Nursing homes get some bad press. Just the name commonly conjures up a vision of someplace we do not want to be. Be they good, bad, or otherwise, our notions of nursing homes can always be improved if we take the time to visit those confined to these facilities and help out the staff when we are visiting our loved ones. There are some things, due to the fact that we are not skilled nursing professionals, we cannot attend to, but these hard working caregivers may be really happy to have us add some TLC and smiles to what can be an otherwise stressful day.

So where does oral health care come in here? It does not need to be said that the nursing home staff work very hard for their clients. What we, as oral healthcare workers tend to forget, is that they are medically trained and not dentally trained. It can be very foreign and uncomfortable for some of these workers to place their hands in their patient's mouths and perform excellent oral hygiene. We need to make sure this is being done, however. As most of us know, the mouth is attached to the body. Not only is it part of the body, it is the beginning of the digestive tract, the place where all sustenance generally enters the body. It is important in talking, smiling, eating, drinking, and swallowing. Anyone with a mouth probably knows a clean mouth makes you feel better.

I just read a Cochrane Library systematic review about research that has been done on nursing home patients and their oral health. The review of four studies concluded that there may be less incidence of aspiration pneumonia, but not enough good research has been done to draw a direct line from improving daily oral care and fewer pneumonia deaths.

Aspiration pneumonia is caused by aspirating food, fluids, saliva, or mucous and can make patients very ill and even cause death. Dental hygienists have long subscribed to the theory that the better the oral health is, the less chance of developing aspiration pneumonia. Patients who are trying to recover from any of a variety of illnesses are more prone to pneumonia as they lay in bed. We have all coughed when food or saliva 'goes down the wrong pipe". Those who are ill sometimes either may not feel it, or lack the reflexes to stop the stuff that doesn't belong there from drifting down the wind pipe into their lungs. The goal of good, daily plaque removal is to reduce the bad bacteria, fungi, etc., from accumulating in the oral cavity, so there are fewer "bad actors" or pathogens available to cause disease. 

Though the research is still out on whether or not performing oral hygiene daily on patients in nursing homes, I can only believe that it helps and the smiles I get from patients after I have cleaned their teeth is evidence they feel better. We have to take our victories for these patients where we can get them. Ask any RDHAP. We believe we can make a difference and reduce the incidence of aspiration pneumonia.

If you are having questions about what to look for when visiting your loved ones in a care facility, or would like an RDHAP to look in on a particular patient, please go to the map on I Need and RDHAP to find a practitioner near you who can help you and your family care for everyone's oral health.

Are you pregnant? Take care of your oral health during your pregnancy.

There are several reasons for this advice.

Please read on.

Is it safe to see the dentist when I am pregnant? Pregnant women have so many things to be concerned with as they strive to  protect their health and the health of their baby. Among these concerns should be their oral health.

The first that thing that needs to be said is that it is important to visit your dentist and dental hygienist to have your teeth cleaned and checked during pregnancy. Your dental hygienist or dentist will take thorough medical history and, should there be a reason they feel you should not be seen for preventive dental hygiene care, they will consult with your physician to insure your health and that of your baby are not put at risk. Please don't assume they know you are pregnant. It is important to share that information and any concerns you may have.

All that stated, pregnant mother's tend to be uncomfortable lying on their backs for long periods of time late in their pregnancies. Therefore, it is best to seek dental hygiene care early in the pregnancy, so your dental team can optimize your care before the baby is born.  

Why are my gums bleeding? Several things can cause bleeding gums during pregnancy. It is impossible to diagnose in this article, so the message is to see your dentist or dental hygienist. Basically, however, either periodontal disease (gum disease) or gingivitis (gum infection) cause bleeding gums. Often during pregnancy, hormonal changes increase swelling and bleeding in the gums. This should not be ignored. In fact, advice from dental providers is to strive for healthy teeth and gums before you start considering pregnancy. This advice is good for prospective fathers, as well.

Research has shown that women with uncontrolled periodontal disease are at risk for delivering preterm and low birth weight babies. Periodontal disease (gum disease) can be treated successfully during pregnancy to help increase the chance of a successful pregnancy and birth.

Tooth decay: Long story short - tooth decay (dental caries) is a transmissible and preventable disease. So what does this have to do with being pregnant? Babies are not born with teeth or the bacteria that cause tooth decay. They are "infected" with these bacteria by loving parents, family members, caregivers, and even other children. How? Through sharing foods and beverages, cleaning pacifiers with the parent's saliva, and sharing toys.

Every pregnant mother should ask her family and friends who want to love on her 0-3 year old baby to make sure they have healthy teeth. Babies are most susceptible to infection with decay-causing bacteria in the first 3 years of life. Ask you dental hygienist how to care for your baby's young teeth as well.

The American Dental Association has some wonderful materials and guides as you navigate pregnancy and your oral health. Contact an RDHAP near you to see if you qualify for dental hygiene care in your home. The services of an RDHAP can be especially beneficial if you already have little ones at home and making your trips to the dental office is difficult or impossible.

