Scenario 1
Mr Osmond is a new resident. He is a frail, well-mannered and cooperative gentleman. He has a diagnosis
of early onset dementia and high blood pressure.
Mr Osmond has settled well into his new surroundings. He has a good appetite and loves sweet foods and
treats. He likes to drink coffee with two teaspoons of sugar.
Mr Osmond is sometimes forgetful but he is able to manage his activities of daily living with standby
assistance and occasional prompting. The GP has recently put him on several new medications to treat his
dementia and high blood pressure.
On admission, the RN performed an Oral Health Assessment. Mr Osmond has natural teeth and an upper
partial denture. His oral health was found to be ‘healthy’ and a referral to a dentist was not needed.
Based on this, the Registered Nurse asked you to assist in developing an Oral Health Care Plan for Mr
Osmond to use routine oral hygiene care and products to prevent his oral health problems.
1. What are the factors that might potentially impact Mr Osmond’s oral health care in the future?

2. What information about oral health care and products should be included in Mr Osmond’s care plan
and explained to him? Include five (5) oral health care and products and their application processes,
volumes or strength in your answer.

Several months have passed. Mr Osmond’s behaviour has changed. He has recently become confused and
uncooperative. The GP is treating him for a suspected urinary tract infection.
Mr Osmond is not cleaning his teeth and he won’t let you help him. If you try, he won’t open his mouth.
When Mr Osmond is like this it is easier to leave him and not do his oral hygiene care. This seems to be
happening a lot. Other staff members have been doing the same and leaving out his oral hygiene care.
You notice his breath smells and it is unpleasant to be around him. You also notice Mr Osmond is having
difficulty eating his food.
3. What oral health problems might be happening here due to Mr Osmond’s progression of dementia?

4. Identify three (3) risk factors that might contribute to the occurrence of symptoms?

5. What could you do to encourage Mr Osmond to open his mouth? Identify five (5) measures.

Scenario 3
You have been able to get Mr Osmond to open his mouth and you take out his partial upper denture which
has metal wires.
You notice his denture is very dirty and one of the metal wires is broken. When you look at Mr Osmond’s
mouth, you see the part of the mouth where the partial denture has been is red and sore. When you brush
his teeth his gums begin to bleed.
6. What should you report?

7. What could happen to Mr Osmond if his oral health gets worse? State six (6) health problems that
might be caused by his poor oral health

Scenario 4
The Registered Nurse has conducted an Oral Health Assessment for Mr Osmond. The Oral Health
assessment findings include:
– Oral thrush
– Accumulation of plaque and calculus
– Gingivitis (gum disease) as indicate by bleeding gums
– Confirms partial denture needs repair
8. What oral care and products could treat Mr Osmond’s current oral health problems.

9. List three (3) various applicators that Mr Osmond can use to apply the different types of oral care
products, taking his dementia condition into account.

Scenario 5
After taking the medications for months, Mr Osmond complains he has a very dry mouth. He has difficulty
with eating and/or speaking and feels there is only a small amount of saliva in the mouth. His saliva is
thick, stringy or rope-like.
10. Briefly explain what reasons might cause Mr Osmond’ dry mouth syndrome or xerostomia.
11. What oral care and products can assist Mr Osmond’s dry mouth symptoms.

Scenario 6
Marie is a palliative patient with the diagnosis of advanced lung cancer. She is experiencing taste changes
with her cancer treatment.
She told you that she has a “horrible metallic and chemical taste and ulcers” from her medications and a
“dry mouth”. Marie states that she doesn’t feel like eating.
12. Identify the oral health problems associated with Marie palliative care needs.

13. Provide five (5) actions you would undertake to manage Marie’s oral health problems.

Scenario 7
Jason has been diagnosed with halitosis. You refer to his oral care plan, and it states that he is to use a
tongue scraper.
14. How would you educate Jason in the use of a tongue scraper as he states that “he hasn’t used one
of those before”?

Scenario 8
Lucy is a resident in the nursing home where you work. She is a 82 years old lady who suffered a cerebral
vascular accident (CVA) three years ago. She wears partial dentures.
Lucy has the following symptoms:
– Weakness on the right side (hemiparesis)
– Impaired gag reflex
– Imbalance (ataxia)
– Difficulty in understanding or expressing language (aphasia)
– Slurred speech (dysarthria)
– Dry mouth
15. Describe three (3) techniques including positioning Lucy and yourself properly and comfortably to
suit Lucy’s situations and needs for oral health care.

Scenario 9
Due to Lucy’s CVA condition, her need for appropriate aids for oral and denture hygiene has been
assessed. You refer to her oral healthcare plan which states the following “client is assisted to use an
electric toothbrush with a modified handle to aid handling.”
You notice that Lucy is distressed when you are assisting with oral health care and starts calling out and
biting the toothbrush.
16. How will you respond in this situation? Identify three (3) measures to use.

Scenario 10
Zoe has been nil by mouth (NBM) for a few days as a result of a recent surgery on each wrist. She has
had difficulty attending to her oral cares lately.
She complains that her tissues bleed during brushing and flossing and food and floss catch between her
teeth and some teeth are loose and sensitive, and she has a partial denture that she has concerns with
cleaning and adhesive. In addition, she is experiencing side effects from her medication, including a dry
mouth.
17. Identify ten (10) oral hygiene products and aids would you suggest for Zoe?