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How To Clean a Denture Animation - Mouth Care Matters (HEE, 2020)

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NHS England Workforce, Training and Education

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How To Clean a Denture Animation - Mouth Care Matters

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Cleaning Removable Partial and Denture Appliances (MATCHEALTH, 2012)

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Cleaning Removable Partial and Denture Appliances

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Oral pathological changes from Medications and Disease

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Oral pathological changes from Medications and Disease

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Oral Physiological changes from natural Aging

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Oral Physiological changes from natural Aging

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- Tooth wear from long-term use
- Loss of muscle tone in mastication
- Increased bone loss and Periodontitis as we age
- Thinning of oral epithelium, and more
(Bowen & Pieren, 2019;CDHA, n.d.a)

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Myth Buster: Reduced Salivary flow is NOT a part of normal aging

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Myth Buster: Reduced Salivary flow is NOT a part of normal aging

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Many older adults suffer from xerostomia (dry mouth) but this does not mean reduced salivary flow is a normal part of aging like reduced epithelium thickness, hearing loss and vision loss are. Rather, research shows that reduced salivary flow is caused by pathological changes related to disease or medications. "The major risk factor for dry mouth is the taking of particular medications, and older people take more of those than any other age group, not only for symptomatic relief of various age-associated chronic diseases, but also in order to reduce the likelihood of complications which may arise from those conditions" (Thompson, 2015). Overall, the more medications someone takes, the greater the anticholinergic burden is which related to the severity and likelihood that someone will suffer from dry mouth. Most importantly, it is critical that dental health professionals do not overlook xerostomia in older adults and ensure that they properly identify and treat the cause as they would with younger clients. (Bowen & Pieren, 2019;Thomson, 2015)

TREATMENT OPTIONS FOR XEROSTOMIA IN AGED ADULTS:

• "Daily and thorough brushing with fluoride dentifrice and thorough interproximal plaque removal through flossing and/or use of interdental aids
• Use of fluoride rinses, gel, or paste depending on patients’ preferences and providers’ judgment
• Frequent use of salivary substitute and dry mouth products
• Nutritional counseling
• Antimicrobial use (e.g., 0.12% chlorhexidine mouth rinses)
• Use of amorphous calcium and phosphate pastes
• Frequent professional debridement
• Frequent professional application of topical fluoride
• Use of xylitol-containing products" (Bowen & Pieren, 2019, p. 777).

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Dental decay (caries, "cavities") occurs when oral bacterial biofilm ("plaque") is not brushed away, allowing the acidic by-products of these colonies to demineralize the tooth structure. The severity of dental decay is related to the area it is found and the depth of the cavitation. (Bowen & Pieren, 2021). For older adults, the risk for developing caries increases for the following reasons:
- Reduced chewing ability and efficiency
The loss of chewing muscle tone, tooth structure, challenges associated with dentures, and tooth loss can make chewing foods more difficult for the older client. This can lead to food being retained on the teeth in areas, allowing for longer acid-attacks on the tooth structures. This can also be compounded when older clients also suffer from xerostomia. Likewise, it is more likely that older adults will consume softer or liquified foods which tend to be more cariogenic and less saliva-stimulating. (Bowen & Pieren, 2019).
- Increased root exposure related to ginigval recession/bone loss in periodontitis
Age is a risk factor for periodontitis. That being said, the loss of the periodontium with periodontitis leads to exposed root surfaces that are not covered by enamel. Acids may penetrate these susceptible root surfaces much easier than enamel surfaces. (Bowen & Pieren, 2019).
- Visual and motor decline in oral self-care ability
The loss of motor and visual ability is related to age,  and may be worsened by disease and medications. Dental Hygienists must assess an older individual's ability to perform adequate self care at home, as not doing so could result in undisturbed biofilm deposits consistently being missed. Regular hygiene instruction, the introduction of mobility-focused oral self care aids, and caregiver instruction all ways that Dental Hygienists can individualize OSCI care for older adults affected by motor/visual impairment. (Bowen & Pieren, 2019)
- Access to dental care benefits decreases and reliance on caregivers
In Canada, access to adequate oral care is more difficult for older adults in general, as they are more likely to live in long term care homes, have reduced mobility, or may have less ability to pay for dental services than they did when they were younger. Government programs are available to help offset these burdens to older adults but the access is still limited. Overall this can lead to an increased caries risk as routine dental hygiene care and caregiver availability and/or skill are lacking in this demographic (CDHA, 2021)

"Fluoride varnish has been shown to be an effective caries-preventive agent for coronal and root caries in the elderly" (Bowen & Pieren, 2019, p. 776).

