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Growth and Ageing Assignment
You have been put in charge of a dental team providing dental care to a large
(100 bed) nursing home facility. Discuss the likely dental health needs of the
residents of this facility and describe how you would plan and deliver appropriate
care to them?
he strategy used to identify the literarure listed involved a thorugh search of
the !"#$ %rtcile &earch Database using key search terms and limiting this to the
#'. urther searches included ochrane *eview+ ,ub "ed+ -ritish Dental ournal+
/nternational %ssociation for Dental *esearch and individual ournal websites+ eg
Gerodontology.
Dental Health in Instituionalised Older People
%s one ages+ ones teeth transform considerably. he adult dentition is e2pected
to last a lifetime and oral health should be a lifetime concept. 3igh 4uality oral
healthcare should be available to all people regardless of their age orcircumstances. 3owever the reality is rather di5erent. he %dult Dental 3ealth
&urvey #' 1667 found that age is the single biggest reason for the decrease in
sound and untreated teeth. 8evertheless+ this pattern of elderly people
e2pecting to lose their teeth is changing because of the 9baby boomer:
generation who are e2pected to maintain and enhance the demand for dental
care amongst the new cohort of elderly1.
his recent trend amongst the elderly is not indicative of dental care in nursing
home facilities. % study looking at residents of nursing homes across -ristol;
found considerable neglect with regards to oral health. of the residentshad not seen a dentist for over ve years. %mongst the denture wearers 7;>
were unable to clean their dentures and needed assistance from the sta5 and
denture@related stomatitisa5ected AA>. !uite shockingly+ unhygienic dentures
were worn by almost all of the subects. hose fortunate enough to be in the
dentate population su5ered a similar plight. of subects and root cariesin CA> of subects. he
overriding message from this study was that residents of care homes re4uired
assistance with cleaning their dentures and teeth yet the appropriate level of
care was not provided for by the sta5.
1 3&* E. D
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% further studyAfound consistent results with the above research. he ndings
showed high levels of both coronal and root caries. ,la4ue retention is a problem
in elderly people who have diFculty in mechanically removing pla4ue owing to
diminished manual de2terity+ impaired vision+ or illness. ,oor denture hygiene
has been found. %lthough residents preferred assistance in cleaning their teeth
and dentures+ only 6G reported that the sta5 had helped them. he compelling
part of this research was that even in cases where sta5 helped the residents
clean their dentures and teeth+ they wer no cleaner than those cleaned by
residenets. his suggest a possible training issue.
he study also found that many residents received medications known to
produce 2erostomia+ A6C were given syrups containing sugar and A7H residents
reported su5ering with dry mouth. /n this case this lead to denture stomatis
(particulary with residents who wear dentures at night)+ angular chelitis+ oral
ulcerations+ sore and ssured tongues. he role of medication and poly pharmacy
plays a part in oral health for the elderly.
he research found that the managers indicated that there was no systematic
approach to arranging dental care. Dental care was sought only when residents
or their relatives complained of acute dental problems such as pain or a broken
denture. Dental assessments were not carried out when residents were admitted+
neither was a care plan developed that included intraoral care. 8o emphasis is
given to prevention in a care home environment.
Dental 'a(tors that (ontri)ute to *ualit+ o' li'e
here are many disabling e5ects of dental and oral disorders that are fre4uent
amongst elderly and that have a profound impact on health. % study deploying a
4uestionnaireGin a nursing home found that the maority of the residents had
diFculty eating+ communicating and had problems with taste. *esearch has
found that elderly edentulous patients could not eat food which was necessary
for a stable diet for e2ample raw carrots+ apples+ steaks or nuts.H urther research
AD &imonsa+%" 'iddb+D -eightonbI Oral health o' elderl+ o((upants inresidential homes The $ancet+ Jolume AHA+ /ssue 61CC+ ,age 1=C1+ ;; "ay 1666
G D &imonsa+ %" 'iddb+ D -eightonbI Oral health o' elderl+ o((upants in
residential homes The $ancet+ Jolume AHA+ /ssue 61CC+ ,age 1=C1+ ;; "ay
1666
H &heiham.B. &teele E. "arcenes&. inch+ %.E.B. Ealls. The impact of oral
health on stated ability to eat certain foods; Findings from the National Diet and
Nutrition Survey of Older People in Great ritain. Berontology Jolume 1C /ssue 1pages 11 @;0 uly 1666.
