Older People Flashcards by Katie Glass

what are the challenges of the ageing population

increased number of people with long term conditions
increasing age with concurrent increase in co-morbidities
polypharmacy

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what is the impact of ageing and systemic disease on dental care

population at increased risk of oral disease
polypharmacy
impaired ability to co-operate
access - moving and handling
medical conditions complicate provision of dental treatment
medical conditions contraindicate provision of dental treatment

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what types of oral disease can older person get

caries
periodontal disease
poor OH
oral mucosal disease
lichen planus
head and neck cancer

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what are the complications of lichen planus

discomfort when eating
risk of malignant transformation

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why do older people sometimes present with quite advanced oral cancer

delayed diagnosis
symptoms unable to be communicated
lack of attention paid
misdiagnosis

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what is the most common cause of death in patients with dysphagia

aspiration pneumonia

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what is good health according to WHO

complete physical, social and mental well-being and not merely absence of disease or infirmity

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what does quality of life mean for older people

having good social relationships
maintaining social activities and retaining a role in society
having a positive psychological outlook
having good health and mobility
enjoy life and retain ones independence and control over life

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what should treatment planning be like in early stage dementia

plan for future
identify and attempt to retain key teeth
high quality restorations
are complex restorations going to be cared for properly?
preventative regime

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what key teeth should be kept for quality of life

occluding pairs of teeth
number of teeth
attempt to retain anterior teeth

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what are the reasons against rendering someone edentulous

natural teeth have impact on quality of life
chewing and eating
nutrition
independence/pride
social aspects of life

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what should treatment planning be like in mid stage dementia

maintenance and prevention
consider medical status and implications on care

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what should treatment planning be like in late stage dementia

comfort
moist, clean, healthy mouth free of pain and infection
non-invasive
emergency management if need be

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what do we need to control to secure oral health

oral hygiene and biofilm removal
sugar
level and quality of care
teeth
fluoride
operative intervention

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how do you communicate with a person with dementia

approach from front
break it into steps
non-verbal - smiles, touch
get environment right

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what is caring for smiles

national programme to promote good oral health for residents in care homes given by the carers

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what issues do older people face

frailty
polypharmacy
continence
falls
bone health
nutrition and weight loss

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what is frailty

a state of increased vulnerability to stressors due to age related declines in physiological reserve across neuromuscular, metabolic, and immune systems

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what does frailty present like

unintentional weight loss
exhaustion
weakness
slow walking speed
low physical activity

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what is rockwood frailty

consequence of deficits that are associated with ageing

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define oral health

multifaceted and includes speaking, smiling, smelling, taste, touch, chewing, swallowing, conveying emotions without pain, discomfort and disease

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what are the 2 models of bringing quality of life into practice

prevention
delivery of clinical care

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how does caring for smiles work

adults moving into care home have mouth care needs assessed on admission
adults living in care home follow personal care plan
supported to clean teeth twice a day and undertake daily oral care for dentures

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what are the major oral health complaints in the older population

dry mouth
ulceration
infection and pain

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what is the oral health improvement plan for older population

domiciliary care provision enhanced skills partnership between health and social care

what is needed to more forward in caring for older people

further education and research

what teeth related things has a positive impact on quality of life for older people

increased number of teeth, anterior teeth occluding pairs of teeth

what is a haemangioma

collection of blood vessels which will bleed if traumatised

how do you remove a haemangioma

surgery done in hospital

what is a fibroepithelial polyp

build up of tissue which occurred after trauma

what is a black hairy tongue

overgrowth on surface of tongue which picks up stains normal

who more commonly has a black hairy tongue

smokers

how do you treat a black hairy tongue

brush with toothbrush from midline forwards

what is a geographic tongue

areas of atrophy surrounded by white margins

what is atrophic glossitis

smooth tongue

what is the causes of atrophic glossitis

low iron or low vit b12

what do you do if you see someone with atrophic glossitis

ask GP for haematinics

what is frictional keratosis

white patch caused by trauma which keratinises

what is speckled leukoplakia

hyperplastic candidosis pre-malignant

how do you treat speckled leukoplakia

biopsy - refer to oral med

what denture induced problems can we get

traumatic keratosis hyperplasia stomatitis

how does denture hyperplasia occur

denture slips around causing rubbing at sites leading to overgrowth

how do you treat denture hyperplasia

remove denture and then can surgically remove hyperplastic area if it does not go away itself

