Older People Flashcards
1
Q
What are the potential reasons for loss of teeth?
A
- exfoliation
- NCTSL
- endodontic infection
- dental caries
- periodontal disease
- head and neck cancer
- trauma
- congenitally missing
2
Q
What are the risk factors for loss of teeth?
A
- salivary flow
- impairment/disability
- access
- oral hygiene
- sugar
- socioeconomic status
- genetic
- nutritional deficiencies
- smoking/tobacco use
- alcohol
- HPV
- medical status
- lifestyle
- environmental
- socio-cultural
2
Q
What are the risk factors for loss of teeth?
A
- salivary flow
- impairment/disability
- access
- oral hygiene
- sugar
- socioeconomic status
- genetic
- nutritional deficiencies
- smoking/tobacco use
- alcohol
- HPV
- medical status
- lifestyle
- environmental
- socio-cultural
3
Q
What are the potential factors that increase the caries risk in the older population?
A
- frailty
- mental confusion
- housebound/institutionalised
4
Q
What are the challenges to dental care related to the ageing population?
A
- population at increased risk of oral disease
- polypharmacy
- impaired ability to cooperate
- access (moving and handling - wheelchair, hoist, etc.)
- medical conditions complicating/contraindicating dental treatments
5
Q
Why is oral hygiene challenging in the elderly population?
A
- patients likely to be care dependent
- third party care
- poor manual dexterity possible
- may have reduced visual activity
6
Q
What type of caries are often seen in the older population?
A
- root caries
- circumferential around the cervical margins
- crown fracture leaving carious retained roots
- high risk sites include RPD clasp locations
7
Q
What disease processes are seen in the older population?
A
- caries
- periodontal disease
- oral mucosal disease
8
Q
What types of oral mucosal disease may be seen in the elderly population?
A
- denture induced stomatitis
- opportunistic
- ulceration
- angular chelitis
- lichenoid tissue reactions
9
Q
How does lichen planus present in the elderly?
A
- autoimmune condition causing discomfort in the mouth
- difficulty eating
- difficulty performing oral hygiene
- management
- medications
- toothpaste without SLS
- treatment be contraindicated by existing medications
- risk of malignant change
10
Q
What are the additional challenges presented by head and neck cancer in older people?
A
- delayed diagnosis (more advanced disease)
- unable to communicate symptoms
- lack of attention paid
- misdiagnosis
- access challenging
- high risk of recurrence after previous head and neck cancer
- radiation induced xerostomia
- reduced mouth opening
- oral hygiene challenging
11
Q
What is aspiration phneumonia and what is its relevance to the elderly population?
A
- plaque, bacteria, calculus, mucus crusting can be aspirated into the lungs
- bacterial reservoirs
- most commonly staphylococcus aureus
- can be fatal
- most common cause of death for patients with dysphagia associated with neurological impairment
- dried secretions
- NG tube or PEG fed
- mouth secretions
- carers think brushing is not required as not eating through mouth
- preventable with good oral hygiene
11
Q
What is aspiration phneumonia and what is its relevance to the elderly population?
A
- plaque, bacteria, calculus, mucus crusting can be aspirated into the lungs
- bacterial reservoirs
- most commonly staphylococcus aureus
- can be fatal
- most common cause of death for patients with dysphagia associated with neurological impairment
- dried secretions
- NG tube or PEG fed
- mouth secretions
- carers think brushing is not required as not eating through mouth
- preventable with good oral hygiene
12
Q
What does quality of life mean for older people?
A
- having good social relationships
- maintaining social activities and retaining a role in society
- having a positive psychological outlook
- having good health and mobility
- to enjoy life and retain independence and control over life
13
Q
What is the importance of teeth for older people?
A
- positively influenced by natural teeth
- easier to eat and maintain good nutrition levels
- preservation of teeth contributes to positive body image and self worth
- more comfortable socialising
14
Q
What does early stage dementia treatment planning involve?