   

I was happy and sad at the same time. I hate it when that happens, but alas, it happens to everyone occasionally. On Saturday, October 20, the Care Partnership Day and Caregiver Pathways held a caregiver fair in Sacramento. I really wanted RDHAP Connect to be there. It is important, and fun to expose our services to the many people who are not aware we exist. Unfortunately for me, my nephew was marrying his beautiful fiancée the same weekend. Though I thoroughly enjoyed being a part of my nephew's important day, I was sad to miss the health fair.

Fortunately for me,  two of my RDHAP colleagues were happy to represent RDHAPs and RDHAP Connect at the Care Partnership Day. Kathryn Eldridge and Brenda Paquin, both local practitioners, took toothbrushes, flyers, oral health information, and spread the message of the importance of good oral health for the elderly and all needing oral health care.

Forgive me for starting this posting with healthy snack pictures. This is really one of the answers to the tooth decay problem we have among our nation's children. But I digress...

I recently read Teeth, by Mary Otto. I knew the name Mary Otto, but frankly, the title interested me long before I knew what it was about.  Ms. Otto is a journalist who published an article in the Washington Post in 2007, about a boy named Deamonte Driver. Please do not forget his name.

Deamonte died as a result of an untreated cavity. He was not the first boy to die as a result of a decayed tooth, and unfortunately he will not be the last, but after reading Mary's initial article in 2007 on his tragic death, I have taken every opportunity to share his story and how oral health care providers, caregivers, and parents all play an important role in making sure no other child has to suffer the pain of untreated tooth decay.

The book discusses the journey America is undergoing as we struggle to care for the oral health of our population. Teeth details the path our national health care system has taken to care for our general health, while failing to realize the oral cavity is connected to the body. Deamonte had dental coverage, as do most, if not all children in the United States. The problem is with the insurance reimbursement to dentists, leading to the fact that many dentists will not accept the insurance created to protect children. This child had a toothache. His mother tried to find a dentist to help the child. She was unable to find someone to treat his toothache. Deamonte subsequently developed a dental abscess that migrated into a brain abscess, tragically ending his young life.

Deamonte and his family lived in Washington D.C., which may seem far from your neighborhood. But children die more commonly than is reported as a result of a preventable disease, tooth decay. This is happening today and probably in your town. Children die during dental surgery from the anesthesia. These are children who may not have even needed surgery had the dental disease been prevented or treated in the early stages.

I write this not to scare you. OK, I do want to scare you. I want to scare all oral health care providers who read this to find a way to help your community reduce the decay rate in children. If you are a dentist, dental hygienist, or independent dental hygiene care provider, join the Halloween Candy Buy-Back program this year. Trick or treating if fun. The candy  resulting "feeding of the germs" as I call is, is not! Take this opportunity to join the program and trade candy for dollars while sharing a little tidbit of dental disease prevention information with children and their parents. 

Parents, ask your dentist or dental hygienist how to wean your kids from the fermentable carbohydrates (cookies, candy, cracker-like snacks). One tip: introduce healthy snacks into their diets slowly. Almonds, white cheese, fresh veges, replace the sugar and add calcium. The last thing the child should do before going to bed is to brush thoroughly, not snack. Don't give those germs sugar to feast on during the night. The old adage: Rome wasn't built in a day, is true. If you fail, keep trying. This is a marathon, not a sprint. Yes. I love my adages. :;-)

There is so much to say on this topic. I was challenged by a friend to update my blog today and October is always a month where Deamonte Driver is on my mind. Call an RDHAP on the map in the website and ask how we can help you and your family be free of tooth decay. Happy Halloween!

I was reminded that RDHAPs can actually work for dentists in traditional clinical settings. Practically speaking, this does not affect the practice or care of the clinician, but I still wanted to include this for clarity.

There are many clinics through the country, including Indian clinics, federally qualified health clinics, free clinics, and even dental school and dental hygiene schools, where patients can receive dental hygiene care. Since the RDHAP does not need to be overseen by a dentist to practice, they can be hired to work in a variety of settings in an effort to increase access to care.

Among the many skills of every dental hygienist (RDH) and registered dental hygienist in alternative practice (RDHAP) is that of oral health education. Not only can we teach you how to keep your teeth clean (OK, nag about brushing and flossing :-) ), we can train caregivers how to best work with their clients, parents to care for their children's teeth, and give presentations to public groups, professional caregivers, and school children, all with the goal of helping everyone maintain the best oral health possible. Just ask!

I guess to conclude this 5 part series of our scope of practice. If you see a unmet dental hygiene need or feel your community could be improved by connecting with and RDHAP capable of serving your area, use this website as a way to connect with one. Each of us is capable of answering your questions and can either establish a practice or be a resource for you to find an RDHAP to meet your oral health care needs.

Also, please leave a comment if you would like further information.