AGED CARE AND ORAL HEALTH Dr Chris Callahan BA BDSc FRACDS FADI 29 November 2007.
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Transcript of AGED CARE AND ORAL HEALTH Dr Chris Callahan BA BDSc FRACDS FADI 29 November 2007.
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AGED CARE AND ORAL HEALTH
AGED CARE AND ORAL HEALTH
Dr Chris CallahanBA BDSc FRACDS FADI
29 November 2007
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Poor oral health in aged care affects -Poor oral health in aged care affects -
• Eating ability• Weight• Speech• Hydration• Severity of
behavioural problems• Appearance• Social interactions
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Meeting Standard 2.15Meeting Standard 2.15
• Residents’ oral hygiene is assessed, documented, regularly reviewed and acted upon.
• Residents have timely access to treatment for oral and dental conditions.
• Appropriate procedures for oral and dental care, in accordance with a residents’ needs and preferences, have been established.
Commonwealth Residential CareStandard 2.15, Oral and Dental Care
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• Provide a varied and nutritious diet,
• Ensure that each resident has a toothbrush and toothpaste.
• Remind and encourage residents to brush their teeth or dentures, or assist where required, at least once every day.
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Meeting Standard 2.15Meeting Standard 2.15• Enable residents with restricted movement to brush their
teeth by arranging for changes to the shape or size of their toothbrush.
• Make sure that residents’ oral and dental needs are assessed by a dentist at least every two years.
• Ensure that residents have access to a dentist of their own choice.
• Ensure that the name and contact details of the resident’s dentist are recorded on the resident’s record.
• Record any assistance required with oral and dental care on the resident’s care plan.
• Record the date that the resident’s next dentist appointment is due on their care plan.
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Ageing – oral health impactAgeing – oral health impact
• Medications can reduce the production of saliva
• Reduced saliva flow with ageing, even when not taking medications
• Taking long-term, sugar based medications
• Changed eating habits: small snacks, sucking boiled lollies or drinking sugared tea
• Reduced ability to maintain toothbrushing and denture care
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Ageing – oral health impactAgeing – oral health impact
• Fluoride for life on natural teeth:fluoridated tap water, toothpastes,mouth rinses and gels
• Reminding and assisting people with their toothbrushing and denture care
• Monitoring and reducing sugar intake where needed for people with natural teeth
• Regular dental visits with dental professionals who understand and are experienced in caring for someone with dementia
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Monitor sugarMonitor sugar
• If sugar needs to be reduced, use artificial sweeteners in drinks and snacks. Check this with the doctor if the person is diabetic
• Try to use sugar-free snacks
• Drink water or diet drinks with reduced or
• no sugar
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Medications – oral health impact Medications – oral health impact
• Dry mouth
• Common side effect
• Saliva substitutes
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DenturesDentures
• Store dentures in containers labelled with the resident’s name.
• Dentures can be labelled individually with a special marker or insert for residents who may be at risk of misplacing personal belongings.
• A dentist or dental technician can advise on this.
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DenturesDentures
• Ensure that any necessary assistance is provided for a resident in caring for and storing their dentures, and record that assistance in the resident’s care plan.
• Do not store dentures dry as this can harm the plastic.
• If dentures are damaged, arrangements should be made immediately for their repair or replacement.
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Denture CareDenture Care
• Denture lifespan: 5 – 8 years may require replacement or reline.
• Design changes: weaker hands, poor motor skills.• Dentures should be cleaned often over a basin partly
filled with water. So if dropped will not fracture.– Use a soft brush and soap– Toothpaste will wear the plastic– Soak in proprietary solution for no longer than 30
minutes several times a week– Dentures should be stored overnight in water
Patients should not adjust dentures themselves
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Dental CariesDental Caries
• Tooth
• Plaque Bacteria
• Source of sugar
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Help prevent dental decay Help prevent dental decay
• May need more than toothbrushes• Encourage purchase of soft toothbrush• Explain importance of good oral hygiene
which prevents decay, gum disease• Smoking also a risk factor in gum disease,
and oral cancer• Refer to local dentist for instructions if
resident doesn’t know how to floss and / or brush
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Help prevent dental decayHelp prevent dental decay
• Dentistry: the Era of Prevention has arrived• Early intervention also important; so if patient
has any problem such as:- tooth sensitivity
- lost filling
- bleeding gums
• they should be advised to attend a dentist as soon as possible.
