Teeth are forever oral health and the older adult

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Nov 4th 2013

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  • Good morning, my name is Calla Effa. I am a homemaker and a Registered Dental Assistant. I have worked in the Yorkton area for the past 29 years. My presentation will address the new Realities of society and dentistry, Oral Care & Management and Long Term Care.
  • Many seniors have a mouth full of crowns and bridge work.
  • This is good news but what does it mean? Everything has to last longer… That means our bodies, our natural and artificial teeth
  • Twenty years ago, most seniors had complete dentures or an complete upper denture and perhaps a few of their own teeth.
  • So we fast forward to today … A majority of individuals have been employed in businesses and organizations that have had insurance benefits. These include health, vision, audio and of course dental benefits. As a society we have become more conscious of our dental health and able to afford regular prevention and treatment. Thanks to insurance, more people routinely have their teeth checked and cleaned once or twice per year.
  • Cavities are filled, chipped or broken down teeth are repaired either with new filling or crowns. Root canal therapy and crown and bridge treatments are now a common occurrence for most clients. In the years leading up to retirement, many individuals maximize their insurance benefits by getting new glasses, new hearing aids, and completing any outstanding dental treatment as well as some cosmetic improvements.
  • An eighty year old entering long term care today will often have their natural teeth. But, what about implants? Dental technology has advanced so that dental implants are often the treatment of choice!
  • If you are wondering about dental implants, perhaps this will help to explain the procedure.. There are many different types of implants available.
  • An over-denture may also be a new word. The screws noted in the earlier slide are fitted with abutments and an actual denture can be worn with the abutments holding it firmly in place. These need to be cleaned on a daily basis, regularly assessed by a dentist, and most likely cleaned by a hygienist twice a year.
  • This is an over-denture and you will note the model of the patient lower arch. Those metal bolt-looking objects are actually screwed into the bone.
  • This is another view to give you a sense of the final product. Our world has changed! And as an aside, the cost for this procedure could be in the range of twenty thousand dollars.
  • Failure to care for these mouths will be an recipe for disaster!
  • Is everyone able to get to the dental office?
  • The Dean of Dentistry at the College of Dentistry, University of Saskatchewan recently presented these statistics at a conference.
  • Keep in mind that access can relate to many issues.
  • What are the issues?
  • Long term care workers have speculated that 90% of the pain experienced by the elderly in long term care is orally related.
  • A decrease in manual dexterity is natural. Changing to an electric tooth brush could greatly increase brushing effectiveness. There are many other aids available, check with your dental team.
  • Is transportation available?
  • All of these points are extremely important. What about choosing the best time of day for appointments? When is the client most alert?
  • Ill fitting dentures will cause sores in the mouth and may cause an individual to not wear their denture. This leads to digestive problems, followed by a general deterioration.
  • Biotene rinse, toothpastes etc. available at a drugstore can be added to list of medications covered by our provincial drug plan. [Calla – this was on your note page from the last presentation]
  • Refined white sugar, white bread, white rice…. Coke is reported to have 18 teaspoons of sugar per can!
    I will emphasis again that Snacks must be healthy snacks!
  • Most medical conditions have oral implications. Oral care matters!
  • These pictures are of residents in care homes. These are not the way any of us ever want our mouths to look. When you look at this mouth, what do you see? I see someone who has all their teeth. They have a porcelain crown and a gold crown with a porcelain veneer, and a severe case of neglect. These are very sad pictures but unfortunately a reality.
  • What do you see here? I see the progression of a lack of care. The plaque has calcified to calculus that will need to be professionally removed. I also see sever recession that may result in loss of teeth. There could be cavities under the plaque. You will notice bad breath. A professional should also look at this gentleman’s tongue.
  • What do you see here? Notice that there is “Crown and Bridge” work on lower anterior teeth. This gentleman also has gold crowns on the upper posterior teeth. Obviously this person spent time and money on his teeth. Also notice that there retained roots in the upper anterior. Can you imagine the pain that he is experiencing?
  • Xylitol is used in sugarless gum etc.
