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Elderly Flashcards

1
Q

What behavioural strategies are present for OHI?

A

Bridging- Describe and show the toothbrush, then mimic brushing your on teeth.
Give the toothbrush to the patient and they mirror your behaviour of brushing their own teeth.

Chaining- Gently bring the person’s hand to their mouth while describing the activity. Carer starts the activity and the individual finishes it.

Hand over hand- place your hand over the hand of the individual and gently brush the teeth together.

Distraction- distract the individual by placing a familiar item in thirdhand while you brush their teeth.

Rescuing- carer leaves and a “rescuer” comes to take over.

Develop a routine, find a time that works best for the patient.

Find a staff member that they like to do their OH and keep that the same as much as possible.

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2
Q

How would you brush someone’s teeth who was peg fed?

A

Sit them upright
Non-foaming toothpaste
Aspiration

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3
Q

What other types of toothbrushes might you employ if someone is resistant to OH?

A

Collis Curve
Dr Barmann’s toothbrush
Two toothbrush technique
Toothbrush with meaning- different colours for different quadrants
Toothbrushes with foam handles, round handles

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4
Q

What prevention should be done in the elderly?

A

OHI- think of what you can do to improve this
Diet advice
Ensure oral environment is moist- dry mouth care
Determine why they are resistant to oral care
Use sensory aids
Communication- marathon, social story, action cards
Denture hygiene

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5
Q

What issues are present in elderly patients with regards to oral health?

A

Patients are living longer and keeping their teeth for longer
Co-morbidities and medications- polypharmacy
Cost of dental treatment
Dementia- impaired ability to co-operate
Accessing oral healthcare
Complex dental treatment history
Reliant on others to perform OH
Reduced dexterity
Care home residents
Unable to communicate issues
Poor mobility/frailty
Falls
Continence- might not want to have long appointments

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6
Q

What oral diseases are common in the elderly?

A

Caries- particularly root caries
Periodontal disease
Oral mucosal disease- candida, Herpes Simplex, denture stomatitis
Angular Cheilitis
Lichen Planus
Head and neck cancer- usually goes undiagnosed

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7
Q

If oral health is not maintained in someone who is PEG fed, what is the risk?

A

Risk of aspiration pneumonia
- bacteria gets in to the lungs.

Can be fatal

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8
Q

What would you say to someone who said a patient doesn’t need to have their mouth checked because they are PEG fed?

A

Tend to be mouth breathers- mouth becomes dry and crusty.

Still get plaque accumulation, crusting of mucosa- bacterial reservoirs.

Reduce the risk of aspiration pneumonia.

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9
Q

What is dementia?

A

Acquired progressive loss in cognitive function beyond that which might be expected from normal ageing.

Severe enough to interfere with daily functioning.

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10
Q

What is dementia characterised as?

A

Amnesia
Inability to concentrate
Disorientation in time, place or person
Intellectual impairment

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11
Q

What problems might arise in dentistry for a patient with dementia?

A

Difficulty communicating
Capacity concerns
Social behaviour
Forgetting to brush teeth/forgetting appointments
Concentrating, planning, organising
Visuospatial skills
Anxiety and depression
Irritability/disinhibition

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12
Q

What are the different types of dementia?

A

Alzheimer’s
Vascular Dementia
Lewy body
Frontotemporal

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13
Q

What is Alzheimer’s?

A

Reduction in size of the cortex, severe in the hippocampus.

Plaques and tangles form.
- Plaques- beta-amyloid that builds up in the spaces between nerves.
- Tangles- twister fibres of tau proteins build up inside cells.

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14
Q

What are the distinctive features of Alzheimers?

A

Short term memory loss
Aphasia
Communication difficulties
Muddled over every day activities
Mood swings
Withdrawn
Loss of confidence

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15
Q

What are the associated features of dementia?

A

Age
Gender- affects more women than men
Head injury
SMoking
Hypertension, low folate
Genetic- abnormalities on chromosome 1, 14 or 21.

