The Mouth and Oral Cavity

1. 13 Lecture Note PowerPoint Presentation The Mouth and Oral Cavity

2. LEARNING OUTCOME 1 Explain normal changes of aging in the mouth and oral cavity.

3. 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

4. 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

5. 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

6. 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

7. LEARNING OUTCOME 2 Identify common diseases of older persons in the mouth and oral cavity.

8. Common Diseases of Aging Relating to the Mouth and Oral Cavity • Increased oral diseases in communities without fluoridation

9. 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

10. 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

11. Gingivitis and Periodontal Disease • Inflammation of the gums • Manifestations • Redness • Swelling • Bleeding • Results from bacterial colonization at gum margin

12. Figure 13-2Gingivitis and resulting gum erosion.

13. Gingivitis and Periodontal Disease • Risk factors • Smoking • Diabetes • Medications • Poor nutrition • Stress • Illness • Genetic susceptibility

14. 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-Americans It 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

15. 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

16. Figure 13-3Population over the age of 60, worldwide and developing regions.Source: Centers for Disease Control, 2001.

17. 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

18. 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

19. Xerostomia (dry mouth) • Affects 25–40% of older Americans • May be caused by medications • Antihistamines • Diuretics • Antipsychotics • Antidepressants • Anticholinergics • Chemotherapeutic agents • Antiparkinson drugs

20. Xerostomia (dry mouth) • Associated with • Dysphagia • Difficult chewing • Candidiasis • Denture slippage • Gum irritation and erosion

21. 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

22. Sjogren’s Syndrome • Inflammation of epithelial tissue • Other disorder manifestations include dry eyes, skin changes, and thyroid disease

23. Oral Candidiasis • Fungal infection • Caused by Candida albicans • Managed with antifungal agents • Risk factors • Dry mouth • Diabetes • Altered immune response • Use of inhaled steroids

24. Stomatitis • Inflammation of the mouth • Commonly caused by chemotherapeutic agents • Manifestations • Eroded ulcerations in the oral cavity • Secondary infection • Pain with eating and drinking

25. Consequences of Poor Oral Care • Social isolation • Depression • Systemic illness • Aspiration pneumonia • Heart disease

26. 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 )

27. LEARNING OUTCOME 3 List common nursing diagnoses of older persons related to oral problems.

28. 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

29. 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

30. 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

31. 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

32. Nursing Diagnoses • Impaired Dentition • Altered Dentition • Impaired Oral Mucous Membranes • Altered Oral Mucous Membranes • Nutrition Imbalance: Less Than Body Requirements

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

34. Nursing Interventions to Improve Xerostomia • Regular dental evaluation • Low sugar diet • Mouth rinses • Sugar-free chewing gum, hard candies, and mints

35. 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

36. 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)

37. 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

38. 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

39. 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

40. 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

41. LEARNING OUTCOME 5 Identify medications that may cause or aggravate oral problems.

42. Problematic Common Mouth Care Products • Lemon glycerin swabs • Hydrogen peroxide • Mouth rinses

43. 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

44. 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