Oral Health Needs of the Older Client by Sydney Urion

Geriatrics & Gerontology

sydneyurion73 — 2024-02-17 17:06:53 UTC

Geriatrics: the branch on medicine concerned with illness of old age and treatment.

Gerontology: scientific study of the factors affecting the normal aging process and effects of aging.

Chronologic age: the age as measured by calendar time since birth

Functional age: the age based on capabilities to maintain activities

It is important to note this terms are not interchangeable.

(Bowen. M. D., Pieren. A. J. 2020)

Other Important Terms

sydneyurion73 — 2024-02-17 17:13:31 UTC

Chronologic age: the age as measured by calendar time since birth

Functional age: the age based on capabilities to maintain activities

(Bowen. M. D., Pieren. A. J. 2020)

Disengagement Theory

sydneyurion73 — 2024-02-17 17:16:00 UTC

Aging individuals in society gradually with-drawl from socializing with others (friends or family) for mutual benefit.

This theory is underdetermined by recognizing that each aging individual has a different aging process.

As dental hygienists we need to understand how this affects a persons behaviour within society. For example, how they react to conflict. Are they aggressive? Are they rude? How can we best facilitate this client?

(Bowen. M. D., Pieren. A. J. 2020)

Active Theory

sydneyurion73 — 2024-02-17 17:20:56 UTC

Maintaining norms of middle aged. For example, employment, activity, relationships. Losses for these individuals may create problems and barriers for maintaining these things in life.

As dental hygienists we need to encourage and motivate this types of client to seek support systems.

(Bowen. M. D., Pieren. A. J. 2020)

Continuity Theory

sydneyurion73 — 2024-02-17 17:27:27 UTC

The aging of a person depends on their psychological making up and their habits. The person's ability to continue social roles.

As dental hygienists we want to encourage the client's oral wellness and educate them or proper oral self care.

(Bowen. M. D., Pieren. A. J. 2020)

Tooth Changes

sydneyurion73 — 2024-02-17 17:30:09 UTC

Cementum:

Dentin: obstruction of dentinal tubules (dentin sclerosis). causing the dentin in the tooth to decrease.

Pulp: the pulpal blood supply decreases, number of cells decrease. Pulp calcification also increases with aging and the size of the pulp chamber becomes smaller.

Enamel: Erosion and attrition are very common with age due to habits developed over time. Erosions can be caused by acid on the teeth, this can happen from acid reflux or acidic foods. Attrition can be caused by occlusal force causing wear on the enamel.

(Bowen. M. D., Pieren. A. J. 2020)

On-Site Dental Programs

sydneyurion73 — 2024-02-18 20:04:47 UTC

This could be a dental hygienist coming to a long-term care fatality and providing dental care to seniors who are unable to leave these facilities to receive dental care.

Advantages of these programs include:

Disruption of transportation.
These client are treated in a comfortable environment they are used to . This can help to reduce anxiety.
As a dental hygienist it is important we provide these clients with educational programs, fluoride application, develop individual care plans, make modifications to oral self care aids that best suit the client.
(Bowen. M. D., Pieren. A. J. 2020)

Arthritis

sydneyurion73 — 2024-02-18 20:13:33 UTC

Client Education: Toothbrush handles with larger grips (ex. electric toothbrushes).

DH Considerations: Possible increased bleeding with medications, reduced dexterity, joint discomfort.

(Bowen. M. D., Pieren. A. J. 2019)

Chronic Obstructive Pulmonary Disease

sydneyurion73 — 2024-02-18 20:17:13 UTC

Client Education: Respiratory infection related to oral health

DH Considerations: Management of dyspnea, chair position (upright), contraindications for ultrasonic instrumentation, avoid nitrous oxide.

(Bowen. M. D., Pieren. A. J. 2020)

Diabetes

sydneyurion73 — 2024-02-18 21:03:27 UTC

Client Education: Eating and taking necessary insulin before appointments. Maintaining blood sugar before and after appointments. Educations about risk of periodontal disease and diabetes.

DH Considerations: Risk of hypoglycaemia, Hba1c level under 7, if diabetes is uncontrolled medical clearance is required, may be immunocompromised.

