Oral Health of the Elderly Flashcards
Today the Elderly equals ____
Their health care costs equals _____
___ million people
13 % of US popl
36 %
31 million people
Socioeconomic Considerations
*Life expectancy is greater for ___ of all ages.
*Women outlive men ___ years
*Number about ___ million by __
*___% of older adults live in the community
*___% (85 +) living in nursing homes
Socioeconomic Considerations
*Life expectancy is greater for women of all ages.
*Women outlive men 7-8 years
*Number about 37 million by 2030.
*85% of older adults live in the community
*15% (85 +) living in nursing homes
Implications for Dentistry
*___ go to the dentist more than___
*Nearly ___ as many teeth are projected to be at___ for dental disease in 2030 as were in 1972.
*More primary __ ___ and __ ___ will be required.
___ and___ needs will increase.
Implications for Dentistry
*Women go to the dentist more than men
*Nearly twice as many teeth are projected to be at risk for dental disease in 2030 as were in 1972.
*More primary oral health and preventive services will be required.
*Periodontal and prosthodontic needs will increase.
*Higher levels of___ and ___ will result in the elderly seeking __ ___ throughout their lives.
*More will ___ their teeth and a higher risk for ___ caries with increasing age may predict the need for more ___ dental care as our population ages.
*Incidence of edentulism is ____g in age 65+
*US=___%
*Texas=___%
Expectations of the Elderly
*Higher levels of income and education will result in the elderly seeking dental services throughout their lives.
*More will retain their teeth and a higher risk for root caries with increasing age may predict the need for more complex dental care as our population ages.
*Incidence of edentulism is declining in age 65+
*US=20.5%
*Texas=16.8%
*Dentists’ Attitudes
*The demand for geriatric care will far ___ the number of dentists currently willing and able to provide such care.
*__ ___ DDS retirement will reduce the number of dentists.
*The demand for geriatric care will far exceed the number of dentists currently willing and able to provide such care.
*Baby boom DDS retirement will reduce the number of dentists.
Institutionalized Elderly
Institutionalized Elderly
*In the United States, there are an estimated ____ million nursing home beds.
*While __% of those 65 to 74 years lived in a nursing home in 1990, __ in ___ aged 85 or older did.
*___% of these residents are over age 65.
*A report by the U.S. General Accounting Office estimated that ___ % of all Americans age 65+* will reside in a nursing home at some time in their life.
*In addition, long-term care residents are less likely to have ___ to comprehensive dental care.
*Majority have __ ___
Institutionalized Elderly
*In the United States, there are an estimated 1.8 million nursing home beds.
*While 1% of those 65 to 74 years lived in a nursing home in 1990 one in 4 aged 85 or older did.
*80% of these residents are over age 65.
*A report by the U.S. General Accounting Office estimated that 43% of all Americans age 65+* will reside in a nursing home at some time in their life.
*In addition, long-term care residents are less likely to have access to comprehensive dental care.
*Majority have dental needs
Instit Elderly
The Geriatric Dental Patient
The Geriatric Patient
*Need to understand ____ and state its causes and the relationship of osteoporosis to ___ ___
*Become and observer of changes in oral conditions of the aging patient as they pertain to the:
*__ __
*__
*___
*___
*___
*Know what___ looks like and its effects
*What are the considerations for dental ____ care when planning and conducting appointments for the older patient.
* Know about ___ ___ formation and recommendations for plaque ___ in the elderly.
* What are the considerations of___ and ___ in the elderly.
*Need to understand osteroporosis and state its causes and the relationship of osteoporosis to perio disease .
*Become and observer of the changes to oral conditions of the aging patient as they pertain to the:
*oral mucosa
*lips
*tongue
*teeth
*periodontium
*Know what xerostomia looks like and its effects
*What are the considerations for dental hygiene carewhen planning and conducting appointments for the older patient.
* Know about dental plaque formation and recommendations for plaque removal in the elderly.
* What are the considerations diet and nutrition of in the elderly.
What affects health outcomes?
___ ___s 30%
__ ___ 20%
___ and ___c Factors 40%
___ ___10%
___ : Length of Life
___ : Quality of Life
What affects health outcomes?