A
- oral assessment
- multi-disciplinary care
- planning for future
- dementia will progress
- assessment
- identify and attempt to retain key teeth
- focus on high quality restorations
- complex restorative treatments can be difficult to care for
- establish a preventative regime
- high fluoride toothpaste
- regular cleaning
15
Q
How can provision for loss or breakage of dentures for dementia patients be made?
A
- consider replica dentures
- take impressions/scans
- make new dentures if lost or broken
- removes challenge of having to take impression from older person
16
Q
What teeth are considered key teeth?
A
- occluding pairs of teeth
- essential for mastication
- number of teeth
- SDA
- anterior teeth
- aesthetics
- confidence
17
Q
What are the considerations for a full clearance in an elderly patient?
A
- natural teeth have a significant impact on quality of life
- chewing and eating
- nutrition
- independence/pride and achievement
- social aspects of life
18
Q
What does mid-stage dementia treatment planning involve?
A
- aims to have clean and healthy teeth
- maintenance and prevention essential
- limited ability to provide care and intervention
- reduced cooperation
- medical status
- polypharmacy
- access challenging
- attending appointments
- costs associated
19
Q
What is atraumatic restorative technique?
A
- removal of soft infected carious tissue leaving a layer of stained affected dentine over the pulp, sealed and restored with glass ionomer
- maintains tooth and keeps cleanable
- seals off bacteria
- can be performed with limited cooperation
- spoon excavator and glass ionomer
20
Q
What are the risk factors for restoration failure after atraumatic restorative technique
A
- low number of tooth brushings per day
- absence of prosthesis (increased force applied to teeth)
- posterior teeth
- higher baseline plaque index
21
Q
What does late stage dementia treatment planning involve?
A
- focus placed on comfort
- moist, clean and health mouth
- pain free
- free from infection
- non-invasive
- access is difficult
- emergency management
- limited options
22
Q
How can oral bio-film based diseases be controlled?
A
- control of
- oral hygiene and removal of biofilm
- sugar
- level and quality of care
- teeth
- fluoride
- operative intervention
23
How can communication be altered to suit a patient with dementia?
- approaching from the front
- break down tasks into steps
- short words
- simple sentences
- non-verbal
- smile
- gentle touch
- right environment
- quiet
- avoid sensory overload
- techniques
- distraction
- bridging (brief answer then new topic if potential to upset)
- hand over hand (hold hand to guide person)
- chaining (start task and they finish or vice versa)
24
What is Caring for Smiles?
- national programme to promote good oral health for residents in care homes
- trains carers
- values dependent people and those involved in their care
- adults moving into care homes have their mouth assessed on admission
- mouth care needs recorded in personal care plan
- supported to clean teeth twice daily or daily denture care
25
What type of tasks do elderly people potentially struggle with?
- mobility
- dexterity
- communication
26
What is dementia?
- acquired progressive loss of cognitive functions, intellectual and social abilities severe enough to interfere with daily function
- chronic or progressive nature
- deterioration in cognitive function
- beyond that expected of normal ageing
27
What does dementia affect?
- memory
- particularly day to day
- difficulty recalling recent events
- thinking
- process of thoughts altered
- orientation
- visuospatial skils (distance, 3D vision)
- losing track of day or date
- confused about location
- comprehension
- calculation
- learning capacity
- inhibited
- language
- difficulty following conversation
- difficulty finding correct word
- judgement
- organisation
- concentrating, planning and organising challenging
- difficulties making decisions and problem solving
- challenging to carry out sequences of tasks
28
What is dementia characterised by?
- amnesia
- inability to concentrate
- disorientation in time, place or person
- intellectual impairment
29
What accompanies the impairment of cognitive function in dementia?
- deterioration in:
- emotional control
- social behaviour
- motivation
30
What is Alzheimer's?
