Changing practice: use of audit to change oral care practice.

Although oral problems are common in palliative care, oral care can be a neglected area of practice. This article discusses the introduction of an oral care protocol and standard in one palliative care unit. The project used audit tools developed by Lee et al (2001) and involved a survey of the oral care knowledge of nursing and medical staff, and a retrospective survey of current practice using 50 sets of patients' notes. A standard and documentation were developed with the aim of ensuring oral care was both consistent and in line with best practice. Training was provided to all staff within the unit. Three months later oral care practice was audited. The results suggested improvement in all aspects of oral care practice. Dissemination of oral care documentation and training across the trust is underway. This article describes the processes used, highlighting the importance of assessment in oral care and the need for teamwork in rolling out changes both within and beyond a single unit.

Documentation↗
PubMed2003

The effect of oral care feed-back devices on plaque removal and attitudes towards oral care.

OBJECTIVES: Two studies were carried out to investigate whether the effect of specific oral care feed-back devices would result in better plaque removal (Study 1) and lead to changes in attitudes and views relating to oral health (Study 2). The objective of the first study was to compare the ability of a toothbrush system consisting of a new toothbrush plus plaque disclosing tablet (SIGNAL Integral) to remove supra-gingival plaque to that of a marketed toothbrush (Oral B Cross Action) following a single unsupervised brushing. METHODS: Study 1 had a cross-over design and included 21 healthy adult volunteers. Subjects refrained from any form of oral hygiene for 24 hours prior to each test session. Plaque levels (Modified Quigley-Hein Plaque index) were assessed prior to and following each unsupervised brushing. When the new toothbrush was used, subjects self-disclosed their plaque with a disclosing tablet (erythrosine) immediately prior to brushing. At each occasion, brushing time (in sec) was also recorded. Study 2 had a two-cell, parallel design (test and control group) and lasted for five days. Healthy adult volunteers were enrolled. Subjects in the test group (n = 30) were given a fluoride toothpaste and four saliva test strips to use at home. The saliva test strip is designed to change colour in the pH range of 6.5 to 10, allowing the user to verify the effect of brushing. The control group (n = 29) received no saliva test strips. Subjects completed a questionnaire after 4 days of product use. RESULTS: In Study 1, significantly more plaque was removed (p < 0.05) and brushing time was increased by more than 20% when subjects used the new toothbrush together with the disclosing tablet compared to brushing with the marketed toothbrush. In Study 2, significant increases in motivation relating to oral hygiene were found in the test group who had been using the saliva test strip. CONCLUSION: The two studies have provided significant evidence that the provision of feed-back devices in an oral care context can lead to improved removal of plaque and increased motivation.

Adult↗
PubMedDate not supplied

Nursing home executive directors' perception of oral care in long-term care facilities.

Oral health in long-term care (LTC) facilities has been repeatedly documented as less than ideal. The complex nature of this environment has made it difficult to understand and improve the oral health status of residents through education and training. The purpose of the study was to investigate how the executive directors (EDs) of LTC facilities value oral health and to determine facility variables, which may influence how oral care is delivered. A mail survey of the EDs of all LTC facilities in Ohio (n = 1018) was conducted with 338 responses received after secondary follow-up (33.2% response rate). The 30-item survey included information concerning the nursing facility, the EDs, the EDs' perception of the level of oral health care, and value statements rated on a Likert-like scale. The results of the survey showed that more than two-thirds of the EDs were female and that most facilities were proprietary (70.3%). ED gender was not statistically associated with any of the oral health variables. Fifty-three percent of the EDs rated their residents' oral health as fair or poor but were still satisfied with the oral care provided at their facilities. The apparent discontinuity between perceived levels of oral health and satisfaction with oral care suggests that EDs are distanced from the oral care of their residents or they do not acknowledge oral health care needs. While the survey results revealed important facility characteristics and administrators' perceptions about oral health, the most important aspect of this project was the low response rate despite secondary follow-up. That, coupled with the negativity expressed upon follow-up, suggests a larger issue that may affect oral health in nursing facilities: oral health continues to have a low priority in this setting. Continuing efforts to improve oral health and educate LTC professionals about oral health's influence on general health is critical for managing the oral health of future generations of aging adults.

Administrative Personnel↗
PubMed2004

Aged care staff perspectives on oral care for residents: Western Australia.