Health Behaviors 30%
Clinical Care 20%
Social and Economic Factors 40%
Physical Environment 10%
Mortality: Length of Life
Morbidity: Quality of Life
Chronic Illness Sign
Chronic Illness Significance
*Almost ___ercent of the elderly have at least one chronic illness
*About ___ percent have at least two chronic illnesses
*lead to severe and immediate disabilities, such as __ __s and ___
*progressive disability that slowly erodes the ability to care for ___
*___% need help bathing, dressing, eating and toileting
Chronic Illness Significance
*Almost 75 percent of the elderly have at least one chronic illness
*About 50 percent have at least two chronic illnesses
*lead to severe and immediate disabilities, such as hip fractures and stroke
*progressive disability that slowly erodes the ability to care for themselves
*14% need help bathing, dressing, eating and toileting
Circulatory Disease
*Categories
*High ___ __ – 73 million
*___ heart disease – 18 million
*___ – 6.5 million
*____failure – 6 million: Accum of fluid in air sacs in lungs
*___ pectoris – 8 million
*__ ___ __e (PVD)
*__ __ ___s (DVT): Swelling below the blockage site
*___ are at greater risk after 65
*__ __ of all ages are at risk
*Beginning medications reduces risk by ___
Circulatory Disease
*Categories
*High blood pressure – 73 million
*Coronary heart disease – 18 million
*Stroke – 6.5 million
*Heart failure – 6 million: Accum of fluid in air sacs in lungs
*Angina pectoris – 8 million
*Peripheral Vascular Disease (PVD)
*Deep Vein Thrombosis (DVT): Swelling below the blockage site
*Women are at greater risk after 65
*African-Americans of all ages are at risk
*Beginning medications reduces risk by 1/3rd
Cardio Disease
Cardiovascular Disease
*Reduce patient’s risk atherosclerotic cardiovascular disease
*moderate to severe___
*receive ____ and possible treatment
*Collaboration with physicians
*reduce ____
*a target factor for cardiovascular disease
*75 % of adults in the United States have been affected by ___ ___
*estimated 80.7 million adults (____/_____) have been a victim of ___ in 2011
*Women ___ men to see dentist in past 6 months
*Women have ___ periodontal health indicators
Cardiovascular Disease
*Reduce patient’s risk atherosclerotic cardiovascular disease
*moderate to severe periodontitis
*receive evaluation and possible
treatment
*Collaboration with physicians
*reduce inflammation
*a target factor for cardiovascular disease
*75 % of adults in the United States have been affected by periodontal disease
*estimated 80.7 million adults (1 out of every 3) have been a victim of CVD in 2011
*Women 2x men to see dentist in past 6 months
*Women have better periodontal health indicators
Cerebral Disorders
Cerebral Disorders
*CVA – usually ____ in elderly
*____ leading cause of death in US (7%)
*____new strokes each year
*A__ ___ and ____at greatest risk
*___ deaths/year
*_/__ of all stokes occur in age 65+
*Risk Factors
*Chronic ____
*___
*____
*Tobacco use
*____ disease
*___
*___
*Elevated ___ & ___
*___ Use
*___
Cerebral Disorders
*CVA – usually ischemic in elderly
*Third leading cause of death in US (7%)
*730,000 new strokes each year
*African American Women at greatest risk
*160,000 deaths/year
*2/3 of all stokes occur in age 65+
*Risk Factors
*Chronic hypertension
*Atherosclerosis
*Smoking
*Tobacco use
*Heart disease
*Diabetes
*Inactivity
*Elevated cholesterol & lipids
*Alcohol Use
*Obesity
Stroke Impairments
*___ control and coordination
*___
*____
*Decrease in____ tone of affected side
*___ deficits such as confusion
*___disturbances or perceptions
*Communication deficits (word +_____g)
*Changes in the f____l muscles, movement or sensory problems due to dysphasia or numbness.
*Dentures may no longer __ ___→discomfort, pain
*Reduced __ ___ → dry mouth may result
*Reduced ability to ___ or ___ → poor nutrition→ poor health
*____ therapy → dry mouth
*_____s → dry mouth is a side effect of ___% of drugs, some contain sugar=decay
*Food ____ in mouth → needs total oral care assistance
Stroke Impairments
*Motor control and coordination
*Dysphagia
*Dysarthria
*Decrease in muscle tone of affected side
*Cognitive deficits such as confusion
*Visual disturbances or perceptions
*Communication deficits (word-finding)
*Changes in the facial muscles, movement or sensory problems due to dysphasia or numbness.