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Myth Buster: The Characteristics of Age should be based on one's FUNCTIONAL ABILITY and not their chronological age

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Myth Buster: The Characteristics of Age should be based on one's FUNCTIONAL ABILITY and not their chronological age

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When provide evidence-based, individualized care to seniors, clinicians must asses their functional ability when care planning rather than assuming "all 85-year-olds are unable to c-method floss" or otherwise. Seniors are actually MORE likely to adhere to oral hygiene self care than younger adults, and have a great response when given new oral self care instruction. This is why care planning must be individualized for a seniors functional ability rather than chronological age as not doing so leads to ethical and legal issues of discriminatory care. (Bowen & Pieren, 2019).

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OPINION: "While retention of natural teeth in older adults is very positive, this does bring the challenges of managing chronic dental diseases including caries, periodontitis and tooth wear into old age" (McKenna et. al, 2021)

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OPINION: "While retention of natural teeth in older adults is very positive, this does bring the challenges of managing chronic dental diseases including caries, periodontitis and tooth wear into old age" (McKenna et. al, 2021)

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CONFIRM

1. The diversity of the client

2. The client's attitudes surrounding the importance of their teeth, and the ultimate fate of their natural dentition

3. Confirm any assumptions that you or other healthcare providers may have about the aged client, before acting on them

AVOID

X Talking over the senior client.

X Addressing them on a first name basis. (Use Mr. ___ or Ms. ____ instead until they instruct you otherwise)

X Assuming the client is not capable of learning new tasks. (Assuming this for all senior clients is patronizing and discriminatory)

(Bowen & Pieren, 2020)

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ENAMEL CHANGES:
- Darkened tooth shade. This occurs after a lifetime of consuming stain-producing foods as well as years of secondary dentin production that lays down a darker shade of dentin that shadows the enamel appearance.
- Translucent appearance of Enamel
- Acquired Lamellae - enamel surface cracks become more numerous
- Brownish-black discolouration in areas of arrested dental caries due to a "lifelong uptake of stain in enamel lamellae" (Bowen & Pieren, 2019, p. 775)

CEMENTUM CHANGES
- Increased Fluoride and Magnesium content.
- Cementum deposition at tooth apices and bifurcated root areas. This occurs slowly throughout life to compensate for occlusal tooth wear.

DENTIN CHANGES
- Secondary dentin formation
- Dentinal Tubule obturation (dentin sclerosis) resulting in loss of dentin vitality, sensitivity and overall permeability.

PULP CHANGES
- Decreased blood supply and cells, like other body tissues in aged adults
- Increased pulpal fibers
- Reduced pulp chamber size as a result in increased pulp calcification

Erosion, Abrasion and Occlusal Wear
- A lifetime of acidic food/drink consumption, as well as acid reflux, is why eroded teeth are common and expected in aged individuals.
- Similarly, a lifetime of using harder-bristled toothbrushes with the 'scrub-brushing' technique results in physicochemical abrasion of the enamel and exposed root surfaces.
- Lastly, occlusal wear from a lifetime of chewing is expected, and sometimes the dentin becomes visible or even exposed in aged adults. Hygienists must be careful not to heavily instrument the occlusal grooves on teeth with severe attrition.
(Bowen & Pieren, 2019)

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FUN FACT: "In those 65 years and older, edentulousness declined from approximately 50% in 1960 to 24% in 2002, to 18% in 2012" (Bowen & Pieren, 2019, p. 776).

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FUN FACT: "In those 65 years and older, edentulousness declined from approximately 50% in 1960 to 24% in 2002, to 18% in 2012" (Bowen & Pieren, 2019, p. 776).

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This is due to a change in dental philosophy (to restore rather than extract), as well as global changes in beauty standards and advances in technology. However, "Tooth loss is greater among those in poverty: 34% of older adults living below the poverty line are edentulous, as compared with 13% of their peers above the poverty line" (Bowen & Pieren, 2019, p. 776).

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Age alone does not indicate the progression of periodontitis when risk factors are controlled (such as blood sugar control for diabetics, smoking cessation, regular SRPs and diligent home care, etc). However, in elderly patients, "the cumulative effect of prolonged microbial challenges contributes to the aging of the periodontium and the greater susceptibility and presence of periodontal disease" (Bowen & Pieren, 2019, p 777). In other words, an elderly person's risk of periodontitis is not due to their age alone. Instead, the risk of periodontitis relates to their increased likelihood of having a gingival recession, attachment loss and higher systemic inflammation from a lifetime of bacterial and inflammatory challenges on their oral tissues. Likewise, bone loss associated with osteoporosis and other age-associated diseases can increase the progression of periodontal disease (Bowen & Pieren, 2019).

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In older clients, their tongues may change in the following ways:
- decreased or atrophied filiform papillae
- decreased sensitivity of remaining papillae
- change in food tastes/appeal
- Presence of sublingual varicosities ('Caviar tongue') which are related to varicose veins but appear as dark black, red or blueish dilated vessels on the floor of the mouth and ventral surface of the tongue. (Bowen & Pieren, 2019)

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Atrophic Glossitis seen in iron-deficiency anemia

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Atrophic Glossitis seen in iron-deficiency anemia

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APA citation list for Padlet diverse communities 