activity 12

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Chapter 12
Perspectives on Oral Care in Healthy Aging and Prevention for the Older Adult

Objectives (1 of 3)

Explain and discuss Oral Health in America: A Report of the Surgeon General, highlighting themes that relate to the oral health and well-being of older adults.

Identify the percentages of periodontal disease, edentulism, and oral and pharyngeal cancers in the elderly.

Objectives (2 of 3)

Recognize dry mouth (xerostomia) and describe the risk factors it poses for the well-being of the older adult.

List dental changes of aging versus signs of a disease state.

Review oral health of the older adult and its correlates to well-being.

List societal and personal barriers for the older adult seeking dental care.

Objectives (3 of 3)

Describe common oral conditions the healthcare professional may encounter.

Describe a simple oral screening procedure that the healthcare professional can do.

Name the basic role of the interprofessional healthcare provider in assisting the older person with oral health concerns.

List new models for oral health care to help alleviate oral health disparities.

Oral Health in America: A Report of the Surgeon General (1 of 3)

Alerted Americans to the full implication of oral health and its link to general health
Oral disease may impact endocrine, cardiovascular, and pulmonary health
Oral bacterial plaque can:
Lead to aspiration pneumonia
Travel through the blood and infect artificial joints or the heart

Oral Health in America: A Report of the Surgeon General (2 of 3)

Stresses two important themes:
“Silent epidemic” of oral diseases affecting older people
Maintaining a clean and healthy oral cavity

Oral Health in America: A Report of the Surgeon General (3 of 3)

Oral health is fundamental to general health
Older people today:
Have lived through the development of oral restorative materials
Were the first group to grow up in the age of dental prevention

Oral Structures and Chronic Oral Diseases (1 of 21)

Oral structures of the craniofacial complex:
Vermillion border
Oral mucosa
Gums
Tongue
Oral pharynx

Oral Structures and Chronic Oral Diseases (2 of 21)

Structures not readily seen:
Salivary glands
Muscles of chewing
Upper and lower jaws
The health of these structures is integral to psychological well-being

Oral Structures and Chronic Oral Diseases (3 of 21)

Oral Structures and Chronic Oral Diseases (4 of 21)

Chronic oral disease in older adults includes:
Periodontal disease
Edentulism
Oral and pharyngeal cancers
Decreased saliva flow
Caries

Oral Structures and Chronic Oral Diseases (5 of 21)

Periodontal disease
Inflammatory reaction and dissolution of bone structures that hold teeth within the jaws
Can be caused by dental plaque
May lead to:
Pain
Inability to chew
Tooth loss
Chronic systemic inflammation

Oral Structures and Chronic Oral Diseases (6 of 21)

Oral Structures and Chronic Oral Diseases (7 of 21)

Inflammatory periodontal disease has been associated with:
Poor cardiovascular health
Ischemic stroke
Dementia

Oral Structures and Chronic Oral Diseases (8 of 21)

Edentulism (toothlessness)
Many causes
Greatly affects food choices and nutrition
Dental caries (cavities)
Bacterial infection attributed to Streptococcus mutans
Major cause of tooth loss
Often go untreated

Oral Structures and Chronic Oral Diseases (9 of 21)

Oral and pharyngeal cancers
Found primarily in older adults
Often a poor prognosis for recovery
Early diagnosis and treatment are essential
Often caused by smoking

Oral Structures and Chronic Oral Diseases (10 of 21)

Oral Structures and Chronic Oral Diseases (11 of 21)

Separating oral aging from disease
Xerostomia (dry mouth)
Associated with decreased saliva flow
Can lead to:
Uncomfortable swallowing
Speech difficulties
Mouth sores
Cavitation of the hard tooth structure
Difficulty clearing food particles

Oral Structures and Chronic Oral Diseases (12 of 21)

Most common cause of dry mouth in older adults is the use of prescription and over-the-counter medicines
Severe xerostomia is life altering
Drug schedules should be modified if possible for maximum effect during the day

Oral Structures and Chronic Oral Diseases (13 of 21)

Xerostomia treatment
Acrylic night guards carrying fluoride gel
Consider easy-to-take formulations for medications, and avoid sublingual doses
Lubricate the mouth and throat with water before taking medication
Avoid decongestants and antihistamines

Oral Structures and Chronic Oral Diseases (14 of 21)

Dry mouth and tooth loss are not signs of aging
Dry mouth may be related to pharmacological inhibition or disease states such as:
Uncontrolled diabetes
Sjögren’s syndrome
Autoimmune diseases

Oral Structures and Chronic Oral Diseases (15 of 21)

Oral Structures and Chronic Oral Diseases (16 of 21)

