Effective Management Strategies for Oral Hygiene in Dementia Patients in Aged Care Facilities

This report draws evidence from scholarly articles and recommends the implementation of Tuckman's teamwork theory and the behavioural theory of management for effective management strategies for oral hygiene in dementia patients in aged care facilities.

Running head: REPORT
Assessment task 1
Name of the Student
Name of the University
Author Note

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Executive Summary
Good oral health has been identified crucial for health and wellbeing. With a progress in
dementia, a neurological condition that results in a deterioration of cognitive faculties such
as, memory and thinking, establishment of a good dental program becomes essential. The
report found that older people suffering from dementia become frail and lose the capabilities
of conducting their activities of daily living such as, showering and grooming. Besides, use of
certain medications were also found to exert an impact on oral health. The report aimed to
formulate effective management strategies by using different theories such as, Tuckman’s
theory and the behavioural theory of management, all of which were directed at improving
the oral health and lowering the risks of poor dental health development among patients in
the aged care facility.

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Table of Contents
Introduction................................................................................................................................3
Literature review........................................................................................................................3
Recommendations......................................................................................................................6
Conclusion..................................................................................................................................8
References................................................................................................................................10

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Introduction
Aged care facilities refer to special-purpose health facilities that are designed in a way
that helps in providing accommodation and different other kinds of support to older adults.
This commonly includes assistance in their intensive care, daily living, and independence of
aged and frail person (Broad et al., 2013). In other words, aged care facilities are aimed for
providing assistance to those individuals who are no longer able to live in their homes, due to
bereavement, illness, disability, and emergency. Their immediate carers are not usually able
to address these conditions properly, without help. Dementia is an umbrella term that is used
for describing a range of symptoms that are associated with a gradual and progressive decline
in memory functions and thinking skills. These symptoms are severe enough to lower the
ability of an affected person to perform activities of daily living (Prince et al., 2013). The
condition most commonly arises due to physical alterations in the brain. Oral hygiene and
health is often overlooked by adults having dementia in, during their stay in aged care
centres. Good oral health has been identified imperative for the overall health, quality of life
and wellbeing of all individuals. This report will draw evidences from scholarly articles in the
form of a literature review, followed by recommendations to manage oral hygiene in
dementia affected patients in an aged care.
Literature review
The primary aim of the literature review was to draw evidences from scholarly paper
that contained substantive findings and theoretical contributions to the concept of oral health
maintenance in dementia patients. The research question for the review was as follows:
What is the relationship between oral health and poor outcome in dementia patients?
The search strategy was developed by the identification of essential key words and
terms that matched the research question. Each component of the research question was

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evaluated for identification of the search terms. The keywords used were ‘dementia’,
‘Alzheimer’s’, ‘older’, ‘elder’, ‘frail’, ‘aged’, ‘oral health’, ‘hygiene’, ‘wellbeing’,
‘maintain’, and ‘manage’. The singular, plural and variant spellings of the terms were also
taken into consideration (if any). These terms were combined with the use of boolean
operators ‘AND’ and ‘OR’. Combining them with ‘OR’ broadened the retrieved hits, while
‘AND’ helped in narrowing down the extracted results (McGowan et al., 2016). Two
databases namely, Google Scholar and PubMed were used for extracting articles that were
relevant to the research question. Following an evaluation of the abstracts and full-texts, eight
articles were selected for inclusion in the review.
Upon comparing the oral health between older adults with and without dementia, it
was found that elderly people diagnosed with dementia most often show a dependence on the
nursing professionals and their caregivers. They frequently encounter oral care resistance
from the patients that contributes to oral health shortcomings. Univariate analysis conducted
for the major target variables and indicated the presence of high amount of plaques in
dementia patients, when compared to the non-dementia group. Furthermore, the mean
community periodontal index of treatment needs for dementia group reported significant
worsening than the counterparts, and all dementia patients reported presence of periodontitis
in one of the sextants, thereby proving the correlation between dementia and poor oral health
(Zenthöfer, Schröder, Cabrera, Rammelsberg & Hassel, 2014).
Similar findings were illustrated by Noble, Scarmeas and Papapanou, (2013) who
presented evidences for the epidemiological associations between reduced oral health and
cognitive impairment in dementia. Inattention to oral health was identified as a precursor to
old age and was associated with impairment in physical movements, and cognitive
difficulties among person aged more than 75 years. The authors also elaborated on the fact
that aged people who are less likely to make dental visits on a regular basis are more