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Prevention of Decay & Gum DiseasePrevention of Decay & Gum Disease
• Mechanical cleaning daily after mealsAvoid snacking especially with sweet
sticky foods – frequency very important
Chewing sugar free gum after meals can help, as saliva buffers and washes away acid
Nearly all decay and gum disease preventable
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BrushingBrushing
• Must be gentle but thorough
• Better maybe to be called tooth sweeping
• Angle into gum 45°
• Use short jiggly motion
• Should be done in front of a mirror
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Where the brush can’t reachWhere the brush can’t reach
• Interdental brushes – bottle brush
• Floss holders
• Toothpicks
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Electric ToothbrushesElectric Toothbrushes
• Good for elderly
• Timers on brush useful
• Still need to be careful and thorough
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MouthwashMouthwash
Use of Chlorhexidine
• Only use for 5 days
• 2 – 3 time per day
• Swish around mouth for 1 minute each time – actually time minute
• Must not be used in isolation, without diagnosis and other focus of treatment
• Risk of staining, tartar buildup
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Gum DiseaseGum Disease
• Studies show 75% of population had gum disease but only 5% thought they had it
• 47% thought healthy gums can bleed easily – when this is in fact classic symptom of disease
• Good oral hygiene will prevent nearly all gum disease
• Flossing especially important
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© Eastman Dental Institute
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Gum DiseaseGum Disease
• Regular removal of plaque and tartar by a dentist also important. How often will depend on patient usually every 6/12 some 3/12 some 12/12
• Two types of gum disease: - Gingivitis
• - Periodontitis
• Gingivitis reversible soft tissue only
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Gum DiseaseGum Disease
• Periodontitis - irreversible- involves bone loss- can be stopped- leads to tooth loss- can occur in isolated way e.g. one tooth only
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© Eastman Dental Institute
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Gum DiseaseGum Disease
• Often people will avoid cleaning because it causes bleeding, so starting a vicious cycle of more plaque more gum disease, less cleaning, etc.
• Must break cycle with cleaning, may take 1 – 2 weeks of bleeding to stop
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Signs of Gum DiseaseSigns of Gum Disease
• Bleeding gums
• Bad breath
• Exposed tooth roots
• Soft swollen or tender gums
• Loose OR ‘moving’ teeth
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Smoking CessationSmoking Cessation
© Eastman Dental Institute
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Oral CancerOral Cancer
© Eastman Dental Institute
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Mouth UlcersMouth Ulcers
• Many different types – diagnosis very important
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© Eastman Dental Institute
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Oral ulcers - typesOral ulcers - types
• Aphthous• Traumatic from dentures, heat sharp objects etc.• Vitamin / mineral deficiency• Neutropaenie• Behcets syndrome• HIV• Herpes Simplex• Syphilis• Malignant
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© Eastman Dental Institute
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Treatment of oral ulcersTreatment of oral ulcers
• Related to cause therefore diagnosis is very important
• Note steroids exacerbate viral infection• Relieve pain• 0.2% chlorhexdine (prevent secondary infection)• Topical anaesthetic e.g.2.5% lignocaine• Analgesia paracetamol• Compound gel with antiseptic, anti inflammatory,
astringent and local anaethetic
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Why refer to a Dentist? Why refer to a Dentist?
• Undergraduate Medical training has limited coverage of Dentistry.
• Practitioners may sometimes issue antibiotics, etc. which mask symptoms and make subsequent diagnosis difficult.
• Often signs and symptoms indicate disease well progressed, as in early stages no signs or symptoms.
• Relationship with local Dentists
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Thank you