the mouth and oral cavity 13 lecture note powerpoint presentation
TRANSCRIPT
The Mouth and Oral Cavity
13Lecture Note PowerPoint Presentation
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 1Explain normal changes of aging in the mouth and
oral cavity.
Gerontological Nursing, Second EditionPatricia A. Tabloski
AGING AND THE MOUTH AND ORAL CAVITY
The epithelium and soft tissues atrophy Reduction in number of taste buds (contain the
receptors for taste) Hypogeusia: is a reduced ability to taste things
Reduced saliva production Overly dry oral mucosa
With proper oral hygiene Teeth and gums appear normal
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
AGING ASSOCIATED WITH DIFFICULTY MAINTAINING ORAL HYGIENE
Potential causes Number and condition of dental restorations Recession (collapse) of gums Impaired visual acuity Possible loss of manual dexterity (skill and ease
in using the hands) Restricted range of motion Effects of medications on oral cavity
Gerontological Nursing, Second EditionPatricia A. Tabloski
THOSE WITH THE POOREST ORAL HEALTH INCLUDE
The economically disadvantaged Those lacking insurance Racial and ethnic minorities Others
Disabled Homebound (Restricted or confined to home) Institutionalized
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 2Identify common diseases of older persons in the
mouth and oral cavity.
Gerontological Nursing, Second EditionPatricia A. Tabloski
COMMON DISEASES OF AGING RELATING TO THE MOUTH AND ORAL CAVITY Increased oral diseases in communities
without fluoridation
Gerontological Nursing, Second EditionPatricia A. Tabloski
COMMON DISEASES OF AGING RELATING TO THE MOUTH AND ORAL CAVITY 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
Gerontological Nursing, Second EditionPatricia A. Tabloski
COMMON DISEASES OF AGING RELATING TO THE MOUTH AND ORAL CAVITY Periodontal disease (those diseases that
affect one or more of the periodontal tissues, such as gingiva) and dental caries The most common cause of tooth loss More common in men than women Lower socioeconomic levels have more severe
disease forms
Gerontological Nursing, Second EditionPatricia A. Tabloski
GINGIVITIS AND PERIODONTAL DISEASE
Inflammation of the gums Manifestations
Redness Swelling Bleeding
Results from bacterial colonization at gum margin
Gerontological Nursing, Second EditionPatricia A. Tabloski
FIGURE 13-2GINGIVITIS AND RESULTING GUM EROSION.
Gerontological Nursing, Second EditionPatricia A. Tabloski
GINGIVITIS AND PERIODONTAL DISEASE
Risk factors Smoking Diabetes Medications Poor nutrition Stress Illness Genetic susceptibility
Gerontological Nursing, Second EditionPatricia A. Tabloski
ORAL AND PHARYNGEAL CANCERS
Primarily diagnosed in older adults Carry a poor prognosis 5-year survival rate
56% white Americans: one of the lowest rates among all cancers
34% African-AmericansIt is estimated that in the United States
approximately 30,000 people are being diagnosed with and 8,000 deaths are occurring annually from oral and pharyngeal cancer
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
FIGURE 13-3POPULATION OVER THE AGE OF 60, WORLDWIDE AND DEVELOPING REGIONS.SOURCE: CENTERS FOR DISEASE CONTROL, 2001.
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
ORAL CANCER
Risk factors Tobacco use Chronic and heavy alcohol use Sun exposure to lips History of leukoplakia Erythroplakia: is a clinical term used to describe
patches of keratosis . It is visible as adherent white patches on the mucous membranes of the oral cavity
Gerontological Nursing, Second EditionPatricia A. Tabloski
XEROSTOMIA (DRY MOUTH) Affects 25–40% of older Americans May be caused by medications
Antihistamines Diuretics Antipsychotics Antidepressants Anticholinergics Chemotherapeutic agents Antiparkinson drugs
Gerontological Nursing, Second EditionPatricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Associated with Dysphagia Difficult chewing Candidiasis Denture slippage
Gum irritation and erosion
Gerontological Nursing, Second EditionPatricia A. Tabloski
SJOGREN’S SYNDROME Systematic, autoimmune disorder
Occurs in association with disorders such as Rheumatoid arthritis Systemic lupus erythematosus: is a
systemic autoimmune disease that can affect any part of the body
Scleroderma:is a chronic systemic autoimmune disease characterized by fibrosis (or hardening), vascular alterations, and autoantibodies.
Polymyositis: many muscle inflammation. Polyarteritis: a serious blood vessel disease in which
small and medium-sized arteries become swollen and damaged
Gerontological Nursing, Second EditionPatricia A. Tabloski
SJOGREN’S SYNDROME
Inflammation of epithelial tissue Other disorder manifestations include dry
eyes, skin changes, and thyroid disease
Gerontological Nursing, Second EditionPatricia A. Tabloski
ORAL CANDIDIASIS
Fungal infection Caused by Candida albicans Managed with antifungal agents Risk factors
Dry mouth Diabetes Altered immune response Use of inhaled steroids
Gerontological Nursing, Second EditionPatricia A. Tabloski
STOMATITIS
Inflammation of the mouth Commonly caused by chemotherapeutic
agents Manifestations
Eroded ulcerations in the oral cavity Secondary infection Pain with eating and drinking
Gerontological Nursing, Second EditionPatricia A. Tabloski
CONSEQUENCES OF POOR ORAL CARE
Social isolation Depression Systemic illness
Aspiration pneumonia Heart disease
Gerontological Nursing, Second EditionPatricia A. Tabloski
CONSEQUENCES OF POOR ORAL CARE
Periodontal disease Malnutrition, vitamin deficiency Pain, halitosis(a term used to describe
noticeably unpleasant odors exhaled in breathing), tooth loss, dental caries, periodontal disease
Denture stomatitis (pathological reactions of the denture bearing palatal mucosa )
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 3List common nursing diagnoses of older persons
related to oral problems.
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING ASSESSMENT OF ORAL PROBLEMS
Oral health history Medications Usual oral hygiene routine Altered sense of taste Chewing or swallowing difficulties Bad breath or halitosis
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING ASSESSMENT OF ORAL PROBLEMS
Oral cavity examination Lips Teeth Interior of buccal mucosa Anterior and base of tongue, gums, soft and hard
palate, and back of throat
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING ASSESSMENT OF ORAL PROBLEMS
Oral cavity examination Presence of cracks, lesions, ulcers, swelling, or
induration Presence of gingival bleeding, hypertrophy, or
dental caries Presence of leukoplakia
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING DIAGNOSES
Impaired Dentition Altered Dentition Impaired Oral Mucous Membranes Altered Oral Mucous Membranes Nutrition Imbalance: Less Than Body
Requirements
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 4Recognize nursing interventions that can be
implemented to assist the aging patient with oral problems.
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING INTERVENTIONS TO IMPROVE XEROSTOMIA
Regular dental evaluation Low sugar diet Mouth rinses Sugar-free chewing gum, hard candies, and
mints
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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)
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
MOUTH CARE STRATEGIES FOR PATIENTS WITH COGNITIVE IMPAIRMENT
Task breakdown Distraction Hand-over-hand:in which the nurse places his
or her hand over the resident’s hand and guides the resident with an activity such as removing or replacing dentures.
Chaining: in which the nurse starts the mouth care activity and the person completes it
Protection
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 5Identify medications that may cause or aggravate
oral problems.
Gerontological Nursing, Second EditionPatricia A. Tabloski
PROBLEMATIC COMMON MOUTH CARE PRODUCTS
Lemon glycerin swabs Hydrogen peroxide Mouth rinses
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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