Elements and Performance Criteria

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.


Oral hygiene requirements appropriate to the client include care of:
Teeth
Crowns, bridges, implants, braces and other orthodontic appliances
Dentures
Mouth
Soft tissue


Person-centred refers to:
Effective service delivery
Involving clients in discussions about service delivery options and issues
Involving clients in informed decision-making relating to their care/service
Listening to and addressing complaints
Obtaining informed consent
Putting clients, carers and their preferences at the centre of service delivery


Good oral health refers to but may not be limited to:
A person's mouth that has:
breath without offensive odour
inflammation and lesion-free soft tissue
intact and stable teeth without cavities
moist lips without chapping
no build up of food, calculus or plaque
no oral pain
pink, moist, uncoated tongue
watery plentiful saliva
Looking after the whole mouth, including natural and artificial teeth, gums, tongue, lips and inside the cheeks
Oral health related quality of life factors, such as appearance, social interaction and self-esteem


Individualised care support plan may include:
A stand-alone individualised oral health care support plan
Care plan written by an appropriate health practitioner
Oral hygiene care plan
Personal care tasks embedded in a wider individualised plan


Client refers to those living in the community and/or facilities and may include:
Children receiving care, including in children's services
Older persons
Palliative care clients
People in care or health facilities
People with acquired brain injury
People with dementia
People with disabilities
People with mental health issues


Substitute decision maker (in relation to consent) must be:
The person appointed with the right to speak for the client, such as:
advocate
carers
guardians
health attorneys
medical power of attorney
members of family
other practitioners
parent of child
person responsible
public trustee


Potential impacts may include but not be limited to:
Positive impacts, such as:
able to chew food
clean mouth
improved general health and wellbeing
improved social engagement or interaction
increased self-esteem
longevity
Negative impacts, such as:
discomfort
disempowerment
embarrassment
fear
humiliation
pain
trauma particularly as a result of poor technique


Situations of risk or potential risk, may include but not be limited to:
Complex care clients, such as those with dementia or parkinson's disease
Emotional reaction from client, such as those related to dementia or anxiety
Infection control
Manual handling
Oral side effects of medication
Physical reaction from client
Pre-existing medical conditions
Reaction to contact with sensitive teeth
Resistance from client
Triggers for seizures


Legislative requirements refers to:
Federal, state or territory legislation that may impact on workers' practices and responsibilities, noting that implementation of the unit of competency must reflect the legislative framework in which a worker operates


Standards may include but not be limited to:
Aged Care Standards
Community Care Common Standards
Disability Service Standards
Home and Community Care (HACC) National Health Standards
Infection Control Standards
National Standards for Mental Health Services


Organisation guidelines may include but are not limited to:
Clinical protocols
Position descriptions
Workplace policies and procedures, including:
infection control
WHS


Oral hygiene products and aids for teeth and soft tissue may include but not be limited to:
Alcohol-free mouthwash directed by an oral health practitioner as part of an oral health care plan
Fluoride toothpaste
Interdental brushes
Manual and electric toothbrushes
Modified toothbrushes
Mouth props (if trained in their use)
Saliva substitutes
Soft toothbrush suitable for bending
Specialised aids
Sprays
Sugar-free gums
Tongue scraper
Tooth remineraliser


Oral hygiene products and aids for dentures may include:
Denture adhesive
Denture brush
Denture disinfection product
Denture labeling kit
Denture soaking products
Denture-friendly cleaner
Named denture storage container (disposable or non-disposable)


Other materials required for oral hygiene may include:
Bowl or hand basin
Cup of fresh water
Disposable gloves
Hand towel to be placed across clients chest
Lip balm
Towel


Toothbrushing may include:
Using currently accepted methods to clean:
natural teeth
fixed and removable prostheses
soft tissue


Soft tissue care refers to:
Care of all soft tissue, including:
cheeks
gums
lips
palate
tongue