*Dentures may no longer stay in →discomfort, pain
*Reduced fluid intake → dry mouth may result
*Reduced ability to chew or swallow→ poor nutrition→ poor health
*Oxygen therapy → dry mouth
*Medications → dry mouth is a side effect of 85% of drugs, some contain sugar=decay
*Food remains in mouth → needs total oral care assistance
Stroke Impairments
*Dentures may no longer stay in →discomfort, pain
*Reduced fluid intake → dry mouth may result
*Reduced ability to chew or swallow→ poor nutrition→ poor health
*Oxygen therapy → dry mouth
*Medications → dry mouth is a side effect of 85% of drugs, some contain sugar=decay
*Food remains in mouth → needs total oral care assistance
*
*Dentures may no longer stay in →discomfort, pain
*Reduced fluid intake → dry mouth may result
*Reduced ability to chew or swallow→ poor nutrition→ poor health
*Oxygen therapy → dry mouth
*Medications → dry mouth is a side effect of 85% of drugs, some contain sugar=decay
*Food remains in mouth → needs total oral care assistance
*
Diabetes
Diabetes
*Affects approximately __ in ___ Americans age 60 and older
*The number of adults age 75+ with an increase from about __ million in 2000 to more than __ million in 2050
*____ of patients 60+
*___ million are undiagnosed
*__% of diabetic patients with severe periodontal disease have experienced one or more major ___, ____ or ___ vascular events when compared to only __ % of diabetics without periodontal disease (Mealey 2006)
*Uncontrolled diabetics exhibit higher levels of ____ that can degrade ___ ___ (Ryan 2003, Salvi 1997)
*Periodontal disease results in higher ___-inflammatory cytokine _____that causes insulin ____. (Grossi 1998)
Diabetes
*Affects approximately one in four Americans age 60 and older
*The number of adults age 75+ with an increase from about 1 million in 2000 to more than 4 million in 2050
*23.1% of patients 60+
*5.7 million are undiagnosed
*82% of diabetic patients with severe periodontal disease have experienced one or more major cardiovascular, cerebrovascular or peripheral vascular events when compared to only 21% of diabetics without periodontal disease (Mealey 2006)
*Uncontrolled diabetics exhibit higher levels of collagenase that can degrade periodontal tissues. (Ryan 2003, Salvi 1997)
*Periodontal disease results in higher pro-inflammatory cytokine TNFalpha that causes insulin resistance. (Grossi 1998)
Oral Conditions
____Mouth
*Can result from medications
___l Infections
*High __ ___r levels or taking____
*Poor ___
*Poor ___ increases chance of ___ after dental surgery
Oral Conditions
*Dry Mouth
*Can result from medications
*Fungal Infections
*High blood sugar levels or taking antibiotics
*Poor Healing
*Poor control increases chance of infection after dental surgery
Mental Disorders
Mental Disorders
__ in ___ have mental disorder
___ largest Category
*Anxiety
*ASD (__ ___ Disorder)
*___phobia/___l Phobia/___ Phobia
*OCD (__ ___e Disorder)
*PTSD (__ __ __s Disorder)
*GAD (__ ___y Disorder)
*Childhood disorders
*___
*Mood - Major ___ and ___ar Disorder (Manic/Depressive)
*Psychoses
* Personality Disorders – ____, _____, schizoaffective (combo)
*Schizophrenia – delusions/hallucinations
*Substance Related – work, sex, gambling, caffeine, nicotine, food, eating, drugs, alcohol
Mental Disorders
1 in 4 have mental disorder
2nd largest Category
*Anxiety
*ASD (Acute Stress Disorder)
*Agoraphobia/Social Phobia/Simple Phobia
*OCD (Obsessive Compulsive Disorder)
*PTSD (Post Traumatic Stress Disorder)
*GAD (General Anxiety Disorder)
*Childhood disorders
*Tourette’s
*Mood - Major Depression and Bipolar Disorder (Manic/Depressive)
*Psychoses
* Personality Disorders – schizoid, narcissistic, schizoaffective (combo)
*Schizophrenia – ____/hallucinations
*____ Related – work, sex, gambling, caffeine, nicotine, food, eating, drugs, alcohol
Dental Implications
*____ brushing
*___ at teeth
*May do __ oral care
*May not ___ treatment
*May +___ your office