Other facial structures undergo atrophy, wasting away, or shrinking
Changes in oral motor functions in older adults tend to be mild
Tongue stereognosis allows an individual to perceive alterations in the mouth
Declines with age

Oral Structures and Chronic Oral Diseases (17 of 21)

Taste disorders are common among older people
Often go unrecognized and underestimated
Causes:
Medications
Zinc deficiency
Oral or systemic disease

Oral Structures and Chronic Oral Diseases (18 of 21)

Color changes in the teeth
May arise from long-term intake of food with coloring agents or prolonged tobacco use
Occlusal or incisal attrition
Caused by long-term dietary habits, occupational factors, bruxism, or xerostomia
Teeth may be more brittle and more prone to chipping and loss of surface detail

Oral Structures and Chronic Oral Diseases (19 of 21)

Aging of dental pulp results in a shrinking nerve
Can contribute to undetected disease
Pulp becomes smaller with physiologic laying down of secondary dentin

Oral Structures and Chronic Oral Diseases (20 of 21)

Mouth is a mirror to overall health
Pink, moist, clean oral cavity lacking inflammation can be a predictor of good health
Unpleasant breath (halitosis) may be a sign of disease
Many systemic diseases have primary signs and symptoms in the oral cavity

Oral Structures and Chronic Oral Diseases (21 of 21)

Oral health is directly related to quality of life of the older adult
Poor quality-of-life scores correlate to the presence of oral problems
Well-being correlates linked to oral health include the number of missing teeth and edentulism
Most older people viewed limitations as a consequence of aging, not solvable problems

Recognizing Barriers to Care

Common barriers for older adults:
Not perceiving a need for dental care
Lifestyle behaviors
Lack of accessibility to dental care
Financial and economic barriers

The Interprofessional Role in Oral Care and Prevention (1 of 8)

The 21st century offers the healthcare professional an opportunity to:
Reassess current curricular structures and practice models
Begin including an interprofessional healthcare team approach for health education, health promotion, and disease prevention

The Interprofessional Role in Oral Care and Prevention (2 of 8)

Prevention
Preventive regimens for the older adult:
Antimicrobial mouth rinses
Fluoride rinses, gels, or toothpastes
Removal of biofilm and hard deposits through toothbrushing 2–3 times a day
Consistent and effective use of dental floss

The Interprofessional Role in Oral Care and Prevention (3 of 8)

Oral care can be problematic in nursing facilities
Staff have limited capacity to deliver needed oral healthcare services
Conducting risk assessments and implementing anticipatory guidance management can make inroads toward oral prevention outcomes

The Interprofessional Role in Oral Care and Prevention (4 of 8)

Functional capacity
Higher-level functional capacity is an indicator for completing oral hygiene behaviors
Otherwise, it is the caregiver’s duty to provide basic oral hygiene to the older adult with limited functioning

The Interprofessional Role in Oral Care and Prevention (5 of 8)

Oral prostheses (dentures)
Must be removed and rinsed after eating
Mouth must also be cleaned
Dentures should be:
Scrubbed at least once a day
Handled carefully
Kept moist to keep their shape
Worn consistently

The Interprofessional Role in Oral Care and Prevention (6 of 8)

Simple oral screening
Can provide early detection of oral or pharyngeal cancers and other oral conditions
Risk factors for oral and pharyngeal cancer:
Alcohol and tobacco use
Older age
Excessive sun exposure
Human papilloma virus (HPV)
Diet low in fruits and vegetables

The Interprofessional Role in Oral Care and Prevention (7 of 8)

Oral candidiasis (oral yeast infection)
Can appear as:
Red or white lesion
Cracks at the corners of the mouth
Oral screening
Should take only a few minutes
Use a flashlight and tongue depressor

The Interprofessional Role in Oral Care and Prevention (8 of 8)

New Models of Care (1 of 3)

Interprofessional healthcare teams
Can deliver more flexible and individualized care
Interprofessional programs:
Aim to develop, implement, evaluate, and sustain interprofessional education and training for healthcare learners
Emphasize improved access to health services for the geriatric population in medically and dentally underserved areas

New Models of Care (2 of 3)

Suggested public health priorities for home and community-based programs:
Integrating oral health into medical care
Implementing community programs
Developing a comprehensive strategy to address the oral health needs of long-term care residents
Assessing the feasibility of preventive and basic restorative services

New Models of Care (3 of 3)

Financial burden of care often placed on clients
Do not seek care if they cannot afford it
Prevention can keep older people functioning at optimal levels
Relying on well-trained mid-level providers can:
Help keep costs affordable and accessible
Provide a valuable alternative to the current system