Transcript No Slide Title - RIS Products Ltd

ORAL HEALTH OF OLDER PEOPLE
Friday 23rd September
M. Petrina Sweeney
WHAT IS ORAL HEALTH?
“It is a standard of health of the
oral and related tissues which
enables an individual to eat, speak
and socialise without active
disease, discomfort and
embarrassment and which
contributes to general well being”
Oral Health Strategy Group, UK Department of Health 1994
ORAL HEALTH AND QUALITY OF LIFE
AMONG THE ELDERLY
Communication
Drinking
Facial
appearance
Eating
THE ORAL MICROFLORA
• 108 microorganisms per millilitre of
saliva
• 350 cultivable bacterial species
MAINTENANCE OF ORAL
HYGIENE IS ESSENTIAL FOR
MAINTAINING ORAL HEALTH
AND QUALITY OF LIFE
ORAL ASSESSMENT
• Oral problems common in care home
patients
• A thorough oral assessment is the
vital first step in planning effective
care
• Encourage patients to report any oral
discomfort
• Use of assessment tools
MAINTENANCE OF ORAL
HYGIENE
•
Should not be difficult or time
consuming
•
Encourage patients to be independent
if possible
•
Regular assessment
•
Frequency of care
•
Multidisciplinary approach
ACTUAL AND PROJECTED % OF EDENTATE ADULTS
IN SCOTLAND BY AGE GROUP (1978-2028)
An Analysis of the Dental Workforce in Scotland – A Strategic Review 2010 : Scottish Government
DENTAL CARIES IN THE ELDERLY
“…the incidence of caries in a
population aged 65 and older is greater
than in a population of 14-year olds
living in a non-fluoridated area.”
Ettinger RL Dental Clinics of North America
1997: 41: 633-49
DENTAL CARIES IN THE ELDERLY
Reduced manual
dexterity: poor
oral hygiene
Dry mouth: often
drug-induced
Sweet diet
TOOTHBRUSHING
Procedure
Comments
Clean teeth at least
twice daily
Use a personal toothbrush and a fluoridated
toothpaste. Carers must undertake toothbrushing for dependent patients
Chemical plaque control
Consider using chlorhexidine mouthwash,
spray or gel
Maintain cleanliness of
oral mucosa
Clean mucosa with a water-moistened gauze
or a foam stick (if necessary)
Clean partial dentures
separately
Maintain complex
dental work
Always remove denture from the mouth and
clean separately from natural teeth
The dental team should provide advice on oral
hygiene for patients with complex
restorations e.g. implants, crowns and bridges
PERIODONTAL DISEASES
A group of diseases affecting the
marginal periodontium, representing an
inflammatory and immune reaction to
the presence of microbial plaque.
ADVANCED CHRONIC
PERIODONTITIS
ORAL HEALTH AND NUTRITIONAL
STATUS
THE DENTURE WEARER
DENTURE CARE
• High level of denture hygiene essential
• Dentures removed and cleaned out of
the mouth
• Dentures cleaned daily
• Encourage patients to remove their own
dentures if possible
MAINTAIN
DENTURE
HYGIENE?
ORAL CANDIDOSIS
‘A disease of the diseased’
PSEUDOMEMBRANOUS
CANDIDOSIS
Non-adherent white plaques
DENTURE
STOMATITIS
ANGULAR
CHEILITIS
Candida spp
Staphylococcus
aureus
CARE OF DENTURES
VIRAL INFECTIONS
HSV
REACTIVATION
HSV
REACTIVATION –
COMPROMISED
HOST
Often intra-oral
Clinically atypical
Painful
High index of
suspicion
STAPHYLOCOCCAL MUCOSITIS
Aspiration risk  pneumonia
ORAL HEALTH AND SYSTEMIC
DISEASE
•
Respiratory tract infections
• Septicaemia
• Septic arthritis
• Endocarditis
• Cardiovascular disease
PNEUMONIA IN THE ELDERLY
• Fourth overall leading cause of death
• Leading infectious cause of death in
the elderly
• Most cases of bacterial pneumonia are
caused by micro-aspiration of
colonised oropharyngeal flora
Chan ED, Welsh C. Geriatric Respiratory Medicine
Chest 1998; 114: 1704-1733
OTHER COMMON
PROBLEMS
FIBROEPITHELIAL POLYP
DENTURE-INDUCED HYPERPLASIA
DENTURE-INDUCED HYPERPLASIA
ATROPHIC GLOSSITIS
IRON TABLET
BURN
 septicaemia
LICHEN PLANUS
DRY MOUTH
ORAL CANCER
EARLY SCC TONGUE
SO HOW COMMON
ARE THESE
PROBLEMS ?
CARE HOME NEEDS ASSESSMENT:
THE GLASGOW PICTURE
Pilot project
• 10 care homes
• Assessment team: dentist, research nurse and
hygienist
• Standard screening form devised in-house
• 288 of 316 residents consented to examination
• Examinations performed in sitting/bedrooms
• Standard light source
CARE HOME NEEDS ASSESSMENT:
THE GLASGOW PICTURE
Pilot project: results summary
Dentate
75 (26%)
55 (73%) had dental caries
Edentulous
213 (74%)
179 (84%) wore F/F or F/-
Mucosal
lesions
106 (37%)
Erythematous
candidosis
Ulceration
Treatment
required
135 (47%)
Urgent
treatment
58 (20%)
13 (5%)
18 (6%)
PERSONAL INTERVIEWS WITH STAFF
Results: Care home managers
• Mouth care not high priority
• Formal mouth care policy not in place
• Oral assessment, on admission, but not by dentist/
trained staff
• Annual dental screening not routine
• Mouth care training at induction by non-dentally
qualified personnel
• Requested further education
PERSONAL INTERVIEWS WITH STAFF
Results: 22 Care staff
• Mouth care not documented routinely
• All agreed mouth care was within their remit
• Many found mouth care difficult/distressing
• 6 had received specific mouth care training but
not in-house
• 5 had some formal nursing qualifications
• Overwhelming request for training
Maintenance of oral health
an essential element of
holistic care
Many oral health problems
are preventable
Input of the dental team
should be availableto
all dependent older people
REGULAR ORAL ASSESSMENT
AND ORAL CARE AN ESSENTIAL
ELEMENT OF CARE FOR THE
ELDERLY
60
Thank You