1. AGED CARE AND ORAL HEALTH Dr Chris Callahan BA BDSc FRACDS FADI 29 November 2007

2. Poor oral health in aged care affects - Eating ability Weight Speech Hydration Severity of behavioural problems Appearance Social interactions

3. Meeting 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 Care Standard 2.15, Oral and Dental Care

4. 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.

5. Meeting 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 residents dentist are recorded on the residents record. Record any assistance required with oral and dental care on the residents care plan. Record the date that the residents next dentist appointment is due on their care plan.

6. Ageing – 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

7. Ageing – 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

8. Monitor 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

9. Medications – oral health impact Dry mouth Common side effect Saliva substitutes

10. Dentures Store dentures in containers labelled with the residents 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.

11. Dentures Ensure that any necessary assistance is provided for a resident in caring for and storing their dentures, and record that assistance in the residents 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.

12. Denture 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

13. Dental Caries Tooth Plaque Bacteria Source of sugar

14. 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 doesnt know how to floss and / or brush

15. Help 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.

16. Prevention of Decay & Gum Disease Mechanical cleaning daily after meals Avoid 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

17. Brushing 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

18. Where the brush cant reach Interdental brushes – bottle brush Floss holders Toothpicks

19. Electric Toothbrushes Good for elderly Timers on brush useful Still need to be careful and thorough

20. Mouthwash 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

21. Gum 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

22. © Eastman Dental Institute

23. Gum 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

24. Gum Disease Periodontitis - irreversible - involves bone loss - can be stopped - leads to tooth loss - can occur in isolated way e.g. one tooth only

25. © Eastman Dental Institute

26. Gum 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

27. Signs of Gum Disease Bleeding gums Bad breath Exposed tooth roots Soft swollen or tender gums Loose OR moving teeth

28. Smoking Cessation © Eastman Dental Institute

29. Oral Cancer © Eastman Dental Institute

31. Mouth Ulcers Many different types – diagnosis very important

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33. Oral ulcers - types Aphthous Traumatic from dentures, heat sharp objects etc. Vitamin / mineral deficiency Neutropaenie Behcets syndrome HIV Herpes Simplex Syphilis Malignant

34. © Eastman Dental Institute

35. Treatment 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

36. 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

37. Thank you