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13. Lecture Note PowerPoint Presentation. The Mouth and Oral Cavity. LEARNING OUTCOME 1. Explain normal changes of aging in the mouth and oral cavity. Aging and the Mouth and Oral Cavity. The epithelium and soft tissues atrophy
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13 Lecture Note PowerPoint Presentation The Mouth and Oral Cavity
LEARNING OUTCOME 1 Explain normal changes of aging in the mouth and oral cavity.
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
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
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
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
LEARNING OUTCOME 2 Identify common diseases of older persons in the mouth and oral cavity.
Common Diseases of Aging Relating to the Mouth and Oral Cavity • Increased oral diseases in communities without fluoridation
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
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
Gingivitis and Periodontal Disease • Inflammation of the gums • Manifestations • Redness • Swelling • Bleeding • Results from bacterial colonization at gum margin
Gingivitis and Periodontal Disease • Risk factors • Smoking • Diabetes • Medications • Poor nutrition • Stress • Illness • Genetic susceptibility
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
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
Figure 13-3Population over the age of 60, worldwide and developing regions.Source: Centers for Disease Control, 2001.
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
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
Xerostomia (dry mouth) • Affects 25–40% of older Americans • May be caused by medications • Antihistamines • Diuretics • Antipsychotics • Antidepressants • Anticholinergics • Chemotherapeutic agents • Antiparkinson drugs
Xerostomia (dry mouth) • Associated with • Dysphagia • Difficult chewing • Candidiasis • Denture slippage • Gum irritation and erosion
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
Sjogren’s Syndrome • Inflammation of epithelial tissue • Other disorder manifestations include dry eyes, skin changes, and thyroid disease
Oral Candidiasis • Fungal infection • Caused by Candida albicans • Managed with antifungal agents • Risk factors • Dry mouth • Diabetes • Altered immune response • Use of inhaled steroids
Stomatitis • Inflammation of the mouth • Commonly caused by chemotherapeutic agents • Manifestations • Eroded ulcerations in the oral cavity • Secondary infection • Pain with eating and drinking
Consequences of Poor Oral Care • Social isolation • Depression • Systemic illness • Aspiration pneumonia • Heart disease
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 )
LEARNING OUTCOME 3 List common nursing diagnoses of older persons related to oral problems.
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
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
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
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
Nursing Diagnoses • Impaired Dentition • Altered Dentition • Impaired Oral Mucous Membranes • Altered Oral Mucous Membranes • Nutrition Imbalance: Less Than Body Requirements
LEARNING OUTCOME 4 Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.
Nursing Interventions to Improve Xerostomia • Regular dental evaluation • Low sugar diet • Mouth rinses • Sugar-free chewing gum, hard candies, and mints
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
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)
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
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
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
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
LEARNING OUTCOME 5 Identify medications that may cause or aggravate oral problems.
Problematic Common Mouth Care Products • Lemon glycerin swabs • Hydrogen peroxide • Mouth rinses
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
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