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LectureNotePowerPointPresentation

TheMouthandOral
Cavity
LEARNING OUTCOME 1
Explain normal changes of aging in the mouth and oral
cavity.

Gerontological Nursing, Second Edition


Patricia 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 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

Gerontological Nursing, Second Edition


Patricia 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 Edition


Patricia 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 Edition


Patricia A. Tabloski
LEARNING OUTCOME 2
Identify common diseases of older persons in the mouth
and oral cavity.

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

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
Regionaldifferences noted
Impacts multiple areas of life
Nutrition
Self-esteem

Speech

Facial appearance

Source of halitosis

Gerontological Nursing, Second Edition


Patricia 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 Edition


Patricia A. Tabloski
GINGIVITIS AND PERIODONTAL
DISEASE
Inflammation of the gums
Manifestations
Redness
Swelling
Bleeding
Results from bacterial colonization at gum
margin

Gerontological Nursing, Second Edition


Patricia A. Tabloski
FIGURE 13-2
GINGIVITIS AND RESULTING GUM EROSION.

Gerontological Nursing, Second Edition


Patricia A. Tabloski
GINGIVITIS AND PERIODONTAL
DISEASE
Risk factors
Smoking
Diabetes
Medications
Poor nutrition
Stress
Illness
Genetic susceptibility

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: 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

Gerontological Nursing, Second Edition


Patricia A. Tabloski
ORAL CANCER
Occurs most often in people over age 45
Symptoms
Sorethat 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 Edition


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

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

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: 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 Edition


Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Affects 2540% of older Americans
May be caused by medications
Antihistamines
Diuretics
Antipsychotics
Antidepressants
Anticholinergics
Chemotherapeutic agents
Antiparkinson drugs

Gerontological Nursing, Second Edition


Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Associated with
Dysphagia
Difficult
chewing
Candidiasis
Denture slippage
Gum irritation and erosion

Gerontological Nursing, Second Edition


Patricia A. Tabloski
SJOGRENS 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 Edition


Patricia A. Tabloski
SJOGRENS SYNDROME
Inflammation of epithelial tissue
Other disorder manifestations include dry eyes,
skin changes, and thyroid disease

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

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

Gerontological Nursing, Second Edition


Patricia A. Tabloski
CONSEQUENCES OF POOR ORAL
CARE
Social isolation
Depression

Systemic illness
Aspiration pneumonia
Heart disease

Gerontological Nursing, Second Edition


Patricia 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 Edition


Patricia A. Tabloski
LEARNING OUTCOME 3
List common nursing diagnoses of older persons related
to oral problems.

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

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

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

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

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

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.

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

Gerontological Nursing, Second Edition


Patricia A. Tabloski
NURSING INTERVENTIONS TO
IMPROVE XEROSTOMIA
Artificial saliva and mouth lubricants
Bedside humidifiers

Dietary modifications
Avoidhard-to-swallow or chewy foods
Careful use of fluids while eating

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)

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

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

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

Gerontological Nursing, Second Edition


Patricia 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 residents 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 Edition


Patricia A. Tabloski
LEARNING OUTCOME 5
Identify medications that may cause or aggravate oral
problems.

Gerontological Nursing, Second Edition


Patricia A. Tabloski
PROBLEMATIC COMMON MOUTH
CARE PRODUCTS
Lemon glycerin swabs
Hydrogen peroxide

Mouth rinses

Gerontological Nursing, Second Edition


Patricia A. Tabloski
MEDICATIONS TO USE WITH
CAUTION
Diabetes medications
Gingivitis and periodontal disease
Potential causes of xerostomia
Tricyclicantidepressants
Sedatives
Tranquilizers
Antihistamines
Antihypertensives
Alpha- and beta-blockers

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

Gerontological Nursing, Second Edition


Patricia A. Tabloski