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                                                        DR. DAN PETERSON

                                                                      1415 SAGE STREET ~ GERING, NEBRASKA 69341 
                                                             
      Call: 308-436-3491       www.dentalgentlecare.com           

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DAILY DENTAL CARE TIPS FOR
 THOSE CARING
FOR THE OLDER ADULT

    Good dental health is vital for everyone because a healthy mouth is important for speaking, chewing, and overall health.  This is why it is essential that all older adults receive good dental health care on a daily basis.  It is important for the caretakers of older family members or older patients to learn what techniques will provide them with the best dental care.

     Remember many older adults or patients are sensitive to having their mouth and/or head touched.

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 Always be sure to move slowly and explain exactly what you are going to do in order to not caught them off guard or startle them. 

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While you brush and floss their teeth talk in a soft, soothing, and friendly voice to put them at ease.

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They will struggle and fuss less if you approach them in an gentle and caring manner.

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    Here are some dental health tips:

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Brushing:

  1.  Use a soft bristle toothbrush

  2.  Brush their teeth with a gentle circular massaging motion on the outside and inside surfaces of their teeth.

  3. Be sure to brush the biting surfaces of their teeth.

  4. Do not brush their tongue, it can cause irritation.  Scrape their tongue with a tongue scrapper to remove bacteria and debris.

  5. Replace their toothbrush about every three months.

  6. You can try to give them some independence by strapping their toothbrush to their hand by using a wide elastic band that attaches their toothbrush to their hand.

  7. You can enlarge the brush handle by "taping" it to a sponge, bike handle grip or rubber ball.  Or try using "good old" duck tape wrapped around the handle to increase the size of the handle to make it easier for them to grip.

  8. You can lengthen the handle of the toothbrush by taping tongue depressors, Popsicle sticks or a ruler to the handle.

  9. An automatic toothbrush is another option that we recommend to many patients.

  10. Don't let them share toothbrushes with anyone else.

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Flossing tips:

  1. If they are not use to flossing try the automatic flosser.  Their gums may bleed and be sore for about a week but that will stop with regular flossing.

  2. If they are use to using tread type floss you need to use the following flossing technique:  How to floss, but don't forget to floss behind the last teeth in their mouth, on each side ,because it removes bacteria and food around and under the gumline where a toothbrush can not reach.

  3. While you are flossing their teeth try visiting with them or turn on the radio or TV. for a distraction.

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Denture care:

  1. Each morning BEFORE dentures are placed in the mouth, it is important that the gums and roof of the mouth be gently brushed with toothpaste to remove plaque and stimulate the gums.

  2. The tongue should be scrapped for fresher breath.

  3. The dentures are to be cleaned daily to remove plaque, food and to prevent staining.  To learn how to clean dentures see: Denture Care.

  4. Any denture that is broken, chipped or cracked should NOT be repaired by you but taken to their dentist to be professionally repaired.

  5. If their denture is loose or ill-fitting they should be taken to the dentist immediately, because poorly fitting dentures can make painful sores in their mouths

     If you notice any of the following condition/s PLEASE contact their dentist or doctor:

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Bleeding gums

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Change in how their teeth fit together

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Red, swollen or tender gums

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Pus at the gumline of a tooth

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Change in the fit of their dentures or partials

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Very bad breath

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Loss of taste and weight loss

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Loose or chipped teeth

(Information provided by CDA)              

Newer communication techniques for people with dementia include:

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Rescuing - a second caregiver tells 1st carer to leave so that she can
"help" her friend the resident.

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Distraction - busy boards with familiar objects.

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Bridging - residents holds toothbrush while RDH uses prop to break the peri-oral muscles spasms.

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Hand-over-hand – carer’s hand placed over resident’s hand to guide
activity.

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Chaining - carer starts the activity, resident completes it.

