• CHCOHC404A - Recognise and respond to signs and symptoms that may indicate oral health issues

Recognise and respond to signs and symptoms that may indicate oral health issues

This unit describes the skills and knowledge required to recognise and respond appropriately to signs and symptoms that may indicate a potential for oral health issues in clients


This unit is intended to address skills and knowledge appropriate for direct care workers in a range of health and community services environments whose work roles enable them to recognise potential oral health issues through observation of the behaviour, habits and physical condition of clients


Not Applicable

Elements and Performance Criteria



1. Identify variations in client behaviour

1.1 Identify client behaviour and habits that may indicate oral health issues or associated pain or discomfort

1.2 Observe, listen for self-reports and question client and/or carer or other relevant people as required to determine whether the client is experiencing any pain or discomfort that may be associated with oral health issues

1.3 Take into account contributing factors that may produce variation from normal behaviour

2. Undertake basic visual oral check and questioning

2.1 Obtain consent from the client or substitute decision maker to conduct basic visual oral check and questioning

2.2 Ensure comfort of client by developing trust and rapport and working in an appropriate environment and at an optimal time

2.3 Ensure client is in a position which provides access to the mouth seeking their assistance to open their own mouth limiting contact inside the mouth

2.4 Provide support for client's head or chin if necessary to enhance visual access without creating discomfort for the client

2.5 Perform basic visual oral check in line with legislative requirements, organisation guidelines, policies and procedures and within own work role

2.6 Ensure visual check is conducted in accordance with standard precautions

2.7 Identify signs and symptoms of potential oral health issues that may indicate variation from normal and actively listen to and be aware of self-reports

3. Follow up and promote ongoing oral health care

3.1 Complete reporting processes, using information from client and/or carer or other relevant people as well as own observations in relation to potential oral health issues

3.2 Discuss potential oral health issues with client and/or relevant others in line with organisation policies and procedures and respecting client priorities and choices

3.3 Take appropriate action within work role, including discussing with supervisor in consultation with client

3.4 Provide client with information relevant to promoting and maintaining goodoral health using appropriate communication strategies

3.5 Support clients to take a self-care approach to oral health in line with individual needs where possible

3.6 Identify and address key barriers to management or self-management of oral health

Required Skills

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

These include knowledge of:

Awareness of the National Oral Health Plan and other relevant state, territory and national government policy and programs

Basic anatomy and physiology underpinning oral health, including what is considered healthy and unhealthy

Causes and prevention of tooth wear, including erosion, abrasion and attrition

Effective self-care practices for oral health

Factors that impact on oral health, including:


access to services

accumulation of plaque and calculus

alcohol, licit and illicit drugs and substances and over the counter and herbal treatments

alcohol misuse

bacteria in dental plaque

client education

correct infant feeding practices

diet and nutrition, including fluids


general health and wellbeing

immunosuppressant conditions

medical history

oral piercings

psychological issues, such as fear of being seen without dentures or persisting with ill fitting dentures for satisfaction of others

salivary function


social and cultural determinants of health

susceptible tooth surfaces

transmission of bacteria particularly from parent to child

trauma, such as from seizures

Guidelines for use of relevant technology, including information technology

Healthy eating recommendations as identified in the National Health and Medical Research Council's (NHMRC) Australian Dietary Guidelines

Impact of certain health conditions and related treatments on oral health e.g. immunosuppressant conditions, HIV, chemotherapy and radiation

Infection control standards and guidelines

continued ...

Essential knowledge (contd):

Key elements of accurate reporting

Oral disease and broad treatment options available

Oral side effects of medications, such as metallic taste in the mouth, dry mouth syndrome and ulcers

Organisation policies and procedures relating to:

client confidentiality and consent

limits to own role and authority/responsibility

referral, including various levels of urgency

Own ability and role in relation to client oral health

Range of behavioural changes that may be indicative of oral health issues

Range of relevant oral health referral options

Saliva and its role in the maintenance of oral health:

acting as a lubricant

delivering calcium, phosphate and fluoride to the tooth surface

protecting teeth by neutralising acid

Systemic conditions which influence the development of oral disease

The interaction between oral health and general health

Essential skills:

It is critical that the candidate demonstrate the ability to:

Accurately differentiate between healthy and unhealthy oral presentation

Carry out effective oral health self-care practices

Communicate effectively to provide information of processes and protocols to be undertaken

Consistently apply standard precautions where necessary

Elicit relevant information from client or documents

Identify situations when assistance is required

Recognise changes in clients behaviour, habits and physical condition that might indicate potential oral health issues

Reflect on and improve own level and application of skills and knowledge to achieve desirable outcomes and maintain own capabilities

Use active listening and questioning skills

Use appropriate reporting and documentation practices

Use communication skills to effectively establish a relationship of trust with clients, their family and/or carers and other relevant people

Use initiative in finding opportunities to promote oral health care

Use relevant technology, including information technology safely and effectively

continued ...

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

These include the ability to:

Apply basic problem-solving skills to resolve problems within organisation protocols

Apply literacy and numeracy skills required to fulfill work role in a safe manner and as specified by the organisation

Consistently demonstrate interpersonal skills, including empathy when relating to people from a range of backgrounds and abilities

Work effectively with clients, colleagues and supervisors

Evidence Required

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

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. 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.

Client refers to those living in the community and/or facilities and may include:

Children receiving care, including in children's services

Older people

Palliative care clients

People in care facilities

People with dementia

People with disabilities

People with mental health issues

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


Difficulty with eating, including spitting out food

Hands in the mouth

Inconsistent wearing of dentures


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

Other relevant people may include but not be limited to:

External health care providers

Other service providers

Personnel internal to the service provider

Contributing factors may include but not be limited to:






Substance misuse

Systemic illness

Substitute decision maker (in relation to consent) must be:

The person appointed with the right to speak for the client, such as:




health attorneys

medical power of attorney

members of family

other practitioners

parent of child

person responsible

public trustee

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

Organisation guidelines may include but are not limited to:

Clinical protocols

Position descriptions

Workplace policies and procedures, including:

infection control

occupational health and safety

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




Disposal of PPE

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)


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

tooth sensitivity

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


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 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

Information from client may include but is not limited to:

Basic dietary information on eating patterns and cariogenic food and drink intake

Client concerns, beliefs and preferences regarding their signs and symptoms

Clinical progress notes relevant to the presenting problem

Current prescribed and other medications

Current support mechanisms

Family and community circumstances, including environmental factors that may contribute to client's health

History of the presenting problem e.g. character, severity and duration of symptoms and past dental visits

Medical history, e.g. chemotherapy

Significant ongoing health conditions

Good oral health refers to but is not 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


Not Applicable

Employability Skills

This unit contains Employability Skills

Licensing Information

Not Applicable