Care of dentures refers to:
Cleaning, identifying and storing using currently accepted methods taking into account individual needs and preferences in line with the care plan


Use of alcohol-free mouthwash may refer to:
That which is directed by a health practitioner as part of an oral health care plan to enhance oral hygiene


Interdental cleaning refers to:
Cleaning between the teeth


Standard toothbrush care refers to:
Cleaning, storage and replacement of toothbrush to currently accepted standards


Techniques to improve oral hygiene practices may include but are not limited to:
Bridging:
engages clients senses especially sight and touch
engage client first and describe and show toothbrush
mimic brushing of own teeth to provide physical prompt
place brightly coloured toothbrush in client's preferred hand and they may mirror behaviour
Chaining:
if not initiated through bridging, gently bring clients hand and toothbrush to mouth, describing activity and then encourage the client to continue
Hand over hand:
if chaining does not work, place hand over client's hand and start brushing client's teeth so you are doing it together
continued...
Techniques to improve oral hygiene practices may include but are not limited to (cont'd):
Distraction:
if hand over hand method is not successful, place a familiar item, such as towel, cushion or activity board, in client's hand while brushing their teeth
Rescuing:
if attempts at oral hygiene are not successful tell client you will leave it for now
ask for assistance and perhaps have someone else take over


Modified oral hygiene methods and aids may include but are not limited to:
Appropriate alcohol-free mouthwash and gel
Backward bent toothbrush, or similar implement to retract cheek while brushing with another toothbrush
Bite block
End tufted brush
Flossers
Hand grip on toothbrush for clients with reduced grip strength
High fluoride toothpaste wiped onto teeth instead of brushing as a short term alternative only
Mouth props for clients who clench or bite or who have difficulty opening mouth (specific training required)
Mouth spray
Mouth swabs
Saliva substitute
Suction swabs
Tongue scraper and/or brush


Standard precautions refer to infection control and may include:
Wash hands before and after oral care
Appropriate use of personal protective equipment (PPE):
eye/facial protection e.g. glasses/face shield
gloves
gown
mask
Disposal of PPE


Additional precautions refer to:
Those infection control precautions that should be used, in addition to standard precautions, when these alone might not contain transmission of infection


Appropriate environment may include but is not limited to:
Choosing location where client is most comfortable
Ensuring good lighting
Maintaining client's preferred routines
Turning off competing background noise, such as television or radio
Using aids that may ease client anxiety e.g. hand mirror
Using brightly coloured toothbrush that can be easily seen e.g. for children or for clients with dementia or visual impairment


Effective communication includes but is not limited to:
Active listening and questioning
Always explaining actions and processes and reinforcing with gestures where appropriate
Asking questions that require a yes or no response when oral hygiene practices are being carried out
Giving one instruction or piece of information at a time
Observing client closely as lack of response, signs of frustration, anger, disinterest or inappropriate responses may suggest communication is too complex or that client is uncomfortable
Speaking at appropriate volume, clearly and at clients pace
Using reassuring words and positive feedback
Using words client can understand


Appropriate body language may include but is not limited to:
Being aware of approaching client appropriately e.g. diagonally from the front and at eye level
Gently touching the client on the hand or lower arm to get attention, if necessary
Positioning self at eye level and maintaining eye contact, as appropriate
Being aware that personal space of clients can vary
Being consistent in approach with positive expression and caring language


Caring attitude includes but is not limited to:
Allowing plenty of time for client to respond to questions or instructions
Focusing on building a good relationship before starting oral hygiene
Using the client's name
Using a calm, friendly and non-demanding manner
Working with a person-centred approach


Client behavioural responses may include but are not limited to:
Biting toothbrush
Coughing
Distress induced vomiting
Fear response
Gagging
Grabbing or hitting out
Leaving
Not opening the mouth
Not responding to directions
Spitting
Verbal aggression


Review may include but not be limited to the following questions and suggestions:
Are the oral hygiene aids appropriate for the client?
Do others e.g. family and/or carer have input?
Has the observed behaviour improved?
Is attitude and approach considerate of client needs?
Is the approach and routine consistent for client?
Is the client more receptive to oral hygiene support?
Is the environment, timing, language and expression right for client?