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vulnerable to incidence of dementia. Other authors also presented similar views in relation to
the link between risks of dementia and poor oral hygiene. Following the acceptance of
proinflammatory states as factors that increase the risks of dementia and cognitive
impairment, poor oral health was recognised as a potential exposure that exists in close
correlation with systemic inflammatory responses. Gingival bleeding, tooth loss, and loss of
periodontal attachment were closely associated with poor cognitive function. The authors
were also able to establish a link between psychomotor speed, poor attention, gingival
bleeding and absence of periodontal attachment (Stewart et al., 2015).
The impact of oral healthcare on the well-being and quality of life of Alzheimer’s
disease patients were measured in another study that successfully illustrated the findings that
individuals suffering from AH report more dental decay, fewer teeth and poor oral hygiene.
Periodontal disease was also identified as the key factor that resulted in an increase in the
OHIP value among dementia patients. Furthermore, the relation between poor quality of life
with probing depth less than 4mm and gingival bleeding were clearly established in the
literature, thus providing adequate evidence for the failure of dementia patients in
maintaining their oral health. Foltyn, (2015) also supported the aforestated evidences in
stating that delirium and a decline in neurocognitive capabilities, as commonly observed in
dementia patients with poor oral health. The author stated that older adults diagnosed with
dementia have often been found to report frailty, falls, incontinence, vision and hearing
impairment, and medication noncompliance. All of these are found to directly interfere in
their capabilities in taking self-care such as, grooming, dressing and showering, which in turn
contributes to their failure to maintain adequate oral hygiene. Mouth pain was also identified
as a common problem in dementia patients that directly led to devastating effects in the
elderly such as, compound psychosocial issues, disruption in family dynamics and poor
appearance. Hence, chronic periodontal infection, rapid dental decay and dry mouth were

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some common symptoms found in dementia affected person. Tooth loss has also been
recognised as a major factor that increases the susceptibility of cognitive decline and
dementia among patients. In other words, older men and women with less teeth are
considered more likely to develop dementia at a later stage in their life. Lowered masticatory
capability was found to impair the nutritional intake, thereby resulting in inflammation that
acted as a risk factor for progressive decline in memory (Batty et al., 2013).
Furuta et al., (2013) also gave similar opinion on the association between the two
factors and stated that cognitive ability and nutritional status are found in direct correlation
with the swallowing function and oral health status among older patients. Upon conducting
path analysis, the authors found that cognitive impairment and poor status of oral health
create a direct negative impact on the denture wearing, and subsequent dysphagia. All of the
aforementioned factors were thus found to directly interfere with the activities of daily living.
Controlling bacterial dental plaque with maintenance of oral hygiene was also identified
essential, in order to prevent the onset of oral diseases such as, periodontal disorder and
caries. The older adults, suffering from mild impairment in their cognitive capabilities are
always at an increased risk for such oral disease. The findings elaborated on the fact that
gingival inflammation, bacterial plaque accumulation and deficient oral hygiene act as major
indicators for cognitive impairment, a characteristic feature of dementia (Gil‐Montoya et al.,
2017).
Recommendations
Hence, the findings illustrated above state that older patients suffering from cognitive
decline due to dementia are unable to maintain proper oral health. The primary
recommendation is to implement Tuckman’s teamwork theory to make all the professionals
involved in the aged care facility adopt essential strategies for oral health maintenance.