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16
Q

What is vascular dementia?

A

Caused by reduced blood flow to the brain, which damages and eventually kills the brain cells.

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17
Q

What is Dementia with Lewy bodies?

A

Deposits of abnormal protein called lewy bodies inside brain cells.
- also found in Parkinson’s disease.

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18
Q

What are the risk factors for Vascular dementia?

A

SMoking
High cholesterol diet
Diabetes
AF
Hypertension

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19
Q

What are the typical symptoms of vascular dementia?

A

Usually after a TIA or stroke.

Emotional disturbance, memory problems of sudden onset, visuospatial difficulties, anxiety, delusions.

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20
Q

What are the signs and symptoms of Lewy body dementia?

A

Inappropriate social behaviour
Lack of empathy/social tract
Visual hallucinations
Parkinsonism features- bradykinesia, falls, incontinence.

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21
Q

What is Frontotemporal dementia?

A

Damage to the frontal lobes of the brain.
Causes changes in personality and behaviour, difficulties with language.

Caused by TDP 43 and Tau protein.

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22
Q

What are the early stage symptoms in dementia?

A

STML
Difficulty communicating
Confusion
Poor judgement
Unwilling to make decisions
Anxiety
Agitation

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23
Q

What are the middle stage symptoms of dementia?

A

More support required- reminders to eat, wash and dress
Failure to recognise people
Distress
Aggression
Wandering
Behave inappropriately

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24
Q

What are the late stage symptoms of dementia?

A

Inability to recognise familiar objects, surroundings or people
Physical frailty
Difficulty eating and swallowing
Incontinence
Gradual loss of speech