    Fluoride will help to strengthen exposed root surfaces
    MI Paste is a topical paste with calcium and phosphate, used for sensitivity (due to root exposure), it can buffer against plaque, restoring minerals that keep teeth strong.
    A growing number of studies suggest that eating a piece of cheese after a meal or snack may actually protect against cavities.
  • Water, Water, Water! Sugarless candy can promote saliva production.
  • Oral care will need to be delivered bedside. Just because he is bed-ridden, his need for care has not diminished. If anything it has increased!
  • What are the issues: avoid change, consistent care, do not waken, there may be swallowing issues, they may not be willing to open their mouth, do not use toothpaste, brush with water only. While this is not your issue, it is a huge dental concern.
  • Recall I mentioned labeling dentures in the list of competencies? Apparently 70% of the dentures being worn in long term care are not labeled.
  • Thank you for your time and attention. It was my honor to present to your conference. Are there any question?
  • Teeth are forever oral health and the older adult

    1. 1. Teeth Are Forever: Oral Health and the Older Adult Saskatchewan Dental Assistants’ Association 2012 1
    2. 2. The paradigm shift relative to dental treatment… REALITIES OF 2012 2
    3. 3. Societal Shifts Our population is living longer 3
    4. 4. In The Past Twenty years ago… 4
    5. 5. Cosmetic Dentistry Baby Boomers have had access dental insurance programs and extensive oral care 5
    6. 6. Prepared Teeth for Crown and Bridge 6
    7. 7. Dental Implants Everybody is getting implants these days! 7
    8. 8. Implant Procedure Actual screws are placed into the bone structure and serve as an attachment for a replacement tooth. 8
    9. 9. 9
    10. 10. A Type of Removable Over-denture 10
    11. 11. Actual view of implants and denture in place You need to know what you are working with and the incredible expense involved in these types of treatments. Caregivers need to know! 11
    12. 12. Implant Care Implications Caregivers need to be aware that this type of dental treatment is becoming more common. The attachments need to be cleaned on a daily basis. The client will need regular dental hygiene care. These attachments can break or need to be tightened in a dental office… 12
    13. 13. Access Everyone has different issues! 13
    14. 14. Access to Care 95% of the population over 65 live at home 5% are homebound 17% have mobility limitations THEREFORE over 70% can still travel to the dentist. Majority of older adults are healthy and dependent! 14
    15. 15. Access to Care Access to care can be physical, geographic, medical, cognitive and financial… 15
    16. 16. Seniors ORAL CARE ISSUES 16
    17. 17. Considerations Oral health is linked to general health – Chewing, swallowing & nutrition – Pain – Affect quality of life issues such as self image, communication & social interaction – Increased susceptibility to systemic infectious diseases, especially pneumonia… 17
    18. 18. Dexterity Issues Frailty: increases the need for regular oral assessment 18
    19. 19. Mobility Issues Homebound: may be unable to attend the dental office and may have increased need for assistance 19
    20. 20. Considerations for Dental Care Transportation to dental clinic Accompanied by a caregiver Shorter appointments Bring a printed list of medications 20
    21. 21. As people live longer and retain more teeth that are often more heavily restored they will require significantly more complex treatment, therefore considerable emphasis should be placed on caries prevention and education. PREVENTION & MANAGEMENT 21
    22. 22. Dental Services Regular check-ups with your dentist Regularly cleanings – May need to be as often as 4 times a year – Reduces bacterial invasion of the lungs Edentulous? – All dental prosthesis require reassessment and maintenance over time – Your mouth still needs to be examined 22
    23. 23. Prevention Before problems develop sound preventive habits need to be adopted Brushing twice a day – Consider an electric toothbrush Flossing – Floss aids are available to assist an individual with manual dexterity issues Mouth rinses – Anticariogenic products (chlorhexadine rinse) 23
    24. 24. Diet Dietary Counselling Minimal consumption of fermentable dietary sugars and carbohydrates Healthy between meal snacks Boost and Ensure are sticky and high in sugar (unless sugar free) Read labels! Choose items with less fat, trans fat, saturated fat, sugar and sodium 24