Ischemic Heart Disease, Angina and Myocardial Infarction

sydneyurion73 — 2024-02-18 21:09:15 UTC

Client Education: Nitroglycerin must be brought to every appointment

DH Consideration: Limit use of epinephrine. INR should be 2.0-3.0.

(Bowen. M. D., Pieren. A. J. 2020)

Hypertension

sydneyurion73 — 2024-02-18 21:12:14 UTC

Client Education: Discuss risk factors and importance of medications.

DH Considerations: Always refer to CDHO blood pressure guide. Take BP before every appointment, if needed refer for medical consult. Avoid risks for anxiety and anything that may elevate BP. Diuretic medication may cause client to have to use the restroom often.

(Bowen. M. D., Pieren. A. J. 2020)

Dementia and Alzheimer disease

sydneyurion73 — 2024-02-18 21:13:11 UTC

Client Education: Educate caregiver.

DH Considerations: Possible behavioural problems, decrease in motor skills, fluoride varnish, reduced cooperation.

(Bowen. M. D., Pieren. A. J. 2020)

Osteoporosis

sydneyurion73 — 2024-02-18 21:13:26 UTC

Client Education: Osteonecrosis of the jaw.

DH Considerations: Risk increase for osteonecrosis, complete dental treatment before taking any medications

(Bowen. M. D., Pieren. A. J. 2020)

Parkinson disease

sydneyurion73 — 2024-02-18 21:13:40 UTC

Client Education: Difficulty with fine motor skills (brushing, flossing, etc.). Electric toothbrush is a good recommendation (big handle and does most of the work). Educate caregiver

DH Considerations: Possible involuntary movements can make restorative care difficult.

(Bowen. M. D., Pieren. A. J. 2020)

Stroke

sydneyurion73 — 2024-02-18 21:13:51 UTC

Client Education: Decrease motor skills, educate caregiver.

DH Consideration: Elective care for 6 months after stroke occurs, client may experience confusion and communication barriers, short sessions and chair in upright position.

(Bowen. M. D., Pieren. A. J. 2020)

References

2024-02-21 16:04:45 UTC

Bowen, D. M., & Pieren, J. A. (2020). Darby and Walsh dental hygiene : theory and practice (5th ed.). Elsevier.

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Planning

janellehill4 — 2024-02-21 16:11:21 UTC

Appointment time: short morning appointments are best

Accessibility and transportation to dental office: parking lots, ramps ,and doorways must always accommodate wheelchairs

Legal considerationsMultiple health conditions and drug therapies

Communication with long-term care facilities

(Bowen. M. D., Pieren. A. J. 2020)

Implementation

janellehill4 — 2024-02-21 16:14:09 UTC

As little trauma as possible to gingiva is required

Loss of elasticity of lips and oral mucosa and xerostomia may make retraction of oral tissues uncomfortable

Specific and customized client education should be providedAdvocate for home use of topical fluoride

At end of appointment, slowly return dental chair to upright position

(Bowen. M. D., Pieren. A. J. 2020)

Evaluation

janellehill4 — 2024-02-21 16:15:38 UTC

Older patients need to be reevaluated more frequently and more carefully

Dental hygienists must be aware that health status can change quickly;small changes may be significant

Allow for longer time to assess results of soft-tissue debridement

More frequent maintenance intervals are recommended

(Bowen. M., Pieren. A. J. 2020)

Documentation

janellehill4 — 2024-02-21 16:16:59 UTC

Critical to document ongoing patient progress

Document both active therapy and regular maintenance are

Provide and document informed consent with all older patientsWhen necessary, discuss and document treatment with family and/or caregivers

(Bowen. M. D., Pieren. A. J. 2020)

Xerostomia

2024-02-21 16:30:13 UTC

Xerostomia can be more common in older adults

Many older adults are taking many prescription medications that can cause side effects like xerostomia

Management of xerostomia includes taking saliva supplements, oral lubricants, and candies and gum containing xylitol

People experiencing xerostomia are at a very high risk for caries. It is important to have thorough oral self care, have fluoride treatments, and frequent debridement appointments.

(Bowen. M. D., Pieren. A. J. 2020)