Report may include:
Non-verbal:
care plans
case notes
hazard and incident reports
photographs
progress reports
Verbal:
face-to-face
telephone
recorded


Variations in client behaviour and habits may include:
Anxiety around, or avoidance of, specific events
Apparent pain or discomfort in or around the mouth
Behaviours of concern
Change in eating habits
Change in mood or demeanour
Changes in communication
Crying
Difficulty with eating, including spitting out food
Hands in the mouth
Inconsistent wearing of dentures
Lethargy
Physical aggression
Refusal to open mouth
Rubbing own teeth or gums
Seemingly normal behaviours e.g. coughing could be indicator that food is in the lungs
Self-harming behaviour
Social isolation or withdrawal


Signs and symptoms of potential oral health issues may include but not be limited to:
Observed and/or reported signs in or around the mouth, such as:
bad breath (halitosis)
bleeding
broken teeth
brown or discoloured teeth
calculus (mineralised plaque that will not brush off) on teeth particularly at gum line
change in colour or coating of tongue
dry mouth
eruption issues for children
evidence of build up of dental plaque on teeth, particularly at gum line
holes in teeth
lip blisters, sores or cracks
loose or mobile teeth
mouth debris/excessive food left in mouth
mouth ulcers
premature loss of baby teeth
receding or enlarged gums
soft tissue lesions e.g. red or white spots
swelling of face or localised swelling/inflammation
continued.....
Signs and symptoms of potential oral health issues may include but not be limited to (cont'd):
Issues reported by client and/or others, such as:
tooth sensitivity
refusal of oral care
sore mouth, gums, tongue or teeth
Other observations, such as:
change in appetite
change in demeanour or mood
difficulty eating/speaking
inability to open mouth very wide
irritability
refusing to open mouth
weight loss
Observed and/or reported issues with dentures, such as:
broken metal wires/clips on partial denture
calculus on denture
chipped or missing teeth on denture or chipped or broken acrylic (gum) areas on denture
denture movement when client is speaking or eating
refusal or failure to wear denture
sore spots caused by wearing denture
unclean denture


Other relevant people may include but is not limited to:
External health care providers
Other service providers
Personnel internal to the service provider


Contributing factors may include but not be limited to:
Abuse
Ageing
Disability
Injury
Medications
Substance misuse
Systemic illness

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 unit of competency:
The individual being assessed must provide evidence of specified essential knowledge as well as skills
This unit is best assessed in the workplace or in a simulated workplace under the normal range of conditions
Consistency in performance should consider the particular workplace context


Access and equity considerations:
All workers in health and community services environments should be aware of access, equity and human rights 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 issues facing Aboriginal and/or Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on Aboriginal and/or Torres Strait Islander people
Assessors and trainers must take into account relevant access and equity issues relating to factors impacting on Aboriginal and/or Torres Strait Islander clients and communities


Context of and specific resources for assessment:
This unit can be delivered and assessed independently, however holistic assessment practice with other community services units of competency is encouraged
Resources required for assessment include:
access to appropriate workplace where assessment can take place
simulation of realistic workplace setting


Method of assessment:
In cases where the learner does not have the opportunity to cover all relevant aspects in the work environment, the remainder should be assessed through realistic simulations, projects, previous relevant experience or oral questioning on 'What if?' scenarios
Assessment of this unit of competency will include observation of processes and procedures, oral and/or written questioning on essential knowledge and skills and consideration of required attitudes
Consistency of performance should be demonstrated over a range of relevant workplace conditions


Related units:
This unit may be assessed independently or in conjunction with other units with associated workplace application