Prevention and Disease Management for Older Adults( Article 2 of 4)

The rapid growth of population that is 65 and older will profoundly affect dental care in a number of ways.
Risk assessment for this vulnerable group  will help develop the most appropriate prevention plan and treatment strategy.

 Prevention:

Majority of older patients suffer from hyposalivation or Drymouth

Simple preventative remedies  to alleviate drymouth include-

Regular sips of water throughout the day
Limiting number of alcoholic beverages and beverages
Limiting beverages high in sugar and caffeine particularly sodas,juices and sweetened coffee and tea
Avoid spicy and salty foods
Caution using mouth washes containing alcohol
Using  salivary substitutes  such as Oralbalance gel, Biotene Moisturing spray, liquid mouthspray etc
.
In extreme cases, a salivary stimulant may be prescribed which does require consulting with patient's physician. 
Discussion with physician and or pharmacist regarding substitution of medicines causing dry mouth can also be an option.

Caries:
For patients with an increased risk of caries or dental decay, an oscillating tooth brush is best.  Automated toothbrushes remove more plaque than manual brushing alone. It is particularly helpful for patients with limited dexterity and arthritis.

Use floridated toothpaste daily and floride rinses
 Periodic topical application of 5% sodium floride varnish in severe cases of caries.
  This mode is inexpensive, non invasive and shown to reduce decay.

As the old adage goes " an ounce of prevention is worth more than a pound of...."

Visit www.mydentistchino.com or Call 909 627 6699 to contact our office. We are more than happy to help you with your question.

Oncology Pocket Guide to Oral Health

Head and Neck Radiation Therapy

Patients receiving radiation therapy to the head and neck are at risk for developing oral complications. Because of the risk of osteonecrosis in irradiated fields, the best time to perform oral surgery is before radiation treatment begins. Prior to treatment, the dentist will consider extracting all teeth that may pose a problem in the future.

Before Head and Neck Radiation Therapy

• Refer the patient to a dentist for a pretreatment oral health examination, ideally 1 month before cancer treatment begins.
• Tell the dentist the treatment plan and timetable. Be sure the dentist is knowledgeable about cancer care issues.
• Help prevent tooth demineralization and radiation cavities by making sure the patient has a good oral hygiene program and has received instruction on fluoride gel application.
• Allow at least 14 days of healing for any oral surgical procedures before radiation treatment.
• Make sure pre-prosthetic surgery is done before treatment begins—surgical procedures may be contraindicated on irradiated bone.

During Radiation Therapy

• Make sure the patient follows the recommended oral hygiene regimen, whether at home or in the hospital.
• Monitor mucosa and oral structures for bleeding and infection.
• Advise patients not to wear removable appliances during treatment.

After Radiation Therapy

• Consult with the dental team about dentures and other appliances after mucositis subsides. Patients with friable tissues and xerostomia may not be able to wear them again.
• Make sure that the patient follows up with a dentist for fluoride gel/home care compliance. Lifelong, daily applications of fluoride gel are needed for patients who are severely xerostomic.
• Monitor the patient for trismus. Check for pain or weakness in masticating muscles in the radiation field. Instruct the patient to exercise jaw muscles three times a day, opening and closing the mouth as far as possible without pain; repeat 20 times.
• Advise against oral surgery on irradiated bone because of the risk of osteonecrosis. Tooth extraction, if unavoidable, should be conservative; use antibiotic coverage and possibly hyperbaric oxygen therapy.
• Consult the dentist to monitor irradiated craniofacial and dental structures for abnormal growth and development in pediatric patients.
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