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Similar to LTC-Part-I- march 16 comments and changes
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LTC-Part-I- march 16 comments and changes
- 1. Part 1 – How to Perform an Oral Assessment in Long-Term Care: The Normal Mouth Presenters: Paige Henry and Amanda Monette Algonquin College Dental Hygiene Students Originally recorded on March 17, 2015
- 2. Acknowledgements This presentation was created through a partnership between the RNAO Long-Term Care Best Practices Program (LTC BPP) Coordinators working within the Champlain and North West LHINs and the Dental Hygiene Program at Algonquin College. Funding used to support the development of this Oral Health Assessment Series was from the LTC BPP through the Ministry of Health and Long-Term Care and from an Algonquin College Innovation Funding grant. The following dental hygiene students: Paige Henry, Brieanna Duffy, Yingke Zhang, Kelci Cape, Amanda Monette and Ashley Hartin developed this presentation as part of DEN4466 - Community Health Outreach, with support and direction from Professor Tonia Peachman-Faust, and LTC BP Coordinators - Heather Woodbeck and Ibo MacDonald. We would like to recognize Angela Nuelle, Full Time Faculty in the Dental Hygiene Program at Algonquin College for her leadership and coordination of this Oral Care Partnership 2
- 3. Objectives • To demonstrate an approach to oral health status assessment in residents • To illustrate normal changes in oral health status associated with aging
- 4. Required equipment: Gloves and a mask Tongue depressor • Helps to control the tongue Gauze • Helps with holding the tongue (when able) • May be used to remove debris Light source Optional equipment: Hand-held disposable oral mirror • Helps to effectively examine tissues/teeth at the back of the mouth Head lamp Oral Health Status Assessment
- 5. During the Exam • Introduce yourself • Explain what you’re going to do • Get resident’s consent • Seek feedback continuously • Monitor for body language, visual and verbal cues • Stop if the resident no longer cooperates
- 6. Oral Health Status Assessment Video
- 7. Image: Canterino and Katsman Dentistry Image: Soda Head Image: Mead Family Dental Debris Is NOT normal and must be removed. It is important to recognize the many variations: Plaque - bacterial debris in the mouth - it can be seen on all oral tissues. Food debris – seen in between teeth **Both of these should be removed daily by brushing** Calculus is hardened plaque build-up which can only be removed during a dental visit - it appears chalky white, stained brown, or grey/black.
- 8. Examples: Image: Oral Care Debris (cont’d) Image: Oral Care Image: Oral Care
- 9. Image: EPPLEY Plastic Surgery Image: DermNet NZ Lips Normal age related changes: • More wrinkles • Thinner lips At rest, lips should be touching Failure to close may cause dry mouth May be moist, dry, or cracked Lesions associated with aging Although frequently benign, these findings should be recorded and monitored for changes Image: MedicineNet.com
- 10. Image: Smiles By Design Image: Smiles By Design Image: Mouths Matter Image: NYC dentist Image: Sarkissiandds Image: South Charlotte Dentistry Teeth Normal age related changes: Generally even in color but different shades of white/yellow - Staining is normal Recession or seeing exposed root surfaces Missing teeth/no teeth Teeth may be straight, appear crowded, tilted, or rotated Heavily restored teeth – i.e. fillings Signs of wear (attrition)
- 11. Image: Easy Notecards (Chapter 7 Flashcards) Gums (gingiva) Image: Oral Health Patient Information, Gum Disease Normal age related changes: Pink, firm, moist Ideally pointed to fill interdental spaces Often blunted and/or cratered (missing) in an aged mouth Variation of normal: Pigmentation Image: Oral Health Buzz
- 12. Image: National Institute of Dental and Craniofacial Research Linea Alba Tissue trauma Canker sores Variations of normal If any lesion remains after 2 weeks it must be looked at by a physician or dentist Normal: Pink and moist Oral Tissues Image:Maher Dental Specialty Clinic Image: Study Blue Image: StarBrite Dental
- 13. o . Tongue Normal: Pink in colour and covered with different sized taste buds Image: Introduction to Preliminary Diagnosis of Oral Lesions
- 14. Image: Maria Tigner – Introduction to preliminary Diagnosis of Oral Lesions Coated Tongue o Results from debris, bacteria and dead cells getting caught between the taste buds Geographic Tongue o Red patches with white borders o Exacerbated by stress Fissured Tongue o Deep fissures or grooves on the top of the tongue Tongue – Variations of Normal Images: Maria Tigner - Introduction to Preliminary Diagnosis of Oral Lesions Images: Maria Tigner - Introduction to Preliminary Diagnosis of Oral Lesions
- 15. Must note: • Presence/amount of saliva – light, medium, abundant • Consistency of saliva – on a continuum from watery to thick *The ideal finding is medium - abundant, watery saliva* Saliva Image: WikiHow Abundant & watery Image: Indian Journal of Palliative Care Light & thick
