can occur at any age but is prevalent in older adults
usually starts with gingivitis; red and slightly swollen gums caused by accumulation of plaque on the tooth if let untreated, gingivitis may progress to “periodontitis”
Symptoms and Impact
What are the symptoms of periodontitis?
tender, bleeding gums
painful chewing
chronic bad breath
teeth that are sensitive to cold/heat
change in fit or comfort of partial dentures
receding gums
untreated periodontitis may lead to destruction of gums and tissues that support teeth
teeth may become loose and if untreated tooth extraction may be required
Impact on physical health
gums pull away from the teeth and form pockets that become infected
immune system fights the bacteria as plaque spreads and expands below gum line
bacteria toxins and immune system response may break down bone and connective tissue
evidence of relationship between cardiovascular disease and poor oral health
oral infections increase glucose levels in blood and make diabetes harder to control
Impact on psychosocial well being and quality of life
medications that reduce saliva and cause dry mouth increase vulnerability to gum disease
medications that cause abnormal overgrowth of gum tissue make proper oral hygiene more difficult
illnesses including cancer or AIDS and their treatments may negatively affect health of gums
illnesses including diabetes and Parkinson’s disease may affect salivary glands and cause dry mouth, which increases production of bacteria
Diagnosing periodontitis
symptoms may be sign of serious problem
see your dentist
dentist or hygienist may take medical history to identify underlying conditions or risk factors
dentist or hygienist will examine guns
may use “probe” to check for and measure pockets (this is usually painless)
may take x-ray to determine if bone loss has occurred
may refer to periodontitis if needed
Treating periodontitis
deep cleaning (scaling and root planning)
dentist may prescribe medication as part of treatment (medication alone is insufficient treatment)
dentist may recommend surgery including flap surgery, or bone and tissue grafts
Treatment decisions
when considering any extensive dental or medical treatment options, you may want to get a second opinion
to find a dentist or periodontitis for a second opinion call your local dental society for a list of qualified dental professionals in your area
Preventative measures
reduce sugar intake
stop smoking
use toothpaste containing fluoride
brush teeth twice a day
floss daily
antimicrobial mouth rinse can assist in controlling plaque
visit dentist regularly (take a complete list of all medications to dental appointments and advise dentist of side effects including dry mouth)
maintain cleanliness of dentures and dental bridges
ensure dentures and bridges fit properly
Advice for special needs
electric toothbrushes can help individuals with arthritis or mobility restrictions
who have difficulty or pain holding standard toothbrush maintain good oral hygiene
for mildly impaired mobility, a washcloth or sponge can be wrapped around toothbrush handle and secured with elastic
Older Adults RequiringAssistance with Oral Hygiene
Oral hygiene may be very difficult for individuals living with dementia and they may sometimes require assistance from caregivers. Behavior problems or agitation often associated with dementia may be symptomatic of undiagnosed oral pain, including cavities, tender gums or lesions in the mouth. It is important for caregivers to ensure that their care receiver maintains a good oral hygiene routine. Providing oral care to an individual with dementia, however, may be difficult for both the caregiver and care receiver.
Here are some things to keep in mind when providing or assisting with oral care:
Most care receivers will fall into one of four categories for oral care capabilities: independent/no assistance required; needs prompting and reminding; needs some assistance; needs full assistance
Think of each step required in brushing teeth or daily care of dentures
Observe the care receiver during their oral hygiene routine to determine what steps in their oral care routine they are able to perform independently
Encourage them to perform as many steps as they are able to do independently and assist them with the remainder
This process is referred to as “Task Breakdown” and promotes dignity and independence
Advice for Caregivers Assisting with and Providing Oral Care
Have all equipment ready
Have care receiver sit in comfortable position
Sit or stand at same level as care receiver and maintain eye contact
Describe what you are doing prior to each step
Smile, speak in a calm voice and minimize sensory stimulation in environment
If care receiver becomes overly agitated or resistant to oral care, caregiver should not force the task, but instead stop and re-try a few minutes later or ask another care giver to try if possible
Strategies
Bridging
Engaging the care receiver’s senses including sight and touch, which helps to clarify your actions
Place toothbrush or dentures in care receiver’s hand
After a short period of time some care receivers will independently brush teeth/clean dentures at this stage
Distraction
Involves placing familiar object (towel, activity board, small pillow) in care receiver’s hand during oral hygiene routine
This helps to distract care receiver from task being performed
Familiar music may also be played during oral care
Chaining
Caregiver begins oral hygiene routine and then asks care receiver to help complete the task
Hand-over hand
Technique to help improve the sensory awareness of the task
Caregiver places his/her hand over the care receiver’s hand and begins to brush teeth or remove/replace denture
You should not rely on information tools for medical, financial or legal advice. It provides general information only. NICE is not responsible for any use of the information other than for general educational/informational purposes and no claim can be made against NICE or any of its personnel for any such use.
