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Oral Hygiene And Quality Of Life
 

Oral Hygiene And Quality Of Life

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    Oral Hygiene And Quality Of Life Oral Hygiene And Quality Of Life Presentation Transcript

    • Oral Hygiene & Quality of Life
      • Mary Ann Suda
      • Graduate Certificate Gerontology
      • Certified Medication Administration Trainer
    • A Lifetime of Proper Oral Hygiene Improves Quality of Life The U.S. Surgeon General David Satcher, in May of 2000 reported dental disease as “a silent epidemic” among older people. Fleck, Carole; Nothing to Smile About; AARP Bulletin, September 2006; Vol 47; 8; 14-18.
    • Did You Know...
      • Bacteria (plaque) forms in two to three hours after brushing and flossing
      • Flossing can increase your life span up to 6.4 years
      • Flossing delays the effects of aging
      • Smoking may lead to more than half of all cases of gum disease
      http://www.fitnessandfreebies.com/health/oralhealth.html The "Signs and Stages of Gum Disease" are from information given by Colgate in the interest of better dental health . Suda 11.07
    • Anatomy of the Tooth
      • Blood vessels - carry nutrients to the tooth
      • Bone - alveolar bone forms the tooth socket and provides it with support
      • Cementum - the layer of hard bone-like tissue covering the root of the tooth
      http://www.umanitoba.ca/outreach/wisdomtooth/anatomy.htm Suda 11.07
    • Anatomy of the Tooth
      • Cemento -enamel junction the point where the enamel and cementum meet
      • Dentin - the hard yellow tissue underlying the enamel and cementum, makes up most of the tooth
      http://www.umanitoba.ca/outreach/wisdomtooth/anatomy.htm
    • Anatomy of the Tooth
      • Enamel - the hard, white outer layer of the tooth
      • Gingiva - the gum tissue surrounding the tooth
      • Ligament - the connective tissue that surrounds the tooth and connects it to bone
      http://www.umanitoba.ca/outreach/wisdomtooth/anatomy.htm
    • Anatomy of the Tooth
      • Nerves - relay signals such as pain to and from your brain
      • Pulp - located in the center of the tooth, it contains the arteries, veins and nerves
      • Root canal - canal in the root of the tooth where the nerves and blood vessels travel through
      http://www.umanitoba.ca/outreach/wisdomtooth/anatomy.htm
    • The Full Body Connection
      • Bacteria that causes periodontal disease can be spread through close contact between people
      http://www.antisdeldental.com/services.htm#hygeine
    • The Full Body Connection Approximately 90% of all systemic diseases have links to oral health People who have periodontal (gum) disease double their risk of a fatal heart attack Infections in the mouth increase the risk of respiratory infection http://www.antisdeldental.com/services.htm#hygeine
    • The Full Body Connection
      • Gum disease raises the risk for:
        • Bronchitis
        • Pneumonia
        • Emphysema
        • Chronic Obstructive Pulmonary Disease
        • http://www.antisdeldental.com/services.htm#hygeine
    • The Full Body Connection
      • Poor oral health can contribute to heart disease and stroke
      • Diabetics with periodontal disease have more difficulty controlling their blood sugar
      http://www.antisdeldental.com/services.htm
    • Tooth Decay
      • Plaque is an almost colorless bacteria that forms on the teeth
      • Gingivitis sets in plaque and calculus forms on the teeth, and the irritated gums turn red and puffy (this creates tartar on the teeth)
      http://www.baptistonline.org/health/library/agin3393.asp
    • Periodontal Disease
      • Periodontitis occurs when the infected gums recede
      • Plaque and calcium continues to increase
      • Pockets become infected and bone loss starts
      http://www.tooth.net/info/periodz0.htm
    • Periodontal Disease
      • Periodontal disease causes 70% of tooth loss
      • It effects 3 out of 4 people during their life
      Advanced Periodontal Disease The American Academy of Periodontology; Atrix Laboratories, Inc.; Non-surgical Periodontal Therapy: Essential and Adjunctive Methods," by P.R. Greene, BDS, FDSRCPS, the British Dental Journal, 1995; "Four Steps to Soft Tissue Management," by S.N., Bhaskar, DDS, Dentistry Today, October, 1995
    • Causes of Periodontal Disease
      • Lack of daily , complete oral hygiene
      • Lack of professional cleaning on a regular basis
      • A poorly balanced diet
      • Poor-fitting dental appliances (dentures, retainers, etc.)
