Gerontological Nursing: Fourth Edition

Gerontological Nursing
Fourth Edition
Chapter 13
The Mouth and Oral Cavity
Copyright © 2019, 2014, 2010 Pearson Education, Inc. All Rights Reserved
Learning Outcomes (1 of 2)
13.1 Explain normal changes of aging in the mouth and
oral cavity in older adults.
13.2 Identify common oral problems, causes, and risk
factors in older adults.
Learning Outcomes (2 of 2)
13.3 Identify medications that may cause or aggravate
oral problems.
13.4 Recognize nursing interventions that can be
implemented to assist the aging patient with oral problems.
Introduction (1 of 4)
• The mouth is the beginning of the digestive system and
also serves as an airway for the respiratory system.
• The oral cavity consists of the lips, palate, cheeks,
tongue, salivary glands, and teeth.
• Maintaining good oral hygiene becomes more difficult due
to:
– The number and condition of dental restorations
– Changing alignment between adjacent teeth due to
recession of the gums
– Impaired visual acuity
• Maintaining good oral hygiene becomes more difficult due
to:
– Possible loss of manual dexterity
– Restricted range of motion
– The effects of medications on oral health
• With tooth loss and malocclusion, the older person may
avoid eating healthy foods high in fiber such as fruits and
vegetables, causing further problems related to poor
nutrition.
• Social isolation may occur when older people lose self-
esteem due to cracked or missing teeth.
Common Diseases of Aging: Mouth
and Oral Cavity (1 of 2)
• Medicare does not cover routine dental care or most
dental procedures such as cleanings, fillings, tooth
extractions, or dentures.
• Medicaid funds dental care in some states, but
reimbursement rates are so low that it is often difficult to
locate a dentist who will accept older persons with
Medicaid.
Common Diseases of Aging: Mouth
and Oral Cavity (2 of 2)
• About 19% of adults ages 65 and older no longer have
any natural teeth.
• Periodontal disease or dental caries most often cause
tooth loss.
• The rate and severity of periodontal disease increases
with age.
• The use of fixed dentures, implants, crowns and
restorations is becoming more widespread.
Common Diseases of Aging Related
to the Mouth and Oral Cavity
• Most older Americans take prescription and over-the-
counter medications that can decrease salivary flow and
result in xerostomia, or dry mouth.
• Decreased salivation is associated with increased oral
disease as saliva contains antimicrobial components and
minerals that help rebuild tooth enamel attacked by
decay-causing bacteria.
Barriers to Mouth Care (1 of 2)
• Lack of training and knowledge about the importance of
oral hygiene
• Lack of perceived need for oral care
• Heavy workloads
• Resistance by older persons with dementia
Barriers to Mouth Care (2 of 2)
• Nurses have a responsibility to monitor and supervise
nursing assistants to ensure appropriate technique and
behavioral approaches so that oral care that meets
accepted standards can be provided to those in need of
assistance.
Negative Effects of Poor Oral Care (1
of 2)
• Consequences of poor oral care include the following:
– Social isolation and depression
– Systemic illness such as aspiration pneumonia, heart
disease, and stroke
– Periodontal disease, which can negatively affect
glycemic control in persons with diabetes
Negative Effects of Poor Oral Care (2
of 2)
• Consequences of poor oral care include the following:
– Malnutrition, vitamin deficiencies
– Pain, halitosis, tooth loss, dental caries, periodontal
disease
– Denture stomatitis
Risk Factors for Oral Problems
• Diseases commonly found in the older person, such as
diabetes mellitus, can suppress neutrophil production,
alter the structure of the lining of the blood vessels, and
cause decreased circulation to the skin and mucous
membranes.
– Delays healing of oral ulcerations
– Increases risk for secondary infections
Nursing Assessment of Oral
Problems
• A complete oral-cavity assessment includes examination
of the lips, teeth, interior of the buccal mucosa, anterior
and base of the tongue, gums, soft and hard palate, and
back of the throat.
Common Oral Problems
• Common problems of the mouth that occur with aging
include xerostomia, oral candidiasis, gingivitis and
periodontal disease, stomatitis, and oral cancer.
Providing Oral Care to Older
Persons with Cognitive Impairments
• Strategies that may be used/adapted in the nursing-home
setting:
– Task breakdown
– Distraction
– Hand over hand
– Chaining
– Protection
Nursing Diagnoses (1 of 2)
• Impaired oral mucous membrane integrity
• Oral pain
• Edentulism with ill-fitting dentures
• Tooth loss
Nursing Diagnoses (2 of 2)
• The presence of acute and chronic pain and nutrition
problems would also be noted.
• The presence of infection, communication difficulties, and
self-esteem problems should also be indicated.
Complementary and Alternative
Therapies
• Chamomile used topically for stomatitis related to
chemotherapy
• Chewing raw garlic or garlic paste may have antifungal or
antibacterial properties.
• Mint or parsley to freshen breath and improve halitosis
• Tannin for relief of canker sores
• Oil clove for toothaches
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