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