Huntington s Disease Support Group Discussion May 18, Dental Perspective
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1 Huntington s Disease Support Group Discussion May 18, 2018 Dental Perspective
2 May 17, Raleigh Dr. Mary Makhlouf 1682 Westbrook Ave, Burlington (Elon) NC DocMary
3 Outline 1. Dental threats 2. Tips for home Exam 3. Resources
4 WHAT exactly IS the dental threat?...
5 Primary and Secondary Threats Bad Breath Increased germs in the mouth Increased risk for aspirating these germs into the lungs Toxins and acid in the plaque cause gum disease and cavities (decay) Uncontrolled gum disease and decay turn into toothaches and tooth loss (and expense) Higher risk for heart attacks, strokes and inflammatory response
6 Who are the BAD GUYS? PLAQUE Germs and Germ Glue + Germ Acid Free food for the germs Lemon & Glycerin! ACID: Produced by Germs or from Sugars or from Drinks (Sports drinks, sodas, energy drinks) SUGAR: (Mints, cough drops, Drinks, juice)
7 Who are the GOOD GUYS? Water Xylitol (gum, etc. - laxative effect too) Fluoride Family Caregivers Dentist Hygienist
8 Huntington s Disease and the Mouth Uncontrolled movements >>> How to brush effectively?? Can we even THINK of flossing?? Loss of cognitive function>>> Do we remember oral hygiene? Need high calorie diets>>> free food/sugar for the bacteria!
9 Dental Signs and Issues Dry mouth (meds for depression) vs. drooling Burning tongue or mouth syndrome Changes in taste (and smell) Decline in oral hygiene and plaque control Swallowing problems (aspiration risk) Squirrelling of food Cavities, gum disease, toothaches, loss of teeth
10 Effects on the Dental Visit 1. Decreased bladder control: more bathroom breaks or protective underwear 2. Anxiety and compliance: Solution: morning appointments? When is our loved one at their best? 3. posture and poor muscle control: Fall precaution awareness, transfers to the chair 4. Airway protection difficulties: Will need double suction, rubber dam, sedation?? 5. Chorea: Rodeo dentistry
11 Transfer belt and techniques
12 Poor Plaque Control = More cavities More gum disease Bad breath Mouth infections Bleeding gums Irritability
13 WHAT IS A CAVITY??? It s an acid burn on the tooth. Acid comes from: - Plaque OR - Food stuck to the teeth OR - Acidic drinks - AND lack of saliva to wash it off
14 Why are teeth and Gums Important? Healthy teeth are less likely to surprise you with a toothache, or bleeding tender gums, bad breath Healthy teeth/gums decrease your risks for heart attacks or strokes (by 3 X). Diseased teeth or gums silently affect your medical health: fatigue, arthritis, immune system Some studies show a much higher risk for cancers in men with gum disease.
15 Normal Normal Gums
16 Tips for a Home Exam You can always run a gloved finger along the gums between the teeth and the cheek. Looking for signs of discomfort or pus or fluid lumps.
17 Tips for a Home Exam Look on the inside of cheeks (and anywhere else you can look) for white curd like deposits that rub off. Watch for bleeding gums when teeth are being brushed.
18 Tips for a Home Exam Look for plaque at the gum line
19 Tips for a Home Exam Look for a gum boil
20 Abscess
21 But. Crowns look normal
22 Look Closer: Cavity Under Crown
23 Easier to see
24 Poor Oral Hygiene on Denture
25 Tips for a Home Exam Look for exposed bone, especially under the denture. Dentures need to be removed at night and soaked in a denture cleaner overnight. Brush them after meals Look for soft overgrowth and report it. (It could be anything from normal to a tumor.)
26 Exposed bone under a denture LOOK
27 Bad yeast infection
28 Yeast
29 Tips for Home Exam Headlight Free up hands for an exam
30 My Philosophy & Strategy Dry Mouth: FLUORIDE prescription gel or Fluoride Prescription Toothpaste, in office Fluoride Varnish or SDF. Antiseptic Mouthwash Fluoride Varnish at every hygiene visit not just for kids!! Photographs of teeth where you are missing plaque we can those! Phased Treatment: CUSTOMIZED 1. Getting ready for the long haul (no bridges, consider crowns), improve baseline 2. Maintenance, Monitoring and Prevention based on stages and decreasing abilities to comply. 3. Constant education of family/caregivers *Financial arrangements (Care Credit or 3% - 10% discount or inhouse savings plan)
31 Fluoride Trays
32 Fluoride Varnish Rx to be professionally applied.
33 Fluoride Varnish
34 Silver Diamine Fluoride!!! (SDF) 38% Fluoride 90% effective after 2 applications 1 week apart 70% effective in halting decay if applied once
35 Tiny SDF bottle
36 Black!!
37
38 Resources Vac U Brush: PR Medical, Inc Plak-Vac Suction Toothbrush: Mountainside Medical Equipment
39 Resources RES-Q-VAC Hand Powered Portable Suction System AbleData, 8630 Fenton Street, Suite 930, Silver Spring, MD or
40 Resources ResQVac Combo Kit #83419 AliMed: $183
41 Resources for toothettes Definitely NEVER lemon and glycerin swabs
42 Molt Mouth Prop/ Mouth Gag
43 Resources Mouth prop Sources (dental supplier) Hu Friedy # Miltex # J&J #
44 Home Strategies Floss Aid - Single handed strategies for flossing: Listerine Ultraclean Flosser (better than small ones) Changing the head may be difficult. Large handles
45 Listerine Flosser
46 Flosser use: It takes a TEAM
47 RESOURCES Kid s Sonicare & Adult Sonicare
48 Resources Hummingbird Products
49 Resources Chlorhexidine Gluconate (by Rx) antiseptic mouthwash
50 Resources Cheek Retractor DynaFlex, International Plaza Dr., St Ann, MO
51 Xylitol products: Resources &
52 Resources Bite blocks (careful when using them with fluids) Tongue depressors need to be doubles always (can break) Monoject Syringe
53 Resources Benefit Brush ( 3D Clean Jr Toothbrush
54 Dr. Mary Makhlouf Board Certified in Special Care Dentistry: Dentistry for people suffering from a variety of medical conditions. Post Doctoral Masters & training in Dentistry for Seniors Founding Director of Moses Cone Hospital Dentistry Fellow of the International College of Dentistry (4% of dentists worldwide) ON SITE Board Certified Dental Anesthesiologist
55 Dr. Mary Makhlouf 1682 Westbrook Ave, Burlington (Elon) NC or DocMary
56 We will all greet you
57 Maria will guide you
58 Early stages: stabilization only
59 Fully Equipped for General Anesthesia and Sedation
60 Dr. Atwood Board Certified Dental Anesthesiologist
61 Together, We can Rise Above All Challenges
62 Questions: Website
Course #:
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