      National Health Enhancement Systems, Inc. (602) 230-7575. http://www.baptistonline.org/health/library/agin3393.asp
    • Causes of Periodontal Disease
      • Broken fillings or teeth
      • Misaligned or crowded teeth
      • Systemic factors such as: poor nutrition and certain diseases
      • Drugs , particularly those that cause dry mouth (xerostomia)
      http://www.baptistonline.org/health/library/agin3393.asp
    • Periodontal Disease Symptoms
      • Red, puffy gums
      • Gum tenderness or pain
      • Gums that bleed during brushing and flossing
      • Persistent bad breath or a bad taste in the mouth
      NIH Publication No. 02-1142 Updated September 6, 2006
    • Periodontal Disease Symptoms
      • Changes in the way teeth fit together when you bite
      • Teeth that have shifted or loosened
      • Pus coming from between teeth and gums
      http://www.mayoclinic.com/health/periodontitis/DS00369/DSECTION=2 Pus coming from between teeth and gums Suda 11.07
    • Medications and Oral Health J Am Dent Assoc, Vol 135, No 10, 1440-1448. © 2004 American Dental Association JADA Continuing Education; Medications’ Impact on oral health; Sebastian G. Ciancio, D.D.S Oral Candidiasis, Recurrent oral viral infections Corticosteroids (Prednisone) Taste disorders Vasodilators (Nitro Patch) Salivary Dysfunction Anti-Parkisonian (Levodopa, Carbidopa) Salivary Dysfunction Gingival enlargement Calcium Channel Blockers (Norvasc, Cardizem, Verapamil) Oral Health Problem Drug Classification
    • The Functions of Saliva http://www.uspharmacist.com/publish/images/8_2037_1.jpg
    • Salivary Flow Rates
      • Low salivary flow negatively impacts oral soft tissue lesions, dental caries and tooth loss
      • Xerostomia increases oral Candida growth
      • Improving the salivary rates improves oral health
      www.nzma.org.nz/.../117-1194/892/CONTENT04.jpg M Koseki, Y Maki, T Matsukubo, Y Ohashi, K Tsubota (2004) Salivary flow and its relationship to oral signs and symptoms in patients with dry eyes Oral Diseases 10 (2), 75–80.
    • Medications and Xerostomia J Am Dent Assoc, Vol 135, No 10, 1440-1448. © 2004 American Dental Association JADA Continuing Education; Medications’ Impact on oral health; Sebastian G. Ciancio, D.D.S
    • Relieving Xerostomia http://www.uspharmacist.com/publish/images/8_2037_1.jpg
    • Treatment for Oral Candida (Thrush)
      • Nystatin Ketoconazole 2%
      • Nizoral 200-400mg/day
      • Clotrimazole lozenge
      M Koseki, Y Maki, T Matsukubo, Y Ohashi, K Tsubota (2004) Salivary flow and its relationship to oral signs and symptoms in patients with dry eyes Oral Diseases 10 (2), 75–80.
    • Oral Health Care Products http://www.uspharmacist.com/publish/images/8_2037_1.jpg
    • Proper Oral Hygiene
      • How does your mouth feel in the morning before you brush your teeth?
      • How does your mouth feel after you brush your teeth?
      • What type of behavior changes take place after brushing your teeth?
      Suda 11.07
    • Proper Oral Hygiene
      • Proper oral hygiene can prevent tooth loss, periodontal disease and tooth decay
    • Proper Oral Hygiene
      • Oral Candida
      • on the tongue
      Healthy, clean tongue Tongue Scraper Build up of bacteria on the tongue can lead to tooth loss and systemic diseases
    • Long-Term Care & Oral Hygiene for Residents Several clinical studies on oral health in long-term care reveal significant deficits in oral hygiene for residents Residents who needed assistance with oral hygiene had an increased rate of gingivitis and plaque Status of oral healthcare in long-term care facilities Authors: Pino A. 1 ; Moser M. 1 ; Nathe C. 1 International Journal of Dental Hygiene , Volume 1, Number 3, August 2003 , pp. 169-173(5) Suda 11.07
    • How Does Poor Oral Hygiene Affect Your Residents?
