Health Issues Related to Oral Health in Old Age

Health Issues Related to Oral Health Introduction

Oral health is a critical aspect of overall health, especially in older adults. As individuals age, maintaining good oral hygiene becomes increasingly important due to its profound impact on general health, nutrition, and quality of life. This article delves into the various oral health issues faced by older adults, the tools for oral assessment, and the nursing strategies and interventions that can be employed to address these issues effectively.

Oral Health-Related Health Issues

Oral health problems in older adults are often interconnected with other health conditions. Poor oral health is associated with several systemic health issues, including:

1. Malnutrition and Dehydration: Older adults with oral health problems, such as tooth loss, oral pain, or poorly fitting dentures, often face difficulties in chewing and swallowing. This can lead to reduced food intake, poor nutrition, and dehydration, which further exacerbates health problems (Coulthwaite & Verran, 2007; Touger-Decker & Mobley, 2007).
2. Respiratory Infections: Poor oral hygiene is linked to respiratory diseases like pneumonia and aspiration pneumonia. The oral cavity can harbor pathogens that, if aspirated, can infect the lungs, leading to severe respiratory conditions (Adachi et al., 2007; Azarpazhooh & Leake, 2006).
3. Cardiovascular Disease: There is a growing body of evidence suggesting a connection between poor oral health and cardiovascular diseases. Bacteria from periodontal infections can enter the bloodstream, contributing to conditions like endocarditis, valvular heart disease, and atherosclerosis (Lockhart et al., 2009; Sato et al., 2006).
4. Diabetes Management: Poor oral health can negatively impact glycemic control in individuals with diabetes, creating a bidirectional relationship where diabetes increases the risk for periodontal disease, and periodontal disease complicates diabetes management (Touger-Decker & Mobley, 2007; Kelsey & Lamster, 2008).
5. Mental Health and Quality of Life: Oral health significantly affects self-esteem, social interactions, and mental well-being. Conditions like tooth loss, halitosis, and oral pain can lead to social withdrawal, anxiety, and depression (Gil-Montoya et al., 2008; Montero et al., 2009; Naito et al., 2010).
6. Oral Cancer: Older adults are at increased risk for oral cancers, especially those with a history of tobacco use or alcohol consumption. Early detection through routine oral assessments can improve outcomes significantly (Christensen, 2007; Saunders & Friedmann, 2007).
7. Secondary Infections: Dental plaque and poorly maintained dentures can harbor harmful microorganisms, including Streptococcus, Staphylococcus, and various gram-negative bacteria, leading to infections that can spread beyond the oral cavity (Coulthwaite & Verran, 2007).

Oral Health Issues in Older Adults

Common oral health issues in older adults include:

1. Plaque Retention: Plaque retention is a prevalent problem in older adults, particularly those with reduced manual dexterity, impaired vision, or chronic illness. These individuals often struggle to effectively remove plaque through mechanical means like brushing or flossing (Coulthwaite & Verran, 2007; Hakuta et al., 2009).
2. Denture-Related Issues: Many older adults use dentures, which can harbor bacteria if not properly maintained. Poorly fitting dentures can cause ulcerations, oral fungal infections (e.g., candidiasis), and denture stomatitis, a condition characterized by red, inflamed tissue beneath dentures due to fungal infections and insufficient oral hygiene (Coulthwaite & Verran, 2007).
3. Medication Side Effects: Several medications commonly prescribed to older adults can have side effects that impact oral health. For example, cardiac medications may cause gingival enlargement, while steroids can predispose individuals to oral candidiasis. Cancer treatments, such as chemotherapy and radiation, can lead to conditions like stomatitis, xerostomia (dry mouth), and oral infections (Touger-Decker & Mobley, 2007; Quagliarello et al., 2009).
4. Dry Mouth (Xerostomia): Reduced saliva production, often a side effect of medication or certain medical conditions, can increase the risk for cavities, oral infections, and difficulties in speaking or swallowing. The lack of saliva also reduces the mouth’s natural cleansing mechanism, leading to plaque accumulation and periodontal disease (Christensen, 2007).
5. Oral Mucosal Diseases: Conditions such as lichen planus, cicatricial pemphigoid, and pemphigus vulgaris can affect the oral mucosa, causing pain, inflammation, and bleeding. These diseases require prompt diagnosis and management to prevent severe complications (Kanchisa et al., 2009; Montero et al., 2009).

Assessment of Oral Health Issues

The Role of Nursing in Oral Health Assessment

Nurses play a vital role in assessing and promoting oral health in older adults. Oral health assessment is a critical component of the nurse’s head-to-toe assessment, performed on admission and at the beginning of each shift. The assessment includes:

1. Condition of the Oral Cavity: The nurse checks for the presence of natural teeth, dentures, or any missing teeth. The oral cavity should appear pink, moist, and intact. Nurses also assess the patient’s ability to chew, speak, or swallow.
2. Fit and Function of Dentures: Dentures should fit comfortably without causing sores or irritation. Poorly fitting dentures can lead to ulcerations, pain, and infections like candidiasis.
3. Identification of Abnormal Findings: Nurses document any signs of oral health issues, such as dryness, swelling, sores, ulcers, bleeding, white patches, decayed teeth, halitosis, and ill-fitting dentures. These findings should be communicated to the healthcare team for further evaluation and management.
4. Assessment of Functional Ability: Nurses assess the patient’s manual dexterity and cognitive ability to perform effective oral hygiene. They observe the patient’s oral care routine and provide assistance if necessary.

