Putting the Mouth Back Into the Body

Improving Preventative Oral Care

Author: Mark Parkinson RPh:  President  AFC-CE

Credit Hours 1- Approximate time required: 60 min.

 

Educational Goal:

To put emphasis on more effective oral care in adult foster care homes  

Educational Objectives:

Explain about the disconnect between medical care and oral conditions in the mouth

List the medical conditions affected by neglected oral care

Explain about oral care factors in adult foster care

Provide a list of oral care products available today

Provide a list of helpful hints

Procedure:

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Disclaimer

   The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.

 

Putting the Mouth Back Into the Body

Improving Preventative Oral Care

 

It may sound funny, but there is a major new health initiative to put the mouth back into the body. Let me explain; in the past, there has been a huge disconnect in oral medical care. Conditions in the mouth were shunted off to an almost separate health system called dentistry.  Non-dentistry medical practitioners ignored conditions in the mouth. They, for the most part, relied on the patient to seek out dental care by themselves. Unfortunately, no one likes going to or paying for dentists, including insurance companies.  The result—for a large portion of the population, medical problems in the mouth were ignored. This disconnect occurred even when there were clear links between what goes on in the mouth and the health of the rest of the body. The result was a downward spiral in health for these patients. Their medical conditions contributed to poor oral health and hygiene. Inflammations, infections, and tissue destruction resulted in the mouth. This led to pain, discomfort, and bad breath, leading to alteration in behaviors in the patient. Untreated infections continued to grow, destroying dental tissues and negatively altering normal facial looks. This led to further social isolation and negative behaviors. The continued pain led to altering diets, becoming poorer in quality. The downward spiral continued as general health declined. Infections spread to areas outside of the mouth. Depression and irritated attitudes grew, creating further social isolation, leading to even more depressions. Poor diets and infections contributed to a weakened body, which made other disease states even worse.

 

 

Medical conditions directly affected by the conditions of the mouth

It is hard to say which came first—the systemic disease or poor oral health—but the following conditions have a proven link to dental health:

Diabetes − When there are infections, the body increases the blood glucose to fight off the infection, including infections in the mouth. Poorer diets that result from painful teeth contribute to loss of glycemic control. Chronic infections lead to chronic inflammation which weakens the body. This can contribute to the development or the worsening of diabetic symptoms.

Respiratory disease − The more bacteria in the mouth, the greater the chance that bacteria will be inhaled into the lungs. Pneumonia can result. Lung infections can also worsen the symptoms of asthma and chronic obstructive pulmonary disorder (COPD).

Cardiovascular disorders − Bacteria from oral infections can enter the bloodstream and infect the heart. More often, though, it’s the chronic inflammatory factors that negatively affect the cardiovascular system.

Mental Health − The chronic pain that results from oral infections and the loss of teeth negatively affect mental health conditions. Social interactions involving food decrease, leading to isolation.  The degradation in the appearance of the teeth and the associated increase in bad breath contribute to a negative self-image. The loss of social interaction and a negative self-image worsen mental health disorders.  

Failure to Thrive − In the elderly and the infirm, all of the above can have a significant negative effect on the body as a whole. Poor oral health contributes to the patient just giving up on living.

Cancer − Chronic oral infections have been linked to an increase in periodontal cancers.

 

The growing body of evidence is irrefutable. Cavities and periodontal disease have a major negative impact on the health of patients. Despite this growing awareness, there still seems to be a wall between oral health concerns and the rest of the body. I am just as guilty as anyone else. I remember several cases where I just did not connect the decrease in oral health and the worsening of the overall health of my residents.

I remember a little old lady who we could just not keep healthy. Despite all of our effects, there was a general decline in health. I remember the doctor just about gave up and labeled the condition ‘failure to thrive.’  Finally, she landed in the hospital, and she never returned to our home. I was shocked when I heard that the reason for the hospital admittance was a dental infection.

I also remember several cases where ill-fitting dentures caused us lots of problems. It was only after we addressed the denture problems that the residents returned to their normal behaviors. I wonder how much effort we could have saved if we had only worked on the dental problem first.

Now that I am thinking about it, I even ashamedly remember a few cases where the resident had such bad breath that nobody wanted to get near them. How bad is that? Social isolation in a care home!

