Only $35.99/year

10 oral health and common oral problems in the elderly

Terms in this set (16)

ASSESSMENT.

FACE AND LIPS:
-examine face with lips at rest
-identify facial deformity, skin or per-oral lesions
-SQUAMOUS CELL CARCINOMA of lip is common and may present as dry, scaly or ulcerated non-healing lesion
-creasing of facial skin at lip corners often due to tooth loss and poorly fitting denture predisposes patient to ANGULAR CHEILITIS

GUMS AND TEETH:
-remove dentures
-assess for caries, root caries, gingivitis, periodontal disease, oral hygiene status, broken or worn teeth, extensive plaque and periodontal disease

AGE-RELATED CHANGES
-gingival recession resulting in root surface exposure
-worn incisal edges and yellowing
-dark staining
-tobacco staining

BONY EXOSTOSES
-tori
-buccal surfaces

TONGUE
-must grasp tip of tongue with gauze to pull forward and up
-inspect lateral margins and undersurface where disease changes often occur
-AGE RELATED: fissuring, mucosal thinning, sublingual varicosities
-number of TASTE BUDS DECREASES with age but decreased taste sensitivity is more often due to SMOKING,DRUGS AND DRY MOUTH

ERYTHEMA MIGRANS/GEOGRAPHIC TONGUE:
-this is a normal variant!!!
1. symtoms:
-may cause tongue pain or burning with spicy foods
-most often asymptomatic
-waxes, wanes, migrates
2. etiology
-migratory inflammatory filiform papillae atrophy
-exact etiology uncertain
3. treatment
-normal variant, reassurance only
-no treatment needed
-topical steroid gels and antihistamine mouth rinses can reduce tongue sensitivity

MUCOSA
-mucosa should appear wet and glistening
-pay particular attention to mucosa under dentures
-aging results in thinning of oral mucosa and decreased elasticity
-dry mucosa interferes with denture retention and increases risk of caries
ORAL SYSTEMIC LINKAGES IN THE ELDERLY CONTINUED...


ASPIRATION PNEUMONIA:
-associated with oral bacteria especially in bedridden patients
-mechanically ventilated patients are particularly at risk
-oral hygiene strategies in skilled nursing facilities are hospitals can reduce incidence

VASCULAR DISEASE:
-periodontal disease is associated with coronary artery disease and cerebrovascular disease
-causation is unclear
-inflammatory cytokines implicated in atherogenesis are produced in patients with periodontal disease
-treatment of periodontal disease has not been shown to reduce cardiovascular risk
-STROKES can result in multiple oral problems like:
--oral sensory and motor deficits
--poor tongue function and lip seal
--dysphagia
--reduced oral clearance of foods and increased food packing
--reduced dexterity negatively affecting oral hygiene performance
--increased caries and periodontal disease risk

RHEUMATOID ARTHRITIS:
-periodontal disease is more common in patients with RA
-treatment of periodontal disease may reduce severity of RA
-RA may involve TMJ and affect chewing
-diminished salivary output (sjogrens) leads to xerostomia and caries
-reduced dexterity negatively affects oral hygiene performance
-increased caries and periodontal disease risk

DEMENTIA:
-patients and dementia have increased risk for caries, periodontal disease and oral infections
-self care deficits
-dependence on caregivers
-challenging behaviors
-resistance to care
-chronic disease burden
-dietary changes
-postural impairments
-swallowing difficulty
-difficulty complying with medications, oral hygiene, dental appointments
MANAGING ANTICOAGULATION:
-THROMBOEMBOLISM in a patient where anticoagulation is discontinued is 3x more likely than major bleeding if anticoagulation is continued
-cleanings, fillings and simple extractions can be performed without interrupting anticoagulation or antiplatelet agents
-effective interprofessional communication is vital
-most procedures can be performed with an INR between 1.8-3.5
-updated INR should be obtained within 1 week of routine dental procedure and 2 days for surgical procedure
-if patients who must remain anticoagulated requires major oral surgery with high bleeding risk, transition to perioperative heparin should be considered

medical conditions REQUIRING ANTIBIOTIC PROPHYLAXIS FOR SOME DENTAL PROCEDURES:
-prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts
-prosthetic material used for cardiac valve repair like annuloplasty rings and chords
-previous infective endocarditis
-unrepaired cyanotic congenital heart disease or repaired congenital heart disease with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device
-cardiac transplant with valve regurgitation due to structural abnormal valve

medical conditions MAY need antibiotic prophylaxis:
-vascular grafts (less than 6 months old)
-arteriovenosis hemodialysis shunts
-neurosurgical shunts (type dependent)
-immunosuppressed patients

PROPHYLACTIC ANTIBIOTICS ARE GENERALLY NOT RECOMMENDED FOR PATIENTS WITH PROSTHETIC JOINT IMPLANTS PRIOR TO DENTAL PROCEDURES