Halitosis in long term care

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Bad breath is not bad because of the smell. People in long term care are often living behind this wall of stink, alone and depressed. Not to mention breathing in those toxic gases.

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  • Very nice slide series Shirley!!! Design is great!

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  • This is bacteria on the tongue
  • Proteins in the tissue break down into gasses. Things like these compounds are released into the air. They are called volitile sulfur compounds. Not only do these gasses smell bad, they also have an effect on the tissue, it makes it more permeable. The space between the cells making up the tissue becomes larger, allowing bacteria more free access.
  • Volatile sulfur compounds also stimulate bacterial growth. These toxic gasses have a systemic effect as well as a social effect.
  • Quality of Life has components that have yet to be determined. Increasing the Quality of Life of residents in LTC is a mission we’re all on. Science tells us that a low Quality of Life brings on depression, and is a goal we all avoid. How do you feel when your breath doesn’t feel fresh, or if you think your breath smells bad? How do you feel when you’re talking to someone who has bad breath?
  • Residents with poor oral health have poor breath smells. In some facilities we can smell the bad breath of residents in the halls, the whole facility has poor air quality. Residents themselves have a decreased Quality of Life if their breath is particularly foul. They can be isolated by a wall of foul air, other residents may find speaking to someone with halitosis or denture breath off putting. Their sense of smell may be hindered, and that may affect their sense of taste, impacting their nutritional intake. It’s all part of a nasty cycle of ill health. A cycle that can be improved by frequent oral cares.
  • As we saw, bad breath can be caused by bacterial infections in the mouth, and just decaying food in the mouth. Bacteria also harbor in the tongue between the tastebuds. Badly cleaned dentures also contribute to bad breath. Oral cancer and throat infections also make for bad breath.
  • Other reasons for bad breath can be described by speaking to the comments in the slide.
  • Spend time talking about diet and oral habits that contribute to oral malodors. Ask questions about how the care giver takes care of themselves when they eat odor causing foods, and would they want someone to take care of them if their breath smelled.
  • The lack of saliva works in both directions. It rinses food from the mouth, and it also has elements that fight the bacteria that are accumulating. Most residents are on a number of medications that either slow or eliminate saliva production and flow. That puts them at risk for a number of problems like cavities, or periodontal disease and bad breath.
  • Polyphamacy issues arise on many levels. The biggest issue is the lack of concern for the lack of this precious bodily fluid. Medications have a synergy that can lead to sever discomfort and an inability to do a number of things.
  • Cariogenic bacteria live in an acidic environment. With good saliva not only are the teeth bathed in a fluid that contains the minerals that keep teeth whole, saliva creates a hostile environment for the bacteria. Because saliva is mostly water, it also dilutes bacterial byproducts.
  • http://apod.nasa.gov/apod/ap110517.htmlThe smell of the gasses is unmistakable. Think of it as cadaverine and you’ll be very motivated to find ways to clean the resident’s teeth.
  • The gasses, in higher concentrations (although no one has checked on the amount of damage is done at this level), are very toxic and may contribute to respiratory problems in the resident an others!
  • These are examples from MSDS sheets from these gasses.
  • http://www.atsdr.cdc.gov/tfacts139.pdf
  • http://medical-dictionary.thefreedictionary.com/cadaverine
  • http://medical-dictionary.thefreedictionary.com/cadaverine
  • http://xylitol.org/medical-info-xylitol-doctorsXylitol can be applied as a nasal spray, mouthwash, toothpaste, gum, mint
  • http://xylitol.org/medical-info-xylitol-doctors
  • http://xylitol.org/medical-info-xylitol-doctors
  • http://xylitol.org/medical-info-xylitol-doctors
  • http://xylitol.org/medical-info-xylitol-doctorsI included simplifying bathroom issues because some residents don’t remain hydrated because they don’t like going to the bathroom. In some instances bathroom issues can be simplified so addressing this can be helpful.
  • Int J Dent Hyg. 2007 May;5(2):69-74.Professional oral health care by dental hygienists reduced respiratory infections in elderly persons requiring nursing care.Adachi M, Ishihara K, Abe S, Okuda K.SourceDivision of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Aobaku, Sendai, Japan. mieko-a@k9.dion.ne.jpAbstractOBJECTIVES:Respiratory infection is a major cause of death in the elderly. We have evaluated the role of professional oral health care (POHC) by dental hygienists in reducing respiratory infections in elderly persons requiring nursing care.METHODS:Two populations of elderly persons, one receiving POHC and one not, were examined to determine numbers of microorganisms, potent pathogens of respiratory infection, enzymatic activity in saliva, fevers, prevalence of fatal aspiration pneumonia and prevalence of influenza.RESULTS:In the first population, we found a high prevalence of potent respiratory pathogens such as Staphylococcus species, Pseudomonas aeruginosa and Candida albicans. Patients who received POHC showed a lower prevalence for these pathogens than those who did not. The ratio of fatal aspiration pneumonia in POHC patients was significantly lower than that in patients without POHC (non-POHC) over a 24-month period (P < 0.05). The prevalence of a fever of 37.8 degrees C or more in POHC patients was significantly lower than that in the non-POHC group (P < 0.05). In the second study population, we investigated the effects of POHC on infection with influenza over a 6-month period. In the POHC group, neuraminidase and trypsin-like protease activities decreased, and one of 98 patients was diagnosed with influenza; whereas, in the non-POHC group, nine of 92 patients were diagnosed with influenza. The relative risk of developing influenza while under POHC was 0.1 (95% CI 0.01-0.81, P = 0.008).CONCLUSION:These results suggest that POHC by dental hygienists is effective in preventing respiratory infections in elderly persons requiring nursing care.
  • Halitosis in long term care