OBJECTIVE: To determine manager and staff perceptions of oral health and dental service issues for residents in aged care facilities in the Perth Metropolitan Area, Western Australia. DESIGN: Focus groups and face-to-face semi-structured interviews with aged care facility managers and staff. SETTING AND SUBJECTS: Personnel at 12 facilities (high-level and low-level care) located in the Perth Metropolitan Area participated in the study. Interviews were conducted with 14 facility managers. Focus groups and face-to-face interviews were conducted with 40 facility staff. RESULTS: Managers and staff had similar views regarding most issues. While resident oral health was considered important, regular oral care programmes were limited or lacking. In general, high care facility residents did not have regular dental checkups, while those in low-level care facilities usually visited their own dentist for checkups or treatment. Barriers to maintaining regular oral care included: resident noncompliance; financial concerns; lack of co-operation from family; mobility issues; and lack of interest from dental professionals. Suggested improvements to current services included regular on-site visits, staff education and specialised dental professionals. CONCLUSION: Residents face many barriers to maintenance of adequate oral health care, particularly those who are functionally dependent and cognitively impaired. There is an urgent need for appropriate oral care programmes for aged care residents, which include dentists with aged care experience and continuing education for facility staff. Any major programmes should be evaluated carefully.

Aged↗
PubMed2001

Erosive potential of oral care products.

Seven oral care products and orange juice as a positive control were tested for the erosive potential by immersing each enamel specimen (10 per group) into solutions of the various products for 10 and 20 min. Before and after the experiment Knoop surface hardness (SMH) was measured. The enamel microstructure before and after immersion was assessed by scanning electron microscopy and confocal laser scanning microscopy. Orange juice produced the most marked losses of hardness after 10 and 20 min. Among the dental hygiene products only the fluoride-free toothpaste produced a significant reduction of hardness after 10 as well as after 20 min. With the exception of Elmex gel, all tested oral care products led to a significant (p < 0.05) increase of enamel hardness. The results of the hardness measurements corresponded with the microstructure findings. It may, therefore, be concluded that the tested fluoride-containing oral care products do not exhibit any erosive potential, which could be picked up with the methodologies under study.

Amines↗
PubMed2007

Oral care in the intensive care unit: a review.

Oral care for patients in the hospital's Intensive Care Unit (ICU) is important, but this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow. The problems of maintaining oral care with oral intubation, performing oral assessment, guidelines for oral hygiene care, frequency of oral care needed, and suggested mouth care protocol followed by recommendations are presented and discussed in this paper.

Clinical Protocols↗
PubMed1998

A pilot study on improving oral care in long-term care settings. Part I: Oral health assessment.

Surveys of oral health in long-term care (LTC) settings have consistently documented low levels of health. In the complex LTC environment, programs to improve oral health have yet to be well defined. The purpose of this pilot project was to determine if a program of training for nursing assistants in combination with adjunctive aids to oral care could improve resident oral health indicators. This pilot study demonstrated improved oral health indexes among residents cared for by trained nursing assistants who had access to adjunctive oral care aids. Additional studies are needed to define the nature of oral caregiving in LTC settings as well as specific regimens which can assure continued oral health improvement in this environment.

Aged↗
PubMed2000

Oral care for successful aging in long-term care.

The oral health of frail elders residing in long-term care facilities is very poor, probably because access to dental services is limited and help with daily mouth care is almost nonexistent. Recent concerns and interest have been raised through the cooperation of administrators, nursing staff, and dental personnel to address this apparent neglect. Moreover, evidence shows that caries and periodontal disorders can be managed successfully in geriatric populations. Consequently, there is a basis on which to develop a practical strategy for mouth care that should reduce the morbidity and early mortality in long-term care and to assist an increasingly frail and dependent population to age successfully.

Aged↗
PubMed2005

Frequency of oral care and positioning of patients in critical care: a replication study.