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25
What is important in the early stages of dementia in terms of treatment planning?
Full assessment of the patient and dentition- E/O and I/O OPT and PAs where required. Retain key teeth Focus on high quality restorations Establish a preventative regime Take impressions for replica dentures- incase they lose them. Will complex restorative treatment b able to be maintained in the future? Involve carers in prevention - OHI, fluoride, smoking cessation, alcohol. Xerostomia- mouth care. Think about the stage of life they're at- if they are in palliative care, then is it worth doing complex treatment? Could this make things worse?
26
What should be done in the mid-stage of dementia for treatment planning?
Maintenance and prevention is essential
27
What treatment planning is done in the late stage of dementia?
Focus on comfort Moist, clean and healthy mouth- free of pain and infection Non-invasive
28
What are key teeth?
Occluding pairs Try to keep canines- good abutment tooth for dentures Try to keep anterior teeth SDA if possible
29
What is atraumatic restorative technique?
Partial caries removal, leave some caries over the pulp roof and then restore with GI.
30
Who should be seen for a domiciliary visit?
Patient confined to bed Patient on oxygen therapy Patient in hospital End of life care
31
If someone cannot physically make it into the surgery, what could you offer?
Domiciliary visit - Equality Act 2010 states that appropriate measures should be made so that individuals are not disadvantaged.
32
Who should be doing the domiciliary visits?
GDP Special care dentist Public dental service Enhanced practitioner GDP
33
What should you do to prepare for the domiciliary visit?
Phone ahead- check it is okay to go Send appointment ahead in writing- let them know your name. Ask about if you need any keys or door code to get in Parking Manual handling- where are you going to see the patient? Risk assessment ID badge Always have a chaperone
34
On arrival to the domiciliary visit, what should you do?
Introduce yourself, present name badge. Confirm patient details on arriva Assess capacity and gain consent Ensure you are in an environment that you can maintain confidentiality and dignity for the patient
35
What equipment would you bring to a domiciliary visit?
Portable suction Medical emergencies kit Sharps box PPE Infection control equipment Oxygen cylinder Equipment specific to the procedure you'll be doing
36
What treatment would you carry out in a domiciliary visit?
Replacing denture Soft tissue disease Restorations Perio treatment Prevention Grade 3 mobile teeth to be extracted
37
What do the Scottish Palliative care guidelines state with regards to oral care?
Routine oral assesssments to ensure comfort and minimise pain Gives advice on oral hygiene, denture care Moisten mouth every 30 mins with water sprays, ice chips, water soluble lubricant Risk of pain from sharp teeth, dry mouth, haematinic deficiency, viral infection, RAS, malignancy and mucositis
38
What can be done to make a dental surgery dementia-friendly?
Reception desk visible from the front door Colour and tone of furniture should be distinctive from the walls Avoid non-essnrtial signs Signage should be at eye level Use pictorial elements on signage Good natural light Any staff only or locked rooms should be coloured the same as the walls to avoid attention
39
What treatment might be involved in dementia?
Counselling Aspirin and reduce cardia risks- reduce blood pressure, weight, exercise, diet. NSAIDs Anticholinesterases- galantamine, Donepazil.
40
What are the risks of Diabetes in the dental setting?
Hypoglycaemia Impaired wound healing Increased risk of infection Increased risk of periodontal disease Inability to transfer to chair- peripheral neuropathy Retinopathy- cannot see or read. Fatigue for treatment
41
What levels of HbA1c would be accepted for treatment in general practice?
Less than 7%. If it is 9%- only emergency treatment should be conducted, surgical procedures in a hospital setting. If greater than 12%- delay treatment until glycaemic control maintained again.
42
Describe the two different types of stroke?
Ischaemic- central infarction. - neurological deficits occur where the occluded artery is and affects cerebral circulation. - Thrombotic stroke or embolic stroke. Haemorrhagic- cerebral haemorrhage- neurological deficits due to collection of blood from rupture of blood vessel. - Intracerebral haem stroke or subarachnoid haem stroke.
42
What is a stroke?
Sudden interruption of blood supply to brain leading to rapid focal or global neurological disturbance which lasts for longer than 24 hours. TIA- lasts for less than 24 hours, neurological function is restored within this time.
43
What are the signs and symptoms of stroke?
Facial weakness Arm weakness Slurred speech (dysarthria) Gait disturbance Urinary incontinence Loss of taste Headache Confusion Loss of consciousness Face/neck pain Loss of voluntary movement of the opposite side of the body to the cerebral lesion. Dysphagia Diplopia (double vision) Aphasia (difficulty understanding language)
43
What documents can you refer to for the oral care of stroke patients?
Guidelines for the oral healthcare of stroke survivors, British society of Gerontology, 2010.
44
What acronym is used to assess for stroke?
FAST Facial weakness Arm weakness Speech slurred Time to call 999
45
What are the risk factors of stroke?
Hypertension Smoking Obesity Poor diet Family history Antiphospholipid syndrome