*Lot of the ___ cause side effects – xerostomia
*Dyskinesia and dystonia - abnormal ____s (dentures are difficult)
* Sometimes behavior is ___
Dental Implications
*Over brushing
*Picking at teeth
*May do no oral care
*May not accept treatment
*May upset your office
*Lot of the meds cause side effects – xerostomia
*Dyskinesia and dystonia - abnormal movements (dentures are difficult)
* Sometimes behavior is unusual
Cognition and other age related dementias
Cognition and Other Age Related Dementias
*Symptoms of :
*Rapidly ___ memory
*Dis___
*____
*Difficulty___ thoughts
*Paranoid suspicion about her ___ and the ___ ___
*Cause – death of___ ___s in brain
*2007 there were ___ million cases
*Management - home health/community-> adult day care ->facility
*Symptoms of :
*Rapidly failing memory
*Disorientation
*Confusion
*Difficulty expressing thoughts
*Paranoid suspicion about her family and the hospital staff
*Cause – death of neuronal cells in brain
*2007 there were 5.1 million cases
*Management - home health/community-> adult day care ->facility
Dental Considerations
Dental Considerations
*Cost -is ___ that of non-dementia
*2005 – cost was ______
*Dental Management
*____
____ appointments
*___
*Focus on p____
*Acknowledge ___
*Decide what is ___
Dental Considerations
*Cost -is 3X that of non-dementia
*2005 – cost was $300 billion
*Dental Management
*Uncooperative
*Morning appointments
*Sedation
*Focus on preventive
*Acknowledge caregiver
*Decide what is maintainable
Tests to help diagnose
Tests to Help Diagnose
___ ___ Scale
___ ____ Test
___ ___ ____ exam
*____ testing for substance abuse
Tests to Help Diagnose
*Geriatric Depression Scale
*Clock Drawing Test
*Mini-mental state exam
*CAGE testing for substance abuse
Cancer
Cancer
*Primarily a disease of those passed ___
*Treatment has extreme oral side effects that affect ability to eat
*___
*____
*Complications of ___ amd ____y must be taken into consideration before dental treatment
Cancer
*Primarily a disease of those passed 65
*Treatment has extreme oral side effects that affect ability to eat
*Mucositis
*Candidiasis
*Complications of radiation and chemotherapy must be taken into consideration before dental treatment
Resp Diseases
Respiratory Diseases
*COPD – ___ ____ ____ disease
*Chronic ____
____
____
*90% caused by ___
*Air pollution
*Symptoms
*___ and ____
*Severely restricts ___
*Irreversible damage
*Medications
___
___ ___
*COPD – chronic obstructive lung disease
*Chronic bronchitis
*Emphysema
*Asthma
*90% caused by smoking
*Air pollution
*Symptoms
*Cough and breathlessness
*Severely restricts movement
*Irreversible damage
*Medications
*Bronchodilators
* Steroid inhalers
33
Dental Management of Resp Diseases
Dental Management of Respiratory Diseases
COPD
*URI - __ __ ___
*____ positioning
*Avoid __ ___ in severe cases
*Pulse oximetry (if pulse ox <91%, use low flow ____L/min)
*Avoid __ ___/o___n in severe cases
*Avoid___, ___, ___, ___
*___ supplementation ???
*Drug interactions with COPD medication
Dental Management of Respiratory Diseases
COPD
*URI - do not treat
*Upright positioning
*Avoid rubber dam in severe cases
*Pulse oximetry (if pulse ox <91%, use low flow 2-3L/min)
*Avoid Nitrous oxide/oxygen in severe cases
*Avoid barbiturates, narcotics, antihistamines, and anticholinergics
*Steroid supplementation ???
*Drug interactions with COPD medication
ASTHMA Dental Management
ASTHMA
*Avoid ____ actors
*Bring ___r for each appointment
*Avoid ___, ___, ___, ____
*Drug interactions -asthmatic medications (ex. Theophylline vs. Antibiotics, Cimetidine)
*Steroid supplementation ???
*For sedation,____/___ and/or small doses of oral ____ is recommended
Dental Management of Respiratory Diseases
ASTHMA
*Avoid precipitating factors
*Bring inhaler for each appointment
*Avoid ASA, NSAIDs, barbiturates, and narcotics
*Drug interactions -asthmatic medications (ex. Theophylline vs. Antibiotics, Cimetidine)
*Steroid supplementation ???
