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1

Today the Elderly  equals ____

Their health care costs equals _____

___ million people

13 % of US popl

36 %

31 million people

2

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

 

3

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.

 

 

4

 

*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%

 

5

*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. 

6

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

 

7

Instit Elderly

8

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. 

9

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

10

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

 

11

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

 

12

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

 

13

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

 

14

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

 

 

15

 

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 

 

*

16

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)

17

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

18

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

19

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

20

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

21

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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

30

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.