13
Lecture Note PowerPoint Presentation
The Mouth and Oral
Cavity
LEARNING OUTCOME 1
Explain normal changes of aging in the mouth and oral
cavity.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING AND THE MOUTH AND ORAL
CAVITY
The epithelium and soft tissues atrophy
 Reduction in number of taste buds (contain the
receptors for taste)



Reduced saliva production


Hypogeusia: is a reduced ability to taste things
Overly dry oral mucosa
With proper oral hygiene

Teeth and gums appear normal
Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING AND THE MOUTH AND ORAL
CAVITY

Gums recede


Increased vulnerability of teeth below gum line to cavities
Enamel erosion
Stains
 Cavities


Tooth loss and malocclusion
Difficulty eating
 Social isolation

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING ASSOCIATED WITH DIFFICULTY
MAINTAINING ORAL HYGIENE

Potential causes
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Number and condition of dental restorations
Recession (collapse) of gums
Impaired visual acuity
Possible loss of manual dexterity (skill and ease in
using the hands)
Restricted range of motion
Effects of medications on oral cavity
Gerontological Nursing, Second Edition
Patricia A. Tabloski
THOSE WITH THE POOREST ORAL HEALTH
INCLUDE
The economically disadvantaged
 Those lacking insurance
 Racial and ethnic minorities
 Others

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Disabled
Homebound (Restricted or confined to home)
Institutionalized
Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 2
Identify common diseases of older persons in the mouth
and oral cavity.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
COMMON DISEASES OF AGING
RELATING TO THE MOUTH AND ORAL
CAVITY

Increased oral diseases in communities without
fluoridation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
COMMON DISEASES OF AGING
RELATING TO THE MOUTH AND ORAL
CAVITY

30% of adults age 65 and older have no natural
teeth
Regional differences noted
 Impacts multiple areas of life

Nutrition
 Self-esteem
 Speech
 Facial appearance
 Source of halitosis

Gerontological Nursing, Second Edition
Patricia A. Tabloski
COMMON DISEASES OF AGING
RELATING TO THE MOUTH AND ORAL
CAVITY

Periodontal disease (those diseases that affect
one or more of the periodontal tissues, such as
gingiva) and dental caries
The most common cause of tooth loss
 More common in men than women
 Lower socioeconomic levels have more severe disease
forms

Gerontological Nursing, Second Edition
Patricia A. Tabloski
GINGIVITIS AND PERIODONTAL DISEASE
Inflammation of the gums
 Manifestations

Redness
 Swelling
 Bleeding


Results from bacterial colonization at gum
margin
Gerontological Nursing, Second Edition
Patricia A. Tabloski
FIGURE 13-2
GINGIVITIS AND RESULTING GUM EROSION.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
GINGIVITIS AND PERIODONTAL DISEASE

Risk factors
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Smoking
Diabetes
Medications
Poor nutrition
Stress
Illness
Genetic susceptibility
Gerontological Nursing, Second Edition
Patricia A. Tabloski
ORAL AND PHARYNGEAL CANCERS
Primarily diagnosed in older adults
 Carry a poor prognosis
 5-year survival rate

56% white Americans: one of the lowest rates among
all cancers
 34% African-Americans
It is estimated that in the United States approximately
30,000 people are being diagnosed with and 8,000
deaths are occurring annually from oral and
pharyngeal cancer

Gerontological Nursing, Second Edition
Patricia A. Tabloski
ORAL CANCER
Occurs most often in people over age 45
 Symptoms

Sore that does not heal
 Lump on lip or mouth
 White or red patch on gum, tongue, or buccal mucosa
 Unusual bleeding, numbness, or pain

Gerontological Nursing, Second Edition
Patricia A. Tabloski
FIGURE 13-3
POPULATION OVER THE AGE OF 60, WORLDWIDE AND DEVELOPING REGIONS.
SOURCE: CENTERS FOR DISEASE CONTROL, 2001.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
ORAL CANCER

Symptoms

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Feeling of something caught in the throat
Difficulty or pain with chewing or swallowing
Swelling in jaw
Voice changes
Pain in ear
Gerontological Nursing, Second Edition
Patricia A. Tabloski
ORAL CANCER

Risk factors

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Tobacco use
Chronic and heavy alcohol use
Sun exposure to lips
History of leukoplakia
Erythroplakia: is a clinical term used to describe
patches of keratosis . It is visible as adherent white
patches on the mucous membranes of the oral cavity
Gerontological Nursing, Second Edition
Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Affects 25–40% of older Americans
 May be caused by medications
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Antihistamines
Diuretics
Antipsychotics
Antidepressants
Anticholinergics
Chemotherapeutic agents
Antiparkinson drugs
Gerontological Nursing, Second Edition
Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)

Associated with
Dysphagia
 Difficult chewing
 Candidiasis
 Denture slippage


Gum irritation and erosion
Gerontological Nursing, Second Edition
Patricia A. Tabloski
SJOGREN’S SYNDROME

Systematic, autoimmune disorder

Occurs in association with disorders such as
Rheumatoid arthritis
 Systemic lupus erythematosus: is a systemic autoimmune disease
that can affect any part of the body
 Scleroderma:is a chronic systemic autoimmune disease
characterized by fibrosis (or hardening), vascular alterations, and
autoantibodies.
 Polymyositis: many muscle inflammation.


