Dry mouth in long term care
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Dry mouth is more than a little problem. Between bad breath, periodontal disease, and tooth breakdown, people suffering from dry mouth have a lot to worry about. Sjogren's to medication induced dry mouth your dental hygienist can be your best ally.
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Dry mouth in long term care
- 1. Dry Mouth Not for sissies
- 2. Is Spit It? Children have plenty Helps in o Speaking o Swallowing o Chewing
- 3. Salivary Stimulation Teething stimulates saliva Teeth erupt into the mouth not fully mineralized Salivary components help teeth mineralize
- 4. Very Important Bodily Fluid Buffering Dilution Coating • Acids • Sugars • Food • Acids • Mucosa Breaks down sugars Kills bacteria Releases flavors • Complex carbohydrates • Enzymes • Solubilizes dry food • Lactoferrin
- 5. • Subjective • Sensation Xerostomia • Noticed at 70% decrease • Lack of salivary gland function Hyposalivary • Radiation, medication, surgery function
- 6. Xerostomia Lipstick on teeth Asking for extra liquids at dinner Avoid dry foods Asks for soups Needs gravy or sauce
- 7. Hyposalivary function Damage to the salivary glands Surgery Medication Radiation
- 8. Dysphagia Malnutrition and dehydration. Dysphagia can make it difficult to take in enough food and fluids to stay adequately nourished. People with difficulty swallowing are at risk of malnutrition and dehydration. http://www.mayoclinic.com/health/difficulty-swallowing/DS00523/DSECTION=complications
- 9. Dysphagia Respiratory problems. If food or liquid enters airway (aspiration) respiratory problems or infections can occur, such as frequent bouts of pneumonia or upper respiratory infections.
- 10. J Am Geriatr Soc. 2007 Nov;55(11):1808-16. Epub 2007 Aug 28. Association between aspects of oral health-related quality of life and body mass index in community-dwelling older adults
- 11. Aust Dent J. 2011 Sep;56(3):290-5. doi: 10.1111/j.1834-7819.2011.01347.x. Risk factors and symptoms associated with xerostomia: a cross-sectional study.
- 12. Dialysis The prevalence of oral lesions was significantly higher in renal patients both dialysis and transplant. The most prevalent oral clinical findings were saburral tongue and for both groups. Quintessence Int. 2011 Feb;42(2):127-33. Clinical oral findings in dialysis and kidney- transplant patients.
- 13. Oral Preparatory Goal: reduce food to a Swallowing food bolus and position it for transport Initial transport (the bolus lacement) - tongue positions the food to ready it for reduction Reduction phase - bolus is chewed & mixed with saliva Bolus placement - bolus is positioned for transport
- 14. Denture wearing
- 16. Cures Swapping medications Saliva stimulating mediations Chewing gum Sipping water Moisturizing lip balm
- 17. Palliative Help Chewing Gum Mouth Spray Stimulates saliva Targeted Increases facial Easy to carry muscle tone Stimulates bowel Use PRN motility
- 19. Increased emphasis At least Every day the front of teeth Between From teeth tongue Disrupting biofilm
- 20. Increased Emphasis Avoid smoking Incorporating Low carbs - watery foods diabetes Eating raw Less simple foods sugar Diet Changes
- 21. Cures Drink Chew gum water Foods with Simplify high water bathroom content Hydration
- 22. Cures Biofilm Professional Monthly removal
- 23. Not cures Sour candies Glycerin Sour foods
- 24. Conclusion Dry mouth is more complicated than just uncomfortable. Steps to increase saliva should be taken. Watch out for improper “cures.”
- 25. Find out the laws restricting dental hygienists in your state! Mandating a dental hygienist on the staff of all Medicaid funded care facilities can save millions of dollars a year just in people with diabetes.
- 26. Credits PowerPoint designed by Cross Link Presentations, LLC Presentation design Shirley Gutkowski, RDH, BSDH, FACE crosslinkpresent@aol.com Script Shirley Gutkowski, RDH, BSDH, FACE Photos: Dreamstime, Gutkowski, Stone Characters: PresenterMedia Copyright 2011 Exploring Transitions, LLC
Notes de l'éditeur
- This highlights the need for saliva in providing healthy teeth. Talk about how slow teeth erupt and need to be in the presence of saliva and fluoride to make them strong. Fluoride is to be used topically only.
