The Mouth and Oral Cavity

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The Mouth and Oral
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
     Regional differences 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
     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 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 25–40% 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
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 Edition
    Patricia A. Tabloski
SJOGREN’S 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
     Avoid hard-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 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 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
       Tricyclic antidepressants
       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

				
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