- most common form of dementia (60%)
- reduction in size of cortex
- severe in hippocampus
- plaques deposited in spaces between nerve cells
- deposit of protein fragment (beta-amyloid)
- tangles are twisted fibres of tau protein build up inside cells
- distinctive features
- short term memory loss
- aphasia
- communication difficulties
- muddled over everyday activities
- mood swings
- withdrawal
- loss of confidence
31
What factors are associated with the development of Alzheimer's?
- age
- gender
- more female than male
- head injury
- lifestyle
- increased risk
- smoking
- hypertension
- low folate
- high blood cholesterol
- decreased risk
- physical, mental and social acitivities
- genetic
- abnormalities on chromosomes 1, 14 or 21
32
What is vascular dementia?
- dementia caused by reduced blood flow to the brain
- damages and eventually kills the brain
- can develop as a result of
- small vessel disease
- narrowing and blockage of deep small vessels
- single large stroke
- many mini-strokes
- underlying health conditions
- high blood pressure
- diabetes
- smoking
- overweight
- distinctive features
- memory problem of sudden onset
- visuospatial difficulties
- anxiety
- delusions
- seizures
33
What is dementia with lewy bodies?
- deposits of an abnormal protein called levy bodies inside brain cells
- same deposits as Parkinson's disease
- areas responsible for memory and muscle movements
- distinctive features
- short term memory less
- cognitive ability fluctuates
- visuospatial difficulties
- attentional difficulties
- overlapping motor disorders (speech and swallowing)
- sleep disorders
- delusions
34
What is frontotemporal dementia?
- dementia affecting the frontal lobe
- changes in personality and behaviour
- difficulties with language
- younger age of onset
- distressing for loved ones
- distinctive features
- short term memory loss in some cases
- uncontrollable repetition of words
- mutism
- repetition of other peoples words
- personality change
- decline in personal and social conduct
35
What are the rarer forms of dementia?
- HIV
- Parkinson's disease
- corticobasal degeneration
- multiple sclerosis
- Niemann-Pick disease
- Creutzfeldt-Jakob disease
36
What are the risk factors for dementia?
- age
- gender
- genetic background
- medical history
- lifestyle
37
What are the risk factors for dementia?
- age
- gender
- genetic background
- medical history
- lifestyle
38
What are the early stage symptoms of dementia?
- often misattributed to stress, bereavement or normal ageing
- takes around 3 years for diagnosis
- only a third of sufferers have a diagnosis
- short term memory loss
- confusion, poor judgement, unwilling to make decisions
- anxiety, agitation, distress over perceived changes
- inability to manage everyday tasks
- communication problems
39
What are the middle stage symptoms of dementia?
- more support required
- reminders to eat, wash, drink, use toilet, dress
- increasingly forgetful
- may fail to recognise people;e
- distress, anger, aggression, mood changes
- risk of wandering and getting lost, leaving cooking unattended
- may behave inappropriately
- going out in nightclothes
- may experience hallucinations
- throw back memories
- progressive and irreversible
40
What are the late stage symptoms of dementia?
- inability to recognise familiar objects, people, areas, etc.
- may have flashes of recognition
- increased physical frailty
- altered gait
- bed bound/wheelchair confined
- difficulty eating and swallowing
- weight loss
- incontinence
- gradual loss of speech
41
How is dementia diagnosed and how is progression measured?
- MMSE
- mini mental state exam
- demential screen
- eliminated treatable causes
- FBC, U&E, kidney/liver/thyroid function
- glucose, serum B12, urinalysis
42
How is dementia diagnosed and how is progression measured?
- MMSE
- mini mental state exam
- demential screen
- eliminated treatable causes
- FBC, U&E, kidney/liver/thyroid function
- glucose, serum B12, urinalysis
43
What is a mini mental state exam (MMSE)
- tests attention, recall, language ability, ability to follow commands
44
What cognitive tests are available for dementia?
- MMSE
- Blessed dementia scalre
- Montreal Cognitive Assessment
- single/combined neuropsychological tests
45
What treatment is available for dementia?