*For sedation, nitrous oxide/oxygen and/or small doses of oral diazepam is recommended
Musculoskeletal Disease
Musculoskeletal Disease
___
____s
____
____
*Over 100 others
* ___t Pain
* Tenderness and inflammation
* CRP=C-Reactive Protein
* Produced in the ___ during acute inflammation/ infection
* Loss of ____ of Motion
* ___
* Joint Deformity
* Overweight, Fatigue
* Unexplained ___
Musculoskeletal Disease
*Arthritis
*Osteoarthritis
*Rheumatoid
*Gout
*Over 100 others
* Joint Pain
* Tenderness and inflammation
* CRP=C-Reactive Protein
* Produced in the liver during acute inflammation/ infection
* Loss of Range of Motion
* Stiffness
* Joint Deformity
* Overweight, Fatigue
* Unexplained fever
Osteoarthritis
Osteoarthritis
*____ and ___ ___ - slightly better than placebo
*____’s med of choice
*Affect joint cartilage ____
*Greater risk of ___
*Can cause ___ bleeding
*Peptic ___ aggravation
*Leading cause of ____
*Affects___ million
*Severely limits ability to perform___ ___ ___
*Glucosamine and Chondroitin sulfate - slightly better than placebo
*NSAID’s med of choice
*Affect joint cartilage metabolism
*Greater risk of toxicity
*Can cause GI bleeding
*Peptic ulcer aggravation
*Leading cause of disability
*Affects 8 million
*Severely limits ability to perform Activities of Daily Living (ADL’s
Implications for Dental Treatment
Rheumatoid
Implications for Dental Treatment
Rheumatoid
___ ____ Treatment
*Self-reported rheumatoid arthritis prevalence was 3.95%
*Patients not referred for periodontal treatment (0.66 % )
*Reported in the general population (1.0%).
*Of those referred patients with rheumatoid arthritis - 62.5%
____ orms of periodontal disease
* Self-reported prevalence of___ ___
___ ___
*Conclusions (based on data derived from self-reported health conditions) conclude that there is good evidence to suggest that individuals with moderate to severe ____ disease are at higher risk of suffering from r____ ____ and vice versa.
Implications for Dental Treatment
Rheumatoid
Periodontal Disease Treatment
*Self-reported rheumatoid arthritis prevalence was 3.95%
*Patients not referred for periodontal treatment (0.66 % )
*Reported in the general population (1.0%).
*Of those referred patients with rheumatoid arthritis - 62.5%
* Advanced forms of periodontal disease
* Self-reported prevalence of cardiovascular disease
*Diabetes mellitus
*Conclusions (based on data derived from self-reported health conditions) conclude that there is good evidence to suggest that individuals with moderate to severe periodontal disease are at higher risk of suffering from rheumatoid arthritis and vice versa.
Dental Management
Dental Management
*____ brushing – can the person____ toothbrush
*Toothbrush modifications – check ___ grasp
*Arthritis ____ – implications for treatment especially if they will have pain after appointment
*____ coverage if joint replacement failure
*Do better for ____ appointment – will be more comfortable
Dental Management
*Observe brushing – can the person maneuver toothbrush
*Toothbrush modifications – check finger grasp
*Arthritis medication – implications for treatment especially if they will have pain after appointment
*AB coverage if joint replacement failure
*Do better for afternoon appointment – will be more comfortable
The Aged-Implications for Dentistry
The Aged Implications for Dentistry
*Assess each category of chronic condition
*Know effects for ___ and ___
*Learn __- and ___ given
*Elderly are not __ ___ of status, past disease, medications
*Collaborate with other health care professionals to know your patient’s__ ___
The Aged Implications for Dentistry
*Assess each category of chronic condition
*Know effects for body and mouth
*Learn treatments and medications given
*Elderly are not dependable reporters of status, past disease, medications
*Collaborate with other health care professionals to know your patient’s past history
Competency to Treat
*Must think __ ___y – not just tooth to repair/replace!
*____t everything
*Be aware of __ ___ signs and symptoms
*Not all patients will tell the ___ or ___ correctly
*___ your patient walk, talk, do hands shake, etc.
41
*Must think whole body – not just tooth to repair/replace!
*Document everything
*Be aware of non-verbal signs and symptoms
*Not all patients will tell the truth or remember correctly
*Watch your patient walk, talk, do hands shake, etc.
41
