Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Background
  • Research has consistently indicated that oral health has a significant impact on quality of life (Almomani, Brown & Williams, 2006; Chalmers, Carter & Spencer, 2002; Petersen, Bourgeois, Ogawa, Estupinan-Day & Ndiaye, 2005; Sheiham, 2005; Watt, 2005).
  • Good oral health enables individuals to communicate effectively, to eat and enjoy a variety of foods (Watt, 2005).
  • Poor oral health affects the ability to sleep well, especially in the presence of pain, and impacts on a person’s perception of self – both their self-esteem and self-confidence.
  • The relationship between oral health problems and specific medical conditions is being substantiated by evidence from clinical, epidemiological and laboratory studies. “Oral organisms have been linked to infections of the endocardium, meninges, mediastinum, vertebrae, hepatobilary system and prosthetic joints” (Shay, 2002, p. 1215). In addition, oral pain can have an economic impact on society through time away from work, lost productivity and increased health care expenditures (Watt, 2005).
  • The greatest burden of oral disease is to disadvantaged and poor population groups, both in developing, and developed countries (Petersen et al., 2005).
  • Residence of long term care: “Aspiration of oropharyngeal (including periodontal) pathogens is the dominant cause of nursing home acquired pneumonia; factors reflecting poor oral health strongly correlate with increased risk of developing aspiration pneumonia” (Shay, 2002, p.1215). Nursing home-acquired pneumonia is the leading cause of death from infection in long-term care home residents, and is the second most common cause for hospitalization (Oh, Weintraub & Dhanani, 2004; Shay, 2002).  Not brushing the teeth or not receiving adequate oral hygiene care significantly increases oral bacteria in the saliva that residents swallow and may aspirate.
  • Person with mental illness: Persons with psychiatric illnesses, including those with schizophrenia, schizoaffective disorder, depression and bipolar disorder may have their oral health compromised, not only by the illness, but also from the medications used to treat the illness. These medications can cause a range of oral complications and side effects, with tooth decay, periodontal diseases and xerostomia being encountered most frequently (Almomani et al. 2006).
  • Client receiving chemotherapy and radiation: Mucositis is a painful complication of chemotherapy and/or radiotherapy, and good oral hygiene protocols are important. Mucositis requires effective oral hygiene and a multi-disciplinary approach to management.  Infection of the gums prior to chemo or radiotherapy is a potential compounding factor and therefore, when vulnerable populations are scheduled to have chemotherapy or radiotherapy, it is imperative that prior to this treatment they have good oral health.
  • Tobacco use: Smoking has significant effects on the oral cavity, including oral cancers and pre-cancers, increased severity and extent of periodontal diseases, and poor wound healing (FDI/WHO, 2005). Up to one half of all adult cases of periodontitis are linked directly to tobacco use and when health care providers advocate for smoking cessation programs, they are advocating for better oral health.