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 Team management- The four stages of Tuckman’s teamwork theory will be
effectively utilised in this scenario. The forming stage might show discrepancies
between the opinions and ideas of the healthcare professionals in the team (Betts &
Healy, 2015). However, upon utilisation of the theory, gradually all the members will
develop a sense of belonging with the team in the storming stage and develop
processes and ground rules, thereby clarifying each member’s role in the norming
phase. This will be followed by the final performing stage where a due focus will be
placed on the team relationship and the intended task of improving the oral hygiene.
This theory will focus on the role of a nutritionist in ensuring that the dementia
patients are not given food that are rich in sugar content, both at mealtimes and
between meals. The storming stage will also make the nutritionist learn the need of
restricting consumption of drinks that are not labelled sugar-free (Pretty et al., 2014).
This teamwork theory will also make the concerned physician and nursing staff learn
about the duties they are entitled with and develop an effective collaboration with
other members of the team in order to encourage the dementia patients clean their
dentures daily, or assist them in the task (Humphrey & Aime, 2014). Furthermore, an
effective teamwork will also promote the dentist to provide consultation to the
patients regarding designing of new set of dentures or providing them guidance
regarding cleaning of the dentures with the use of a non-perfumed runny soap or
denture paste.
 Emotional intelligence- Although teamwork is an essential prerequisite in any
organisation, it is often categorised as an unnatural act that takes into consideration
discipline, strategy and practice for development and growth (Stoller, Taylor &
Farver, 2013). Thus, emotional intelligence should be taken into account, while
implementing strategies for managing and understanding self and the entire team.

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Emotional intelligence will get adequately utilised under situations that involve a
close monitoring of the individual performance of each team member namely, the
dentist, geriatrician, registered nurse, nutritionist, and allied health professionals
(Goleman, Boyatzis & McKee, 2013). Social interactions between them regarding
their thoughts on the strategies that can be adopted will also promote emotional
intelligence.
 Quality management- Quality of the care delivered to dementia patients can be
managed encouraging adoption of the recommended practices in order to assist the
residents for maintaining their oral health. Quality management will also be facilitated
by incorporating practice recommendations such as, wearing dentures, cleaning them
over a sink or bowl of water, taking dentures overnight, and encouraging other forms
of oral care (Free et al., 2013).
 Changing care routine- This recommendation will be followed by providing short and
clear instructions to all health professionals and adequately demonstrating them what
steps should they follow in order to assist the older dementia patients adhere to oral
hygiene standards. Management of the condition will also involve providing adequate
guidance to the team members regarding the ways by which the teeth and mouth can
be taken care of, in the older patients. This can directly be implemented by following
the behavioural theory of management that was developed with the aim of responding
to the needs to account for motivation and behaviour among employees
(Amanchukwu, Stanley & Ololube, 2015). This theory will be applied in order to gain
a better understanding of behaviour of the team members in the aged care centre such
as, conflict, motivation, group dynamics, enhanced productivity and expectations.
 Certain medications are also found to result in dry mouth in patients, in addition to the
onset of a range of oral health issues (Thomson, 2015). Thus, effective collaboration

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needs to be initiated by following the human relations theories, in order to allow all
concerned health professionals gain an awareness of the possible avoidable factors
that can contribute to a deterioration in the oral health of the patients affected with
dementia.
Conclusion
Good dental care has been identified imperative for the maintenance of healthy gums,
teeth and tongue. Thus, it can be concluded from the literature that poor oral hygiene is allied
with dementia, and further so amid people in progressive stages of the neurological illness.
Suboptimal oral well-being such as, dental caries, tooth loss, gingivitis, and edentulousness
appear to be related with augmented risks of the development of dementia and subsequent
cognitive impairment. Older adults diagnosed with dementia and its associated conditions
such as, Alzheimer’s disease thus demonstrate an elevated risk for suffering from tooth decay
and associated gum diseases, which can be attributed to loss of ability to brush their teeth in
an effective manner. Medications and less attention given to personal grooming habits
worsen the condition and complicate the overall oral health status of such older patients.
Hence, an effective team work is required for addressing the major health issue and can only
be achieved by the implementation of proven management theories. Implementation of the
Tuckman’s theory of team management or behavioural theory of management is essential for
ensuring that adequate steps are taken by all concerned healthcare staff working in the aged
care facility for maintaining oral health and hygiene of the target population.

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