- no pharmacological, surgical or behavioural cure
- counselling
- may delay residential care by up to a year
- symptom relief and slowing of progression
- aspirin
- reduced cardiac risk
- may halt deterioration of vascular type
- NSAIDS, vitamin E, ginko biloba
- may slow progression
- anticholinesterases
- mild to moderate Alzheimer's
- defer cognitive deterioration
- assists behavioural difficulty
46
What adaptations can be made to make a care home dementia friendly?
- walls, floor coverings, skirting boards and doors coloured
- good visual contrast
- labels and images on drawers
- let people find what they need without assistance
- bedroom bathroom
- visible from bed on sitting when lying down
- personal pictures and items with personal relevance
- radiators are low temperature heating
- furniture is traditional and domestic
47
What adaptions can be made to make healthcare enviroments dementia friendly?
- reception desk visible from entrance door
- ceilings, floors and floor coverings
- acoustically absorbent
- supports audible communication
- colour and tone of walls and furniture should be distinctive from flooring
- avoid non-essential signs
- signage at eye level with simple, clear text
- pectoral elements
- good levels of natural light
- minimise artificial light
- staff or locked rooms painted same colour as walls
- avoids attention
48
What is frailty?
- state of increased vulnerability to stressors due to age related declines in physiological reserve across neuromuscular, metabolic and immune systems
- distinct to single organ conditions associated with advancing the and multi-morbidity, but can coexist
49
What is frailty phenotype?
- unintentional weight loss (4.5kg in a year)
- self-reported exhaustion
- weakness (grip strength in lowest 20%)
- slow walking speed
- low physical activity
3+ frail
1-2 = pre-frail
nil = fit
50
What is Lockwood frailty?
- accumulation of deficits that are associated with ageing
- addition of number of deficits to create frailty index
51
What is oral health related quality of life?
multidimensional construct that reflect people's comfort when eating, sleeping and engaging in social interaction, their self esteem and their satisfaction with respect to their oral health
52
What is the sequence of biological ageing?
- continuation of adult life
- reduced function, no support required
- some support required
- dependency
53
What factors can be measured to determine oral health related quality of life?
- chewing
- eating
- social contacts
- appearance
- pain
- worry
- self-consciousness
- happiness
- social life
- relationships
- functional limitation
- psychological discomfort
- physical disability
- psychological disability
- social disability
54
How are number of teeth and occluding pairs seen to affect oral health related quality of life?
- increased number of teeth and occluding pairs is positively associated with oral health related quality of life
55
What barriers exist to an oral care model for older people?
- integrated work between health and social care
- mutual decisions improve outcomes
- nominated care lead
- sharing in planning interventions and flexibility
56
What is a haemangioma?
- collection/malformation of blood vessels
- will bleed if traumatised
- any site in the mouth
- lip
- edge of tongue
- bunch of grape like appearance under the tongue
- increase in size
- removal in hospital due to bleeding risk
- removed by cryotherapy
- only concern is bleeding
57
What is a fibroepithelial polyp?
- lump covered in same mucosa as surrounding tissue
- sessile (broad base or on a stalk)
- tip of tongue common
- side of cheeks common (grinding, clenching)
- can be traumatised
- further build up of tissue
- ulcerated if rubbing against teeth
- removal if growing too big
- cot concerning
58
What is black hairy tongue?
- overgrowth of surface of the tongue
- stains due to tannins
- more common in smokers (especially pipe smokers)
- unpleasant appearance and smell
- difficult to get rid of
- not concerning
- clean from the midline forward (bacteria should not go down throat)
59
What is geographic tongue?
- erythema migrans
- changes shape, size and location
- areas of atrophy (depapillated) with white, slightly raised margin
- variation of normal
- may be associated to sensitivity to spicy or citrus foods
60
What isa tropic glossitis?