- 16. Challenges to Oral Exam • Resident won’t open mouth - try stroking the cheek • Prioritize - Do as much as you can, - Focus should be on RAI-MDS section L - Debris present in mouth prior to going to bed at night - Has dentures or removable bridges - Some or all natural teeth lost – does not have or does not use dentures or partial plates - Broken, loose, or carious teeth - Inflamed gums, swollen or bleeding gums, oral abscesses, ulcers or rashes
- 17. Bruch, J., & Treister, N. (2010). Clinical oral medicine and pathology. New York: Humana Press Canterino and Katsman Dentistry. [on-line image]. Retrieved February 18, 2015, from www.jacantennodds.com DermNet NZ. [on-line image]. Retrieved February 18th, 2015 from http://www.dermnetnz.org/lesions/labial-melanosis.html Easy Notecards (Print Chapter 7 Pictures flashcards). [on-line image]. Retrieved March 16, 2015, from http://www.easynotecards.com/print_list/6167 EPPLEY Plastic Surgery. [on-line image]. Retrieved February 18th, 2015 from http://www.exploreplasticsurgery.com/tag/lip-wrinkles/ Ibsen, O., & Andersen Phelan, J. (2014). Oral pathology for the dental hygienist (6th ed.). St. Louis: Saunders Elsevier. Indian Journal of Palliative Care. [on-line image]. Retrieved February 18th, 2015 from http://www.jpalliativecare.com/article.asp?issn=0973-1075;year=2010;volume=16;issue=2;spage=74;epage=78;aulast=Mol Johnson, T. (2014, October 29). Yeast Infections (Candidiasis) in Men and Women. Retrieved February 11, 2015 from http://www.webmd.com/skin-problems-and-treatments/guide/candidiasis-yeast-infection Kummer, A. (n.d.). The ASHA Leader. Retrieved February 24, 2015 from http://www.asha.org/publications/leader/2005/051227a.htm Madden, R. (n.d.). Tra-oral Examination: Intra-oral Examination: Normal Anatomy Normal Anatomy. Retrieved February 24, 2015 from http://student.ahc.umn.edu/dental/2012/5121/PEI-Intraoral_anat_2009.pdf Maher Dental Specialty Clinic [on-line image] Retrieved March 15, 2015, from http://dentistrajkot.com. Mead Family Dental [on-line image]. Retrieved February 18, 2015, from http://meadfamilydental.com/2011/11/plaque-vs-biofilm- and-the-research-that-could-change-dentistry-as-we-know-it/ MedicineNet. [on-line image]. Retrieved March 14th, 2015 from http://www.medicinenet.com/image- collection/venous_lakes_picture/picture.htm Mouths Matter [on-line image] retrieved on March 03, 2015 from http://www.mouthmattersbook.com/mrsdalloway/wp- content/gallery/book-images/gum_recession.jpg National Institute of Dental and Craniofacial Research. [on-line image]. Retrieved March 15, 2015, from http://www.nidcr.nih.gov. Neild-Gehrig, J.S. (2010). Oral Examination. Patient Assessment Tutorials: A step-by-step guide for the dental hygienist (2nd ed., pp. 465- 473). Philadelphia, PA: Lippincott, Williams, & Wilkins NYC Dentist [on-line image] retrieved on March 03, 2015 from http://www.nycdentist.com/blog/2008/12/page/2/ Oral Care. [on-line image]. Retrieved February 18th, 2015 from www.oralcare.com Oral Health Buzz. [on-line image]. Retrieved March 16, 2015, from http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/ColgateNewandNow/Personal/2013/April/article/SW -281474979063347.cvsp Oral Health Patient Information | Gum Disease. [on-line image]. Retrieved March 16, 2015, from http://www.mypil.net/gumdisease.htm References
- 18. Sarkissiandds [on-line image] retrieved on March 03, 2015 from http://sarkissiandds.com/articles/amalgam/7-galvanism-3.jpg Smiles By Design [on-line image] retrieved on March 03, 2015 from http://www.smilesbd.com/SmileGallery.html Soda Head. [on-line image]. Retrieved February 18, 2015 from www.sodahead.com South Charlotte Dentisry [On-line Image] Retrieved on March 03, 2015 from http://south-charlotte-dentistry.com/wp- content/uploads/2011/05/ground-teeth2.jpg StarBrite Dental. [on-line image]. Retrieved March 15, 2015, from http://eastbaydentist.com. Study Blue. [on-line image]. Retrieved March 15, 2015, from https://www.studyblue.com. Tigner, M. (Fall, 2013). Introduction to preliminary diagnosis of oral lesions [Powerpoint presentation slides]. Retrieved from https://blackboard.algonquincollege.com/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps% Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_179912_1%26url%3D WikiHow. [on-line image]. Retrieved on February 18th, 2015 from http://www.wikihow.com/Blow-Saliva-Bubbles Wilkins, E. M. (2013). Extraoral and intraoral examination. Clinical Practice of the Dental Hygienist E4(11th ed., pp. 146-149). Philadelphia, PA: Lippincott, Williams, & Wilkins Wyatt Jr., A. (2014, June 23). Bad Breath Causes, Treatments, and Prevention. Retrieved February 11, 2015 from http://www.webmd.com/oral-health/guide/bad-breath References (cont’d)
Editor's Notes
- Plaque is debris commonly seen in the mouth, it can be on all oral tissues in the mouth and can be wiped or brushed off with normal daily oral hygiene. Large amounts of plaque are seen in the elderly because of lack of oral hygiene (daily brushing), medications or manual dexterity issues and cannot do it on their own. Food debris is food stuck between teeth in the mouth, it can also be brushed off with daily oral care. Calculus is more tenacious and requires regular dental visits to be removed, if plaque is not removed it could result in calculus.
