1. “Elderly suffer a disproportionate & debilitating amount of oral disease.” - Alliance for Aging Research

2.  People with Diabetes are at a greater risk of developing gum disease.  Hypertension (High Blood Pressure) medications can affect your mouth. TRUE or FALSE?  Healthy eating can contribute to the condition of a an individuals mouth.

3.  Among new military recruits in 2010, what percentage were not deployed because of significant dental issues?  A. 0-40%  B. 40-60%  C. 60% +

4. Why is oral health so important?

5.  Heart Disease  Stroke  Pneumonia  Diabetes “… providing mechanical oral hygiene may prevent 1 in 10 deaths from pneumonia in dependent elderly people and show similar pneumonia prevention effect.” (Sjogren, P., et al: JAGS 2008 (56); 2124-30)

6.  35% of all Americans have some form of PD  13% have severe periodontal disease  75% of all Americans have inflammation of the gums (gingivitis)  Progression of gingivitis to bone loss:  Pockets form around the teeth  Pockets gradually deepen, ulcerate  Bone loss visible on x-rays

7.  Nearly 1/3 of people with diabetes have severe bone loss (CDC)  Diabetics are 3 - 4 times more likely to develop periodontal disease (gum disease)  Develop infections easier  Can contribute to heart disease  Can contribute to pneumonia (http://www.perio.org/consumer/mbc.diabetes.htm)

8. Oral Health as We Age

9.  “A feeling that there is not enough saliva in the mouth, all or most of the time.” (NIH Senior Health, 2003) Xerostomia: Dry Mouth

10.  Sjögren's syndrome  HIV/AIDS  Alzheimer's disease  Diabetes  Anemia  Cystic fibrosis  Crohn’s disease  Systemic Lupus Erythematosis  Rheumatoid arthritis  Hypertension  Parkinson's disease  Stroke  Scleroderma  Hepatitis Risk Factors for Dry Mouth A side effect of certain diseases and infections:

11.  Antidepressants  Antihypertensives  Narcotics  Anticholinergics  Antipsychotics  Anti-Parkinson  Antiasthmatics  Anorexiants  Anticonvulsants  Antacids  Hormone replacements  Diuretics  Sedatives  Inhalants  Decongestants  Glaucoma eye drops  Antihistamines  Pseudoephedrine Risk Factors for Dry Mouth A side effect of over 500 medications: (USDHHS, 2008)

12.  Dry, sticky oral tissues  Thick saliva  Ulcers in mouth  Cracking of the corners of the mouth or tongue  Bad breath  Frequent yeast infections  Red gums that bleed easily  Increased tartar build up Increased dental decay

13. o Sore or burning mouth, lips or tongue o Sleep interruptions due to thirst or oral discomfort o Difficulty chewing, speaking, swallowing and wearing dentures o Difficulty clearing leftover food in the mouth o Patient may avoid eating dry foods

14. Dry mouth may contribute to:  Inflammation  Yeast infections  Tooth decay  Gum disease

15. …the longer one waits

16.  Over the counter products might be sufficient  Talk with doctor/ dentist for prescriptions Prevent or Manage Dry Mouth

17. Mints and Hard Candies AVOID SUGAR CANDY Sugar-Free Candies Okay!

18.  Handle with great care – very expensive  Brush & rinse dentures daily – soft bristles designed for dentures  Clean with denture cleanser – NOT toothpaste Denture Care  Dentures need to be kept moist when not worn

19.  Important to remove to allow oxygen to get to tissues  ONLY a dentist/ prosthodontist should adjust dentures Denture Care Put in denture case NOT a Kleenex/paper towel!  Remember to still brush gums and palate

20.  Conditions with a high risk of infection  antibiotics are recommended prior to some dental procedures  Most conditions of the heart, pace makers, heart valves etc.  Check with doctor/dentist Antibiotics (http://www.mouthhealthy.org/en/az-topics/p/Premedication-or-Antibiotics)

21.  Aging in general increases the risk of oral cancer  Dry mouth from RX’s  Eventually dependant on care giver

22.  Early stages  help remind about daily brushing  Increase fluoride treatments  Use alcohol-based pen to write name on dentures

23. Promoting Healthy Habits

24.  Be SMART brushers ◦ 2x day for 2 minutes  Floss daily  Prevent dry mouth ◦ Biotene or generic brand ◦ Keep mouth moist!  Eat healthy fruits & vegetables Daily Prevention Habits

25.  Use floss holders  Arthritis or other conditions that limit movement… Electric toothbrush Duck tape a golf ball securely to handle of regular toothbrush  NEVER put your fingers between teeth Helpful Tips (http://www.arthritistoday.org/news/gum-disease.php) Studies show professional teeth cleaning lowers inflammation and pain in Arthritis patients…

26. (South Australian Dental Service, 2009)

27.  Fear if being touched  Not opening mouth  Not understanding or responding to directions  Biting the toothbrush  Grabbing or hitting out (South Australian Dental Service, 2009)

28.  Talk clearly, mime  Allow resident to inspect the items  Right environment  Body language  Overcoming fear of being touched ◦ Bridging ◦ Chaining ◦ Hand over hand ◦ Distraction ◦ Rescuing (South Australian Dental Service, 2009)

29.  Bleeding gums  Sore mouth or tongue  Sore corners of mouth, tongue  Thrush (candidiasis)  Gum disease (gingivitis) or severe gum disease (periodontitis)

30.  Ulcers and sore spots  Dry mouth  Tooth decay, root decay, retained tooth roots  Dentures that are ill- fitting or require attention

31. Maintain a healthy diet in order to maintain good: Nutrition Contributes to Overall Wellness Physical condition Memory Bone health Eye health Blood circulation Immune system ORAL HEALTH

32.  Half of plate = fruits and vegetables  At least half of grains = whole grains  Vary protein choices  Cut back on foods that are high in sodium or fat  Drink plenty of fluids ◦ As we age, we start loosing our sense of thirst.  Exercise! Nutrition Guidelines (USDA MyPlate, 2013)

33. Any Questions??? http://www.mouthhealthy.org/en/adults-over-60/healthy-habits.aspx