M. Petrina Sweeney

ORAL HEALTH OF OLDER PEOPLE

Friday 23rd September

“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

WHAT IS ORAL HEALTH?

ORAL HEALTH AND QUALITY OF LIFE AMONG THE ELDERLY

CommunicationFacial appearance

Drinking

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

Dry mouth: often drug-induced

Reduced manual dexterity: poor oral hygiene

Sweet diet

TOOTHBRUSHING

Procedure CommentsClean teeth at least twice daily

Use a personal toothbrush and a fluoridated toothpaste. Carers must undertake tooth-brushing 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

Always remove denture from the mouth and clean separately from natural teeth

Maintain complex dental work

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 NUTRITIONALSTATUS

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 CHEILITISCandida 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 floraChan 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 summaryDentate 75 (26%) 55 (73%) had dental caries

Edentulous 213 (74%) 179 (84%) wore F/ F or F/ -

Mucosal lesions

106 (37%) Erythematous candidosis

58 (20%)

Ulceration 13 (5%)

Treatment required

135 (47%) Urgent treatment

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

• 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

Results: 22 Care staff

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

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Thank You