I’m sure many of us have woken up in the morning at some point in our lives with breath so bad, that we’ve actually lept out of bed like an Olympic gymnast to grab that minty fresh toothpaste before anyone can notice.
But what would happen if you were an elderly patient or resident who lacked the independence and mobility you once had and struggled to brush your teeth without help? Would you still want to talk to people or eat and drink if your teeth had not been brushed?
In the past, hydration, nutrition and oral health have been viewed in isolation. However, research indicates they are interlinked, greatly influencing one another and having a significant effect on general health and well-being (Humphreys & Vadher et al., 2017).
Afterall, the mouth is the gateway to the rest of our body!
Hospitalisation can lead to a deterioration in oral health of patients, which can be linked to poor nutritional intake; increased length of hospital stay; increased hospital-acquired infections such as pneumonia; dry mouth; and higher care costs (Terezakis & Needleman et al., 2011).
Examples of patients most at risk include dementia; frail elderly; ventilated patients; poor mobility; and stroke, to name a few.
As people are living longer in the UK, we are also keeping our teeth for longer. However, older people tend to have large fillings, crowns, bridges and dental implants, which need extra care and attention to maintain. This can become more difficult if the older person starts to decline medically, physically, or cognitively (Mouth Care Matters, 2016).
Evidence also suggests mouth care is often neglected in hospitals, with common nursing barriers including lack of knowledge, time and equipment; minimal training; and lack of oral assessment tools (Adams, 1996).
“Mouth care should be a fundamental part of care. But we [Mouth Care Matters] often find hospitals and care homes have poor standards of oral care and patients suffering from dry mouth due to a lack of awareness around the importance of a healthy mouth. This can affect general health and well-being. There is often a lack of effective products for staff to use who often lack confidence and skills to undertake any mouth care.”
Loraine Lee, Mouth Care Matters Lead for East Surrey Hospital
However, good mouth care is also the responsibility of carers working in domiciliary care and care homes. This is because there are links between gum disease and diabetes, cardiovascular disease, and infective endocarditis (Mouth Care Matters, 2016).
Furthermore, older people may struggle with malnutrition and dehydration if experiencing difficulty due to mouth related problems, for example ill-fitting dentures. Of course, poor oral health can also affect a person’s desire to speak or smile. This can make it difficult to communicate thirst or alternatively they may avoid drinking and eating to avoid asking for the toilet.
How can Clinicians and Care Staff Work to Improve Mouth Care?
In hospitals, good mouth care and oral health should be the responsibility of doctors; speech and language therapists; dieticians; occupational therapists; physiotherapists; and pharmacists, not just nursing staff (Mouth Care Matters, 2016). However, a lack of knowledge and skills can hinder this holistic approach to care.
“Mouth Care Matters have introduced a permanent mouth care lead nurse to train all new and existing staff with the knowledge and skills to ensure effective oral care is undertaken for the benefit of our often vulnerable patients. Staff also get added support and guidance when needed and are expected to record daily mouth care carried out on patients to ensure continuity of care to individual patients.”
Loraine LEE, Mouth Care Matters Lead for East Surrey Hospital
With this in mind, it is clear that education, knowledge, and improving confidence and skill set are vital for those working in hospitals, care homes and domiciliary care. However, we also recognise the barriers to achieving this. We would therefore advise that for additional support and resources, please take a look at Mouth Care Matters.
At Aquarate we want to see nutrition, hydration and mouth care working together to promote good health and well-being in the older population. We would therefore like to thank Loraine Lee and Mouth Care Matters for all the hard work they do to promote good oral health across the UK!
If you would like to know more about the work Aquarate are doing, please get in touch here or follow us on social media to stay updated!
Adams, R. (1996) “Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards”. Journal of Advanced Nursing, 24, pp. 552-560.
Humphreys, K., Vadher, D., Allen, Y., Patel, N., Shah, S. (2017) “Examining the links between hydration, nutrition and mouth health.” British Journal of Nursing, May 25;26(10), pp. 566-570.
Mouth Care Matters (2016) “A guide for hospital health care professionals.” Available at: http://www.mouthcarematters.hee.nhs.uk/wp-content/uploads/2019/04/MCM-GUIDE-2016_100pp_OCT-16_v121.pdf
Terezakis, E., Needleman, I., Kumar, N., Moles, D., Agudo, E. (2011) “The impact of hospitalization on oral health: a systematic review.” Journal of Clinical Periodontology; 38 (7), pp. 628-636.