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
Teeth Are Forever: Oral
Health and the Older Adult
Saskatchewan Dental Assistants’ Association
The paradigm shift relative to dental
REALITIES OF 2012
is living longer
Actual view of implants and denture in
You need to know what you are working with and the incredible
expense involved in these types of treatments. Caregivers need to
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
The client will need regular dental hygiene
These attachments can break or need to be
tightened in a dental office…
Access to Care
95% of the population over 65 live at
5% are homebound
17% have mobility limitations
THEREFORE over 70% can still travel to
Majority of older adults are healthy and
Access to Care
Access to care can be
Oral health is linked to general health
– Chewing, swallowing & nutrition
– Affect quality of life issues such as self image,
communication & social interaction
– Increased susceptibility to systemic infectious
diseases, especially pneumonia…
Homebound: may be
unable to attend the
dental office and may
have increased need
Considerations for Dental Care
Accompanied by a
Bring a printed list of
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
Regular check-ups with your dentist
– May need to be as often as 4 times a year
– Reduces bacterial invasion of the lungs
– All dental prosthesis require reassessment
and maintenance over time
– Your mouth still needs to be examined
Before problems develop sound preventive
habits need to be adopted
Brushing twice a day
– Consider an electric toothbrush
– Floss aids are available to assist an individual
with manual dexterity issues
– Anticariogenic products (chlorhexadine rinse)
Minimal consumption of fermentable
dietary sugars and carbohydrates
Healthy between meal snacks
Boost and Ensure are sticky and high in
sugar (unless sugar free)
Choose items with less fat, trans fat,
saturated fat, sugar and sodium
and place a
on the bristles
of the brush
on the tooth
It is important
to brush the
all of the
best for you.
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
between the teeth.
the floss up
Make sure each
surface of the
teeth is floss,
and the floss
passes up and
floss after use.
used to clean
Insert the brush
between the teeth,
and clean with an
The brushes do
wear our so they
must be replaced,
but can be rinsed
off and reused
while still in good
it easier to
USING A FLOSS HOLDER
MASSAGE GUMS & ROOF OF MOUTH
water can be used
to massage the
gums, the roof of
the mouth and the
from the mouth
least once a
day. Clean the
Clean over a
sink filled with
water in case
you drop it.
It is usually best to
remove your dentures
while sleeping. If you
prefer to wear them
area under and
around the denture
must be kept very
Dentures should be
dry when not in your
mouth and should be
stored in a marked
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….
Medical Factors (cont’)
Denture sores that impair eating
Candida yeast in the mouth (treat denture
as well as mouth)
Cancer treatment and post cancer
Caries Prevention Can Include:
Fluoride Products: mouthwashes, fluoride
MI Paste (available at dental offices)
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
There are a variety of products on the
market that can lessen the effects of the
Long Term Care
plan based on
With the progression
of Alzheimer Disease
this individual will