      • Depression
      • Anti-social behaviors
      • Weight loss
      • Poor self-esteem
      Status of oral healthcare in long-term care facilities Authors: Pino A. 1 ; Moser M. 1 ; Nathe C. 1 International Journal of Dental Hygiene , Volume 1, Number 3, August 2003 , pp. 169-173(5)
    • How Does Poor Oral Hygiene Affect Your Residents?
      • Dignity Issues
      • Impedes speech and communication
      • Decreases quality of life
      Status of oral healthcare in long-term care facilities Authors: Pino A. 1 ; Moser M. 1 ; Nathe C. 1 International Journal of Dental Hygiene , Volume 1, Number 3, August 2003 , pp. 169-173(5)
    • Residents with Teeth
      • Resident’s teeth and tongue should be brushed
      • in the morning and prior to going to bed at night
    • Oral Hygiene Strategies: Challenging Resident
      • Use distraction techniques, music
      • For aggressive behavior perform oral hygiene at a different time of day
      • Use a mouth-prop ; twin toothbrush
      • Enlist assistance from another caregiver
      • List successful strategies in resident care plan*
      • http://www.wihd.org/dental/dental_products_adult_props.html
    • Oral Hygiene Strategies: Challenging Resident
      • Bridging- Initiates a sensory connection by giving the resident the same object you are using to hold
      • Hand-over-hand- The caregiver places their hand over the residents hand and guides the toothbrush
      • Chaining- The caregiver starts the oral care and the resident completes it
      • Rescuing- A second caregiver enters the room and tells the first caregiver to leave so they can “help” the resident
      Coleman, Patricia, PhD, RN, APRN, BC; Improving Oral Health Care for the Frail Elderly: A Review of Widespread Problems and Best Practices; Geriatric Nursing; Vol. 23: No. 4July; 2002; 189-199.
    • Oral Hygiene Strategies: Challenging Resident Twinbrush helps clean teeth and gums at the same time http://www.wihd.org/dental/dental_products_adult_props.html
    • Oral Hygiene Strategies: Challenging Resident Open Wide Plus Mouth Prop Durable, disposable, foam material helps keep the mouth open http://www.wihd.org/dental/dental_products_adult_props.html
    • Oral Hygiene Strategies: Challenging Resident
      • Homemade mouth prop
      • Wrap several tongue depressors together with a large
      • amount of tape around one end
      http://www.wihd.org/dental/dental_products_adult_props.html
    • Partial Tooth Loss or Total Tooth Loss
      • Dentures and partial dentures should be thoroughly cleansed daily with a denture brush or toothbrush
      • To reduce the risk of breaking , a washcloth should be placed in the sink before cleaning dentures
      • Clean resident’s tongue with tongue scraper each day
      Linking Oral Health and General Health: Issues of the Older Patient Yolanda A. Slaughter, DDS, MPH Assistant Professor of Dental Care Systems, School of Dental Medicine Adjunct Assistant Professor of Nursing, School of Nursing University of Pennsylvania, Philadelphia, PA
    • Partial Tooth Loss or Total Tooth Loss
      • Remove dentures at night and soak in a denture cleanser ( only after they have been cleaned)
      • All prosthesis should be labeled with the residents’ name
      • Ongoing reinfection by dentures may lead to microbial disease that can cause systemic diseases
      Linking Oral Health and General Health: Issues of the Older Patient Yolanda A. Slaughter, DDS, MPH Assistant Professor of Dental Care Systems, School of Dental Medicine Adjunct Assistant Professor of Nursing, School of Nursing University of Pennsylvania, Philadelphia, PA
    • Enterogastric Tubes
      • Dysphagia coupled with neurological diseases often result in the insertion of entergastric tubes
      • G-tubes provide hydration and nutrition
      • Salivary flow rates are diminished in residents with g-tubes
    • Enterogastric Tube & Aspiration Pneumonia
      • Residents with g-tubes are at high risk of aspiration pneumonia
      • Poor oral hygiene results in:
            • copious secretions
            • halitosis
            • poor dentition
      • The results of aspiration pneumonia include:
            • morbidity
            • mortality
      Leibovitz, Arthur; Plotnikov, Galina; Habot, Beni; Rosenberg, Mel; Segal, Rephael; Pathogenic Colonization of Oral Flora in Frail Elderly Patients Fed by Nasogastric Tube or Percutaneous Enterogastric Tube; Journal of Gerontology: Medical Sciences; 2003, Vol, 58A, No. 1, 52-55.
