Oral Health and the Older Adult

Spring 2007

Sara Abbott, Katherine Martinez,

Erin Michalk and Ashley Powdrill

UTHSCSA Dept. of Dental Hygiene

Objectives

• Recognize the appearance of the normal oral cavity

• Recognize signs of oral cancer or abnormalities that may need a doctor’s abnormalities that may need a doctor’s referral

• Explain how to approach uncooperative patients

• Discuss the importance of oral hygiene in the elderly

� Discuss the care and maintenance of dentures

� Discuss different ways to combat root cavities in the elderly

Objectives Cont.

cavities in the elderly

� Explain different ways to treat dry mouth

Normal Oral Cavity

Dental Abnormalities

• Xerostomia (dry mouth)

• Cavities

• Malodor

• Possible Cancerous Lesions• Possible Cancerous Lesions

Dry Mouth

Signs and Symptoms

• Dehydration

• Enlarged tongue

• Pain-burning tongue

• Gums are shiny and red• Gums are shiny and red

• Saliva appears foamy or thick

• Stickiness of tongue to palate

• Alterations in taste and smell

• Infection of salivary glands

Dry Mouth can lead to:• Root Decay and possible cavities

• Lowered pH in the mouth leading to a more acidic environment for bacterial growth

• Enamel erosion and wear• Enamel erosion and wear

• Oral fungal infection (commonly called “Thrush”)

Common Causes

• Primary Medications– Allergy, anxiety, hypertension, antiparkinson, depression, pain, muscle relaxation, sedative and digestion

– Average older adult in a long term care – Average older adult in a long term care facility on average is taking 8 medications.

• Systemic Diseases– Sjogren’s syndrome

• Normal Aging Process

Management of Dry Mouth

• Oral lubricants, saliva substitutes and gels (Biotene)

• Sugar-free chewing gum/lozenges

• Daily application of plain water

• Vitamin E chapsticks for lips• Vitamin E chapsticks for lips

• Prescribed meds by physician, i.e., Pilocarpine

Root Decay

Why are Older Adults at Risk?

• Receding gums

• Multiple medications

• Lack of oral hygiene

– Exposed roots = more plaque – Exposed roots = more plaque

– Fluoride is extremely important

What to do to prevent root

cavities• Fluoride Varnish

Causes for Oral Malodor

• Food particles remain in mouth

• Allergy drainage

• Cavities

• Periodontitis (gum disease/pyroia)• Periodontitis (gum disease/pyroia)

PERIODONTITIS

Periodontal Disease

• Affect on the overall body

– Cardiac disease

– Diabetes

– Stroke– Stroke

– Low birth weight babies

– Increase risk for aspiration pneumonia

Alert Dentist or Physician

• Loose teeth

• Foul odor

• “long teeth”

• Food debris/calculus buildup• Food debris/calculus buildup

– Team approach needed (physician, nurses

and staff)

What to do for patients with

malodor• Ensure regular and adequate brushing

• If cavities are present, refer to dentist

• If problem endures, refer to physician

Oral Cancer

• Squamous cell carcinoma– 30,000 new cases a year

– Survival rate is low

• Most common sites– Floor of the mouth– Floor of the mouth

– Sides and bottom of the tongue

– Lesions that do not go away in two weeks, refer to DDS or physician

– REMEMBER: It is important to RECORD color, size, shape of any tissues that appear abnormal and report it to the patient’s Physician.

“Perform a

death-defying act”

The 90 second oral examinationThe 90 second oral examination

How to help stop cancer early

Oral Examination

• Head and Neck

• Lips and Cheeks

• Gingiva (gums) and Teeth

• Tongue- check top, bottom and lateral • Tongue- check top, bottom and lateral sides

• Floor of the Mouth

• Palate or the roof of the mouth

• Oropharynx

Possible Findings of the Intraoral

Examination

• Cracked corners of the lips (commonly called angular cheilitis)

• Fungal infection (Thrush)

• Denture sore mouth (Epulis Fissuratum)• Denture sore mouth (Epulis Fissuratum)

• Canker Sore (Apthous Ulcer)

• Herpes

• Hairy Tongue

Angular Cheilitis

Epulis Fissuratum

Apthous Ulcers

Herpes

Hairy Tongue

Oral Hygiene Instructions

• Circular brushing motions

• Brush at the gum line

• Rotary or battery powered if available

• Water pik/oral irrigator• Water pik/oral irrigator

– Not to use on patients that could aspirate

water

• Patients that can not open their mouths

– Use tongue blades wrapped with gauze and

tape to prop mouth open

Mouth Prop

Maintenance of Dentures• Care for Prosthetic Appliance (Dentures)

– Remove denture/partial while sleeping or daily

– Clean daily after meals and before storage with a denture

brush

– Thoroughly rinse after cleaning or soaking with a denture – Thoroughly rinse after cleaning or soaking with a denture

solution

How to Handle an Uncooperative

Patient• Never approach the patient from behind—this

may frighten them and make them more uncooperative. Make sure you greet them and let them know you are there to inspect and clean their mouth before proceeding.