46
What is the oral impact of stroke?
Facial palsy- weakness on one side Dysphagia- avoid elective treatment for 3-6 months, always use rubber dam, high volume aspiration, have the patient upright. During OH- use aspiration, non-foaming toothpaste, aspirating toothbrush, remove excess water from toothbrush before placing in mouth, have the patient upright. Dentures can be difficult to keep in place- reduced muscle control. Root caries caused by xerostomia Periodontal disease Poor OH- reliant on others, reluctance of others. Bleeding risk
47
What other factors would you need to consider in a stroke patient?
Aphasia Dysarthria Body support in dental chair Impaired manual dexterity Confusion and memory loss- capacity Care with anticoagulants Care with adrenaline containing LA- can cause hypertension. Avoid Benzodiazepines due to respiratory depression.
48
What aspects of treatment planning in stroke are important?
Prevention- high risk of root caries - high fluoride toothpaste (non-foaming), topical fluoride. Mouth care- keep hydrated, reduce risk of xerostomia. Be aware of antiplatelets and anticoagulants for extractions. Avoid BZD because of respiratory depression Consider replica dentures Shortened dental arch ART Keep appointments short- may struggle with long, complex appointments.
49
When will a stroke patient recover their swallowing abilities?
1 month
49
How might a stroke patient be fed?
PEG or NG tube Thickeners Tuck chin to chest when swallowing to allow epiglottis to cover larynx. Read to help swallowing
50
What communication adjuncts can be used in stroke patients?
Pen and paper Wired amplification Electronic voice output devices Picture book
51
If a denture no longer fits, what could you do?
Reline Also make a replica denture. - will be easier for the patient to adjust to, rather than a whole new denture. - Maximise retention and resistance factors. Advise the patient to use fixative
52
What barriers exist for stroke patients to access oral healthcare?
Transport to dental clinic Disabled parking on premises Stairs/lift into the practice Loss of manual dexterity Cannot sit comfortably in the dental chair Falls risk Dysphagia Loss of vision Capacity Confusion/memory loss Unable to communicate issues Reliant on others to carry out mouth care
53
What is Parkinson's disease?
Chronic and progressive neurological disorder that is caused by degeneration of dopaminergic neurone in the substantial Nigra of the basil ganglia.
54
What are the clinical features of Parkinson's?
Mask-like face Resting temor Muscular rigidity Bradykinesia- slow movement Dyskinesia- involuntary movement Impaired balance and co-ordination. Postural instability. Shuffling gait- increased risk of falls Communication difficulties
54
What drugs might someone with Parkinson's be on?
Levodopa - can cause taste disturbance, parafunction.
55
What are the dental implications of Parkinson's?
Accessing healthcare can be challenging Xerostomia Root caries Periodontal disease Poor OH- adapt toothbrush handles - Often reliant on others for oral care. Reduced manual dexterity Poor denture retention- lack of neuromuscular control and dry mouth. Movement, difficulty staying still for treatment - body support chair, mouth props/ Drooling Dysphagia- avoid mouthwash, non-foaming toothpaste, sit the patient upright. Communication may be an issue- allow longer appointments for this.
55
What is frailty?
A state of increased vulnerability to stressors due to age related declines in physiological reserve across neuromuscular metabolic and immune systems.
56
What is oral health related quality of life?
Ability to speak, chew, smile, taste, touch, swallow and convey a range of emotions through facial expressions and confidence and without pain. Ask the patient what matters to them.
57
What factors improve oral health related quality of life?
Being dentate increasing numbers of teeth Keeping anterior teeth Occluding pairs Less DMFT Less root caries less decayed teeth and ulceration Less perio disease Functional dentures No dry mouth No pain Studies have shown SDA is better than RPD in terms of quality of life
58
What is Caring for Smiles?
Scotland's national oral health promotion, training and support programme, which aims to improve the oral health of older people, in particularly those living in care homes.
59
What treatment is used for Angular Cheilitis?
Miconazole ointment 2%, 20g tube, apply twice per day to affected areas.
60
What bacteria can cause aspiration pneumonia?
Staphylococcus Aureus
61
What is Multiple Sclerosis?
Demyelination of axons within the CNS. Leads to progressive function loss.
62
What are the signs and symptoms of MS?
Muscle weakness Visual disturbance Paraesthesia Pain Balance/hearing loss Difficulty picking things up- motor control
63
What are the dental implications of MS?
Ability to brush effectively might be compromised. Limited mobility Falls risk/loss of balance Chronic orofacial pain Increased risk of trigeminal neuralgia
64
What is motor neuron disease?
Degeneration in the anterior horn of the of the corticospinal tract in the spinal cord.
65
What will the patient notice in MND?
Progressive loss of motor function. Weakness in limbs Slurred speech A weak grip Weight loss Emotional lability
66
What are the dental implications of MND?
Drooling Dysphagia Inability to lay flat or stay in the dental chair Aspiration pneumonia- PEG fed Poor motor control and muscle weakness to brush teeth

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