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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-

Photo credit: Mark Gutkowski
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

loved one is getting proper oral care.” —Elyse Fetherman Shirley Gutkowski, RDH, BSDH, FACE Shirley Gutkowski,

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.

and technology coach at CareerFusion www.careerfusion.net. Angie Stone, RDH, BS Angie Stone, RDH, BS has an

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.

in many of these venues and is an alumna of CareerFusion. D e n t a

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