Unit of competency details

Descriptor 

This unit of competency describes the skills and knowledge required to promote oral health for older persons. The experience of pain and problems with eating and chewing can adversely affect people's daily lives, self-esteem and well-being

This unit acknowledges the interrelationship between oral health and general health which is especially pronounced among older people

All procedures are carried out in accordance with occupational health and safety policies and procedures, current infection control guidelines, Australian and New Zealand Standards, State/Territory legislative requirements and organisation policy

Application 

This unit applies to dental assistants and to other health care workers who are actively involved in promoting the general well-being of older clients through the promotion of healthy eating habits and good oral health

Pre-requisite units 

This unit must be assessed after successful achievement of pre-requisites:

• HLTAMBFC301C Communicate with clients and colleagues to support health care
• HLTDA407C Implement an individualised oral hygiene program

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement.

ELEMENT 

PERFORMANCE CRITERIA 

1. Assess the oral health needs of an older person

1.1 Actively encourage the client to discuss oral health problems without embarrassment

1.2 Identify individualised factors which increase the risk of oral disease  for older persons

1.3 Identify oral health problems for older people  and their relationship to general health problems

1.4 Look in the client's mouth while cleaning and/or assisting with oral care

1.5 Identify clients with natural teeth, those who wear dentures and those who are non-denture wearers

1.6 Identify problems that require referral  to a dentist

2. Provide support for the maintenance of oral hygiene for older persons

2.1 Ensure flexibility of oral hygiene instruction taking into consideration a client's individual circumstances 

2.2 Demonstrate an understanding of the economic and psychological factors  which may affect the oral health of older people

2.3 Provide an appropriate environment for oral hygiene instruction

2.4 Develop and give oral hygiene information  to clients and carers using language and in a manner they can understand

3. Implement practical solutions to promote oral health

3.1 Actively explain to clients and carers the importance of regular dental care to maintain quality of life

3.2 Recommend lifestyle changes  where salivary flow may be diminished in consultation with dental professional

3.3 Provide appropriate information to clients and carers for healthy food habits that support oral health 

3.4 Actively encourage clients and/or carers to clean teeth or dentures after meals

3.5 Appropriately involve carers who accompany clients in oral health promotion

4. Maintain oral health of persons in residential aged care

4.1 Ensure all removable dentures are visibly marked with a residents identification 

4.2 Record oral health  in the resident's personal care plan

4.3 Implement individual oral health programs  in consultation with dental professional

4.4 Assist clients with special needs to clean their teeth

4.5 Assist clients and their carers to clean and maintain dentures 

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

• Applied oral anatomy

• structures of the oral cavity - hard and soft palate, lateral and posterior borders of the oral cavity, tongue and floor of the mouth
• teeth - form and function
• dentition - Arrangement of the teeth, naming and coding of teeth

• Plaque and its differing roles in the development of dental caries and periodontal disease
• Saliva and its role in the maintenance of oral health

• protecting teeth by neutralising acid
• acting as a lubricant
• delivering calcium, phosphate and fluoride to the tooth surface

• The interaction of factors that lead to the development of dental caries including:

• bacteria in dental plaque
• diet
• susceptible tooth surfaces

• The interaction of factors that prevent and control dental caries

• increasing salivary flow and optimising its composition
• fluorides
• plaque control and removal
• dietary change

• The interaction of factors that lead to the development of periodontal disease including:

• bacteria in dental plaque
• accumulation of plaque and calculus
• smoking

• The interaction of factors that prevent and control periodontal disease including:

• client education
• plaque control

• Causes, and prevention, of non caries tooth wear:

• erosion
• abrasion
• attrition

• Fundamental knowledge of the impact of smoking on oral soft tissues
• Fundamental knowledge of systemic conditions which influence the development of oral disease
• Local oral factors which influence the development of oral disease

continued  ...

Essential knowledge  (contd ):

• Legislative requirements related to the use of fluoride in dentistry
• Modification to standard toothbrushes and other aids for oral hygiene to meet the needs of clients with reduced dexterity
• Modifications to oral health education programs related to special needs due to disability, aged care and dementia

Essential skills :

It is critical that the candidate demonstrate the ability to

• Consistently provide complete and appropriate information on the prevention of oral diseases to clients, carers and others.
• Consistently provide complete and appropriate information, advice and demonstration of oral hygiene techniques to clients, carers and others.
• Consistently implement appropriate prevention programs to suit individual clients.
• Consistently follow procedures to ensure client safety

