Oral Health and Aging

Description

This book provides a comprehensive review of the assessment and management of older people’s oral health care needs. Discussing recent initiatives to emphasize oral health promotion and prevention, the book describes improvements in pharmacological and non-pharmacological approaches for special populations in geriatrics and illuminates the role of barriers to oral health care for older people. Divided into three sections, the book first explores aging and oral health, including age-related changes, epidemiology, nutrition, dysphagia, aspiration pneumonia, xerostomia and hyposalivation, management of periodontal disease and caries, systemic diseases that influence oral health, and considerations for chronic orofacial pain. The second section illuminates the ways in which frailty and other geriatric syndromes influence oral health care in older adults with a special focus on frailty, dementia, delirium and depression, and the delivery of oral health care to vulnerable geriatric populations in long-term care, home care, palliative care, and hospice. Lastly, the book addresses inequalities in the oral health of older minority populations, the disproportionate burden of oral disease and tooth loss, the contribution of these issues to further complications in comorbidities, the association of extended health literacy and periodontal disease, and the social and cultural conditions that might be altered or improved by healthcare programs and health policies. Oral Health and Aging is a useful book written by an international group of experts and designed to educate geriatricians, primary care physicians, nurses, dentists, dental hygienists, speech and language pathologists, dietitians, and health policy advocates. Contents Contributors Age-Related Changes in Oral Health 1 Age-Related Changes in Oral Structures and Function 2 Oral Mucous Membranes 3 Teeth 3.1 Edentulism 4 Salivary Glands 5 Tongue-Lip Motor Function (TLMF) 6 Oral Microbiome 7 Masticatory Function 8 Conclusions References Epidemiology of Oral Health Conditions in the Older Population 1 Thinking About Old Age and Oral Health 2 Sociodemographic Changes 3 Health Differences by Gender, Ethnicity, and Socioeconomic Position 4 Chronic Conditions, Multimorbidity, and Disability 5 Dementia 6 Frailty 7 Ageism 8 Active Aging 9 The Common Oral Conditions Affecting Older People 9.1 Tooth Loss 9.2 Dental Caries 9.3 Periodontitis 9.4 Dry Mouth 9.5 Oral Mucosal Lesions 10 Conclusions References Nutrition and Oral Health 1 Nutrition Risk Factors and Screening Tools Used with Older Adults 1.1 Weight Status and Change 1.2 Medical, Surgical, and Dental History 1.3 Oral Risk Factors 1.4 Dietary Intake 1.5 Nutrition Screening and Assessment Tools 2 Associations Between Tooth Loss and Replacement, Diet, and Nutritional Status in Older Adults 3 Dietary Interventions for Older Adults With Tooth Loss With or Without Dentures 4 Guidance for Healthcare Providers and Older Adults with Tooth Loss 5 Guidance for Healthcare Providers and Older Adults with Dentures 6 Conclusions References Swallowing, Dysphagia, and Aspiration Pneumonia 1 What Is Swallowing? 1.1 Swallowing Definition 2 Swallow Physiology 2.1 Liquid Swallowing: Four Sequence Model of Swallowing 2.1.1 Oral Preparatory Phase of Swallowing 2.1.2 Oral Phase of Swallowing 2.1.3 Pharyngeal Phase of Swallowing 2.1.4 Esophageal Phase of Swallowing 2.2 Solid Food Swallowing: Process Model of Feeding 2.2.1 Stage I Transport 2.2.2 Food Processing 2.2.3 Stage II Transport 3 Swallowing Anatomy 3.1 Swallowing Musculature 3.2 Swallowing Neurophysiology 4 What Is Dysphagia? 