Tools for Oral Health Assessment

1. Oral Health Assessment Tool (OHAT): The OHAT is an eight-category screening tool designed for use with cognitively intact or impaired older adults. It provides an organized method for documenting oral assessments, covering categories like lips, tongue, gums, saliva, natural teeth, dentures, oral cleanliness, and dental pain. Each category is scored from 0 (healthy) to 2 (unhealthy), with a total score range of 0 to 16 (Chalmers et al., 2005).
2. Other Tools: In addition to the OHAT, there are various other tools that can be employed to assess specific oral health issues, such as the Xerostomia Inventory for assessing dry mouth or tools to evaluate plaque levels and gingival health.

Nursing Strategies and Interventions

Interventions for Maintaining Oral Hygiene

Nurses can employ several strategies to promote oral health in older adults:

1. Use of Soft Nylon Toothbrushes: The gold standard for oral hygiene is a toothbrush with soft nylon bristles, which helps in mechanically removing plaque. Foam swabs, often used in care settings, are less effective at plaque removal and should be reserved for cleaning the oral mucosa in edentulous patients (Pearson & Chalmers, 2004).
2. Avoiding Harmful Practices: Lemon-glycerin swabs should not be used as they are drying to the oral mucosa and can cause enamel erosion, especially in older adults with xerostomia. Similarly, commercial mouth rinses containing alcohol should be diluted with water to prevent mucosal irritation (Pearson & Chalmers, 2004).
3. Fluoride Toothpaste: The use of fluoride toothpaste is recommended to prevent cavities and reduce periodontal disease risk. Nurses should educate older adults on proper brushing techniques, ensuring they brush twice daily and use fluoride toothpaste.
4. Chlorhexidine Use: Chlorhexidine, an antimicrobial mouthwash, may be prescribed by a dentist to manage specific oral conditions. Nurses should monitor for side effects such as a bitter taste, altered taste perception, and staining of teeth or dentures, and report these to the healthcare team (Quagliarello et al., 2009).
5. Regular Denture Care: Dentures should be cleaned after every meal and stored properly in a denture cup. They should be removed at night to allow the oral tissues to recover. Nurses should inspect dentures and the oral cavity regularly to ensure proper fit and hygiene (Coulthwaite & Verran, 2007).
6. Nutrition and Hydration: Encouraging adequate hydration is essential for managing dry mouth. Nurses should also advocate for a balanced diet rich in vitamins and minerals to support oral and overall health.

Education and Training

1. Staff Education: Regular education and training sessions for nursing staff on oral hygiene techniques, use of assessment tools, and management of oral health issues are crucial. Staff should be educated on the importance of oral health and equipped with evidence-based protocols to provide optimal care (Touger-Decker et al., 2007; Akar & Ergül, 2008).
2. Patient and Family Education: Educating patients and families about the importance of maintaining oral hygiene, recognizing signs of oral health problems, and dispelling myths related to aging and oral health is essential. This education empowers them to take an active role in oral care.
3. Access to Supplies: Ensuring that the necessary supplies, such as soft toothbrushes, fluoride toothpaste, denture cups, and alcohol-free mouthwashes, are available is fundamental to the provision of proper oral care.

Addressing Barriers to Oral Care

1. Overcoming Functional Limitations: For older adults with cognitive or physical impairments, nurses should provide assistance with oral hygiene, using adaptive devices like electric toothbrushes or handles modified for easy grip.
2. Adapting Care for Cognitive Impairment: For those with dementia or cognitive decline, oral care routines should be simple, familiar, and consistent. Engaging the patient in a calm environment, using clear instructions, and employing positive reinforcement can improve cooperation and adherence to oral care practices.
3. Incorporating Oral Health in Routine Care: Oral health assessments should be a standard part of nursing care. Regular oral examinations, especially in patients with chronic illnesses or those receiving medications that affect oral health, are vital to detect problems early and initiate prompt treatment.

Conclusion

Oral health is an integral component of overall health in older adults, impacting nutrition, quality of life, and the management of other health conditions. Nurses play a crucial role in assessing, maintaining, and promoting oral health in this population. Through comprehensive assessments, education, and evidence-based interventions, nurses can help prevent oral health problems, manage existing conditions, and enhance the overall well-being of older adults.

By prioritizing oral health in nursing care plans, health professionals can mitigate the risk of systemic health issues linked to poor oral hygiene, thereby improving outcomes for older adults. This holistic approach to oral health care will contribute significantly to achieving better health and quality of life for aging populations.