1. The Mouth and Oral Cavity 13 Lecture Note PowerPoint Presentation

2. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 1 Explain normal changes of aging in the mouth and oral cavity.

3. Gerontological Nursing, Second Edition Patricia A. Tabloski A GING AND THE M OUTH AND O RAL C AVITY The epithelium and soft tissues atrophy Reduction in number of taste buds (contain the receptors for taste) Hypogeusia: is a reduced ability to taste things Reduced saliva production Overly dry oral mucosa With proper oral hygiene Teeth and gums appear normal

4. Gerontological Nursing, Second Edition Patricia A. Tabloski A GING AND THE M OUTH AND O RAL C AVITY Gums recede Increased vulnerability of teeth below gum line to cavities Enamel erosion Stains Cavities Tooth loss and malocclusion Difficulty eating Social isolation

5. Gerontological Nursing, Second Edition Patricia A. Tabloski A GING A SSOCIATED WITH D IFFICULTY M AINTAINING O RAL H YGIENE Potential causes Number and condition of dental restorations Recession (collapse) of gums Impaired visual acuity Possible loss of manual dexterity (skill and ease in using the hands) Restricted range of motion Effects of medications on oral cavity

6. Gerontological Nursing, Second Edition Patricia A. Tabloski T HOSE WITH THE P OOREST O RAL H EALTH I NCLUDE The economically disadvantaged Those lacking insurance Racial and ethnic minorities Others Disabled Homebound (Restricted or confined to home) Institutionalized

7. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 2 Identify common diseases of older persons in the mouth and oral cavity.

8. Gerontological Nursing, Second Edition Patricia A. Tabloski C OMMON D ISEASES OF A GING R ELATING TO THE M OUTH AND O RAL C AVITY Increased oral diseases in communities without fluoridation

9. Gerontological Nursing, Second Edition Patricia A. Tabloski C OMMON D ISEASES OF A GING R ELATING TO THE M OUTH AND O RAL C AVITY 30% of adults age 65 and older have no natural teeth Regional differences noted Impacts multiple areas of life Nutrition Self-esteem Speech Facial appearance Source of halitosis

10. Gerontological Nursing, Second Edition Patricia A. Tabloski C OMMON D ISEASES OF A GING R ELATING TO THE M OUTH AND O RAL C AVITY Periodontal disease (those diseases that affect one or more of the periodontal tissues, such as gingiva) and dental cariesdiseasesperiodontal tissues The most common cause of tooth loss More common in men than women Lower socioeconomic levels have more severe disease forms

11. Gerontological Nursing, Second Edition Patricia A. Tabloski G INGIVITIS AND P ERIODONTAL D ISEASE Inflammation of the gums Manifestations Redness Swelling Bleeding Results from bacterial colonization at gum margin

12. Gerontological Nursing, Second Edition Patricia A. Tabloski F IGURE 13-2 G INGIVITIS AND RESULTING GUM EROSION.

13. Gerontological Nursing, Second Edition Patricia A. Tabloski G INGIVITIS AND P ERIODONTAL D ISEASE Risk factors Smoking Diabetes Medications Poor nutrition Stress Illness Genetic susceptibility

14. Gerontological Nursing, Second Edition Patricia A. Tabloski O RAL AND P HARYNGEAL C ANCERS Primarily diagnosed in older adults Carry a poor prognosis 5-year survival rate 56% white Americans: one of the lowest rates among all cancers 34% African-Americans It is estimated that in the United States approximately 30,000 people are being diagnosed with and 8,000 deaths are occurring annually from oral and pharyngeal cancer

15. Gerontological Nursing, Second Edition Patricia A. Tabloski O RAL C ANCER Occurs most often in people over age 45 Symptoms Sore that does not heal Lump on lip or mouth White or red patch on gum, tongue, or buccal mucosa Unusual bleeding, numbness, or pain

16. Gerontological Nursing, Second Edition Patricia A. Tabloski F IGURE 13-3 P OPULATION OVER THE AGE OF 60, WORLDWIDE AND DEVELOPING REGIONS. S OURCE : C ENTERS FOR D ISEASE C ONTROL, 2001.

17. Gerontological Nursing, Second Edition Patricia A. Tabloski O RAL C ANCER Symptoms Feeling of something caught in the throat Difficulty or pain with chewing or swallowing Swelling in jaw Voice changes Pain in ear

18. Gerontological Nursing, Second Edition Patricia A. Tabloski O RAL C ANCER Risk factors Tobacco use Chronic and heavy alcohol use Sun exposure to lips History of leukoplakia Erythroplakia: is a clinical term used to describe patches of keratosis. It is visible as adherent white patches on the mucous membranes of the oral cavity

19. Gerontological Nursing, Second Edition Patricia A. Tabloski X EROSTOMIA ( DRY MOUTH ) Affects 25–40% of older Americans May be caused by medications Antihistamines Diuretics Antipsychotics Antidepressants Anticholinergics Chemotherapeutic agents Antiparkinson drugs

20. Gerontological Nursing, Second Edition Patricia A. Tabloski X EROSTOMIA ( DRY MOUTH ) Associated with Dysphagia Difficult chewing Candidiasis Denture slippage Gum irritation and erosion

21. Gerontological Nursing, Second Edition Patricia A. Tabloski S JOGREN ’ S S YNDROME Systematic, autoimmune disorder Occurs in association with disorders such as Rheumatoid arthritis Systemic lupus erythematosus: is a systemic autoimmune disease that can affect any part of the bodysystemic autoimmune disease Scleroderma:is a chronic systemic autoimmune disease characterized by fibrosis (or hardening), vascular alterations, and autoantibodies. Polymyositis: many muscle inflammation. Polyarteritis: a serious blood vessel disease in which small and medium-sized arteries become swollen and damaged

