ORAL HEALTH & AGING AWARENESS by Michelle Martin RDH, MPH

1. ORAL HEALTH & AGING AWARENESSby Michelle Martin RDH, MPH “Elderly suffer a disproportionate & debilitating amount of oral disease.” - Alliance for Aging Research

2. Oral Health Trivia TRUE or FALSE? • People with Diabetes are at a greater risk of developing gum disease. • Healthy eating can contribute to the condition of a an individuals mouth. • Hypertension (High Blood Pressure) medications can affect your mouth.

3. One Last Trivia Question??? • Among new military recruits in 2010, what percentage were not deployed because of significant dental issues? • A. 0-40% • B. 40-60% • C. 60% +

4. Why is oral health so important?

5. Bacteria in the Mouth… • Heart Disease • Stroke • Pneumonia • Diabetes “… providing mechanical oral hygiene may prevent 1 in 10 deaths from pneumonia in dependent elderly people and show similar pneumonia prevention effect.” (Sjogren, P., et al: JAGS 2008 (56); 2124-30)

6. Periodontal Disease (Gum Disease) • 35% of all Americans have some form of PD • 13% have severe periodontal disease • 75% of all Americans have inflammation of the gums (gingivitis) • Progression of gingivitis to bone loss: • Pockets form around the teeth • Pockets gradually deepen, ulcerate • Bone loss visible on x-rays

7. Gum Disease , Diabetes and our Hearts • Nearly 1/3 of people with diabetes have severe bone loss (CDC) • Diabetics are 3 - 4 times more likely to develop periodontal disease (gum disease) • Develop infections easier • Can contribute to heart disease • Can contribute to pneumonia (http://www.perio.org/consumer/mbc.diabetes.htm)

8. Oral Health as We Age

9. “A feeling that there is not enough saliva in the mouth, all or most of the time.” Xerostomia: Dry Mouth (NIH Senior Health, 2003)

10. Risk Factors for Dry Mouth A side effect of certain diseases and infections: • Sjögren's syndrome • HIV/AIDS • Alzheimer's disease • Diabetes • Anemia • Cystic fibrosis • Crohn’s disease • Systemic Lupus Erythematosis • Rheumatoid arthritis • Hypertension • Parkinson's disease • Stroke • Scleroderma • Hepatitis

11. Risk Factors for Dry Mouth A side effect of over 500 medications: • Antidepressants • Antihypertensives • Narcotics • Anticholinergics • Antipsychotics • Anti-Parkinson • Antiasthmatics • Anorexiants • Anticonvulsants • Antacids • Hormone replacements • Diuretics • Sedatives • Inhalants • Decongestants • Glaucoma eye drops • Antihistamines • Pseudoephedrine (USDHHS, 2008)

12. Signs of Dry Mouth • Dry, sticky oral tissues • Thick saliva • Ulcers in mouth • Cracking of the corners of the mouth or tongue • Bad breath • Frequent yeast infections • Red gums that bleed easily • Increased tartar build up Increased dental decay

13. Symptoms of Dry Mouth • Sore or burning mouth, lips or tongue • Sleep interruptions due to thirst or oral discomfort • Difficulty chewing, speaking, swallowing and wearing dentures • Difficulty clearing leftover food in the mouth • Patient may avoid eating dry foods

14. ORAL CAVITY PROBLEMS Dry mouth may contribute to: • Inflammation • Yeast infections • Tooth decay • Gum disease

15. Severe Decay …the longer one waits

16. Prevent or Manage Dry Mouth Over the counter products might be sufficient Talk with doctor/ dentist for prescriptions

17. Mints and Hard Candies AVOID SUGAR CANDY Sugar-Free Candies Okay!

18. Denture Care • Dentures need to be kept moist when not worn • Handle with great care – very expensive • Brush & rinse dentures daily – soft bristles designed for dentures • Clean with denture cleanser – NOT toothpaste

19. Denture Care Put in denture case NOT a Kleenex/paper towel! • Remember to still brush gums and palate Important to remove to allow oxygen to get to tissues • ONLY a dentist/ prosthodontist should adjust dentures

20. Antibiotics • Conditions with a high risk of infection  antibiotics are recommended prior to some dental procedures • Most conditions of the heart, pace makers, heart valves etc. • Check with doctor/dentist (http://www.mouthhealthy.org/en/az-topics/p/Premedication-or-Antibiotics)

21. Dementia and Oral Health • Aging in general increases the risk of oral cancer • Dry mouth from RX’s • Eventually dependant on care giver

22. Dementia and Oral Health • Early stages  help remind about daily brushing • Increase fluoride treatments • Use alcohol-based pen to write name on dentures

23. Promoting Healthy Habits

24. Daily Prevention Habits • Be SMART brushers • 2x day for 2 minutes • Floss daily • Prevent dry mouth • Biotene or generic brand • Keep mouth moist! • Eat healthy fruits & vegetables

25. Helpful Tips Studies show professional teeth cleaning lowers inflammation and pain in Arthritis patients… • Use floss holders • Arthritis or other conditions that limit movement… • Electric toothbrush • Duck tape a golf ball securely to handle of regular toothbrush • NEVER put your fingers between teeth (http://www.arthritistoday.org/news/gum-disease.php)

26. Helpful Positioning (South Australian Dental Service, 2009)

27. Changed Behavior Fear if being touched Not opening mouth Not understanding or responding to directions Biting the toothbrush Grabbing or hitting out (South Australian Dental Service, 2009)

28. Managing Changed Behavior • Talk clearly, mime • Allow resident to inspect the items • Right environment • Body language • Overcoming fear of being touched • Bridging • Chaining • Hand over hand • Distraction • Rescuing (South Australian Dental Service, 2009)

29. Document and Report • Bleeding gums • Sore mouth or tongue • Sore corners of mouth, tongue • Thrush (candidiasis) • Gum disease (gingivitis) or severe gum disease (periodontitis)

30. Document and Report • Ulcers and sore spots • Dry mouth • Tooth decay, root decay, retained tooth roots • Dentures that are ill-fitting or require attention

31. Nutrition Contributes to Overall Wellness • Physical condition • Memory • Bone health • Eye health • Blood circulation • Immune system • ORAL HEALTH Maintain a healthy diet in order to maintain good:

32. Nutrition Guidelines • Half of plate = fruits and vegetables • At least half of grains = whole grains • Vary protein choices • Cut back on foods that are high in sodium or fat • Drink plenty of fluids • As we age, we start loosing our sense of thirst. • Exercise! (USDA MyPlate, 2013)

33. Thank You! Any Questions??? http://www.mouthhealthy.org/en/adults-over-60/healthy-habits.aspx