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CHAPTER
Gerontological Nursing, Second EditionPatricia A. Tabloski
The Mouth and Oral Cavity
13Lecture Note PowerPoint Presentation
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Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 1Explain normal changes of aging in the
mouth and oral cavity.
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Gerontological Nursing, Second EditionPatricia A. Tabloski
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
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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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 2
Identify common diseases of older persons in the mouth and oral cavity.
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Common Diseases of Aging Relating to the Mouth and Oral Cavity
• Increased oral diseases in communities without fluoridation
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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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Common Diseases of Aging Relating to the Mouth and Oral Cavity
• 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
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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– Institutionalized
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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– 34% African-Americans
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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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Xerostomia (dry mouth)
• Associated with– Dysphagia– Difficult chewing– Candidiasis– Denture slippage
Gum irritation and erosion
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Consequences of Poor Oral Care
• Social isolation• Depression• Systemic illness
– Aspiration pneumonia– Heart disease
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Consequences of Poor Oral Care
• Periodontal disease• Malnutrition, vitamin deficiency• Pain, halitosis, tooth loss, dental caries,
periodontal disease• Denture stomatitis
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Sjogren’s Syndrome
• Systematic, autoimmune disorder – Occurs in association with disorders such as
Rheumatoid arthritis Systemic lupus erythematosus Scleroderma Polymyositis Polyarteritis
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Sjogren’s Syndrome
• Inflammation of epithelial tissue• Other disorder manifestations include dry
eyes, skin changes, and thyroid disease
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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
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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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Figure 13-2Gingivitis and resulting gum erosion.
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Gingivitis and Periodontal Disease
• Risk factors– Smoking– Diabetes– Medications– Poor nutrition– Stress– Illness– Genetic susceptibility
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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
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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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Figure 13-3Population over the age of 60, worldwide and developing regions.
Source: Centers for Disease Control, 2001.
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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
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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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 3
List common nursing diagnoses of older persons related to oral problems.
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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
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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
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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
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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
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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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 4Recognize nursing interventions that can be implemented to assist the aging patient with
oral problems.
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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
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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
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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)
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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
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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
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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
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Mouth Care Strategies for Patients with Cognitive Impairment
• Task breakdown• Distraction• Hand-over-hand• Chaining• Protection
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Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 5Identify medications that may cause or
aggravate oral problems.
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Gerontological Nursing, Second EditionPatricia A. Tabloski
Problematic Common Mouth Care Products
• Lemon glycerin swabs• Hydrogen peroxide• Mouth rinses
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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
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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