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Oral Health in Older Adults

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Geriatric Gastroenterology

Abstract

Systemic gastrointestinal disorders and oral manifestations are well elucidated in current literature. Many chronic disorders such as cardiovascular disease, stroke, brain health, lung disease, and diabetes are associated with oral manifestations. This bi-directional relationship may be a result of inflammatory response to periodontal pathogens. Inflammatory mediators pronounced in the oral cavity may gain access to the circulation resulting in systemic effects. Proper daily oral care, with prevention as the cornerstone, is the most crucial factor in improving oral health in older adults.

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Correspondence to Mary S. Haumschild .

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Book Chapter Quiz Questions: Oral Health in Older Adults

Book Chapter Quiz Questions: Oral Health in Older Adults

  1. 1.

    Which of the following best describes as to why older adults usually fail to seek adequate preventive dental care?

    1. a.

      Lack of mobility

    2. b.

      Poor value judgment

    3. c.

      Inadequate insurance coverage

    4. d.

      Barriers in access to care

    Discussion/Rationale: Dental insurance is typically provided as a benefit for working individuals; therefore, retired persons on fixed incomes are not likely to have dental insurance coverage. In addition, Medicare and Medicaid do not cover dental procedures. The rising costs of prescription drugs cause retired individuals to make a choice about where they will spend their healthcare dollars. Access to care may be affected by several barriers. Among the most common are high costs associated with dental care, transportation to dental clinics, and disabilities that affect mobility.

  2. 2.

    Which of the following systemic illnesses do not have a known or suspected bi-directional relationship with oral health?

    1. a.

      Epstein-Barr

    2. b.

      Diabetes

    3. c.

      Pneumonia

    4. d.

      Crohn’s disease

    Discussion/Rationale: Chronic systemic disease and oral disease share common risk factors. There are over 100 systemic diseases that have oral manifestations, such as cardiovascular disease, stroke, chronic respiratory disease, diabetes, and nutritional deficiencies. This is a bi-directional relationship, the link being inflammation. Periodontal pathogen and inflammatory mediators that are pronounced in the oral cavity may access the circulation and have systemic effects. Stroke patients may have impaired manual dexterity; therefore, oral hygiene will usually deteriorate on the affected side. Epstein-Barr is causative or contributory in various viral infections and in itself is not a true systemic illness.

  3. 3.

    Which of the following oral hygiene aids would be helpful for patients with arthritis or recovering from a stroke?

    1. a.

      Oral irrigator

    2. b.

      Power toothbrush

    3. c.

      Adaptive floss aids

    4. d.

      All of the above

    Discussion/Rationale: Patients may all benefit from using adaptive floss aids, power toothbrushes, and oral irrigators. Pictures and a 2-minute egg timer ensure that the patient will be brushing long enough with the proper 45-degree angle at gumline to remove the bacterial plaque. In addition, a caregiver may need to assist with proper oral care. However, although an oral irrigator is an extremely useful preventive instrument, it does require reasonable dexterity to operate, limiting its usefulness in a patient with severe arthritis or recovering from a stroke.

  4. 4.

    The primary reason why caries rates among older adults are growing faster than in children is best explained by which of the following?

    1. a.

      Dietary considerations

    2. b.

      Insufficient water fluoridation

    3. c.

      Increased retention of plaque biofilm

    4. d.

      Repositioning of gumline with increased age

    Discussion/Rationale: Longitudinal data for older adults suggest that they may have more caries (decay) than children, although the latter are the primary recipients of caries prevention services. Currently, water fluoridation is the main caries prevention program that affects older adults. Because of gum recession, older adults are more prone to have decay on the exposed root area next to the gumline. This area lacks the protective hard enamel coating; therefore, it is softer and more affected by the plaque biofilm and resulting gingival inflammation. The primary reason for increased caries rates in all populations centers around retention of plaque on the dentition. This fact is due to the bacterial component in biofilm that converts carbohydrates to acids capable of decaying calcified tooth structure. Older adults may struggle with dexterity issues that further complicate adequate biofilm removal. For further decay prevention, older individuals should limit the frequency and amount of carbohydrate exposure.

  5. 5.

    What is the most effective way to ensure that institutional barriers in dental access to care for older adults are being more adequately addressed?

    1. a.

      Provide improved oral hygiene training of nursing staff by expert dental hygienists

    2. b.

      Directly utilize more dentists within the facility

    3. c.

      Change laws and statutes to improve language in access to care

    4. d.