what is denture stomatitis

candida infection where it burrows into the surface of the mucosa and plastic of denture

how do you treat denture stomatitis

remind of denture hygiene and not to wear at night clean with sodium hypochlorite/chlorhexidine antifungals

what causes angular cheilitis

bacteria/fungal infection often due to denture being reservoir and decreased OVD

how do we treat angular cheilitis

denture hygiene advice look at denture OVD haematinics medications if nothing else works

what are the causes of xerostomia

polypharmacy, sjogrens, radiotherapy

how do we test for dryness

use mirror on tongue, if it sticks is suggests poor saliva quality

how do we manage xerostomia

change medication salivary replacement salivary stimulants

what can we use as salivary replacements

lots of water saliva orthana biotene oral balance bioxtra

what salivary stimulants can we use

chewing gum glycerine and lemon

what salivary stimulant should never be used for people with natural teeth as it is acidic

glandosane

what type of drugs can give mucosal burns

aspirin and iron

if iron tablets are causing burns to the mucosa what should we try and do

get patient changed to liquid iron

what drugs can give lichen planus and lichenoid tissue reactions

NSAIDs beta blockers diuretics oral hypoglycaemics statins antimalarials sulphonamide

how does lichen planus present in the mouth

reticular, erosive, plaque, atrophic

if a patient presents with erosive oral lichen planus what should you do

refer to oral med

what do bisphosphonates do

inhibit osteoclast formation and osteolytic activity - inhibit bone turnover

what are some non-malignant uses of bisphosphonates

osteoporosis pagets disease osteopenia

what are some malignant uses of bisphosphonates

multiple myeloma breast cancer prostate cancer

what are the risk factors for MRONJ

extremes of age concurrent use of corticosteroids systemic conditions affecting bone turnover malignancy coagulopathies, chemotherapy, radiotherapy duration of therapy previous diagnosis of BRONJ potency of drug invasive dental procedures denture trauma poor OH periodontal disease alcohol or tobacco use thin mucosal coverage

what are the methods of delivery of bisphosphonates

IV or oral

in what jaw is MRONJ more common in

mandible

what does MRONJ present as

sequestrae of bone open area in the mouth as gum does not heal

what do we inform people of MRONJ before treatment

advise of risk informed consent emphasise rarity of condition dont discourage from taking medication

what patient advice should we give to MRONJ patients

regular dental checks maintain good oral hygiene limit alcohol and stop smoking report any symptoms

what is shingles

form of varicella zoster virus

what is the presentation of shingles

prodromal pain 2-3 days later unilateral rash on face and in mouth painful

what is post herpetic neuralgia

constant burning sensation in dermatomal distribution usually resolves within 2 months has had previous episode of shingles

what is the treatment for post herpetic neuralgia

antidepressants gabapentin carbamazepine topical capsaicin transcutaneous electrical nerve stimulation

what is the medical management of trigeminal neuralgia

carbamazepine oxcarbazepine gabapentin pregablin lamotrigine sodium valproate

what is the surgical management of trigeminal neuralgia

cryotherapy injection of alcohol or glycerol neurectomy avulsion of nerve balloon compression

if a younger person has trigeminal neuralgia what else should be considered

multiple sclerosis space occupying lesion

what can burning mouth syndrome be caused by

drugs dry mouth candidosis haematinic deficiencies diabetes parafunctional activity denture factors hypothyroidism allergy

what did the francis report reveal

abuse, neglect, appalling care of people particularly older dependent adults

what reduces chances of aspiration pneumonia

improved oral health

what does the berwick support say

patient safety should be the ever present concern of every person working in or affecting NHS funded care

what nutrition problems can loss of teeth lead to

impaired masticatory function avoidance of foods that are hard to chew not meeting nutritional needs increased intake of processed, high cholesterol and lipid based foodstuffs

what nutrition problems can loss of teeth lead to

impaired masticatory function avoidance of foods that are hard to chew not meeting nutritional needs increased intake of processed, high cholesterol and lipid based foodstuffs

what are the barriers to oral hygiene in the elderly in care homes

oral health is low priority in care plans carers have limited knowledge of oral health carers have difficulty gaining access to teeth high turnover of care staff poorly paid care staff