Geriatric Oral Health Clinical Case #1

Quiz Summary

0 of 3 Questions completed

Questions:

You have already completed the quiz before. Hence you can not start it again.

Quiz is loading…

You must sign in or sign up to start the quiz.

You must first complete the following:

Results

Quiz complete. Results are being recorded.

Results

0 of 3 Questions answered correctly

Your time:

You have reached 0 of 0 point(s), (0)

Current
Review / Skip
Answered
Correct
Incorrect

Question 1 of 3

1. Question
Henry Jones is a 79 year old gentleman who suffered a stroke 6 months ago, leaving him with dense right sided paralysis and slurred speech. Unable to live independently any longer due to his disabilities and lack of local family support, he was forced to move into a nursing care facility. He has overall adjusted well, but has developed a problem with persistent bleeding from his gums.

Robert Henry, DMD, MPH

Henry has developed chronic gingivitis and periodontitis, a common problem for someone in his circumstances. Which of the following factors is least likely to have contributed to his oral condition?
- His stroke-induced arm weakness makes routine oral hygiene very difficult Stroke, disfiguring arthritis, dementia and other chronic conditions of the elderly often contribute to poor oral hygiene and periodontal disease due to functional and cognitive deficits.
- He has been unable to afford to see a dentist in 4 years since he has no dental insurance Medicare does not cover routine dental care, particularly dental preventive care visits. A good, preventive care program includes an appropriate diet, brushing, flossing and regular visits to the dentist or hygienist for deeper cleaning and plaque removal. All of those measures help maintain good oral health.
- His age, because periodontitis is more aggressive in the elderly
- His recent stay at a rehabilitation unit where he received minimal oral care Unfortunately, many nursing care facilities do not address the oral needs of their patients. The 2004 National Nursing Home Survey by the Department of Health and Human Services indicates only 62% of nursing care facilities have contracts with dental care providers for their residents, and many are for emergency care only. Further, oral health training of nursing staff is typically limited and daily oral health activities such as oral hygiene may receive minimal attention in the face of multiple medical issues and low oral health knowledge.
- His new medications causing him to have a dry mouth Xerostomia, or dry mouth, contributes to periodontal disease because the decrease in saliva production reduces the mouth’s ability to adequately protect against bacterial infections.
Correct

Incorrect
Question 2 of 3

2. Question
Unfortunately, even though Mr. Jones was eventually able to access dental care through the Veteran’s Administration, his periodontitis led to gum recession and exposed roots on several of his teeth which subsequently developed root caries. His dentist feels that ultimately these teeth may require extraction. Mr. Jones is very interested in keeping his remaining teeth healthy and avoiding future dental problems.

John McDowell, DDS

Which of the following is the most appropriate next step towards better oral health for Mr. Jones?
- Stop any of his new medicines that could be contributing to dry mouth. Xerostomia, or dry mouth, can contribute to periodontal disease and root caries. Many medicines can contribute to xerostomia. However, Mr. Jones needs to collaborate with his dentist and primary care clinician to determine which medications are safe to discontinue. To reduce the risk of another stroke or other vascular complications, Mr. Jones may need to take anti-hypertensives despite the fact that many of those medications can contribute to xerostomia. On the other hand, he might be able to discontinue his sleep aid, another class of drugs known to cause xerostomia, now that his routines have been re-established. He may also benefit from other treatments such as increasing his fluid intake, avoiding sugary drinks and snacks, and using over-the-counter saliva substitutes. The use of electric toothbrushes has also been shown to increase saliva in some individuals.
- Ensure timely fabrication and delivery of a partial denture to replace already lost teeth. Dentures in this circumstance may decrease oral health. Dentures typically increase plaque retention and make caring for existing teeth more difficult. Further, they may be poorly tolerated due to the xerostomia and may increase the risk of developing candida infections. Dentures will be necessary for replacement of missing teeth but are best provided once oral disease is effectively managed.
- Provide professionally applied fluoride treatments on his exposed roots along with the provision of specially adapted oral hygiene devices.
- Place a standard toothbrush and dental floss on his bedside so he is able to more frequently care for his teeth. Routine oral hygiene is the best first step in promoting a return to good oral health for Mr. Jones. He needs to brush and floss his teeth but clearly his disability will preclude routine brushing and flossing. A specially adapted toothbrush that he can use in his left hand or better still an electric toothbrush will be needed.
- Switch to smokeless tobacco. Use of any tobacco product contributes to periodontal disease. Anyone who uses tobacco products should be encouraged and assisted in quitting. It is important to remember that cigarettes and smokeless tobacco are both carcinogenic and increase the risk of oral cancers as well as periodontitis.
Correct

Incorrect
Question 3 of 3

3. Question
Mr. Jones has done quite well over the next 3 months in the nursing facility. He is walking better, has improved his speech, and with aggressive occupational therapy has learned to perform many of his activities of daily living despite persistent disabilities from his stroke. He uses the Collis Curve toothbrush shown below for his daily oral care. He also uses a salivary substitute to relieve his dry mouth. With professional dental care his periodontal disease is now in control and only the two teeth with severe root caries had to be extracted.

Robert Henry, DMD, MPH

Had Mr. Jones not had the opportunity to address his oral health needs, which of the following complications might he be at risk for?
- Diabetes Periodontal disease does increase the risk of developing diabetes, but other responses are also correct.
- Osteonecrosis of the jaw Mr. Jones is unlikely to develop osteonecrosis of the jaw due to his periodontal disease alone. Factors associated with osteonecrosis include treatment for cancer and bisphosphonate use, especially in the intravenous form.
- Pneumonia Periodontal disease does increase the risk of pneumonia in elders, but other responses are also correct.
- A and C
Correct

Incorrect

Geriatric Oral Health

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question