Transcript The Mouth and Oral Cavity

13
CHAPTER
Lecture Note PowerPoint Presentation
The Mouth and Oral
Cavity
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 1
Explain normal changes of aging in the
mouth and oral cavity.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Aging and the Mouth and Oral
Cavity
• With proper oral hygiene
– Teeth and gums appear normal
• The epithelium and soft tissues atrophy
• Reduction in number of taste buds
– Hypogeusia
• Reduced saliva production
– Overly dry oral mucosa
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Aging and the Mouth and Oral
Cavity
• Gums recede
– Increased vulnerability of teeth below gum
line to cavities
• Enamel erosion
– Stains
– Cavities
• Tooth loss and malocclusion
– Difficulty eating
– Social isolation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Aging Associated with Difficulty
Maintaining Oral Hygiene
• Potential causes
– Number and condition of dental restorations
– Recession of gums
– Impaired visual acuity
– Possible loss of manual dexterity
– Restricted range of motion
– Effects of medications on oral cavity
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 2
Identify common diseases of older persons
in the mouth and oral cavity.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Common Diseases of Aging Relating to the
Mouth and Oral Cavity
• Increased oral diseases in communities
without fluoridation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Common Diseases of Aging Relating to the
Mouth and Oral Cavity
• 30% of adults age 65 and older have no
natural teeth
– Regional differences noted
– Impacts multiple areas of life
 Nutrition
 Self-esteem
 Speech
 Facial appearance
 Source of halitosis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Common Diseases of Aging Relating to the
Mouth and Oral Cavity
• Periodontal disease and dental caries
– The most common cause of tooth loss
– More common in men than women
– Lower socioeconomic levels have more
severe disease forms
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Those with the Poorest Oral Health
Include
•
•
•
•
The economically disadvantaged
Those lacking insurance
Racial and ethnic minorities
Others
– Disabled
– Homebound
– Institutionalized
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Oral and Pharyngeal Cancers
• Primarily diagnosed in older adults
• Carry a poor prognosis
• 5-year survival rate
– 56% white Americans
– 34% African-Americans
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Xerostomia (dry mouth)
• Affects 25–40% of older Americans
• May be caused by medications
– Antihistamines
– Diuretics
– Antipsychotics
– Antidepressants
– Anticholinergics
– Chemotherapeutic agents
– Antiparkinson drugs
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Xerostomia (dry mouth)
• Associated with
– Dysphagia
– Difficult chewing
– Candidiasis
– Denture slippage
 Gum irritation and erosion
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Consequences of Poor Oral Care
• Social isolation
• Depression
• Systemic illness
– Aspiration pneumonia
– Heart disease
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Consequences of Poor Oral Care
• Periodontal disease
• Malnutrition, vitamin deficiency
• Pain, halitosis, tooth loss, dental caries,
periodontal disease
• Denture stomatitis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sjogren’s Syndrome
• Systematic, autoimmune disorder
– Occurs in association with disorders such as
 Rheumatoid arthritis
 Systemic lupus erythematosus
 Scleroderma
 Polymyositis
 Polyarteritis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sjogren’s Syndrome
• Inflammation of epithelial tissue
• Other disorder manifestations include dry
eyes, skin changes, and thyroid disease
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Oral Candidiasis
•
•
•
•
Fungal infection
Caused by Candida albicans
Managed with antifungal agents
Risk factors
– Dry mouth
– Diabetes
– Altered immune response
– Use of inhaled steroids
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Gingivitis and Periodontal Disease
• Inflammation of the gums
• Manifestations
– Redness
– Swelling
– Bleeding
• Results from bacterial colonization at gum
margin
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 13-2
Gingivitis and resulting gum erosion.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Gingivitis and Periodontal Disease
• Risk factors
– Smoking
– Diabetes
– Medications
– Poor nutrition
– Stress
– Illness
– Genetic susceptibility
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Stomatitis
• Inflammation of the mouth
• Commonly caused by chemotherapeutic
agents
• Manifestations
– Eroded ulcerations in the oral cavity
– Secondary infection
– Pain with eating and drinking
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Oral Cancer
• Occurs most often in people over age 45
• Symptoms
– Sore that does not heal
– Lump on lip or mouth
– White or red patch on gum, tongue, or buccal
mucosa
– Unusual bleeding, numbness, or pain
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 13-3
Population over the age of 60, worldwide and developing regions.