Older hands can have a difficult times holding a toothbrush or flossing

Updates on Elderly and Dental Health

Medicated Gum Helps Boost Seniors Oral Health
Older adults can lower their risk of developing oral infections by chewing a sugarless, medicated gum, researchers in England report. Poor oral hygiene among elderly adults can lead to debris-covered dentures and tooth decay, which can in turn affect overall health. High levels of dental plaque, along with a type of oral infection called thrush, can lead to serious illness elsewhere in the body, such as pneumonia. An easy-to-use method for improving oral hygiene could thus help elderly adults improve their overall health.-- Yahoo/Reuters

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Dental problems can boost pneumonia risk in elderly.

Better dental care among the elderly — especially in nursing homes — could reduce cases of a particular type of pneumonia, according to researchers from the University of Michigan and Veterans Administration. Aspiration pneumonia is an infection that occurs after bits of food or stomach contents are inhaled into the lungs. Investigators found patients were at higher risk for this type of pneumonia if they had dental plaque or certain types of mouth bacteria. Overall, patients who had a stroke, chronic obstructive pulmonary disease  or needed help eating were at risk for the ailment. "We know, as a result of previous studies, that it's just an area that tends to be overlooked in nursing homes It's often left to the residents to clean their mouth, and they just ignore it.People with dementia or other conditions that impair their mental status, or those who can't easily move their hands, are especially likely to have dental problems. In the meantime, nursing homes should assign and educate specific staff members, preferably nurse's aides, to do some actual tooth brushing for people who can't brush their own teeth. Additionally, they should encourage the use of a mouthwash, such as chlorhexidine, which can kill some harmful organisms in the mouth. "
By Meg Bryant Washington (Reuters Health) 

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Respiratory infections The oral cavity has long been considered a potential reservoir for respiratory pathogens. The mechanisms of infection could be:
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aspiration into the lung of oral pathogens capable of causing pneumonia

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colonization of dental plaque by respiratory pathogens followed by aspiration

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facilitation by periodontal pathogens of colonization of the upper airway by pulmonary pathogens.

Several anaerobic bacteria from the periodontal pocket have been isolated from infected lungs. In elderly patients living in chronic care facilities, the colonization of dental plaque by pulmonary pathogens is frequent. Notably, the overreaction of the inflammatory process that leads to destruction of connective tissue is present in both periodontal disease and emphysema. This overreaction may explain the association between periodontal disease and chronic obstructive pulmonary disease, the fourth leading cause of death in the United States. These findings underline the necessity for improving oral hygiene among patients who are at risk and those living in long-term institutions. 
[Mojon P Oral Health and Respiratory Infection JCDA 2002;68(6):340-5]

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Poor Dental Hygiene in Elderly May Increase Risk of Type of Pneumonia
    A study of patients aged 57 years to 98 years found an increased risk for aspiration pneumonia in individuals with dental plaque or certain types of mouth bacteria. Aspiration pneumonia is an infection that is caused by bits of food or stomach contents being inhaled into the lungs. The study reviewed records of 408 patients and found those who had a stroke; had chronic obstructive pulmonary disease, including emphysema and chronic bronchitis; or needed help eating, were at risk for the infection.  They suggested that nursing homes encourage the use of mouthwash and that they assign and educate specific staff members to perform tooth brushing for those patients who cannot do it for themselves.

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Another study found: "Nursing home residents who received regular dental cleanings were not only less likely to contract pneumonia, but also less likely to die from the infection if they did develop one. Pneumonia is caused by germs that gather in the lungs and block the flow of oxygen to the body. If air in the mouth is already tainted with disease-causing bacteria, it is easier for an infection to spread to the lungs".  They found that " those who didn't receive the professional cleanings were twice as likely to develop pneumonia and twice as likely to die from the infection."~

Special Care in Dentistry Journal, Vol.20, No 4 2000 pgs. 149-153.
***Colleen Davy, RDH, DHSCL, British Columbia, CAN. davy@seaside.net
Hygiene Cyber Notes, Jan 2001
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Journal of the American Geriatrics Society, Kenneth Shay, DDS July 2002.

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February 06, 2008

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
                                                                                 308-436-3491 Office number

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
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