1. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. CHAPTER Gerontological Nursing, Second Edition Patricia A. Tabloski The Mouth and Oral Cavity 13 Lecture Note PowerPoint Presentation

2. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 1 Explain normal changes of aging in the mouth and oral cavity.

3. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Aging and the Mouth and Oral Cavity With proper oral hygiene –Teeth and gums appear normal The epithelium and soft tissues atrophy Reduction in number of taste buds –Hypogeusia Reduced saliva production –Overly dry oral mucosa

4. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Aging and the Mouth and Oral Cavity Gums recede –Increased vulnerability of teeth below gum line to cavities Enamel erosion –Stains –Cavities Tooth loss and malocclusion –Difficulty eating –Social isolation

5. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Aging Associated with Difficulty Maintaining Oral Hygiene Potential causes –Number and condition of dental restorations –Recession of gums –Impaired visual acuity –Possible loss of manual dexterity –Restricted range of motion –Effects of medications on oral cavity

6. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 2 Identify common diseases of older persons in the mouth and oral cavity.

7. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Common Diseases of Aging Relating to the Mouth and Oral Cavity Increased oral diseases in communities without fluoridation

8. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Common Diseases of Aging Relating to the Mouth and Oral Cavity 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

9. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Common Diseases of Aging Relating to the Mouth and Oral Cavity Periodontal disease and dental caries –The most common cause of tooth loss –More common in men than women –Lower socioeconomic levels have more severe disease forms

10. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Those with the Poorest Oral Health Include The economically disadvantaged Those lacking insurance Racial and ethnic minorities Others –Disabled –Homebound –Institutionalized

11. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Oral and Pharyngeal Cancers Primarily diagnosed in older adults Carry a poor prognosis 5-year survival rate –56% white Americans –34% African-Americans

12. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Xerostomia (dry mouth) Affects 25–40% of older Americans May be caused by medications –Antihistamines –Diuretics –Antipsychotics –Antidepressants –Anticholinergics –Chemotherapeutic agents –Antiparkinson drugs

13. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Xerostomia (dry mouth) Associated with –Dysphagia –Difficult chewing –Candidiasis –Denture slippage  Gum irritation and erosion

14. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Consequences of Poor Oral Care Social isolation Depression Systemic illness –Aspiration pneumonia –Heart disease

15. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Consequences of Poor Oral Care Periodontal disease Malnutrition, vitamin deficiency Pain, halitosis, tooth loss, dental caries, periodontal disease Denture stomatitis

16. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Sjogren’s Syndrome Systematic, autoimmune disorder –Occurs in association with disorders such as  Rheumatoid arthritis  Systemic lupus erythematosus  Scleroderma  Polymyositis  Polyarteritis

17. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Sjogren’s Syndrome Inflammation of epithelial tissue Other disorder manifestations include dry eyes, skin changes, and thyroid disease

18. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Oral Candidiasis Fungal infection Caused by Candida albicans Managed with antifungal agents Risk factors –Dry mouth –Diabetes –Altered immune response –Use of inhaled steroids

19. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Gingivitis and Periodontal Disease Inflammation of the gums Manifestations –Redness –Swelling –Bleeding Results from bacterial colonization at gum margin

20. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Figure 13-2 Gingivitis and resulting gum erosion.

21. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Gingivitis and Periodontal Disease Risk factors –Smoking –Diabetes –Medications –Poor nutrition –Stress –Illness –Genetic susceptibility

22. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Stomatitis Inflammation of the mouth Commonly caused by chemotherapeutic agents Manifestations –Eroded ulcerations in the oral cavity –Secondary infection –Pain with eating and drinking

23. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Oral Cancer 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

24. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Figure 13-3 Population over the age of 60, worldwide and developing regions. Source: Centers for Disease Control, 2001.

25. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Oral Cancer Symptoms –Feeling of something caught in the throat –Difficulty or pain with chewing or swallowing –Swelling in jaw –Voice changes –Pain in ear

26. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Oral Cancer Risk factors –Tobacco use –Chronic and heavy alcohol use –Sun exposure to lips –History of leukoplakia –Erythroplakia

27. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 3 List common nursing diagnoses of older persons related to oral problems.

28. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Assessment of Oral Problems 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. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Assessment of Oral Problems Oral health history –Medications –Usual oral hygiene routine –Altered sense of taste –Chewing or swallowing difficulties –Bad breath or halitosis

30. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Assessment of Oral Problems Oral cavity examination –Lips –Teeth –Interior of buccal mucosa –Anterior and base of tongue, gums, soft and hard palate, and back of throat

31. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Assessment of Oral Problems Oral cavity examination –Presence of cracks, lesions, ulcers, swelling, or induration –Presence of gingival bleeding, hypertrophy, or dental caries –Presence of leukoplakia

32. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Diagnoses Impaired Dentition Altered Dentition Impaired Oral Mucous Membranes Altered Oral Mucous Membranes Nutrition Imbalance: Less Than Body Requirements

33. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Interventions to Improve Xerostomia Regular dental evaluation Low sugar diet Mouth rinses Sugar-free chewing gum, hard candies, and mints

35. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Interventions to Improve Xerostomia Artificial saliva and mouth lubricants Bedside humidifiers Dietary modifications –Avoid hard-to-swallow or chewy foods –Careful use of fluids while eating

36. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Interventions to Improve Oral Candidiasis 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. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Interventions for the Patient with Oral Pain Rule out infection or abscess –Perform oral examination  Inspect mouth, tongue, and teeth –Assess vital signs –Assess respiratory function –Assess lymph nodes

38. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Interventions to Improve Gingivitis and Periodontal Disease 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. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Interventions to Improve Stomatitis 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. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Mouth Care Strategies for Patients with Cognitive Impairment Task breakdown Distraction Hand-over-hand Chaining Protection

41. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 5 Identify medications that may cause or aggravate oral problems.

42. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Problematic Common Mouth Care Products Lemon glycerin swabs Hydrogen peroxide Mouth rinses

43. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Medications to Use with Caution Diabetes medications –Gingivitis and periodontal disease Potential causes of xerostomia –Tricyclic antidepressants –Sedatives –Tranquilizers –Antihistamines –Antihypertensives  Alpha- and beta-blockers

44. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Medications to Use with Caution Potential causes of xerostomia –Diuretics –Calcium channel blockers –Angiotensin-converting enzyme inhibitors –Cytoxic agents –Antiparkinsonian agents –Antiseizure drugs Potential causes of stomatitis –Chemotherapeutic agents