1	Oral Hygiene Management Program
2	Two dramatic demographic changes in geriatric dentistry: 1900 - 2000 1. Increased numbers of adults surviving into older age. 2. Increased numbers of older adults retaining natural teeth.
3	Factors in keeping natural teeth: Education Nutrition Medicine Professional dental care Genetic predisposition Efficient home care
4	Lifetime investment in maintaining natural teeth can be lost in a few months
5	Consequences of poor oral care
6	Consequences of poor oral care Bad breath Loss of self esteem Social isolation
7	Reasons dependent elderly don’t receive sufficient oral care: Major illness Medication that masks dental disease Cognitive and/or physical decline Income decline/uninsured Inability to get to dentist
8	Impact of some medications on awareness and progression of oral disease: Reduction of pain/sensitivity Dry mouth Antibiotics may mask origin of dental plaque disease Sedation
9	Top 10 causes of death in adults age 65 and over: (1966 - US) 1: Heart Disease* 2: Malignant Neoplasms 3: Cerebrovascular Diseases* 4: Chronic Obstructive Pulmonary Disease 5: Pneumonia and Influenza
10	Top 10 chronic conditions in adults age 65 and over: (1994 - US) 1: Arthritis 2: Hypertension 3: Heart Disease* 4: Chronic Sinusitis** 5: Diabetes Mellitus*
11	Risks of Dental Plaque Disease on (DPD) Dependent Elderly Health: Aspiration pneumonia Sepsis Cardiac (co-factor) Diabetes (co-factor) Stroke (co-factor)
12	Healthy Tooth vs Dental Plaque Disease
13	Thick Protective Enamel
14	Decay of Enamel
15	Tight Membrane
16	Loss of Membrane
17	Strong Attachment
18	Loss of Support
19	Oral Health Maintenance Elements Mechanical Tooth brushing, flossing Chemical Fluoride, anti-bacterial, peroxide Nutritional Healthy diet, fiber Regular dentist visits
20	Oral Hygiene Management Program Manual toothbrushes Small head Soft/medium bristles Children’s brushes work well for older mouths Replace brushes routinely
21	Oral Hygiene Management Program Battery spin brushes Inexpensive Easy to operate Gentle movement
22	Oral Hygiene Management Program Cordless, rechargeable toothbrushes, including ultrasonics Strong, effective action Ultrasonic action may bother some seniors Replace brushes routinely
23	Oral Hygiene Management Program Intradental Cleaning Daily flossing recommended Proxabrush may be helpful Stimudents or toothpicks may be needed Ultrasonics
24	Oral Hygiene Management Program Prescription products Fluoride gels; brush on teeth at bedtime without rinsing Chlorhexidine (Peridex, Perioguard); brush on morning after cleaning, do not rinse
25	Oral Hygiene Management Program Nutritional considerations Avoid sugars Healthy diet Regular dental visits
26	Oral Hygiene Management Program Final thoughts Consistent oral care is the key DPD can be silent, painless Healthy mouth and healthy body go together Resource list follows
27	Resources “Providing Oral Care” (videotape), Medcom Trainex (CNA #506), call 1-800-877-1443 “Oral Care for the Dependent Patient” (videotape), West Virginia University Health Sciences School of Dentistry and Geriatric Program, call 304-293-5912
28	Resources “Assuring Dental Health for Nursing Home Residents” (web cast), Centers for Medicare and Medicaid Services, see http://cms.distributedclassroom.org
29	Resources Oral Care in a Long-Term Care Facility” (videotape), University of Washington Instructional Media Services, call 866-791-1278 or see http://www.dental.washington.edu/ conted/cdestore/longterm.htm
30	Resources “A Beautiful Smile is Ageless” (videotape) and “Oral Health Assessment of Nursing Home Residents: An In-Service Training Guide for Nursing Staff” (videotape), Greater Houston Dental Society, call 713-961-4337 or see www.ghds.com/videos.htm
31	Take Your Pearly Whites to the Pearly Gates!