Polyarteritis: a serious blood vessel disease in which small
and medium-sized arteries become swollen and damaged
Gerontological Nursing, Second Edition
Patricia A. Tabloski
SJOGREN’S SYNDROME
Inflammation of epithelial tissue
 Other disorder manifestations include dry eyes,
skin changes, and thyroid disease

Gerontological Nursing, Second Edition
Patricia A. Tabloski
ORAL CANDIDIASIS
Fungal infection
 Caused by Candida albicans
 Managed with antifungal agents
 Risk factors




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Dry mouth
Diabetes
Altered immune response
Use of inhaled steroids
Gerontological Nursing, Second Edition
Patricia A. Tabloski
STOMATITIS
Inflammation of the mouth
 Commonly caused by chemotherapeutic agents
 Manifestations

Eroded ulcerations in the oral cavity
 Secondary infection
 Pain with eating and drinking

Gerontological Nursing, Second Edition
Patricia A. Tabloski
CONSEQUENCES OF POOR ORAL CARE
Social isolation
 Depression
 Systemic illness

Aspiration pneumonia
 Heart disease

Gerontological Nursing, Second Edition
Patricia A. Tabloski
CONSEQUENCES OF POOR ORAL CARE
Periodontal disease
 Malnutrition, vitamin deficiency
 Pain, halitosis(a term used to describe noticeably
unpleasant odors exhaled in breathing), tooth
loss, dental caries, periodontal disease
 Denture stomatitis (pathological reactions of the
denture bearing palatal mucosa )

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 3
List common nursing diagnoses of older persons related
to oral problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING ASSESSMENT OF ORAL
PROBLEMS

Oral health history
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Date of last dental examination
Presence and function of dentures
Missing or loose teeth
Bleeding gums
Dry mouth
Presence of sores or lesions
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING ASSESSMENT OF ORAL
PROBLEMS

Oral health history





Medications
Usual oral hygiene routine
Altered sense of taste
Chewing or swallowing difficulties
Bad breath or halitosis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING ASSESSMENT OF ORAL
PROBLEMS

Oral cavity examination
Lips
 Teeth
 Interior of buccal mucosa
 Anterior and base of tongue, gums, soft and hard
palate, and back of throat

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING ASSESSMENT OF ORAL
PROBLEMS

Oral cavity examination
Presence of cracks, lesions, ulcers, swelling, or
induration
 Presence of gingival bleeding, hypertrophy, or dental
caries
 Presence of leukoplakia

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES
Impaired Dentition
 Altered Dentition
 Impaired Oral Mucous Membranes
 Altered Oral Mucous Membranes
 Nutrition Imbalance: Less Than Body
Requirements

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 4
Recognize nursing interventions that can be
implemented to assist the aging patient with oral
problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS TO IMPROVE
XEROSTOMIA
Regular dental evaluation
 Low sugar diet
 Mouth rinses
 Sugar-free chewing gum, hard candies, and mints

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS TO IMPROVE
XEROSTOMIA
Artificial saliva and mouth lubricants
 Bedside humidifiers
 Dietary modifications

Avoid hard-to-swallow or chewy foods
 Careful use of fluids while eating

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS TO IMPROVE
ORAL CANDIDIASIS
Rinse mouth after use of inhaled steroids
 Use small, soft toothbrush twice daily
 Use swabs to clean and moisten oral mucosa
when unable to brush
 Provide mouth rinses
 Chlorhexidine (Peridex)

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS FOR THE
PATIENT WITH ORAL PAIN

Rule out infection or abscess

Perform oral examination

Inspect mouth, tongue, and teeth
Assess vital signs
 Assess respiratory function
 Assess lymph nodes

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS TO IMPROVE
GINGIVITIS AND PERIODONTAL DISEASE

Educate the patient and family

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Daily flossing
Daily brushing
Use of fluoride toothpaste
Need for oral hygienist referral
Nutrition
Effect of periodontal disease on overall health
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS TO IMPROVE
STOMATITIS

Educate the patient and family

Signs and symptoms
Ulcers in mouth
 Pain with eating and drinking
 Secondary infections


Treatments
Meticulous oral hygiene
 Frequent use of isotonic saline mouthwash
 Avoidance of food extremes
 Providing swish-and-spit solution as prescribed

Gerontological Nursing, Second Edition
Patricia A. Tabloski
MOUTH CARE STRATEGIES FOR PATIENTS
WITH COGNITIVE IMPAIRMENT
Task breakdown
 Distraction
 Hand-over-hand:in which the nurse places his or
her hand over the resident’s hand and guides the
resident with an activity such as removing or
replacing dentures.
 Chaining: in which the nurse starts the mouth
care activity and the person completes it
 Protection

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 5
Identify medications that may cause or aggravate oral
problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
PROBLEMATIC COMMON MOUTH CARE
PRODUCTS
Lemon glycerin swabs
 Hydrogen peroxide
 Mouth rinses

Gerontological Nursing, Second Edition
Patricia A. Tabloski
MEDICATIONS TO USE WITH CAUTION

Diabetes medications


Gingivitis and periodontal disease
Potential causes of xerostomia

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Tricyclic antidepressants
Sedatives
Tranquilizers
Antihistamines
Antihypertensives

Alpha- and beta-blockers
Gerontological Nursing, Second Edition
Patricia A. Tabloski
MEDICATIONS TO USE WITH CAUTION

Potential causes of xerostomia
Diuretics
 Calcium channel blockers
 Angiotensin-converting enzyme inhibitors
 Cytoxic agents
 Antiparkinsonian agents
 Antiseizure drugs


Potential causes of stomatitis

Chemotherapeutic agents
Gerontological Nursing, Second Edition
Patricia A. Tabloski