Guidelines for a Palliative Approach in Residential Aged Care

the tools accuracy for identifying older persons who do not require care, which the
D-E-N-T-A-L is unable to do [222] (Level IV).
Irrespective of which tool is the most appropriate, clear standards are required regarding
routine mouth care. These standards need to address denture care, ‘natural’ teeth care, plaque
removal, tongue care, requisite materials for mouth care, regular oral screening, pathways for
referrals, and types of oral treatments available [217] (Level EO). Assessment should include
the fit of dentures, moistness of the oral cavity, presence of gum inflammation, infections
such as Candida, and presence of mucosal lesions or ulcers. Those most at risk of poor oral
care are residents who are reluctant to eat and drink, who have lost their thirst reflex and are
dehydrated, or are receiving medications (e.g. antidepressants, antihypertensives, antipsychotics,
diuretics, narcotic analgesics) that exacerbate oral problems, i.e. xerostomia (dry mouth;
see Glossary).
The fundamental principles for oral care are that it must be individualised and that the
frequency of care is more important than the use of specialised agents. Individualised
assessment helps determine specific needs and the level of self-care the resident is capable of,
which should then guide any adaptations of standard practices [217] (Level EO).
6.9.2 Management
No single intervention is appropriate for oral care of residents receiving a palliative approach.
Instead, a range of simple measures is the most effective in managing and improving oral care.
These measures, when instigated early, can prevent and reduce oral complications. Regular
oral hygiene, including cleansing with water, is essential for the resident’s comfort. Despite the
number of commercial products available, research has shown that rinsing with water, cleansing
with a soft toothbrush and toothpaste, and regular soaking of dentures in a weak non-toxic
solution are the most effective oral-cleansing agents [225] (Level II).
A multidisciplinary approach is preferable, with collaboration between the aged care team,
dental services, occupational therapists and dieticians to ensure that the aged care team
are supported in their practice of oral care for residents [217] (Level EO). Improved referral
and feedback procedures are also required to ensure that all the aged care team are aware of
these protocols. A continuing education program for the aged care team (of all levels) is also
recommended to promote good oral care practices [217] (Level EO).
Guideline:
Mouth Care
31. Good oral hygiene, regular assessment, cleansing of dentures and oral
fluids can reduce oral complications.
32. Oral health assessments that include the question, “How would
you describe the health of your teeth and gums? Would you say it is
excellent, very good, good, fair or poor?” for residents who are able to
respond increases accuracy in identifying residents who require further
evaluation and dental treatment.
33. Rinsing the mouth with water and cleansing teeth with a soft toothbrush
and toothpaste is an effective oral cleansing routine that is cost-efficient
and reduces the resident’s risk of oral mucositis (mouth ulcers).
Ref No. Evidence
level
221 IV
222 IV
225 II
Guidelines for a Palliative Approach in Residential Aged Care 103