- These are the attributes of saliva. You can spend a few minutes on this slide or just go over each attribute quickly. You may want to dwell on the topic of releasing flavors from food, and how residents may be over salting or adding sugar just to taste anything.
- Xerostomia is a feeling of dry mouth. People may not realize there’s a problem until saliva is decreased by 70%. Mouth breathing in someone who has a cold or exercising will have a sensation of xerostomia.Hyposalivary function is different, in that there is no active gland secreting saliva
- 70% decrease of salivary flow is pretty substantial. One way to notice someone has xerostomia is that they may have lipstick on their teeth, they may ask for extra liquids at mealtime or gravy or sauce may be necessary in order to eat.
- Damage to the glands is not a function of age. It usually comes from some kind of disease or trauma.
- A lack of saliva can cause problems with swallowing. Dysphagia can lead to systemic problems, like malnutrition.http://www.mayoclinic.com/health/difficulty-swallowing/DS00523/DSECTION=complications
- Aspiration can be a problem if swallowing is difficult. Saliva lubricated foods have a smaller chance of going down the wrong pipe.
- J Am Geriatr Soc. 2007 Nov;55(11):1808-16. Epub 2007 Aug 28.Association between aspects of oral health-related quality of life and body mass index in community-dwelling older adults
- Aust Dent J. 2011 Sep;56(3):290-5. doi: 10.1111/j.1834-7819.2011.01347.x.Risk factors and symptoms associated with xerostomia: a cross-sectional study.
- Medical Definition of Saburra1. 1. Foulness of the stomach or mouth resulting from decomposed food. Synonym: sordes. Origin: L. Sand (05 Mar 2000)Dialysis patients also have restrictions on fluids which also contributes to the feeling of dryness, and the reality of dryness. This type of dryness can contribute to dementia symptoms from dehydration. Quintessence Int. 2011 Feb;42(2):127-33.Clinical oral findings in dialysis and kidney-transplant patients.
- http://www.dysphagia.com/swallowingDiscuss how important it is to have saliva to build the bolus. This is a good place to do a little hands on experiment. Crush a few saltine crackers or other dry food and mix it trying to create a bolus. Oh, it won’t work! Now add some water or even spit into the crumbs depending on the audience and your personality. What happens, can you build a bolus now. Talk about how those dry crumbs could be easily aspirated.
- Dentures need saliva to build suction and stay in place. Think of licking a silicone suction cup before sticking it to a mirror.People without saliva may need an implant retained denture.
- This slide is about what an implant retained denture looks like. Point out that the lower picture is a mirror and that the implant is showing. Most CNA have never seen anything like this however they will be seeing a lot of this.
- Changing medications may be an optionChewing gum may also be an option for some peopleSipping water, specially if it is dosed with xylitol is a great optionKeeping the lips moisturized is a great way to keep residents more comfortable.The next few slides go more into detail with curative adjuncts
- Doesn’t always work in this cohort. Residents are on too many medications. If one is swapped, the next medication is still going to likely cause hyposalivary conditions.
- http://xylitol.org/medical-info-xylitol-doctorsBrushing is more important for people without saliva to help protect the teeth.
- http://xylitol.org/medical-info-xylitol-doctorsRaw fruits and vegs contain a lot more water than cooked. Including these types of foods adds hydration without having to drink.
- http://xylitol.org/medical-info-xylitol-doctorsAnother way to stimulate saliva is good smelling foods, it’s short lived but asking residents who can smell to breath deeply and imagine how good something will taste can get some juices flowing.I included simplifying bathroom issues because some residents don’t remain hydrated because they don’t like going to the bathroom. In some instances bathroom issues can be simplified so addressing this can be helpful.
- Professionally removing biofilm from the teeth is also helpful to protect against decay and periodontal infections.
- Although sour foods may increase saliva it’s unclear whether they will increase the saliva enough to outweigh the potentially damaging effects of the acidic food.