http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=EAM+Kiddhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736(00)X0142-0http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=EAM+Kiddhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736(00)X0142-0http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=EAM+Kiddhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736(00)X0142-0http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=EAM+Kiddhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736(00)X0142-07/24/2019 Growth and Ageing Essay
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as shown poor oral health may be an important contributing factor to the
development of signicant involuntary weight loss among the frail elderlyC.he
poor oral status of the institutionalised elderly+ found in this and previous
studies+ may contribute to the eating problems and low nutrient and vitamin
levels found in this group. hese results+ combined with the reduced ability of
elderly people to communicate+ may cause weight loss+ dehydration+ and debility.
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eating and associated embarrassment. 3e emphasised the importance of
aesthetically acceptable and functionally ade4uate dentitions so people can feel
condent about eating at home or in company. iske et aP" e2plored the
emotional reactions to tooth loss and found that tooth loss a5ected self@esteem+
condence+ enoyment of food+ selection of food+ socialisation and forming close
relationships even when teeth were replacedby dentures
Treatment planning Issues
%s people age their health deteriorates and when treatment planning for this
population this needs to be considered. /t is believed that there are currently
=00+000 people with dementia in the #'+ of whom 1H+000 have early onset
dementia+ ie onset before the age of CH. his is considered a maor
underestimate by up to three times because of the way the data relies on
referrals to services. % further compelling statistic is that of of all the peopleliving in care homes+ CG> have some form of dementia6
/t is well recognised that oral health declines as dementia progresses. he impact
of the disorder+ especially in the latter stages+ leads to poor oral hygiene with an
increase in periodontal disease+Chigher levels of coronal and cervical decayand a
greater incidence of other dental problems such as denture wearing or the ability
to comply with oral care procedures. 10he commonest medications used in
dementia also have the potential to cause 2erostomia and+ if medications are
syrup@based+ the potential for the development of caries is increased. O be awre
of the oral manifestations of systemic diseases and the impact they may have onthe treatment plan. %void interaction with and look for oral side e5ects of drugs
taken
he decision making process in planning oral healthcare for people with
dementia or with other forms of cognitive impairments should incorporate a
multidisciplinary care team approach involving the medical practioner+
psyhicatric team+ relatives and carers. reatment should begin from diagnosis so
that oral care can be planned throughout the disease process and does not
become crisis management in the nal phase of the condition. reatment
planning must take account of the stage of the illness and the level of cognitive
impairment. ake a multidicpilinary approach and liase with other individuals
responsible for each patient care e.g general medical practioner+ carer
physiotherapist+ family.
%nother study found that access to dental care for the frail and elderelyw as
worse than other groups. 11
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Ehen considering treatment planning the number of visits etc should account for
this. he study also found that ,atients are retaining some or all of thgeir teeth
into old age and therefore re4uire more comple2 treatment. eeth that re4uire
e2traction are likely to be heavily restored and more likely to re4uire a surgical
approach.
Fiske 7, Gri11iths 7, 7amieson R, +anger 6. Guidelines 1or oral health care 1or long)stay 0atients and residents.
