Palliative Treatment for Frail and Older Adults (Article 4 of 4)

The goal of palliative treatment is to enhance the quality of life during a painful episode  or for someone with a terminal illness A dentist's role could greatly enhance patient comfort and quality of life as the mouth is often the first site on pain.

  The first step in  palliative oral care is establishing good communication with the patient. With a good understanding of the patient's health circumstance, conducting a thorough oral exam  and asking for symptoms, severity and frequency is very important to determine the most bothersome issue and dealing with it promptly.

The most common oral complaint is dry mouth  If possible increase water consumption or use ice chips if choking is not a concern.. Foam swabs are helpful with providing moisture although not effective for plaque removal.  The swabs can be soaked  in warm salt water or an alcoholfree mouth rinse prior to swabbing the inside of patient's mouth.
 Daily oral hygiene is essential with modifications as needed for the palliative patient. An ultra soft  small toothbrush head can be used to promote comfort.

Candidiasis or fungal infections are common in palliative patients.  Anti fungal gels can be applied if patient cannot rinse.  Dentures can be scrubbed with soap and water and antifungal gel applied on the under surface of denture.

Preserving dignity is important part of palliative care. Maintaining a satisfactory facial appearance may be important to some patients and dentures, if needed should be made.

This concludes the series on dental care for the older adults.  Call 909 627 6699  or visit www.mydentistchino.com for more information.

Dry Mouth or Xerostomia

Dry Mouth is a symptom rather than a specific disorder. Saliva cleanses the mouth and begins the digestive process as foods are chewed. Adequate saliva flow coats and lubricates the mouth. When dry mouth or xerostomia occurs, soft tissues get irritated and inflamed and are more susceptible to oral infections. Without the cleansing and shielding effects of adequate salivary flow, tooth decay and periodontal disease become more prevalent.   Constant dryness and lack of protection provided by saliva contribute to bad breath.  In denture wearers, dentures feel less comfortable without the thin film of saliva to help them adhere properly to the mouth.

Causes of Dry Mouth

Prescribed and over the counter medications have emerged as the most common cause of dry mouth.

Medications including  antihistamines, decongestants, pain killers, diuretics, anti hypertensives and anti depressants are among 400 other medications that have side effects of dry mouth.

Aging does minimally reduce the salivary flow.

Radiation of head and neck

Emotional stress 

Autoimmune disease like Sjogren’s  syndrome and diabetes

.

Hormonal alterations associated with  pregnancy and menopause have been associated with dry mouth.

Symptom Relief

Chewing sugar free gum or candy to stimulate salivation

 Drinking frequent sips of water

Use of alcohol free oral rinses

Restricted use of caffeine, alcohol and carbonated beverages

Regular check- ups and teeth cleaning are more important in mouths experiencing  xerostomia  to minimize decay and periodontal disease.  Additional fluoride products may be recommended to safeguard your dental health.

Visit www.mydentistchino.com for additional information.

Dental Health and Seniors

Jawbones are a living part of the skeletal system that  help define a person's face as well as providing a solid surface for which teeth can be firmly anchored. Results of a forty-year study have indicated that jaws can shrink over time resulting in tooth overcrowding in senior mouths.

The jawbone is not the only body part to be impacted by aging as every organ, hair follicle and tooth will be impacted by the natural process of a body's systems slowing down. When it comes to the latter, the appearance of a smile changes because of a shrinking jaw and lessened skin elasticity, however some of the oral changes associated with aging are more than skin deep.

According to the AGS Foundation for Health in Aging, the five most common dental problems associated with aging include:

•    Saliva production will naturally slow down, causing dry mouth.
• Ill-fitting dentures caused by crowding, shifting teeth and receding gums.
• Increased odds of developing gum disease, impacted by seniors implementing less-effective oral hygiene.
• More occurrences of tooth decay.
• Greater odds of developing oral cancer

Dental care and preventative dentistry are essential to ensure that seniors lower their risk of potential dental problems.  The process involves basic principles of brushing, flossing, eating a nutritious diet, exercising, drinking fresh water and maintaining regular dental visits.

“Aging individuals need to find a dental home led by a team with a good understanding of age related dental issues” Dr. Cherukuri cautions.

Dry Mouth

Dry mouth, also called xerostomia is the condition of not having enough saliva, or spit, to keep the mouth wet.  Dry mouth can happen to anyone occasionally—for example, when nervous or stressed.  However, when dry mouth persists, it can make chewing, eating, swallowing and even talking difficult.  Dry mouth also increases the risk for tooth decay because saliva helps keep harmful germs that cause cavities and other oral infections in check.

Causes

Dry mouth occurs when the salivary glands that make saliva don't work properly.  Many over-the-counter and prescription medicines, as well as diseases such as diabetes, Parkinson's disease and Sjogren's syndrome, can reduce saliva formation. .  Other causes of dry mouth include certain cancer treatments and damage to the glands' nerve system.  It's important to see your dentist or physician to find out why your mouth is dry.

Treatment

Depending on the cause of your dry mouth, your health care provider can recommend appropriate treatment. There are also self-care steps you can take to help ease dry mouth, such as drinking plenty of water, chewing sugarless gum, and avoiding tobacco and alcohol.  Good oral care at home and regular dental check-ups will help keep your mouth healthy.

“Frequent use of moistening rinses along with topical fluoride applications and increasing dental recare visits are preventative measures that greatly enhance oral health” says Dr. Cherukuri from her Chino, California  dentalpractice

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.
   Visit www.chinosmiles.com for more information or Call 909 627 6699 to make an appointment for a complimentary consultation.

Dry Mouth

In recent years, prescribed and over-the-counter medications have emerged as the most common cause of dry mouth. Suspect medications include antihistamines, decongestants, painkillers, diuretics, antihypertensive medications and antidepressants. In fact, dry mouth is listed as a potential side effect of more than 400 medications. Be sure to read the literature that accompanies your medications and, if you think a medication is causing dry mouth, tell your dentist or physician. In some cases, substituting medications may alleviate the problem.
 

What is dry mouth?

Dry mouth is caused by a decrease in the amount of saliva in the mouth when the salivary glands do not work properly. The salivary glands help keep your mouth moist, which helps prevent tooth decay and other oral health problems. The medical name of the condition is xerostomia.

Although a common cause of dry mouth these days is medication, the condition may occur when a person experiences stress, or it may even be a sign of a serious health problem, such as AIDS, diabetes or Sjogren’s Syndrome (an autoimmune disease). Other possible causes include aging, radiation therapy and chemotherapy. People with Alzheimer’s disease or who suffer a stroke have been known to experience dry mouth.

How to relieve dry mouth

Your dentist or physician may recommend using artificial saliva — available at local pharmacies — to keep oral tissues lubricated. But the solution may be as simple as increasing your water intake. Other tips on how to ease dry mouth include:

• Brush and floss twice a day
• Chew sugarless gum
• Avoid alcohol, caffeine, carbonated beverages and smoking
• Avoid certain juices (orange, grapefruit and tomato)
• Avoid dry foods, such as toast or crackers
• Avoid overly salty foods
• Use alcohol-free oral rinses 
• Topical fluoride applications

 Visit your dentist regularly. Ask your dentist for advice specific to your situation. 

“Sipping on water throughout the day not only hydrates the mouth but the body as well” adds Dr. Cherukuri from her Chino, California dental practice. ‘It is an easy fix to offset rampant decay and other related dental issues”