• When treating the patient, it’s a good idea to • When treating the patient, it’s a good idea to stand behind them so that you won’t be hit or kicked. Cradle the patient’s head to keep them still and make them feel more secure. With a stubborn patient, it’s important to COMMUNICATE what you are doing, why and how.

Tips when working with

uncooperative patientsThe following communication and behavior management

techniques might increase the potential for successfully performing oral hygiene care, minimize resident “uncooperativeness”, and maximize residents’ abilities:

• develop a routine with oral hygiene care at the same time every day, (not necessarily at bathing time) every day, (not necessarily at bathing time)

• Once a routine is setup, use reminders and prompts for oral hygiene care

• use several caregivers if needed

• provide oral care in a quiet, distraction free environment

• use short, simple sentences and directions. Remember to break down tasks and give one-step instructions– Example: “hold the toothbrush”; “open your mouth”; etc.

Uncooperative Patients, cont.

• use non-verbal cues: facial expressions and reassuring body contact

• use a gentle touch to promote trust

• give the patients something to occupy hands (like an extra toothbrush) to prevent grabbing behaviors.

• use dementia communication techniques such as chaining, bridging, and rescuing

Chaining involves a caregiver starting an oral hygiene care task, and the resident then helping to finish the task. then helping to finish the task.

Bridging uses several of the resident's senses, especially sight and touch, to help them better understand the task such as by placing a spare toothbrush in their hands.

Rescuing is often used to help with completing hygiene care tasks for residents with dementia. If attempts at oral hygiene care are not going well, a caregiver can walk off and then have another caregiver come in and attempt the task - this is almost like playing “good cop/bad cop", but can work well with some uncooperative residents.

Summary

• Oral health effects overall health

• “Oral Health in America: A report of the Surgeon General--“The mouth is the “The mouth is the center of vital tissues and functions that are critical to total health and well-being across the life-span”

• Oral Hygiene the “Missing Link”

References

• Hein, C. (2004). Etiology Fast-forwarded: The Host-bacterial Interaction Theory and the Risk Continuum. Contemporary Oral Hygiene. 4. 16-20.

• Navazesh, M. (2004). Identify Those at Risk. Dimensions of Dental Hygiene. 2. 24-27.

• Rose, L., Mealey, B., & Cohen, W. (2002). Oral Care for patients with cardiovascular disease and stroke. Journal of the American Dental Association. 133. 37s-44s.

• P & G Educational Series. Oral Health and the Older Adult: Module E4. (1993?). San Antonio, TX: The American Dental Hygienists’ Association. Institute for Aging. What is your Aging IQ? <http://www.niapublications.org/pubs/aging_brochure.pdf> (2003. updated August).

• Silverman, S. (2001). Demographics and occurrence of oral and pharyngeal cancers. Journal of the American Dental Association. 132. 7s-11s.

• Peter P. Kambhu, DDS, MS, Steven M. Levy, DDS, MPH “An evaluation of the effectiveness of four mechanical plaque-removal devices when used by a trained care-provider.” Journal of American Association for Hospital Dentists. Volume 13, Number 1, January/February 1993.

• Pearson, Alan; Chalmers, Jane. Best Practice: Evidence Based Practice Information Sheets for Health Professionals. Oral hygiene care for adults with dementia in residential aged care facilities. Volume 8, Issue 4, page 1-6, 2004

• Shtereva, Natalia. Aging and Oral Health Related to Quality of Life in Geriatric Patients. Rejuvenation Research. Vol 9, No. 2, 2006. 355-357.

• Chalmers, Jane; Pearson, Alan. Oral hygiene care for residents with dementia: a literature review. Journal of Advanced Nursing. Vol. 52, No. 4. • Chalmers, Jane; Pearson, Alan. Oral hygiene care for residents with dementia: a literature review. Journal of Advanced Nursing. Vol. 52, No. 4. 2005. 410-419

• MacDonald, Daniel E. Principles of Geriatric Dentistry and Their Application to the Older Adult with a Physical Disability. Clinics in Geriatric Medicine. Vol. 22, 2006. 413-434

• Adam, Helen; Preston, Antony J. The oral health of individuals with dementia in nursing homes. Gerodontology. 2006. Vol 23. 99-105.

• Gil-Montoya, Jose Antonio; Ferreira de Mello, Ana Lucia; Cardenas, Ciro Barreto; Lopez, Inmaculada Guardia. Oral Health Protocol for the Dependent Institutionalized Elderly. Geriatric Nursing, Vol 27, No. 2. 95-101. 2005

• Tsakos, Georgios; Steele, James G., Marcenes, Wagner, Walls, Angus W. G., Sheiham, Aubrey. Clinical correlates of oral health-related quality of life: evidence from a national sample of British older people. European Journal of Oral Sciences. 2006. 114. 391-395