The Mouth and Oral Cavity 13 Lecture Note PowerPoint Presentation.

The Mouth and Oral Cavity

13Lecture Note PowerPoint Presentation

Gerontological Nursing, Second EditionPatricia A. Tabloski

LEARNING OUTCOME 1Explain normal changes of aging in the mouth and

oral cavity.

Gerontological Nursing, Second EditionPatricia A. Tabloski

AGING AND THE MOUTH AND ORAL CAVITY

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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia A. Tabloski

AGING ASSOCIATED WITH DIFFICULTY MAINTAINING ORAL HYGIENE

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

Gerontological Nursing, Second EditionPatricia A. Tabloski

THOSE WITH THE POOREST ORAL HEALTH INCLUDE

The economically disadvantaged Those lacking insurance Racial and ethnic minorities Others

Disabled Homebound (Restricted or confined to home) Institutionalized

Gerontological Nursing, Second EditionPatricia A. Tabloski

LEARNING OUTCOME 2Identify common diseases of older persons in the

mouth and oral cavity.

Gerontological Nursing, Second EditionPatricia A. Tabloski

COMMON DISEASES OF AGING RELATING TO THE MOUTH AND ORAL CAVITY Increased oral diseases in communities

without fluoridation

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia A. Tabloski

COMMON DISEASES OF AGING RELATING TO THE MOUTH AND ORAL CAVITY Periodontal disease (those diseases that

affect one or more of the periodontal tissues, such as gingiva) and dental caries The most common cause of tooth loss More common in men than women Lower socioeconomic levels have more severe

disease forms

Gerontological Nursing, Second EditionPatricia A. Tabloski

GINGIVITIS AND PERIODONTAL DISEASE

Inflammation of the gums Manifestations

Redness Swelling Bleeding

Results from bacterial colonization at gum margin

Gerontological Nursing, Second EditionPatricia A. Tabloski

FIGURE 13-2GINGIVITIS AND RESULTING GUM EROSION.

Gerontological Nursing, Second EditionPatricia A. Tabloski

GINGIVITIS AND PERIODONTAL DISEASE

Risk factors Smoking Diabetes Medications Poor nutrition Stress Illness Genetic susceptibility

Gerontological Nursing, Second EditionPatricia A. Tabloski

ORAL AND PHARYNGEAL CANCERS

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-AmericansIt 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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia A. Tabloski

FIGURE 13-3POPULATION OVER THE AGE OF 60, WORLDWIDE AND DEVELOPING REGIONS.SOURCE: CENTERS FOR DISEASE CONTROL, 2001.

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia A. Tabloski

ORAL CANCER

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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia A. Tabloski

XEROSTOMIA (DRY MOUTH)

Associated with Dysphagia Difficult chewing Candidiasis Denture slippage

Gum irritation and erosion

Gerontological Nursing, Second EditionPatricia A. Tabloski

SJOGREN’S SYNDROME 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 body

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

Gerontological Nursing, Second EditionPatricia A. Tabloski

SJOGREN’S SYNDROME

Inflammation of epithelial tissue Other disorder manifestations include dry

eyes, skin changes, and thyroid disease

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia A. Tabloski

CONSEQUENCES OF POOR ORAL CARE

Social isolation Depression Systemic illness

Aspiration pneumonia Heart disease

Gerontological Nursing, Second EditionPatricia A. Tabloski

CONSEQUENCES OF POOR ORAL CARE

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 )

Gerontological Nursing, Second EditionPatricia A. Tabloski

LEARNING OUTCOME 3List common nursing diagnoses of older persons

related to oral problems.

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia A. Tabloski

NURSING DIAGNOSES

Impaired Dentition Altered Dentition Impaired Oral Mucous Membranes Altered Oral Mucous Membranes Nutrition Imbalance: Less Than Body

Requirements

Gerontological Nursing, Second EditionPatricia A. Tabloski

LEARNING OUTCOME 4Recognize nursing interventions that can be

implemented to assist the aging patient with oral problems.

Gerontological Nursing, Second EditionPatricia A. Tabloski

NURSING INTERVENTIONS TO IMPROVE XEROSTOMIA

Regular dental evaluation Low sugar diet Mouth rinses Sugar-free chewing gum, hard candies, and

mints

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia 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)

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia A. Tabloski

MOUTH CARE STRATEGIES FOR PATIENTS WITH COGNITIVE IMPAIRMENT

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

Gerontological Nursing, Second EditionPatricia A. Tabloski

LEARNING OUTCOME 5Identify medications that may cause or aggravate

oral problems.

Gerontological Nursing, Second EditionPatricia A. Tabloski

PROBLEMATIC COMMON MOUTH CARE PRODUCTS

Lemon glycerin swabs Hydrogen peroxide Mouth rinses

Gerontological Nursing, Second EditionPatricia 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

Gerontological Nursing, Second EditionPatricia 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