4.1 Dysphagia Definition 4.2 Prevalence of Dysphagia 4.3 Signs and Symptoms of Dysphagia 4.4 Types of Swallowing Impairments 4.4.1 Oral Phase Impairments 4.4.2 Pharyngeal Phase Impairments 4.4.3 Esophageal Phase Impairments 5 Risk Factors for Dysphagia 5.1 Risk Factors for Dysphagia in Older Adults 5.2 Poor Oral Health as a Risk Factor for Dysphagia 5.3 Dysphagia as Risk Factor for Poor Oral Health 6 Consequences of Dysphagia 6.1 Pneumonia 6.2 Aspiration Pneumonia 6.3 Malnutrition and Dehydration 6.4 Asphyxiation Risk 6.5 Quality of Life for Oral Health and Swallowing 7 Evaluation of Swallowing 7.1 Clinical Evaluation 7.2 Screening Tests 7.2.1 Patient-Reported Outcome Measures 7.2.2 Water Swallow Tests 7.2.3 Solid Food Test 7.3 Instrumental Swallow Evaluations 7.3.1 Videofluoroscopic Examination of Swallow (VFSS) 7.3.2 Fiberoptic Endoscopic Evaluation of Swallowing (FEES) 8 Prevention of Pneumonia 8.1 Daily Mouth Care for Individuals Intubated or with Dysphagia to Prevent Pneumonia 8.2 Daily Mouth Care Plans 8.3 Chlorhexidine 8.4 Suctioning 8.4.1 Oral Suctioning 8.4.2 Deep Suctioning 8.4.3 Suction Toothbrushing 8.5 Toothbrushing 8.6 Toothpaste 8.7 Sample Protocol for Mechanically Ventilated Critically Ill Patients 9 Prevention and Treatment of Dysphagia 9.1 Prevention and Treatment of Dysphagia in Older Adults 9.2 Compensatory Approaches to Dysphagia Management 9.3 Rehabilitative Interventions for Dysphagia 9.4 Proactive Versus Reactive Approaches to Dysphagia Care 10 Conclusions References Xerostomia and Hyposalivation 1 Causes of Salivary Hypofunction in the Older Patients 1.1 Age 1.2 Gender 1.3 Diseases 1.4 Head and Neck Radiotherapy and Chemotherapy 1.5 Drugs 1.6 Lifestyle Factors 2 Impact of Salivary Disorders in the Oral and General Health of Older Patients 2.1 Changes in Taste 2.2 Changes in Mastication, Alterations in the Formation of the Alimentary Bolus, and Swallowing 2.3 Changes in Biofilm and Their Consequences 3 Diagnosis of Xerostomia and Hyposalivation 3.1 Medical History 3.2 Intraoral and Facial Examination 3.3 Sialometry 3.4 Biopsy of Minor Salivary Glands 3.5 Questionnaires 3.6 Other Diagnostic Methods 4 Treatment 4.1 Preventive Measures 4.2 Changes or Reduction of Drugs 4.3 Local Measures 4.4 Systemic Sialogogues 4.5 Treatment of Sjögren’s Syndrome 5 Practical Considerations 6 Future Research 7 Conclusions References Management of Periodontal Disease in Older Adults 1 Introduction 2 Normal Oral Aging Versus True Oral Pathology 2.1 Salivary Function 2.2 Periodontitis and Tooth Retention 2.3 Masticatory Function and Cognition 3 Management of the Older Patient with Periodontal Disease 4 Social Support and the Periodontium in Older Adults 5 Preserving Teeth or Placing Implant 5.1 Plaque Control: Current and Future 5.2 The Need for Tooth Replacement 5.3 The Bone and General Healing Capacity of Older Adults 5.4 Other Diseases and Conditions that Might Influence Success (Diabetes, History of Periodontitis) 5.5 Maintenance Protocol 5.6 Consideration of Future Implant Complications 6 The Dental Office as a Point of Care in the Management and Screening for Systemic Disease 7 Conclusions References Management of Caries in Older Adults 1 Global Epidemiology 2 The Oral Health of Older Adults 3 Oral Health in Long-Term Care Facilities (LTCFS) 4 Dental Caries 5 Diagnosing Root Surface Caries 6 Risk Assessment 7 Caries Prevention Strategies for Older Adults 7.1 Oral Hygiene Advice for Older Adults 7.2 Fluoride Interventions 7.3 Chlorhexidine Interventions 7.4 CPP-ACP Intervention 7.5 Professionally Administered Interventions 8 Challenges in the Operative Management of Root Caries 9 Utilizing Atraumatic Restorative Treatment (ART) for Caries Management in Older Adults 10 Consideration of Caries Development When Replacing Missing Teeth 11 Conclusions References Systemic Disease That Influences Oral Health 1 Background 2 Geriatric Assessment 3 Systemic Health Affecting Oral Health Management 3.1 Risk of Infection 3.2 Risk of Bleeding 3.3 Risk of Medical Complications Before, During, and After a Dental Procedure 3.4 Risk of Adverse Drug Events and Drug Interactions 4 Systemic Health Manifesting in Orofacial Areas 4.1 Gastrointestinal Disorders 4.2 Renal Disorders 4.3 Cardiovascular Disorders 4.4 Endocrine Disorders 4.5 Hematologic Diseases 4.6 Neurocognitive Disorders 4.7 Respiratory Disorders 4.8 Autoimmune Disease 5 Conclusions References The 3 Ds: Dementia, Delirium and Depression in Oral Health 1 Epidemiology, Assessment, and Management 1.1 Dementia 1.2 Delirium 1.3 Depression 2 The