BACKGROUND: Oral care and head-of-bed elevation are interventions to decrease risk of aspiration pneumonia in hospitalized patients. In a previous study, nurses' self-reports of how often they performed oral care did not match documented provision of such care. OBJECTIVES: To replicate the original study and estimate instrument reliability. METHODS: A cross-sectional design was used, and survey data from nursing personnel and bedside observational data from 9 intensive care units were collected. RESULTS: A total of 181 surveys (47%) were returned, and data were collected from 436 bedsides. Reported frequencies of oral care and use of oral care products differed between nonintubated and intubated patients (P< .001). The mean documented frequency of oral care for nonintubated patients was 1.8 (SD 1.5); self-reported frequency was 3 (SD 2.4). The mean documented frequency of oral care for intubated patients was 3.3 (SD 1.8); self-reported frequency was 4.2 (SD 2.1). Documented oral care frequency differed by unit (P = .006) and intubation status (P < .001). Mean observed head-of-bed position was 38 degrees (SD 24 degrees ) for nonintubated patients and 23 degrees (SD 12 degrees ) for intubated patients (P < .001). Intubation status, but not unit, affected observed head-of-bed position (P < .001). Three survey items had adequate reliability evidence (r = 0.70). Interrater reliability for bedside data collection was 96% or greater. CONCLUSIONS: Despite inadequate estimates of survey reliability, findings generally were comparable to results of the original study; nurses report more frequent oral care than is documented. Intensive care nurses elevate the head of patients' beds in accordance with self-reports.

Beds↗
PubMed2004

A survey of the oral care practices of intensive care nurses.

BACKGROUND: Intensive care unit (ICU) patients have complex oral care needs. Inadequate oral care may predispose ICU patients to nosocomial infections. Recent initiatives have sought to improve the quality and evidence base of ICU oral care provision. OBJECTIVES: To describe the current priority given to oral care, the knowledge and practice of oral needs assessment and oral care methods, and adherence to the local ICU oral care protocol of ICU nurses working in one hospital. METHOD: Self-administered questionnaire survey of all nurses working in adult ICU ( n = 160 ). RESULTS: Replies were received from 103 (response rate 64.5%). On average, oral care was given a similar priority to other aspects of personal care. 13.5% nurses rated oral care as a low priority. Whilst 98% nurses routinely performed an oral needs assessment, only 26% used a written assessment tool. Toothbrushes were used at least once a day by 85.5% nurses and chlorhexidine products were routinely used by 50.5% nurses. The oral care practices of most nurses matched the local ICU protocol. 23.5% nurses had received no training in oral care and 58% nurses requested initial/further training. CONCLUSIONS: Most oral care methods were appropriate, based on the available evidence. A small minority of nurses gave oral care a low priority and were not using evidence-based oral care methods recommended in the local ICU protocol. Encouraging the general use of oral needs assessment tools is a priority, and further oral care training is required.

Adult↗
PubMedDate not supplied

The Oral Care Link Nurse: a facilitator and educator for maintaining oral health for patients at the Royal Hospital for neuro-disability.

This paper describes an ongoing oral health education project developed and implemented at the Royal Hospital for Neuro-disability (RHN) by the Dental Team. The Oral Care Link Nurse (OCLN) project was developed to assist the dental team in the promotion of oral care within the hospital. The Dental Team identified that, in addition to providing knowledge and skills to perform effective oral care, it is important that nursing staff retain positive attitudes and behavior toward providing that care. In conjunction with the Quality Assurance department, oral care guidelines were introduced throughout the hospital, with further input being focused on the training of at least one unqualified nursing auxiliary from each ward. These became the OCLN who were trained by the Dental Team to assist with the promotion of good oral care practices on the wards and to aid communication regarding patient oral health within the multidisciplinary team. Formal evaluation, by clinical audit, indicated that the project continued to improve the overall standard of oral care throughout the hospital. To ensure that this high standard continues, it is essential that continued support, commitment, and enthusiasm be given from the dental team and that support is constant.

Adolescent↗
PubMed2004

Survey of oral care practices in US intensive care units.

BACKGROUND: Research has shown that oral care involving toothbrushes and topical antimicrobials improves the oral health of medically compromised patients and may reduce the incidence of nosocomial infections including pneumonia. This survey research was undertaken to determine the type and frequency of oral care in intensive care units (ICUs) in the United States and the attitudes, beliefs, and knowledge of health care workers. METHODS: A randomly selected survey of 102 ICUs within the continental United States participated with 556 respondents; 97% of respondents were registered nurses. MEASUREMENTS: Frequency and type of oral care provided, attitudes and beliefs, and knowledge and training in oral care were measured. RESULTS: Ninety-two percent of respondents perceived oral care to be a high priority. The primary methods of oral care involved the use of foam swabs, moisturizers, and mouthwash. Toothbrushes and toothpaste were used infrequently by almost 80% of respondents. The majority of nurses indicated a need for research-proven oral care standards and desired to learn more. CONCLUSIONS: In this random sample of ICUs, oral care methods were not consistent with current research and oral care protocols. The translation of oral care research into practice in the ICU may improve the quality of care and decrease the incidence of ventilator-associated pneumonia.

Critical Care↗