AGED CARE AND ORAL HEALTH

AGED CARE AND ORAL HEALTH

Dr Chris CallahanBA BDSc FRACDS FADI

29 November 2007

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

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

• 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.

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.

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

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

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

Medications – oral health impact Medications – oral health impact

• Dry mouth

• Common side effect

• Saliva substitutes

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.

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.

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

Dental CariesDental Caries

• Tooth

• Plaque Bacteria

• Source of sugar

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

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.

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

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

Where the brush can’t reachWhere the brush can’t reach

• Interdental brushes – bottle brush

• Floss holders

• Toothpicks

Electric ToothbrushesElectric Toothbrushes

• Good for elderly

• Timers on brush useful

• Still need to be careful and thorough

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

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

© Eastman Dental Institute

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

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

© Eastman Dental Institute

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

Signs of Gum DiseaseSigns of Gum Disease

• Bleeding gums

• Bad breath

• Exposed tooth roots

• Soft swollen or tender gums

• Loose OR ‘moving’ teeth

Smoking CessationSmoking Cessation

© Eastman Dental Institute

Oral CancerOral Cancer

© Eastman Dental Institute

Mouth UlcersMouth Ulcers

• Many different types – diagnosis very important

© Eastman Dental Institute

Oral ulcers - typesOral ulcers - types

• Aphthous• Traumatic from dentures, heat sharp objects etc.• Vitamin / mineral deficiency• Neutropaenie• Behcets syndrome• HIV• Herpes Simplex• Syphilis• Malignant

© Eastman Dental Institute

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

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

Thank you