the mouth and oral cavity

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CHAPTER

Gerontological Nursing, Second EditionPatricia A. Tabloski

The Mouth and Oral Cavity

13Lecture Note PowerPoint Presentation




LEARNING OUTCOME 1Explain normal changes of aging in the

mouth and oral cavity.




Aging and the Mouth and Oral Cavity

• With proper oral hygiene– Teeth and gums appear normal

• The epithelium and soft tissues atrophy• Reduction in number of taste buds

– Hypogeusia• Reduced saliva production

– Overly dry oral mucosa




Aging and the Mouth and Oral Cavity

• Gums recede– Increased vulnerability of teeth below gum line to

cavities• Enamel erosion

– Stains– Cavities

• Tooth loss and malocclusion– Difficulty eating– Social isolation




Aging Associated with Difficulty Maintaining Oral Hygiene

• Potential causes– Number and condition of dental restorations– Recession of gums– Impaired visual acuity– Possible loss of manual dexterity– Restricted range of motion– Effects of medications on oral cavity




LEARNING OUTCOME 2

Identify common diseases of older persons in the mouth and oral cavity.




Common Diseases of Aging Relating to the Mouth and Oral Cavity

• Increased oral diseases in communities without fluoridation





• 30% of adults age 65 and older have no natural teeth– Regional differences noted– Impacts multiple areas of life

Nutrition Self-esteem Speech Facial appearance Source of halitosis





• Periodontal disease and dental caries – The most common cause of tooth loss– More common in men than women– Lower socioeconomic levels have more

severe disease forms




Those with the Poorest Oral Health Include

• The economically disadvantaged• Those lacking insurance• Racial and ethnic minorities• Others

– Disabled– Homebound– Institutionalized




Oral and Pharyngeal Cancers

• Primarily diagnosed in older adults• Carry a poor prognosis• 5-year survival rate

– 56% white Americans– 34% African-Americans




Xerostomia (dry mouth)

• Affects 25–40% of older Americans• May be caused by medications

– Antihistamines– Diuretics– Antipsychotics– Antidepressants– Anticholinergics– Chemotherapeutic agents– Antiparkinson drugs




Xerostomia (dry mouth)

• Associated with– Dysphagia– Difficult chewing– Candidiasis– Denture slippage

Gum irritation and erosion




Consequences of Poor Oral Care

• Social isolation• Depression• Systemic illness

– Aspiration pneumonia– Heart disease




Consequences of Poor Oral Care

• Periodontal disease• Malnutrition, vitamin deficiency• Pain, halitosis, tooth loss, dental caries,

periodontal disease• Denture stomatitis




Sjogren’s Syndrome

• Systematic, autoimmune disorder – Occurs in association with disorders such as

Rheumatoid arthritis Systemic lupus erythematosus Scleroderma Polymyositis Polyarteritis




Sjogren’s Syndrome

• Inflammation of epithelial tissue• Other disorder manifestations include dry

eyes, skin changes, and thyroid disease




Oral Candidiasis

• Fungal infection• Caused by Candida albicans• Managed with antifungal agents• Risk factors

– Dry mouth– Diabetes– Altered immune response– Use of inhaled steroids




Gingivitis and Periodontal Disease

• Inflammation of the gums• Manifestations

– Redness– Swelling– Bleeding

• Results from bacterial colonization at gum margin




Figure 13-2Gingivitis and resulting gum erosion.




Gingivitis and Periodontal Disease

• Risk factors– Smoking– Diabetes– Medications– Poor nutrition– Stress– Illness– Genetic susceptibility




Stomatitis

• Inflammation of the mouth• Commonly caused by chemotherapeutic

agents• Manifestations

– Eroded ulcerations in the oral cavity– Secondary infection– Pain with eating and drinking




Oral Cancer

• Occurs most often in people over age 45• Symptoms

– Sore that does not heal– Lump on lip or mouth– White or red patch on gum, tongue, or buccal

mucosa– Unusual bleeding, numbness, or pain




Figure 13-3Population over the age of 60, worldwide and developing regions.

