Xylitol for the Ages
F
rom broken teeth to decay to large quantities of
biofilm on teeth, Angie Stone, RDH, BS, and Shir-
ley Gutkowski, RDH, BSDH, saw a plethora of
oral care problems in the residents of a long-term care
facility that they visited for their 2008 pilot study. “The
amount of biofilm on their teeth was unbelievable,” said
Gutkowski.
On the second day of 3 half-day seminars at Xlear’s
3rd Educational Conference on Xylitol, Stone and Gut-
kowski shared the results of this pilot study—Xylitol in
dependent adults—and their recommendations about in-
corporating xylitol into the daily oral care of long-term
care residents.
The results of the study showed “an incredible com-
pliance rate” as well as “incredible biofilm reduction as
evidenced by disclosing solution,” said Gutkowski. “We
are looking at mounting other studies that look not only
at the amount of biofilm on the teeth, but the reduction
in pneumonia.” She added that better oral care can re-
duce pneumonia in dependent adults.
Xylitol is studied extensively in child populations,
and one purpose of the pilot study was to show xyli-
tol working in another age group, Gutkowski said. She
added that to provide seniors and dependent adults with
proper oral care, it is important to understand the limits
of their caretakers.
Limits of CNAs
The hygienists asked the audience, “Who is in charge
of care for these people?” For long-term care residents,
certified nursing assistants (CNAs) provide care for
these dependent adults. Stone and Gutkowski said that
another purpose of the study was to take pressure off of
the long-term care staff. They noted that the CNAs are
provided with “cheap toothbrushes and toothpastes”
and are not properly trained with regard to oral care.
“CNAs are trained very cursorily,” said Gutkowski.
“Training in oral care is 30 minutes of a 3-month
curriculum and is included in the chapter on washing
patients’ hair and trimming their nails.” According
to Stone and Gutkowski, oral care for long-term pa-
tients does not rise to a high level of importance. “[The
CNAs] would much rather do diaper care than clean the
mouth,” said Gutkowski.
Stone shadowed CNAs at work and noted that they
struggled just to get the residents to take their medica-
tions or comply with other daily care protocols. She
noted one instance in which a CNA was sweating after
getting a resident to take a shower.
“[Before entering long-term care facilities] many resi-
dents [were] used to having their teeth cleaned and hav-
ing dentistry done for them,” said Gutkowski. “Not being
able to brush your own teeth or having broken or crooked
teeth, it affects everything.” Stone and Gutkowski shared a
story of a resident whose halitosis was so bad that nobody
wanted to sit with that resident at dinner.
Implementing Xylitol
In an interview with Gutkowski, she said that xyli-
tol was the first choice in introducing a new oral care
regime to the long-term care residents. For their pilot
study, Stone and Gutkowski obtained Xlear’s Spry gum,
mints, and spray as well as MI Paste from GC America
and Young Dental’s 2Tone disclosing solution.
The CNAs worked xylitol into the daily care routines
of the residents; the residents would chew 2 pieces of
xylitol gum for 5 minutes or would dissolve 2 mints in
the mouth.
The residents also received 2 squirts of Rain Spray as
well as MI Paste to help keep tissue moisturized at bed-
Dental Learning
Photo credit: Mark Gutkowski
Angie Stone, RDH, BS, and Shirley Gutkowski, RDH, BSDH share their
2008 pilot study at Xlear’s 3rd Educational Conference on Xylitol.
time. The CNAs tracked their routines via a checklist.
“There was a 79% compliance rate,” said Gutkowski.
“No other study can demonstrate this kind of compliance
over 3 months.” The hygienists noted that the CNAs were
thrilled to be able to give the residents a piece of candy.
Gutkowski quipped, “Nobody doesn’t like candy.”
Stone and Gutkowski agree that xylitol doesn’t need to
only be implemented in the form of gum or mints. They
both suggested that including xylitol in foods such as pud-
ding or ice cream and implementing functional foods like
cranberry juice can help make a big impact on this popu-
lation.
Adopt a Nursing Home
“We have to make some changes,” said Gutkowski,
citing her desire for law changes to allow hygienists into
long-term care facilities to care for the residents. Cur-
rently, according to Stone and Gutkowski, most states
do not allow hygienists to care for these residents with-
out some kind of an affiliation with a dentist. One effort
for change is the Adopt a Nursing Home program. This
national initiative was founded in 2007 by Stone and
Gutkowski as a way to encourage hygienists to educate
people working in long-term care facilities about proper
oral health care.
“We also would like to have these care facilities
looking for an Adopt a Nursing Home hygienist to do
this training,” said Gutkowski. To become an Adopt a
Nursing Home hygienist, hygienists must take online
training courses. In addition to the training, Stone and
Gutkowski have created a speaker’s kit complete with
3 PowerPoints, handouts, and scripts all in one easy-to-
use kit. Stone and Gutkowski hope to spread the word
about this unique program. “We would like the public
to know that this is in existence so they can look for
a facility affiliated with Adopt a Nursing Home,” said
Gutkowski. “They would know that their loved one is
getting proper oral care.”
—Elyse Fetherman
Shirley Gutkowski,
RDH, BSDH, FACE
Shirley Gutkowski, RDH, BSDH, FACE is a clinical den-
tal hygienist, author, and international speaker. She is
past president of her state dental hygiene association
and a recipient of many awards including Alumna of
the Year from her school at Marquette University. She
is the publisher of The Purple Guide series of books
for dental hygienists available at www.rdhpurpleguide.
com and technology coach at CareerFusion www.careerfusion.net.
Angie Stone, RDH, BS
Angie Stone, RDH, BS has an array of experiences in
the dental hygiene profession: Dental Assistant-United
States Navy and Civilian, Front desk Personnel, Clini-
cal Dental Hygienist, speaker, writer, dental assisting
and dental hygiene educator, and owns her own com-
pany, HyLife, LLC. She remains active in many of
these venues and is an alumna of CareerFusion.
www.dentallearning.net