The Oral Health Care Plan (OHCP)
Person: _________________________________ Completed by: ________ /________ / ________ Date: ________ /________ / ________
Dentist: _________________________________ Phone: _________________________________
Date of last dental appointment: ________ /________ / ________ Date for next oral health care plan review: ________ /________ / ________
| Assessment of dentures (please circle) |
Assessment of natural teeth (please circle) |
Interventions for oral hygiene care (check all that apply and circle frequently needed) |
||
|---|---|---|---|---|
| Upper | Lower | Upper | Lower | ___ Use mouth swab ___ Use electric toothbrush ___ Use suction toothbrush ___ Use regular toothbrush ___ Use toothbrush backward bent/2 toothbrushes ___ Use interproximal toothbrush or floss ___ Use regular fluoride toothpaste morning/night ___ Scrub denture(s) with soap and water morning/night ___ Soak denture(s) at night in water/denture tablet ___ Use saliva substitute for dry mouth ___ Use fluoride varnish or other fluoride products ___ Use chlorhexidine mouth rinse (as prescribed by a dentist or medical director) ___ other __________________ ___ other __________________ |
| ___ Full ___ Partial ___ Not worn ___ No denture ___ Named ___ Not named ___ Does / ___ Doesn't wear at night |
___ Full ___ Partial ___ Not worn ___ No denture ___ Named ___ Not named ___ Does / ___ Doesn't wear at night |
___ Yes ___ No ___ Roots Present |
___ Yes ___ No ___ Roots Present |
|
| Denture cleaning: ___ independent ___ needs assistance |
Clean dentures: ___ daily ___ twice daily ___ other _________________ |
Teeth cleaning: ___ independent ___ needs assistance |
Clean teeth: ___ daily ___ twice daily ___ other __________________ |
Regular barriers to
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This form comprises the Oral Health Care Plan. Click here to download a printable copy.
Oral Hygiene Care Plan (Chalmers, 2004 for use by the Iowa Geriatric Education Center; reviewed by Marchini, 2016; Review 2023)