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
Q
How can communication be altered to suit a patient with dementia?
A
- 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
Q
What is Caring for Smiles?
A
- 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
Q
What type of tasks do elderly people potentially struggle with?
A
- mobility
- dexterity
- communication
26
Q
What is dementia?
A
- 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
Q
What does dementia affect?
A
- 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
Q
What is dementia characterised by?
A
- amnesia
- inability to concentrate
- disorientation in time, place or person
- intellectual impairment
29
Q
What accompanies the impairment of cognitive function in dementia?
A
- deterioration in:
- emotional control
- social behaviour
- motivation
30
Q
What is Alzheimer’s?
A
- 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
Q
What factors are associated with the development of Alzheimer’s?
A
- 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
- increased risk
- genetic
- abnormalities on chromosomes 1, 14 or 21
32
Q
What is vascular dementia?
A
- 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
- small vessel disease
- distinctive features
- memory problem of sudden onset
- visuospatial difficulties
- anxiety
- delusions
- seizures
33
Q
What is dementia with lewy bodies?
A
- 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
Q
What is frontotemporal dementia?
A
- 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
Q
What are the rarer forms of dementia?
A
- HIV
- Parkinson’s disease
- corticobasal degeneration
- multiple sclerosis
- Niemann-Pick disease
- Creutzfeldt-Jakob disease
36
Q
What are the risk factors for dementia?
A
- age
- gender
- genetic background
- medical history
- lifestyle
37
Q
What are the risk factors for dementia?
A
- age
- gender
- genetic background
- medical history
- lifestyle
38
Q
What are the early stage symptoms of dementia?
A
- 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
Q
What are the middle stage symptoms of dementia?
A
- 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
Q
What are the late stage symptoms of dementia?
A
- 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
Q
How is dementia diagnosed and how is progression measured?
A
- MMSE
- mini mental state exam
- demential screen
- eliminated treatable causes
- FBC, U&E, kidney/liver/thyroid function
- glucose, serum B12, urinalysis
42
Q
How is dementia diagnosed and how is progression measured?
A
- MMSE
- mini mental state exam
- demential screen
- eliminated treatable causes
- FBC, U&E, kidney/liver/thyroid function
- glucose, serum B12, urinalysis
43
Q
What is a mini mental state exam (MMSE)
A
- tests attention, recall, language ability, ability to follow commands
44
Q
What cognitive tests are available for dementia?
A
- MMSE
- Blessed dementia scalre
- Montreal Cognitive Assessment
- single/combined neuropsychological tests
45
Q
What treatment is available for dementia?
A
- 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
Q
What adaptations can be made to make a care home dementia friendly?
A
- 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
Q
What adaptions can be made to make healthcare enviroments dementia friendly?
A
- 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
Q
What is frailty?
A
- 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
Q
What is frailty phenotype?
A
- 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
Q
What is Lockwood frailty?
A
- accumulation of deficits that are associated with ageing
- addition of number of deficits to create frailty index
51
Q
What is oral health related quality of life?
A
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
Q
What is the sequence of biological ageing?
A
- continuation of adult life
- reduced function, no support required
- some support required
- dependency
53
Q
What factors can be measured to determine oral health related quality of life?
A
- chewing
- eating
- social contacts
- appearance
- pain
- worry
- self-consciousness
- happiness
- social life
- relationships
- functional limitation
- psychological discomfort
- physical disability
- psychological disability
- social disability
54
Q
How are number of teeth and occluding pairs seen to affect oral health related quality of life?
A
- increased number of teeth and occluding pairs is positively associated with oral health related quality of life
55
Q
What barriers exist to an oral care model for older people?
A
- integrated work between health and social care
- mutual decisions improve outcomes
- nominated care lead
- sharing in planning interventions and flexibility
56
Q
What is a haemangioma?
A
- 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
Q
What is a fibroepithelial polyp?
A
- 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
Q
What is black hairy tongue?
A
- 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
Q
What is geographic tongue?
A
- 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
Q
What isa tropic glossitis?
A
- 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
Q
What is frictional keratosis?
A
- white patch as a result of trauma
- keratinisation in area
- look for traumatic cause (sharp tooth or restoration)
- review for healing
62
Q
What is speckled leukoplakia?
A
- 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
Q
What is sublingual keratosis?
A
- 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
- always check high risk sights
- if crosses midline of tongue requires referral to oral medicine
64
Q
What is traumatic keratosis
A
- denture related frictional keratosis
- keratosis in response to long wear of dentures
- ill fitting so move about
65
Q
What is denture induced hyperplasia?
A
- 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
Q
What is denture stomatitis
A
- 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
Q
What is denture stomatitis
A
- 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
Q
What is angular cheilitis?
A
- 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
Q
What is xerostomia?
A
- dry mouth
- causes
- polypharmacy
- Sjögren’s syndrome
- radiotherapy
- uncomfortable
- sticky
- fissures seen in long term cases
69
Q
How is xerostomia managed?
A
- 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
- chewing gum
70
Q
What topical drug reactions can be observed orally?
A
- 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
Q
What are lichen plans and lichenoid tissue reactions?
A
- mucocutaneous disorder
- lichenoid reactions more common
- look like lichen plants
- not autoimmune
- due to drug or material (e.g. amalgam)
- lichenoid reactions more common
- 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
Q
Why are bisphosphonates challenging for dental extractions?
A
- bisphosphonates incorporated into skeleton to inhibit bone turnover
- no repair of micro damage
- anti-angiogenic
- cancellous bone broken during extraction does not heal
73
Q
What are the risk factors for MRONJ?
A
- 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
Q
What is the maximum length of time on bisphosphonates?
A
3 years
75
Q
Why is MRONJ more common in the mandible?
A
- maxilla attached to skull base
- access to more blood vessels
76
Q
What is the process of MRONJ?
A
- bone dies
- sequestrate of bone
- fragments make their way to surface of gingiva
- gingiva does not heal
- area must be kept very clean
77
Q
What advice should be given to patients taking MRONJ?
A
- 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
Q
How are bisphosphonates taken?
A
- once weekly
- taken with lots of water
- sitting up straight for 30 minutes
- can burn otherwise
79
Q
What is herpes zoster?
A
- 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
Q
What is post herpetic neuralgia
A
- 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
- antidepressants
81
Q
What is trigeminal neuralgia?
A
- 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
- cryotherapy
- ganglion surgical management
- balloon compression
- moves surrounding structures away - radio frequency thermocoagulation
- alcohol or glycerol injection
- microvascular decompression
- gamma knife radiosurgery
- balloon compression
82
Q
What is burning mouth syndrome?
A
- 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
Q
How may oral cancer appear in the mouth?
A
- exophytic
- heaped up margins
- ulcerated base
- speckled
84
Q
How may oral cancer appear in the mouth?
A
- exophytic
- heaped up margins
- ulcerated base
- speckled
85
Q
Why is caring for smiles an important programme for elderly
A
- 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