    1. 1. Halitosis<br />Isolation<br />
    2. 2. Caring for those who can’t<br />A dental hygienist is a state licensed professional dedicated to education and providing oral care. <br />
    3. 3. Halitosis<br />Bad Breath<br />
    4. 4. Halitosis<br />Where does it come from?<br /><ul><li>Stomach
    5. 5. Teeth
    6. 6. Tongue
    7. 7. Sinuses</li></li></ul><li>Loneliness<br />Isolated by a wall of stink<br />
    8. 8. Quality of Life<br />Out of place<br />New surroundings<br />Isolated by breath<br />
    9. 9. Living behind the wall<br />
    10. 10. Protect yourself<br />Yeah, right<br />
    11. 11. Bad breath<br />Isn’t funny<br />No dignity <br />
    12. 12. Not Healthful<br />
    13. 13. Bacteria break down tissue<br />
    14. 14. Bacteria<br />Break down proteins<br />
    15. 15. Volatile Sulfur Compounds<br />
    16. 16.
    17. 17.
    18. 18.
    19. 19. Non-oral origins<br />
    20. 20. Foods <br />
    21. 21.
    22. 22. Polypharmacy <br />
    23. 23. Polypharmacy <br />Nearly all medications reduce saliva<br />Average number of medications per resident is 8<br />
    24. 24. Polypharmacy <br />The combination of drugs that all cause dry mouth contribute to halitosis<br />
    25. 25. Saliva’s job<br />Buffer acids created by bacteria<br />Dilute bacterial byproducts<br />
    26. 26. Overgrowth of bacteria<br />Produce gases<br />Gases are exhaled into the atmosphere<br />
    27. 27. Volatile Sulfur Compounds<br />Dangerous gasses<br />Destroy tissues<br />Harmful if inhaled<br />
    28. 28. VSC<br />Hydrogen sulfide<br /><ul><li>Significant H2S poisoning usually occurs by inhalation.
    29. 29. Local irritant effects, along with arrest of cellular respiration, may follow.
    30. 30. Effects similar to cyanide toxicity.
    31. 31. Easily penetrates biologic membranes.</li></li></ul><li>VSC<br />Hydrogen sulfide<br /><ul><li>As a cellular poison, H2S affects all organs, particularly the CNS and pulmonary system.
    32. 32. The spectrum of illness depends on the concentration and duration of exposure.</li></li></ul><li>VSC<br />Methyl mercaptan<br /><ul><li>Methyl mercaptan is a natural substance released from decaying matter.
    33. 33. Little is known about the health effects of this compound.
    34. 34. This chemical has been found in at least 2 of the 1,300 National Priorities List sites identified by the environmental Protection Agency (EPA).</li></li></ul><li>VSC<br />Who wants this in<br />Their mouth<br />n a foul-smelling diamine formed by bacterial decarboxylation of lysine. Cadaverine is poisonous and irritating to the skin.<br />See also ptomaine<br />Cadaverine<br />
    35. 35. VSC<br />Cadaverine<br /><ul><li>n a foul-smelling diamine formed by bacterial decarboxylation of lysine. Cadaverine is poisonous and irritating to the skin.
    36. 36. See also ptomaine</li></li></ul><li>Cures<br />Mouthwash<br />Difficult to use <br />Expensive<br />Alcohol<br />
    37. 37. Cures<br />Xylitol<br />Stops biofilm from growing<br />Not enough bacteria to cause damage<br />Many forms<br />
    38. 38. Cures<br />Xylitol<br />Safe for use with diabetes<br />Fewer calories than sugar<br />
    39. 39. Cures<br />
    40. 40. Cures<br />
    41. 41. Cures<br />
    42. 42. Professional Oral Care<br />These results suggest that POHC by dental hygienists is effective in preventing respiratory infections in elderly persons requiring nursing care.<br />
    43. 43. Bad breath<br />is harmful<br />
    44. 44. Cumulative Effects<br />Cumulative effects of inhaling halitosis have not been studied.<br />
    45. 45. It’s up to all of us<br />Ask how to provide better oral care.<br />Dental hygienists are here to help.<br />
    46. 46. Conclusion<br />Bad breath is not inert<br />Poisonous gases are emitted from decaying food and gum tissue in the mouth<br />Dependent adults are at risk for inhaling those gases.<br />
    47. 47. Find out the laws restricting dental hygienists in your state! <br />Mandating a dental hygienist on the staff of all Medicaid funded care facilities can save millions of dollars a year just in people with diabetes.<br />
    48. 48. Credits<br />PowerPoint designed by <br />Cross Link Presentations, LLC<br />Presentation design<br />Shirley Gutkowski, RDH, BSDH, FACE<br />crosslinkpresent@aol.com<br />ScriptShirley Gutkowski, RDH, BSDH, FACE<br />Photos: Dreamstime, Gutkowski, StoneCharacters: PresenterMedia<br />Copyright 2011 Exploring Transitions, LLC<br />

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