Gerodontology!!!"#$%#&'99):;
!e*uirments 'or pro.iding appropriate (are
,lanning and delivering appropriate level of care to the residents of my hospital
will re4uire a muiltidiciplinary approach and liase with other individuals
responsible for each patient care e.g general medical practioner+ carers
physiotherapist+ family. 3owever+ bearing in mind that we are living in the age of
austerity. oo much resource cannot be used up. 3owever+ in the curerent
climate and austerity resources are limited.
he rst thing / would implement is an initial assessment1;of oral health on
arrival to the nursing home. his initial assessment would involve a simple
4uestionnaire which would alert sta5 to any problems with regards to oral health.
his 4uestionnaire would then be reviewed by sta5 who would pick up on
anything of concern and provide the residenmt with the appropatie level of care
by getting a dentist tp do a more comple2 e2amination involving and orale2amination. hese 4uestionnaire would be submitted every C months. /f
possible this 4uestionnaire should be carried out with family rather than sta5 to
eliminate bias.
he inLuence of diet and nutrition on oral and general health is fundamentally
important.. DaviesPR suggested that good nutrition can have a marked e5ect on
the health+ happiness and independence of older people whereas the poor oral
status of institutionalised older people maycontribute to eating problems+ weight
loss+ dehydration and debilityR. &ugars are not only detrimental to dental health+
they can also have a negative impact on general healthPS hus the reduction of
sugar intake for dental health can also benet general health e.g. reduced
incidence of obesity+ diabetes+ coronary artery disease. he food served to the
residents should be healthy and maority of them should have healthy choices.
%lso dietary advice should be givn and sugar should be limited. 3ealthy eating
choices in line with health promotion.
11 hris o2 E.iden(e summar+: wh+ is a((ess to dental (are 'or 'rail elderl+people worse than 'or other groups; -ritish Dental ournal ;07+ 116 @ 1;; (;010)
1; Fiske 7, Gri11iths 7, 7amieson R, +anger 6. Guidelines 1or oral health care 1or long)stay 0atients and residents.Gerodontology!!!"#$%#&'99):;.
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% further thing i would implement is changing the facilities available to the
residents. / believe that facilities should provide or privacy and dignity in
personal oral care. very resident if budget allows will hav ensuite room tailored
with 2tures and adaptions that meet their needs. Bood lighting and reminders
would also be on their room. his strategy will help promote independence and
self care in a dignied manner.
here is little data on the availability of oral hygiene e4uipment however there is
a wealth of professional anecdotal evidence about the diFculty in obtaining
toothbrushes in hospitals. Despite the fact that a toothbrush is the cheapest and
most e5ective tool for oral hygiene.
and is more e5ective than a foam stick. mouth care packs and foam sticks are
still in general use. . /t is reeommended that managers of long stay and
residential accommodation take on theresponsibility of ensuring that appropriateoral hygiene e4uiptnent is readily available and thatsta5 are made aware of
procedures for obtaining. %II residents will be provided wityh a tootbrush+ regular
tooth paste+ Loss+ mouthwash and denture cleaning e4uipment.
he role of the sta5 is fundamentally important. he maority of residenets are
partially or totally dependent on nursing sta5 and caregivers to maintain oral
hygiene. *easearch as shown % study1Ashowed that a one hour practical
demonstration to nondental health care sta5 in a nursing home improves oral
health considerably. he study indicates that training of care@givers can improve
oral hygiene and health in nursing homes and other long@term care facilities by
enhancing the knowledge of the nursing sta5 through a short one@time lecture
and educational demonstration.urthermore+ the outcome of this study was
assessed C months after the intervention+ and apparently the nursing sta5 was
fully aware of their participation in a health promotional study. %ll tyhe sta5 in
my care home would receive this training and to support the concerpt of oral
health care.
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anyone in long@stay and residential accommodation+ and this includes people in
seeure units. %ccess and referral to dental services should be included in
admission+ transfer and discharge procedures.
ommunication between the dental team and other disciplines is most e5ective
when the dental team provides an input to multi@disciplinary care and
assessment. ollaborative eare planning which provides an opportunity to
demonstrate the contribution of oral health care to general health and well@being
should be endorsed.
inally+ amongst for the care home there will be a code of conduct serving as a
constitioun. 8egotiated and agreed standards and procedures for oral care
promote a structure and process for putting theory into practice and supporting
sta5 in what may be viewed as an unrewarding task. $ocally negotiated
standards should includeQ