- smooth tongue
- shiny appearance
- most common cause is low iron or vitamin B12 levels
- further drop in iron can cause ulceration
- uncomfortable
- difficult to treat
- refer to GP for routine haematinics and bloods
61
What is frictional keratosis?
- white patch as a result of trauma
- keratinisation in area
- look for traumatic cause (sharp tooth or restoration)
- review for healing
62
What is speckled leukoplakia?
- hyperplastic candidiasis
- speckled appearance
- uni or bi lateral
- angle of the mouth/commissure
- common in smokers, especially piper smokers
- pre-malignant
- must be monitored
- microbiological swab (check for candida)
- biopsy
63
What is sublingual keratosis?
- keratosis of ventral surface of tongue
- homogenous white patch
- picked up during intraoral soft tissue exam
- always check high risk sights
- ventral surface of tongue
- midline
- if crosses midline of tongue requires referral to oral medicine
64
What is traumatic keratosis
- denture related frictional keratosis
- keratosis in response to long wear of dentures
- ill fitting so move about
65
What is denture induced hyperplasia?
- caused by ill-fitting dentures
- elderly more comfortable with ill fitting but old dentures
- skin overgrows in area of trauma
- flap of skin produced
- same as surrounding mucosa
- more common with lower dentures
- ulceration may be present
- remove denture but if advanced, tissue will not shrink
- may require surgical treatment to excise excess ridging
- trim denture away from area
66
What is denture stomatitis
- infection as a result of not taking denture out
- poor denture hygiene
- candidate infection
- hyphae burrow into mucosa and acrylic
- very common
- generally painless
- erythema where fitting surface of denture sits
-treatment
- oral/denture hygiene advice
- remove denture as much as possible
- soak denture in dilute sodium hypochlorite
66
What is denture stomatitis
- infection as a result of not taking denture out
- poor denture hygiene
- candidate infection
- hyphae burrow into mucosa and acrylic
- very common
- generally painless
- erythema where fitting surface of denture sits
-treatment
- oral/denture hygiene advice
- remove denture as much as possible
- soak denture in dilute sodium hypochlorite
67
What is angular cheilitis?
- mixed bacterial/fungal infection at corner of the mouth
- denture can act as reservoir
- staphylococcal element
- difficult to heal
- denture hygiene
- reduced OVD
- creation of moist area at corner of mouth
- old or ill fitting dentures
- bloods for low iron, vitamin B12 or folate
- opportunistic infection
68
What is xerostomia?
- dry mouth
- causes
- polypharmacy
- Sjögren's syndrome
- radiotherapy
- uncomfortable
- sticky
- fissures seen in long term cases
69
How is xerostomia managed?
- change medication
- challenging
- liaise with GP
- salivary replacement
- saliva orthana (neutral pH, fluoride containing)
- glandosane (poor, very acidic)
- biotin oral balance/bioxtra (gels, potentially animal products)
- short lived effects so sipping water can be preferable
- salivary stimulants
- chewing gum
- strain on TMJ
- glycerine and lemon
- acidic, damaging to teeth
- medication
- poor side effects as stimulate all glands
70
What topical drug reactions can be observed orally?
- usually in response to aspirin and iron
- medication held in mouth for too long
- chemical burn to mucosa
- can use liquid iron in place of tablets
- can be gold
- arthritis treatment
- lichenoid reactions
- modern drugs
71
What are lichen plans and lichenoid tissue reactions?
- mucocutaneous disorder
- lichenoid reactions more common
- look like lichen plants
- not autoimmune
- due to drug or material (e.g. amalgam)
- lichen planus can affect skin and GI tract
- white striae
- often reticular (faint white pattern, slightly rough)
- can also be erosive, plaque or atrophic
- buccal mucosa, tongue and attached gingiva
- rarely lichen Plans on palate
72
Why are bisphosphonates challenging for dental extractions?
