Sara Abbott, Katherine Martinez, Erin Michalk and Ashley Powdrill

Transcription

1 Oral Health and the Older Adult Spring 2007 Sara Abbott, Katherine Martinez, Erin Michalk and Ashley Powdrill UTHSCSA Dept. of Dental Hygiene

2 Objectives Recognize the appearance of the normal oral cavity Recognize signs of oral cancer or abnormalities that may need a doctor s referral Explain how to approach uncooperative patients Discuss the importance of oral hygiene in the elderly

3 Objectives Cont. Discuss the care and maintenance of dentures Discuss different ways to combat root cavities in the elderly Explain different ways to treat dry mouth

4 Normal Oral Cavity

5 Dental Abnormalities Xerostomia (dry mouth) Cavities Malodor Possible Cancerous Lesions

6 Dry Mouth Signs and Symptoms Dehydration Enlarged tongue Pain-burning tongue Gums are shiny and red Saliva appears foamy or thick Stickiness of tongue to palate Alterations in taste and smell Infection of salivary glands

7 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 Oral fungal infection (commonly called Thrush )

8 Common Causes Primary Medications Allergy, anxiety, hypertension, antiparkinson, depression, pain, muscle relaxation, sedative and digestion Average older adult in a long term care facility on average is taking 8 medications. Systemic Diseases Sjogren s syndrome Normal Aging Process

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

11 Root Decay

12 Why are Older Adults at Risk? Receding gums Multiple medications Lack of oral hygiene Exposed roots = more plaque Fluoride is extremely important

13 What to do to prevent root cavities Fluoride Varnish

14 Causes for Oral Malodor Food particles remain in mouth Allergy drainage Cavities Periodontitis (gum disease/pyroia)

15 PERIODONTITIS

16 Periodontal Disease Affect on the overall body Cardiac disease Diabetes Stroke Low birth weight babies Increase risk for aspiration pneumonia

17 Alert Dentist or Physician Loose teeth Foul odor long teeth Food debris/calculus buildup Team approach needed (physician, nurses and staff)

18 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

19 Oral Cancer Squamous cell carcinoma 30,000 new cases a year Survival rate is low Most common sites 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.

20 Perform a death-defying act The 90 second oral examination How to help stop cancer early

21 Oral Examination Head and Neck Lips and Cheeks Gingiva (gums) and Teeth Tongue- check top, bottom and lateral sides Floor of the Mouth Palate or the roof of the mouth Oropharynx

22 Possible Findings of the Intraoral Examination Cracked corners of the lips (commonly called angular cheilitis) Fungal infection (Thrush) Denture sore mouth (Epulis Fissuratum) Canker Sore (Apthous Ulcer) Herpes Hairy Tongue

23 Angular Cheilitis

24 Epulis Fissuratum

25 Apthous Ulcers

26 Herpes

27 Hairy Tongue

28 Oral Hygiene Instructions Circular brushing motions Brush at the gum line Rotary or battery powered if available 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

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30 Mouth Prop

31 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 solution

32 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 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.

33 Tips when working with uncooperative patients The 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) 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.

34 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. 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.

35 Summary Oral health effects overall health Oral Health in America: A report of the Surgeon General-- 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

36 References Hein, C. (2004). Etiology Fast-forwarded: The Host-bacterial Interaction Theory and the Risk Continuum. Contemporary Oral Hygiene Navazesh, M. (2004). Identify Those at Risk. Dimensions of Dental Hygiene Rose, L., Mealey, B., & Cohen, W. (2002). Oral Care for patients with cardiovascular disease and stroke. Journal of the American Dental Association s-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? < (2003. updated August). Silverman, S. (2001). Demographics and occurrence of oral and pharyngeal cancers. Journal of the American Dental Association s-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 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, Chalmers, Jane; Pearson, Alan. Oral hygiene care for residents with dementia: a literature review. Journal of Advanced Nursing. Vol. 52, No MacDonald, Daniel E. Principles of Geriatric Dentistry and Their Application to the Older Adult with a Physical Disability. Clinics in Geriatric Medicine. Vol. 22, Adam, Helen; Preston, Antony J. The oral health of individuals with dementia in nursing homes. Gerodontology Vol 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 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