22. Gerontological Nursing, Second Edition Patricia A. Tabloski S JOGREN ’ S S YNDROME Inflammation of epithelial tissue Other disorder manifestations include dry eyes, skin changes, and thyroid disease

23. Gerontological Nursing, Second Edition Patricia A. Tabloski O RAL C ANDIDIASIS Fungal infection Caused by Candida albicans Managed with antifungal agents Risk factors Dry mouth Diabetes Altered immune response Use of inhaled steroids

24. Gerontological Nursing, Second Edition Patricia A. Tabloski S TOMATITIS Inflammation of the mouth Commonly caused by chemotherapeutic agents Manifestations Eroded ulcerations in the oral cavity Secondary infection Pain with eating and drinking

25. Gerontological Nursing, Second Edition Patricia A. Tabloski C ONSEQUENCES OF P OOR O RAL C ARE Social isolation Depression Systemic illness Aspiration pneumonia Heart disease

26. Gerontological Nursing, Second Edition Patricia A. Tabloski C ONSEQUENCES OF P OOR O RAL C ARE Periodontal disease Malnutrition, vitamin deficiency Pain, halitosis(a term used to describe noticeably unpleasant odors exhaled in breathing), tooth loss, dental caries, periodontal disease Denture stomatitis (pathological reactions of the denture bearing palatal mucosa )

27. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 3 List common nursing diagnoses of older persons related to oral problems.

28. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING A SSESSMENT OF O RAL P ROBLEMS Oral health history Date of last dental examination Presence and function of dentures Missing or loose teeth Bleeding gums Dry mouth Presence of sores or lesions

29. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING A SSESSMENT OF O RAL P ROBLEMS Oral health history Medications Usual oral hygiene routine Altered sense of taste Chewing or swallowing difficulties Bad breath or halitosis

30. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING A SSESSMENT OF O RAL P ROBLEMS Oral cavity examination Lips Teeth Interior of buccal mucosa Anterior and base of tongue, gums, soft and hard palate, and back of throat

31. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING A SSESSMENT OF O RAL P ROBLEMS Oral cavity examination Presence of cracks, lesions, ulcers, swelling, or induration Presence of gingival bleeding, hypertrophy, or dental caries Presence of leukoplakia

32. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING D IAGNOSES Impaired Dentition Altered Dentition Impaired Oral Mucous Membranes Altered Oral Mucous Membranes Nutrition Imbalance: Less Than Body Requirements

33. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 4 Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

34. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING I NTERVENTIONS TO I MPROVE X EROSTOMIA Regular dental evaluation Low sugar diet Mouth rinses Sugar-free chewing gum, hard candies, and mints

35. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING I NTERVENTIONS TO I MPROVE X EROSTOMIA Artificial saliva and mouth lubricants Bedside humidifiers Dietary modifications Avoid hard-to-swallow or chewy foods Careful use of fluids while eating

36. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING I NTERVENTIONS TO I MPROVE O RAL C ANDIDIASIS Rinse mouth after use of inhaled steroids Use small, soft toothbrush twice daily Use swabs to clean and moisten oral mucosa when unable to brush Provide mouth rinses Chlorhexidine (Peridex)

37. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING I NTERVENTIONS FOR THE P ATIENT WITH O RAL P AIN Rule out infection or abscess Perform oral examination Inspect mouth, tongue, and teeth Assess vital signs Assess respiratory function Assess lymph nodes

38. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING I NTERVENTIONS TO I MPROVE G INGIVITIS AND P ERIODONTAL D ISEASE Educate the patient and family Daily flossing Daily brushing Use of fluoride toothpaste Need for oral hygienist referral Nutrition Effect of periodontal disease on overall health

39. Gerontological Nursing, Second Edition Patricia A. Tabloski N URSING I NTERVENTIONS TO I MPROVE S TOMATITIS Educate the patient and family Signs and symptoms Ulcers in mouth Pain with eating and drinking Secondary infections Treatments Meticulous oral hygiene Frequent use of isotonic saline mouthwash Avoidance of food extremes Providing swish-and-spit solution as prescribed

40. Gerontological Nursing, Second Edition Patricia A. Tabloski M OUTH C ARE S TRATEGIES FOR P ATIENTS WITH C OGNITIVE I MPAIRMENT Task breakdown Distraction Hand-over-hand:in which the nurse places his or her hand over the resident’s hand and guides the resident with an activity such as removing or replacing dentures. Chaining: in which the nurse starts the mouth care activity and the person completes it Protection

41. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 5 Identify medications that may cause or aggravate oral problems.

42. Gerontological Nursing, Second Edition Patricia A. Tabloski P ROBLEMATIC C OMMON M OUTH C ARE P RODUCTS Lemon glycerin swabs Hydrogen peroxide Mouth rinses

43. Gerontological Nursing, Second Edition Patricia A. Tabloski M EDICATIONS TO U SE WITH C AUTION Diabetes medications Gingivitis and periodontal disease Potential causes of xerostomia Tricyclic antidepressants Sedatives Tranquilizers Antihistamines Antihypertensives Alpha- and beta-blockers

44. Gerontological Nursing, Second Edition Patricia A. Tabloski M EDICATIONS TO U SE WITH C AUTION Potential causes of xerostomia Diuretics Calcium channel blockers Angiotensin-converting enzyme inhibitors Cytoxic agents Antiparkinsonian agents Antiseizure drugs Potential causes of stomatitis Chemotherapeutic agents