Importance of Cognition and Mood on Oral Health 2.1 Dementia 2.2 Delirium 2.3 Depression 3 Oral Health Assessment 4 Interventions to Improve Oral Health in Persons with Cognitive Impairment 5 Interventions to Improve Oral Health in Persons with Depression 6 Practical Considerations and Recommendations for Management of Patients with Cognitive Impairment and Mood Disorders 6.1 Simple Advice on Key Issues Based on Expert Opinion [56] 6.2 During Dental Appointments 6.3 Communication 6.4 Involvement of Caregivers 6.5 Managing Care-Resistant Behaviors at the Dental Office 6.6 Oral Self-Care-Resistant Behaviors 7 Future Research Agenda 8 Conclusions References Oral Care in Long-Term Care Settings 1 Introduction 2 Description of Long-Term Care Facilities and Their Population 3 Oral Health Problems Among Residents of LTCFS 4 Types of Oral Health Services for LTC Patients 5 Influence of the COVID-19 Pandemic on Oral Health Services for LTCFS Residents 6 The Integration of Oral Healthcare in LTC Services 7 Some Solutions to Problems Caused by COVID-19 8 Conclusions References Oral Health of the Palliative and Hospice Patient 1 The Concepts of Palliative Care and Hospice 1.1 Palliative Care 1.2 Hospice 2 The Role of the Dental Care Professional in Palliative Care and Hospice 3 The Oral Assessment of the Older Adult with Palliative Care and Hospice Needs 4 Risk Factors of Poor Oral Health 4.1 Poor Oral Hygiene 4.2 Polypharmacy 4.3 Functional Impairment and Frailty 4.4 Cognitive Impairment 5 Common Oral Health Conditions in Palliative and Hospice 5.1 Swallowing Disorders and Aspiration 5.2 Cancer Treatment and Oral Mucositis/Stomatitis 5.3 Problems with Saliva 5.4 Dysgeusia 5.5 Orofacial Pain 5.6 Oral Infections 5.7 Halitosis 6 Oral Health at the End of Life: Dying with Dignity 7 Ethical Considerations at the End of Life 7.1 Withholding and Withdrawal of Life Support 7.2 Shared Decision-Making (SDM) 7.3 Informed Consent 7.4 Decision-Making Capacity 7.5 Advance Care Planning (ACP) and Advance Directives (AD) 8 Conclusions References Ethical Considerations in Geriatric Dentistry 1 What Is Ethics? 2 Providing Care for the Geriatric Patient 3 Informed Consent and the Geriatric Patient 4 Elder Abuse, Evolving Technologies, and Changing Models of Care Delivery 5 Barriers to Care: An Ethical Lens on Medical Mistrust and the History of Racism in Healthcare 6 The COVID-19 Global Pandemic and the Geriatric Patient: An Ethical Lens 7 Ethical Decision-Making: Principles and Embracing Narrative Ethics 8 Conclusions References Health Disparities in Oral Health 1 The Older Adult Population 2 Oral Health in American and the Older Adult Population 3 Social Determinants of Health 4 Health Disparities Defined 5 Health Disparities in Oral Health 6 Dental Coverage 7 Health Literacy 8 Living Conditions and Disabilities 9 Tooth Decay 10 Tooth Loss 11 Gum Disease 12 Dry Mouth 13 Oral Cancer/Precancer 14 COVID-19 15 Summary References Frailty and Oral Health 1 Physical Frailty 2 Recognizing Frailty 3 Evidence-Based Strategies to Manage Frailty 4 The Concept of “Oral Frailty” 5 Frailty and Oral Health: A Bidirectional Relationship 6 Practical Considerations for Oral Health-Care Professionals 7 Future Research 8 Conclusions References The Role of Oral Health Literacy and Shared Decision Making 1 Definitions 2 Extent of the Problem 3 Recognition 4 Consequences of Inadequate Health Literacy 5 Shared Decision-Making and Health Literacy in Dentistry 6 Interventions 6.1 Universal Precautions 6.2 Teach-Back 6.3 Age-Friendly Written Materials 6.4 Image-Based Materials (Pictograms) 6.5 Decision Aids 6.6 Caregivers 7 Practical Considerations for Oral Healthcare Professionals 8 Future Research 9 Conclusions References Barriers to Access to Dental Care 1 Introduction 2 Age-Related Changes, the Presence of Pain, and Self-Perceived Needs 3 The Presence and Absence of Natural Teeth 4 Dental Fear and Communication Between Older Adults and Providers 5 Oral Health-Care Professional Perspectives 6 Cost of Care and Dental Insurance 7 Geographic Residence 8 Transportation 9 Conclusions References Index