- 3 pictures of plaque covered teeth in an elderly persons mouth. The first picture shows a small amount of plaque on the teeth and the second picture shows a much larger amount of plaque on the teeth and some food debris as well. The third picture shows plaque on the gums casuing the gums to turn white. Plaque should be removed daily.
- Next, the lips must be examined. The normal aging process results in the loss of fatty lip tissue causing thinner lips with more wrinkles. At rest, lips should be touching, protecting the oral tissues from drying out. The lips themselves may appear either moist, somewhat dry, or cracked – dry, cracked lips are often seen during the colder, dryer months. Close attention must be paid to any lesion that presents on the lips. Some lesions that are normally seen in an elderly person include freckles or sun spots that appear as dark macules and vascular lesions caused by dilated blood vessels. The bottom picture is a good example of a varicosity often called venous lake likely resulting from many years of smoking, found exactly where a cigarette is/was placed time and time again. Venous lakes may also result after many years of sun exposure. The picture above is a good example of what a freckle on the lip may look like. Although some lesions are normal, all must be examined for any changes in appearance.
- Read the slide In a mouth with metal fillings it is common to see the tooth take on a blue colour this is normal and isn't anything to be concerned with. Although attrition is common severe attrition like this may cause their teeth to be very sensitive to cold or even chewing as there is very little protecting the nerve.
- Healthy gingiva, commonly referred to as gums, should be pink in colour and feel firm and moist to the touch. The papilla which is the gum tissue between the teeth should ideally be pointed. Over time, papillae often become blunted or are missing completely due to many factors associated with aging. The gingiva or gums may also appear pigmented which is a variation of seen on healthy gum tissue.
- The picture on the left shows what healthy oral tissues (cheeks) should look like. The 3 pictures on the left show common findings. Linea alba which is a white line or lines on the cheek is an irritation of tissue that is often related to cheek biting and clenching. It can be found on one or both cheeks. The second picture demonstrates tissue trauma. This can occur from food, cheek biting and other sources. The bottom right image shows a canker sore. Diet, biting and genetic predispositions are some of the causes. Take note ***Any lesion that lasts more than 2 weeks must be looks at by a physician or dentist!*** NIDCR Home. (n.d.). Retrieved March 16, 2015, from http://www.nidcr.nih.gov (n.d.). Retrieved March 16, 2015, from http://www.dentistatrojkot.com (n.d.). Retrieved March 16, 2015, from http://www.studyblue.com Member of: American Dental Association (ADA) California Dental Association (CDA). (n.d.). Retrieved March 16, 2015, from http://www.eastbaydentist.com
- Though many normal and healthy variations can be seen on or underneath the tongue. Typically we are looking to see a pink, non-coated tongue with uniform appearance across the tongue.
- Three very common variations that can be seen are geographical, coated and fissured. Geographic Tongue presents as red patched with white borders as shown here in this photo. The presence can be exacerbated with stress and can be accompanied by complaints of a burning feeling. Avoiding acidic or sugar foods/liquids can help reduce this sensation. Coated Tongue – results from a build up of debris, bacteria and dead cells accumulating between the taste buds on the tongue. It would be helpful to add a tongue cleaner at least once a day to help reduce this build up for the client. Fissured Tongue – presents as deep fissures or grooves on the top of the tongue. Often client experience the same burning sensation as geographical tongue and it is recommended that the client brush their tongue lightly with a toothbrush to remove debris daily. Geo tongue - May be accompanied by complains of a burning feeling No treatment needed - Say it’s Important to brush tongue twice a day to remove debris for both coated and fissured tongue.
- - Saliva is a very important substance that helps defend all oral tissues against disease and destruction. It is for this reason that an assessment of the quality and amount of saliva present in a person’s mouth is essential for determining one’s oral health. When assessing a patient’s saliva, assessors must note its amount and consistency, qualities that are both placed on a continuum. You may detect a light, medium, or abundant amount, ranging from watery to thick or sticky. Ideally, patients would present with a lot of watery saliva that naturally moistens tissues and protects teeth from decay. Some healthy mouths may show signs of thick or light-medium amounts of saliva – as long as all the tissues appear moist to some degree, saliva substitutes may not be necessary. (** Group 2 will be discussing severe dry mouth and the need for saliva substitutes) We have included two examples representing both extremes on the saliva presentation continuums On the left – we have an example of abundant serous, or watery, saliva that tends to pool in certain areas, is clear in appearance, and renders the tissues slippery to the touch On the right – we have a good example of what a dry mouth would look like; notice the white, thick appearance of the saliva; these tissues are lacking moisture and would likely be sticky to the touch.