    • Enterogastric Tubes & Oral Pathogens
      • There are significantly higher rates of
      • pathogenic organisms in the oropharynx
      • for residents with g-tubes:
              • Pseudomonas
              • Klebsiella
              • Proteus
              • Staph Aureus
      Leibovitz, Arthur; Plotnikov, Galina; Habot, Beni; Rosenberg, Mel; Segal, Rephael; Pathogenic Colonization of Oral Flora in Frail Elderly Patients Fed by Nasogastric Tube or Percutaneous Enterogastric Tube; Journal of Gerontology: Medical Sciences; 2003, Vol, 58A, No. 1, 52-55.
    • Enterogastric Tubes & Oral Pathogens
      • Poor oral hygiene increases the risk of:
      • Bacteremia
      • Blood clots which increase the risk of stroke
      Leibovitz, Arthur; Plotnikov, Galina; Habot, Beni; Rosenberg, Mel; Segal, Rephael; Pathogenic Colonization of Oral Flora in Frail Elderly Patients Fed by Nasogastric Tube or Percutaneous Enterogastric Tube; Journal of Gerontology: Medical Sciences; 2003, Vol, 58A, No. 1, 52-55.
    • Enterogastric Tubes & Modified Oral Hygiene
      • Use a toothbrush with suction
      • Swab mouth with gauze soaked in Chlorhexidine
      • Tooth brushing without toothpaste
      Oral hygiene care for functionally dependent and cognitively impaired older adults Research Dissemination Core. Oral hygiene care for functionally dependent and cognitively impaired older adults. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center; 2002 Nov. 48 p. [50 references]
    • Enterogastric Tubes & Modified Oral Hygiene
      • Suction oral cavity regularly to remove excessive drooling as needed
      • Suction during oral hygiene care
      • Review oral hygiene care needs and aspiration risks on a regular basis
      Oral hygiene care for functionally dependent and cognitively impaired older adults Research Dissemination Core. Oral hygiene care for functionally dependent and cognitively impaired older adults. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center; 2002 Nov. 48 p. [50 references]
    • Improving Oral Health in Long-Term Care Facilities
      • Establish a regular time each day for mouth care
      • Break up the steps for cleaning into small simple steps for the resident
      • Explain what you are doing in a gentle, calm manner
      Linking Oral Health and General Health: Issues of the Older Patient Yolanda A. Slaughter, DDS, MPH Assistant Professor of Dental Care Systems, School of Dental Medicine Adjunct Assistant Professor of Nursing, School of Nursing University of Pennsylvania, Philadelphia, PA
    • Improving Oral Health in Long-Term Care Facilities
      • Place a list of step-by-step instructions on a piece of paper and post it in the bathroom , for resident’s who can still read
      • Keep labeled mouth care supplies in the same place all the time
      • Do not assume the person will remember the next day what he or she did today
      Linking Oral Health and General Health: Issues of the Older Patient Yolanda A. Slaughter, DDS, MPH Assistant Professor of Dental Care Systems, School of Dental Medicine Adjunct Assistant Professor of Nursing, School of Nursing University of Pennsylvania, Philadelphia, PA
    • Improving Oral Health in Long-Term Care Facilities
      • Maintain professional dental care visits as recommended by the dentist
      • Create a dental care team at the facility that performs monthly oral screening examinations
      • Seek professional dental care immediately if any changes are noted in the oral-facial region
      Linking Oral Health and General Health: Issues of the Older Patient Yolanda A. Slaughter, DDS, MPH Assistant Professor of Dental Care Systems, School of Dental Medicine Adjunct Assistant Professor of Nursing, School of Nursing University of Pennsylvania, Philadelphia, PA Suda 11.07
    • Oral Health: Quality Indicators for Long-Term Care Facilities
      • Develop, track and enforce a program for on-going evaluation and treatment interventions for residents with xerostomia
      • Create a quality initiative at your facility that focuses on resident oral hygiene
      • Measure clinical outcomes for example: the number of residents reporting oral or facial pain with weight loss
      Guay, Albert H. D.M.D.,Journal of Dental Education; Vol 69:9; The Oral Health Status of Nursing Home Residents: What Do We Need to Know? September 2005; 1015-1017. Suda 11.07
    • Minimum Data Set (MDS) 3.0 Draft: Oral/Dental Status Section L
      • Broken or loose fitting denture or partial (chipped, cracked, uncleanable or loose)
      • No natural teeth or tooth fragment (s) (edentulous)
      • Abnormal mouth tissue (ulcer, masses, oral lesions, including under denture or partial if one is worn)
      • d. Obvious cavity or broken natural teeth
      • e. Inflamed or bleeding gums or loose natural teeth
      • f. Mouth or facial pain, discomfort or difficulty chewing
      • g. None of the above were present
      • h. Unable to examine
      Minimum Data Set (MDS) 3.0 Draft 7/31/06
    • Brush Now or Pay Later… http://www.smilemdc.com/news/gingivitis_3.jpg&imgrefurl=http://www.smilemdc.com/news/index.html&h
    • Bibliography
      • Fleck, Carole; Nothing to Smile About; AARP Bulletin, September 2006; Vol 47: 8; 14-18.