    25. 25. TOOTH CLEANING Rinse the brush with warm water and place a small amount of toothpaste on the bristles 25
    26. 26. TOOTH CLEANING Place bristles of the brush on the tooth and massage back and forth to remove the plaque from all the surfaces. It is important to brush the teeth and gums. 26
    27. 27. TOOTH CLEANING Move around the mouth in sequence, to contact all of the teeth 27
    28. 28. TOOTH CLEANING Finally, rinse the mouth with water. 28
    29. 29. FLOSSING Floss comes in may forms (unwaxed, waxed and yarn) Select the one that works the best for you. 29
    30. 30. FLOSSING Take a 40-50 cm piece of floss, wind it around the middle fingers of each hand. Control with index fingers or thumbs 5 cm of floss so that it can pass comfortable and flexibly between the teeth. 30
    31. 31. FLOSSING The plaque is removed by moving the floss up and down against the surfaces of each tooth 31
    32. 32. FLOSSING Make sure each “in-between” surface of the teeth is floss, and the floss passes up and down cleaning the tooth’s surface. Discard the floss after use. 32
    33. 33. INTERPROXIMAL BRUSHES Interproximal brushes are brushes used to clean the surfaces between the teeth. 33
    34. 34. BRUSH TECHNIQUE Insert the brush between the teeth, and clean with an in-and-out motion. The brushes do wear our so they must be replaced, but can be rinsed off and reused while still in good shape. 34
    35. 35. FLOSS HOLDERS The addition of a handle may make it easier to floss. There are several designs. 35
    36. 36. USING A FLOSS HOLDER Use the floss holder in a similar manner to finger flossing. 36
    37. 37. GUM CLEANING The gum around teeth or under dentures should be cleaned with a brush every day. 37
    38. 38. MASSAGE GUMS & ROOF OF MOUTH A toothbrush moistened with water can be used to massage the gums, the roof of the mouth and the tongue. This removes food debris, improves circulation and prevents bad breath. 38
    39. 39. BRUSH TONGUE 39
    40. 40. DENTURE CLEANING Dentures should be removed from the mouth and brushed thoroughly at least once a day. Clean the inside service. Clean over a sink filled with water in case you drop it. 40
    41. 41. DENTURE CLEANING A toothbrush will remove plaque and food remnants effectively. Avoid abrasive cleansers including toothpaste. 41
    42. 42. DENTURE CLEANING It is usually best to remove your dentures while sleeping. If you prefer to wear them continuously, the area under and around the denture must be kept very clean. Dentures should be dry when not in your mouth and should be stored in a marked container. 42
    43. 43. Medical Factors Dry Mouth (Xerostomia) is caused by the natural aging process and certain medications; (blood pressure medication, antihistamines, Parkinson Disease medication, incontinence medications etc.) Stroke, arthritis & multiple sclerosis etc. Diabetes: bone loss, increased gingivitis, slower healing times…. 43
    44. 44. Medical Factors (cont’) Denture sores that impair eating Candida yeast in the mouth (treat denture as well as mouth) Cancer treatment and post cancer medications 44
    45. 45. Zero Oral Care 45
    46. 46. Progression of Zero Care 46
    47. 47. Just Zero! 47
    48. 48. Caries Prevention Can Include: Xylitol sweetener Fluoride Products: mouthwashes, fluoride varnish etc. MI Paste (available at dental offices) Cheddar cheese 48
    49. 49. Dry Mouth & Treatment Dry mouth is a serious side effect of diseases, medication and conditions A dry mouth can cause rampant decay, difficulty swallowing, denture retention, bad breath, speaking difficulty and mouth sensitivity There are a variety of products on the market that can lessen the effects of the condition 49
    50. 50. Long Term Care Bedridden: a client will require an individual care plan based on accepted best care practices 50
    51. 51. Alzheimer Disease With the progression of Alzheimer Disease this individual will require daily, consistent care… 51
    52. 52. Dental Issues 52
    53. 53. Together, making a difference 53
    54. 54. Early identification and rational management of potential dental problems will support better health, sustained function and a fun and graceful old age! THANK YOU! 54
    55. 55. Teeth are forever! 55

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