 

Adult Foster Care Residents and Dental Health

We have to admit that adult foster care providers are just as guilty as any other health provider at not connecting dental health with the health of the rest of the body. That is really sad too because the elderly clientele that comes into our homes generally have greater incidences of poor oral health.  That also is true for mental health and developmentally disabled homes.

Risk factors for poor oral health found in care home populations:

  • The aged, ill, and infirm have compromised immune systems, making oral infections more likely to occur.
  • 7 out of 10 of the most commonly prescribed medications can cause dry mouth. That includes many mental health drugs. The lack of saliva accelerates tooth decay, and the incidents of oral infections increase.
  • Low self-esteem brought on by mental health issues makes personal oral health a low priority for these residents.
  • Malformed facial features and/or low mental acuity makes dental care problematic in the developed mentally disabled.
  • Arthritis and dementia make personal dental care in the aged much more difficult, so it is easier to be disregarded.
  • There is a misconception that tooth loss is part of the aging process. Society thinks that it’s normal for the elderly to need dentures.
  • Behavioral problems make it more difficult to seek dental care.

The more caregivers think about the subject, the more obvious the problem becomes. Periodontal disease and tooth decay are major problems for our residents. The dental health of our residents needs to become more of a greater priority in our caregiving efforts. If personal dental hygiene is difficult for our residents, we need to encourage and assist them. As patient advocates, if there is a wall between dental health and mainstream medicine, we need to push through it or even knock it down.

 

Good Dental Hygiene

 

The real tragedy of dental disease is that it’s so easily preventable. All it takes are a few simple dental cleaning procedures consistently applied daily. The American Dental Association (ADA) states that we should brush our teeth for two minutes twice a day and floss our teeth either before or after brushing.  They also recommend seeing a dentist on a regular basis. That’s it! No big multistep procedures involving multiple people; just plain and simple stuff.

 

To make good dental hygiene even easier and more effective, the ADA has approved a full line of dental products. They include fluoride toothpaste and mouthwashes, dry mouth relieving products, and oral hygiene devices. The full list can be viewed on their website. 

To explain why such simple procedures can be so effective, let’s take a look at how oral infections and dental cavities occur.  The mouth is a cavity that is the gateway to our insides. We cram all sorts of stuff into it, from delicious cookies to rusty nails and dirty fingers. We also suck in whatever happens to be floating in the air we breathe.  In the moist warm environment of the mouth, all sorts of microorganisms settle in and start to grow. Every time we feed ourselves, its dinner time for our mouth garden too. 

  • Cavities − The bacteria in our mouth turn carbohydrates in our food into acids. The bacteria, food debris, acid combine together in your saliva and form a sticky paste called plaque. The plaque sticks to the surface of your teeth, allowing the acid to start to dissolve the surface of the tooth. The cavity that is formed is a good place for even more plaque to get stuffed into. Soon, the cavity starts to get bigger and deeper. Eventually, it penetrates all the way down to the root of the tooth where the nerves and blood vessels are. The body’s defenses sense that bacteria is growing where it’s not supposed to be and starts the inflammation process. The results are a toothache.
  • Gingivitis − If plaque is allowed to hang around, it hardens into a substance we call tartar. Tartar that forms underneath the gum line is very irritating to the periodontal tissues. The gums become inflamed, painful and bleed more easily. Chronic gingivitis leads to receding gum lines and adds to tooth loss. Tartar cannot be removed by brushing alone. It needs a dentist to remove it.
  • Dentures − Plaque forms on dentures, so gingivitis occurs underneath dentures too. Chronic gingivitis can destroy the gums and even the underlining bone. This changes the shape of the gums so that dentures do not fit anymore. Loose fitting dentures just add to all problems that occur in the mouth.

 

Combating the Problem in Care Homes

In my opinion, care home caregivers can have a greater impact on improving dental health than any other healthcare provider—even dentists. Who else lives with the patient and can ensure proper oral hygiene 24/7? As patient advocates and caregivers, there is no other care provider better suited to putting the mouth back into the body than care home providers.