      • http://www.fitnessandfreebies.com/health/oralhealth.html The "Signs and Stages of Gum Disease" are from information given by Colgate in the interest of better dental health .
      • http://www.umanitoba.ca/outreach/wisdomtooth/anatomy.htm
      • http://www.antisdeldental.com/services.htm#hygeine
      • http://www.baptistonline.org/health/library/agin3393.asp ; 1997 National Health Enhancement Systems, Inc. (602) 230-7575
      • NIH Publication No. 02-1142;Updated September 6, 2006
      • http://www.mayoclinic.com/health/periodontitis/DS00369/DSECTION=2
      • JADA Continuing Education, Medications’ impact on oral health, Sebastian G. Ciancio, D.D.S; J Am Dent Assoc, Vol 135, No 10, 2004;1440-1448.
      • Guay, Albert H. D.M.D., Journal of Dental Education; Vol 69:9; The Oral Health Status of Nursing Home Residents: What Do We Need to Know? September 2005; 1015-1017.
      • http://www.wihd.org/dental/dental_products_adult_props.html
      • Coleman, Patricia, PhD, RN, APRN, BC; Improving Oral Health Care for the Frail Elderly: A Review of Widespread Problems and Best Practices; Geriatric Nursing; Vol. 23: No. 4July; 2002; 189-199.
      Suda 11.07
    • Bibliography
      • The American Academy of Periodontology; Atrix Laboratories, Inc.; "Non-surgical Periodontal Therapy: Essential and Adjunctive Methods," by P.R. Greene, BDS, FDSRCPS, the British Dental Journal, 1995; Four Steps to Soft Tissue Management," by S.N., Bhaskar, DDS, Dentistry Today, October, 1995
      • www.nzma.org.nz/.../117-1194/892/CONTENT04.jpg
      • Status of oral healthcare in long-term care facilities Authors: Pino A.; Moser M.; Nathe C. International Journal of Dental Hygiene , Volume 1, Number 3, August 2003 , pp. 169-173(5)
      • M Koseki, Y Maki, T Matsukubo, Y Ohashi, K Tsubota (2004) Salivary flow and its relationship to oral signs and symptoms in patients with dry eyes Oral Diseases 10 (2), 75–80.
      • Linking Oral Health and General Health: Issues of the Older Patient; Yolanda A. Slaughter, DDS, MPH Assistant Professor of Dental Care Systems, School of Dental Medicine Adjunct Assistant Professor of Nursing, School of Nursing University of Pennsylvania, Philadelphia, PA
      • Minimum Data Set (MDS) 3.0 Draft 7/31/06
      • Leibovitz, Arthur; Plotnikov, Galina; Habot, Beni; Rosenberg, Mel; Segal, Rephael; Pathogenic Colonization of Oral Flora in Frail Elderly Patients Fed by Nasogastric Tube or Percutaneous Enterogastric Tube; Journal of Gerontology: Medical Sciences; 2003, Vol, 58A, No. 1, 52-55.
      • Oral hygiene care for functionally dependent and cognitively impaired older adults Research Dissemination Core. Oral hygiene care for functionally dependent and cognitively impaired older adults. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center; 2002 Nov. 48 p. [50 references]
      Suda 11.07