- bisphosphonates incorporated into skeleton to inhibit bone turnover
- no repair of micro damage
- anti-angiogenic
- cancellous bone broken during extraction does not heal
73
What are the risk factors for MRONJ?
- extremes of ages
- concurrent use of corticosteroids
- systemic conditions affecting bone turnover
- malignancy (e.g. breast cancer)
- coagulopathies, chemotherapy, radiotherapy
- during therapy
- previous diagnosis of MRONJ
- potency of drugs (higher for malignancies)
- invasive procedures (anything manipulating bone)
- denture trauma
- poor oral hygiene
- periodontal disease
- alcohol or tobacco use
- thin mucosal coverage
74
What is the maximum length of time on bisphosphonates?
3 years
75
Why is MRONJ more common in the mandible?
- maxilla attached to skull base
- access to more blood vessels
76
What is the process of MRONJ?
- bone dies
- sequestrate of bone
- fragments make their way to surface of gingiva
- gingiva does not heal
- area must be kept very clean
77
What advice should be given to patients taking MRONJ?
- advise of MRONJ risk
- emphasise rarity of condition
- do not discourage from taking medication
- attend regular dental check ups
- limit alcohol
- stop smoking
- maintain good oral hygiene
- report symptoms such as loose teeth, pain, swelling, tingling
- signs of MRONJ
78
How are bisphosphonates taken?
- once weekly
- taken with lots of water
- sitting up straight for 30 minutes
- can burn otherwise
79
What is herpes zoster?
- shingles
- varicella zoster reactivation
- can affect any branch of the trigeminal nerve
- often unilateral
- often older people
- prodromal pain
- 2-3 days later rash appears on face and in mouth
- very painful
80
What is post herpetic neuralgia
- constant burning sensation in dermatomal distribution
- resolves within 2 months for 50% of people
- can persist for up to two years
- suicide risk
- after previous episode of shingles
- incidence reduced by antiviral therapy and additionally steroids
- treatment
- antidepressants
- unrelenting pain has psychological impact
- gabapentin
- carbamazepine
- topical capsaicin
- TENS
81
What is trigeminal neuralgia?
- electric shock feeling
- not constant
- suicide risk due to pain
- most common in maxillary and mandibular branches
- triggers include shaving, smiling, biting into something, touching face
- consider causes (especially for younger people)
- multiple sclerosis
- space occupying lesion
- medical management
- carbamazepine (bloods required for liver function)
- oxcarbazepine
- gabapentin
- pregabalin
- lamotrigine
- sodium valproate
- phenytoin
- peripheral surgical management
- cryotherapy
- to freeze nerve
- injection of alcohol or glycerol
- to cause nerve damage
- neurectomy
- avulsion of nerve
- ganglion surgical management
- balloon compression
- moves surrounding structures away
- radio frequency thermocoagulation
- alcohol or glycerol injection
- microvascular decompression
- gamma knife radiosurgery
82
What is burning mouth syndrome?
- burning sensation
- all over or on tongue
- feels like mouth is on fire
- distressing
- may be linked to anxiety and depression
- sometimes no cause
- signalling problem between mouth and brain
- can be parafunctional
- grinding
- rubbing tongue
- check bloods and provide antifungals
- can lead to malnutrition
- slow recovery
- reduced quality of life
- anti-stress techniques useful
- tricyclics can be used
- must be aware of medication side effect of xerostomia
83
How may oral cancer appear in the mouth?
- exophytic
- heaped up margins
- ulcerated base
- speckled
84
How may oral cancer appear in the mouth?
- exophytic
- heaped up margins
- ulcerated base
- speckled
85
Why is caring for smiles an important programme for elderly
- good oral health improves overall health, nutrition, quality of life, communication and appearance
- number of older people, including dependent older people is increasing
- more older people retaining their natural teeth
- poor oral care has a detrimental impact on nutrition and hydration
- adults in care homes may have pre-existing oral problems
- dependent older people cannot always perform their own oral care