  • Initial resident screening − It’s going to be nasty, but you’re going to have to inspect the mouth of your new move-ins. Examine the dentures and ask how well they fit. Smell the breath. Ask about dental pain and sore spots. Look for obvious major tooth decay. You don’t have to do a crawl in the mouth. Often just observing and asking the right questions can reveal the problems that need to be addressed. 
  • Ensure dental hygiene − When a person moves into your home, everything changes for the new resident. This is the perfect time to get rid of poor dental care habits and replace them with good ones. Habits aren’t formed unless there is repetition. Repetition doesn’t happen unless there is constant monitoring, support, and encouragement.
  • Removing barriers − Part of knocking down the wall I mentioned earlier is identifying barriers that are preventing proper oral hygiene. Think about the underlying factors. Are there pain issues, ill-fitting dentures, worn out toothbrushes, hard-to-use floss, fear of dentists, fear of the expense, low self-esteem, dry mouths, or doctors who ignore the mouth? Get rid of underlying factors, and good oral hygiene becomes much easier to promote.

Helpful Hints

The following are a few thoughts I think can help you with your dental care efforts. This is by no means an exhaustive list. If you have a dental problem that’s kind of tough to deal with or have further questions, ask the dental professionals. 

 

  • Electric toothbrushes − Electric toothbrushes are well worth the small added cost. It makes it easier to brush longer, especially the gums and hard-to-reach spots. The larger, wider handle makes it easier for arthritic or misshapen hands to grasp. Electric toothbrushes are good for business. It’s a cheap way to make residents feel like they’re getting pampered.
  • String floss is hard to use and nearly impossible for some residents. It might be wise to research these alternatives. Interdental brushes, (Go betweeners, Proaxabrush), water flossers, and prestrung dental pick flossers.
  • Fancy extras − Better tasting mint floss makes it easier to get the resident to use it. Themed toothbrushes make it fun to brush. Specialty handles designed for handicapped hands make brushing easier and less painful.
  • Foam pipe insulating material or tape wrapping can turn regular brushes into handicap brushes.
  • If you have to assist with the dental cleaning duties, have the resident lie down, sit with their heads in your lab, or stand behind the resident. Those positions make it easier and more effective for the caregiver to assist in dental care.
  • Choose a dentist with experience in the type of residents in your home. Not all dentists can handle special needs clients.
  • Dentures can be cleaned with dish soap. It makes that first gross initial cleaning easier.
  • Gums can recover from damage. The initial pain that is experienced in dental hygiene will lessen over time.
  • Singing a song while assisting in brushing and flossing can distract uncooperative residents.
  • Mentally challenged residents sometimes engage in ‘food pocketing’ behavior. They do not swallow all the food in their mouths. Little pockets of food just sit in the mouth, causing future problems. A good practice to clear these pockets out is to have the resident rinse their mouth after every meal. You might even have to wipe their mouth out as well with a clean cloth.
  • Tongues can harbor bacteria as well. They need to have daily brushing or scraping as well.

 

Conclusion

Because of fears, cost, and medical apathy, the mouth was taken out of the body by mainstream medicine. It not only caused a lot of suffering in the mouth but also compounded troubles throughout the body and in other disease states. Those patients that end up in care homes seemed to be particularly at risk. Eldercare, Developmentally Disabled, and Mental Healthcare home providers are in the best position to do something about the problem. Through proper screening, monitoring, support, and providing dental hygiene equipment and supplies, caregivers reduce dental issues and greatly contribute to the health of the rest of the body.

As always, good luck with your caregiving efforts!

Mark Parkinson

References:

Gingivitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gingivitis/symptoms-causes/syc-20354453

Dental Health and Cavities. WebMD.com https://www.webmd.com/oral-health/guide/dental-health-cavities#1Michael Posey, BSPharm. Improving Preventive Oral Care to Enhance Overall Health: The Pharmacist's Role. Power-Pak CE. Jun. 30, 2017https://www.powerpak.com/course/content/115111

Elizabeth Southern Puette, RDH. Providing Daily Oral Care for Seniors as a Caregiver. Tooth Wisdom. Oral Health for Older Adults. https://www.toothwisdom.org/a-z/article/providing-daily-mouth-care-for-loved-ones/

Miriam Davidson. Keeping It Clean: Toothbrushing Tips. MDA/ALS News Magazine Jan. 1 2011. http://alsn.mda.org/article/keeping-it-clean-toothbrushing-tips

Amy L. Cooper, RDH. Alternatives to Flossing. Tooth Wisdom. Oral Health for Older Adults. https://www.toothwisdom.org/a-z/article/when-flossing-is-a-challenge/

 

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