      Employ more nursing staff dedicated to dental health needs

    Discussion/Rationale: Studies have found that nursing staff needs more training by expert dental hygienists and recommend that long-term care facilities consider hiring dental hygienists to assess oral health and oversee oral care. In addition, policymakers and insurance companies need to come together to increase oral health policies and provide reimbursement for older adult dental patients. Standards and protocols need to be implemented to ensure that oral care goals are met. Steps to improve a nursing staff’s performance in addressing the patient’s preventive dental needs would undoubtedly have a positive impact; mid-level dental hygiene professionals are ideally poised to oversee oral care in an institutional setting.

  6. 6.

    All of the following are conditions that are common to the aging mouth except one. Which one is the exception?

    1. a.

      Increased oral cancer risk

    2. b.

      Increased salivary function

    3. c.

      Increased caries risk

    4. d.

      Increased periodontal disease prevalence

    5. e.

      Increased periodontal disease severity

    Discussion/Rationale: Decreased salivary function is common to aging. The elderly have approximately half the salivary flow of other age groups, atrophy of the acinar glands, and high rates of xerostomia.

  7. 7.

    All of the following increase the risk of aspiration pneumonia of the elderly living in nursing homes. Which one is associated with the greatest risk?

    1. a.

      Poor oral care

    2. b.

      Dysphagia

    3. c.

      Feeding problems

    4. d.

      Decreased functional status

    Discussion/Rationale: Due to increased bacteria in the mouth

  8. 8.

    A patient with a removable prosthesis should be advised to not do which of the following?

    1. a.

      Soak prosthesis in water and a cleansing solution at night

    2. b.

      Use an abrasive powder to remove stains

    3. c.

      Rinse prosthesis with water after an overnight soaking

    4. d.

      Place container with prosthesis and cleaning solution away from bedside

    Discussion/Rationale: Avoid abrasive products, which increase scratches and encourage more staining

  9. 9.

    In 2015, HPV-related oropharyngeal squamous cell lesions were most commonly found in which group?

    1. a.

      Females aged ≤70 years

    2. b.

      Females aged ≥70 years

    3. c.

      Males aged ≤ 70 years

    4. d.

      Males aged ≥70 years

    Discussion/Rationale: Males aged 60–69 have the highest rate of HPV-related oropharyngeal squamous cell lesions

  10. 10.

    All of the following oral conditions may be helpful in diagnosing patients with Crohn’s disease except one. Which is the exception?

    1. a.

      Gingival hyperplasia

    2. b.

      Dental caries

    3. c.

      Aphthous ulcers

    4. d.

      Erythematous lesions on the uvula

    Discussion/Rationale: Erythematous lesions on the uvula may be an indication of GERD

  11. 11.

    Which of the following gastrointestinal medications is associated with causing erythema multiform lesions intraorally?

    1. a.

      Histamine-2 blockers

    2. b.

      Proton pump inhibitors

    3. c.

      Interferons

    4. d.

      Sulfas

    Discussion/Rationale: The appearance of erythema multiform lesions is somewhat rare but has occasionally been confirmed in cases of patients taking long-term proton pump inhibitors. In some cases, clinically observable oral ulcerations will actually precede the clinical diagnosis of lesions appearing elsewhere in the GI system. Since many medications routinely prescribed for various gastrointestinal condition are known to cause intraoral lesions, it is imperative for clinicians to carefully debrief patients regarding all medications (prescription and over the counter) being taken at each diagnostic, treatment, or wellness care appointment.

  12. 12.

    According to the content here, which of the following services are typically included in Medicare, Medicaid, and private supplemental insurance policies?

    1. a.

      Dental exams

    2. b.

      Prophylaxis

    3. c.

      Periodontal treatment

    4. d.

      Extractions

    5. e.

      Caries treatment

    Discussion/Rationale: Medicare, Medicaid, and private supplemental insurance policies typically do not cover routine dental examinations, prophylaxis (cleanings), periodontal treatment, or fluoride. They usually cover extractions.

  13. 13.

    Which of these is not considered a barrier to adopting teledentistry?

    1. a.

      Patient privacy issues

    2. b.

      Practice laws regarding supervision of dental hygienists

    3. c.

      Dentist and patient are in close proximity to each other

    4. d.

      Technical issues and training

    Discussion/Rationale: The main reason that teledentistry is used is because the dentist and patient are far away from each other.

  14. 14.

    Which is not considered a benefit of teledentistry?

    1. a.

      Health equality for vulnerable populations

    2. b.

      Early detection

    3. c.

      Access to care in rural remote settings

    4. d.

      Increased time for the patient

    Discussion/Rationale: Teledentistry has been shown to decrease time for the patient because they do not need to travel to the location of the dentist provider.

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Haumschild, M.S., Hammaker, B., Pino, I., Woods, K., Dickey, N. (2021). Oral Health in Older Adults. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-030-30192-7_58

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