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

• Apply fundamental motivational and learning skills
• Consistently follow sequenced written instructions and manufacturer specifications for the preparation of materials and/or medicaments
• Consistently demonstrate interpersonal skills when relating to people from a range of social, cultural and religious backgrounds and physical and mental abilities
• Consistently demonstrate communication skills as required in fulfilling the job role as specified by the dental practice/organisation including:

• acknowledging and responding to a range of views
• active listening
• asking for clarification from client and/or carer
• asking questions
• negotiation

• Consistently deal with conflict
• Consistently work with others and display empathy with client and relatives
• Consistently use problem solving skills required including:

• selecting and preparing special aids for oral hygiene to assist clients with limited dexterity
• using available resources

• Use communication skills to effectively inform and motivate behaviour change

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this competency unit :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• Observation of workplace performance is essential for assessment of this unit
• Consistent compliance with infection control guidelines, occupational health and safety procedures, Australian and New Zealand Standards and legislative
• Consistency of performance should be demonstrated over the required range of workplace situations

Context of and specific resources for assessment :

• Where, for reasons of safety, access to equipment and resources and space, assessment takes place away from the workplace, simulations should be used to represent workplace conditions as closely as possible

Method of assessment 

• Evidence of essential knowledge and understanding may be provided by:

• traditional or online (computer-based) assessment
• questions during workplace assessment
• written assignments/projects

• Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice
• Staff and/or client feedback
• Supporting statement of supervisor
• Authenticated evidence of relevant work experience and/or formal/informal learning
• Role play simulation

Access and equity considerations :

• All workers in the health industry should be aware of access and equity issues in relation to their own area of work
• All workers should develop their ability to work in a culturally diverse environment
• In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people
• Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance.

Factors which increase the risk of oral disease for older persons may include but are not limited to  :

• Lifestyle factors:

• poor diet and dietary habits
• smoking
• habits

• Systemic factors:

• medically compromised
• reduced salivary flow and reduced capacity of saliva to dilute food acids and return ph of saliva back to a neutral level

• Age factors:

• Reduced manually dexterity
• Mental health
• Reduced rate of food clearance from the mouth

• Reduced access to care
• Reduced amounts of fluoride, calcium and phosphate to assist with tooth repair after acid attack

Oral health problems for older people may include but are not limited to :

• Reduced salivary flow which may be a result of:

• consumption of caffeine and alcohol
• medications
• increased levels of stress producing adrenaline

• A high level of tooth loss and edentulism which will:

• reduce chewing capacity
• affect food choices
• cause weight loss

• Dental caries especially root caries
• High prevalence of periodontal disease

Problems that require referral may include but are not limited to :

• Areas in the mouth which are white, red or a combination of white and red areas
• Bad breath
• Broken or lost dentures
• Difficulty in eating
• Dry mouth
• Ill fitting or loose dentures
• Localised or general pain in the mouth
• Swollen, bleeding or inflamed gums, oral abscesses and ulcers

Economic and psychological factors may include but are not limited to :

• A lack of dental care tradition
• Financial hardships following retirement
• Inequity of access to dental care
• Negative attitudes towards oral health
• The cost or perceived cost of treatment

Individual circumstances which require special consideration may include :

• Communication needs
• Culture
• Disability
• Economic circumstances
• Geographical location
• Language

Denture identification marking may include :

• Ensuring all new appliances are marked with the client's name
• Requesting dentist or prosthetist to engrave the client's name into the denture base
• Using a marking kit

• an indelible pencil
• clear varnish

Record of oral health may include but is not limited to :

• Dental status

• own teeth
• partial upper/lower dentures
• full upper/lower dentures

• Medical, psychological and pharmacological conditions impacting on oral health
• Capacity of client to undertake

• personal self-care
• supervised self-care
• assisted or partial self-care
• fully dependent on carer for personal care

• Document details of dental care provided including:

• denture cleaning
• assisted tooth brushing
• dental examination provided by dentist

• Specific oral health concerns including:

• xerostomia

Oral hygiene information may include :

• Manual and electric tooth brushing technique
• Modifications to application of program for carers of special needs and aged care clients
• Modifications to toothbrush handles for specific needs of client and/or carer
• Use of dental floss
• Use of fluoride toothpaste and mouth rinses when appropriate
• Use of other specific oral hygiene aids when appropriate

Lifestyle changes may include :

• Decreasing the intake of acids and fermentable carbohydrates
• Decreasing the intake of alcohol and caffeine
• Increasing water intake
• Reducing or stopping a smoking habit

Healthy food habits that support oral health may include but are not limited to :

• Discouraging continuous snacking with biscuits, confectionary and desserts
• Encouraging the use of sugar-free sweets
• Ensuring that desserts are eaten with meals
• Reducing the frequency of eating sweet, sticky foods, confectionary and soft drinks