Source: Centers for Disease Control, 2001.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Oral Cancer
• Symptoms
– Feeling of something caught in the throat
– Difficulty or pain with chewing or swallowing
– Swelling in jaw
– Voice changes
– Pain in ear
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Oral Cancer
• Risk factors
– Tobacco use
– Chronic and heavy alcohol use
– Sun exposure to lips
– History of leukoplakia
– Erythroplakia
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 3
List common nursing diagnoses of older
persons related to oral problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Assessment of Oral
Problems
• Oral health history
– Date of last dental examination
– Presence and function of dentures
– Missing or loose teeth
– Bleeding gums
– Dry mouth
– Presence of sores or lesions
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Assessment of Oral
Problems
• Oral health history
– Medications
– Usual oral hygiene routine
– Altered sense of taste
– Chewing or swallowing difficulties
– Bad breath or halitosis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Assessment of Oral
Problems
• Oral cavity examination
– Lips
– Teeth
– Interior of buccal mucosa
– Anterior and base of tongue, gums, soft and
hard palate, and back of throat
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Assessment of Oral
Problems
• Oral cavity examination
– Presence of cracks, lesions, ulcers, swelling,
or induration
– Presence of gingival bleeding, hypertrophy, or
dental caries
– Presence of leukoplakia
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Diagnoses
•
•
•
•
•
Impaired Dentition
Altered Dentition
Impaired Oral Mucous Membranes
Altered Oral Mucous Membranes
Nutrition Imbalance: Less Than Body
Requirements
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 4
Recognize nursing interventions that can be
implemented to assist the aging patient with
oral problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Interventions to Improve
Xerostomia
•
•
•
•
Regular dental evaluation
Low sugar diet
Mouth rinses
Sugar-free chewing gum, hard candies,
and mints
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Interventions to Improve
Xerostomia
• Artificial saliva and mouth lubricants
• Bedside humidifiers
• Dietary modifications
– Avoid hard-to-swallow or chewy foods
– Careful use of fluids while eating
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Interventions to Improve
Oral Candidiasis
• Rinse mouth after use of inhaled steroids
• Use small, soft toothbrush twice daily
• Use swabs to clean and moisten oral
mucosa when unable to brush
• Provide mouth rinses
• Chlorhexidine (Peridex)
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Interventions for the Patient
with Oral Pain
• Rule out infection or abscess
– Perform oral examination
 Inspect mouth, tongue, and teeth
– Assess vital signs
– Assess respiratory function
– Assess lymph nodes
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Interventions to Improve
Gingivitis and Periodontal Disease
• Educate the patient and family
– Daily flossing
– Daily brushing
– Use of fluoride toothpaste
– Need for oral hygienist referral
– Nutrition
– Effect of periodontal disease on overall health
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Interventions to Improve
Stomatitis
• Educate the patient and family
– Signs and symptoms
 Ulcers in mouth
 Pain with eating and drinking
 Secondary infections
– Treatments
 Meticulous oral hygiene
 Frequent use of isotonic saline mouthwash
 Avoidance of food extremes
 Providing swish-and-spit solution as prescribed
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Mouth Care Strategies for Patients
with Cognitive Impairment
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•
•
•
•
Task breakdown
Distraction
Hand-over-hand
Chaining
Protection
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 5
Identify medications that may cause or
aggravate oral problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Problematic Common Mouth Care
Products
• Lemon glycerin swabs
• Hydrogen peroxide
• Mouth rinses
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Medications to Use with Caution
• Diabetes medications
– Gingivitis and periodontal disease
• Potential causes of xerostomia
– Tricyclic antidepressants
– Sedatives
– Tranquilizers
– Antihistamines
– Antihypertensives
 Alpha- and beta-blockers
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Medications to Use with Caution
• Potential causes of xerostomia
– Diuretics
– Calcium channel blockers
– Angiotensin-converting enzyme inhibitors
– Cytoxic agents
– Antiparkinsonian agents
– Antiseizure drugs
• Potential causes of stomatitis
– Chemotherapeutic agents
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.