Source: Centers for Disease Control, 2001.




Oral Cancer

• Symptoms– Feeling of something caught in the throat– Difficulty or pain with chewing or swallowing – Swelling in jaw– Voice changes– Pain in ear




Oral Cancer

• Risk factors – Tobacco use– Chronic and heavy alcohol use– Sun exposure to lips– History of leukoplakia– Erythroplakia




LEARNING OUTCOME 3

List common nursing diagnoses of older persons related to oral problems.




Nursing Assessment of Oral Problems

• Oral health history– Date of last dental examination– Presence and function of dentures– Missing or loose teeth– Bleeding gums– Dry mouth– Presence of sores or lesions





• Oral health history– Medications– Usual oral hygiene routine– Altered sense of taste– Chewing or swallowing difficulties– Bad breath or halitosis





• Oral cavity examination– Lips– Teeth – Interior of buccal mucosa– Anterior and base of tongue, gums, soft and

hard palate, and back of throat





• Oral cavity examination– Presence of cracks, lesions, ulcers, swelling,

or induration – Presence of gingival bleeding, hypertrophy, or

dental caries– Presence of leukoplakia




Nursing Diagnoses

• Impaired Dentition • Altered Dentition• Impaired Oral Mucous Membranes• Altered Oral Mucous Membranes• Nutrition Imbalance: Less Than Body

Requirements




LEARNING OUTCOME 4Recognize nursing interventions that can be implemented to assist the aging patient with

oral problems.




Nursing Interventions to Improve Xerostomia

• Regular dental evaluation• Low sugar diet• Mouth rinses• Sugar-free chewing gum, hard candies,

and mints




Nursing Interventions to Improve Xerostomia

• Artificial saliva and mouth lubricants• Bedside humidifiers• Dietary modifications

– Avoid hard-to-swallow or chewy foods– Careful use of fluids while eating




Nursing Interventions to Improve Oral Candidiasis

• Rinse mouth after use of inhaled steroids• Use small, soft toothbrush twice daily• Use swabs to clean and moisten oral

mucosa when unable to brush• Provide mouth rinses• Chlorhexidine (Peridex)




Nursing Interventions for the Patient with Oral Pain

• Rule out infection or abscess– Perform oral examination

Inspect mouth, tongue, and teeth– Assess vital signs– Assess respiratory function– Assess lymph nodes




Nursing Interventions to Improve Gingivitis and Periodontal Disease

• Educate the patient and family– Daily flossing– Daily brushing– Use of fluoride toothpaste– Need for oral hygienist referral– Nutrition– Effect of periodontal disease on overall health




Nursing Interventions to Improve Stomatitis

• Educate the patient and family– Signs and symptoms

Ulcers in mouth Pain with eating and drinking Secondary infections

– Treatments Meticulous oral hygiene Frequent use of isotonic saline mouthwash Avoidance of food extremes Providing swish-and-spit solution as prescribed




Mouth Care Strategies for Patients with Cognitive Impairment

• Task breakdown• Distraction• Hand-over-hand• Chaining• Protection




LEARNING OUTCOME 5Identify medications that may cause or

aggravate oral problems.




Problematic Common Mouth Care Products

• Lemon glycerin swabs• Hydrogen peroxide• Mouth rinses




Medications to Use with Caution

• Diabetes medications– Gingivitis and periodontal disease

• Potential causes of xerostomia– Tricyclic antidepressants– Sedatives– Tranquilizers– Antihistamines– Antihypertensives

Alpha- and beta-blockers




Medications to Use with Caution

• Potential causes of xerostomia– Diuretics– Calcium channel blockers– Angiotensin-converting enzyme inhibitors– Cytoxic agents– Antiparkinsonian agents– Antiseizure drugs

• Potential causes of stomatitis– Chemotherapeutic agents

the mouth and oral cavity

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