M. Petrina Sweeney ORAL HEALTH OF OLDER PEOPLE Friday 23 rd September

“It is a standard of health of the oral and related tissues which enables an individual to eat, speak and socialise without active disease, discomfort and embarrassment and which contributes to general well being” Oral Health Strategy Group, UK Department of Health 1994 WHAT IS ORAL HEALTH?

ORAL HEALTH AND QUALITY OF LIFE AMONG THE ELDERLY Communication Facial appearance Drinking Eating

THE ORAL MICROFLORA 10 8 microorganisms per millilitre of saliva 350 cultivable bacterial species

MAINTENANCE OF ORAL HYGIENE IS ESSENTIAL FOR MAINTAINING ORAL HEALTH AND QUALITY OF LIFE

ORAL ASSESSMENT Oral problems common in care home patients A thorough oral assessment is the vital first step in planning effective care Encourage patients to report any oral discomfort Use of assessment tools

MAINTENANCE OF ORAL HYGIENE Should not be difficult or time consuming Encourage patients to be independent if possible Regular assessment Frequency of care Multidisciplinary approach

ACTUAL AND PROJECTED % OF EDENTATE ADULTS IN SCOTLAND BY AGE GROUP ( ) An Analysis of the Dental Workforce in Scotland – A Strategic Review 2010 : Scottish Government

DENTAL CARIES IN THE ELDERLY “…the incidence of caries in a population aged 65 and older is greater than in a population of 14-year olds living in a non-fluoridated area.” Ettinger RL Dental Clinics of North America 1997: 41:

DENTAL CARIES IN THE ELDERLY Dry mouth: often drug-induced Reduced manual dexterity: poor oral hygiene Sweet diet

TOOTHBRUSHING ProcedureComments Clean teeth at least twice daily Use a personal toothbrush and a fluoridated toothpaste. Carers must undertake tooth- brushing for dependent patients Chemical plaque control Consider using chlorhexidine mouthwash, spray or gel Maintain cleanliness of oral mucosa Clean mucosa with a water-moistened gauze or a foam stick (if necessary) Clean partial dentures separately Always remove denture from the mouth and clean separately from natural teeth Maintain complex dental work The dental team should provide advice on oral hygiene for patients with complex restorations e.g. implants, crowns and bridges

PERIODONTAL DISEASES A group of diseases affecting the marginal periodontium, representing an inflammatory and immune reaction to the presence of microbial plaque.

ADVANCED CHRONIC PERIODONTITIS

ORAL HEALTH AND NUTRITIONAL STATUS

THE DENTURE WEARER

DENTURE CARE High level of denture hygiene essential Dentures removed and cleaned out of the mouth Dentures cleaned daily Encourage patients to remove their own dentures if possible

MAINTAIN DENTURE HYGIENE?

ORAL CANDIDOSIS ‘A disease of the diseased’

PSEUDOMEMBRANOUS CANDIDOSIS Non-adherent white plaques

DENTURE STOMATITIS

ANGULAR CHEILITIS Candida spp Staphylococcus aureus

CARE OF DENTURES

VIRAL INFECTIONS

HSV REACTIVATION

HSV REACTIVATION – COMPROMISED HOST Often intra-oral Clinically atypical Painful High index of suspicion

STAPHYLOCOCCAL MUCOSITIS

Aspiration risk  pneumonia

ORAL HEALTH AND SYSTEMIC DISEASE Respiratory tract infections Septicaemia Septic arthritis Endocarditis Cardiovascular disease

PNEUMONIA IN THE ELDERLY Fourth overall leading cause of death Leading infectious cause of death in the elderly Most cases of bacterial pneumonia are caused by micro-aspiration of colonised oropharyngeal flora Chan ED, Welsh C. Geriatric Respiratory Medicine Chest 1998; 114:

OTHER COMMON PROBLEMS

FIBROEPITHELIAL POLYP

DENTURE-INDUCED HYPERPLASIA

ATROPHIC GLOSSITIS

IRON TABLET BURN  septicaemia

LICHEN PLANUS

ORAL CANCER

EARLY SCC TONGUE

SO HOW COMMON ARE THESE PROBLEMS ?

CARE HOME NEEDS ASSESSMENT: THE GLASGOW PICTURE Pilot project 10 care homes Assessment team: dentist, research nurse and hygienist Standard screening form devised in-house 288 of 316 residents consented to examination Examinations performed in sitting/bedrooms Standard light source

CARE HOME NEEDS ASSESSMENT: THE GLASGOW PICTURE Pilot project: results summary

PERSONAL INTERVIEWS WITH STAFF Results: Care home managers Mouth care not high priority Formal mouth care policy not in place Oral assessment, on admission, but not by dentist/ trained staff Annual dental screening not routine Mouth care training at induction by non-dentally qualified personnel Requested further education

PERSONAL INTERVIEWS WITH STAFF Mouth care not documented routinely All agreed mouth care was within their remit Many found mouth care difficult/distressing 6 had received specific mouth care training but not in-house 5 had some formal nursing qualifications Overwhelming request for training Results: 22 Care staff

Maintenance of oral health an essential element of holistic care Many oral health problems are preventable Input of the dental team should be availableto all dependent older people

REGULAR ORAL ASSESSMENT AND ORAL CARE AN ESSENTIAL ELEMENT OF CARE FOR THE ELDERLY

60 Thank You