Dr Mensch Károly PhD Oral Diagnostics 2021 Old person Based on a recommendation of the WHO gt65 years old in Hungary gt70 years old in the USA and in Germany Definition ID: 930422
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Slide1
Diagnostic examination of elderly patients
Dr.
Mensch
Károly
Ph.D
.
Oral
Diagnostics
2021
Slide2Old person?
Based on a recommendation of the WHO
>65 years old in Hungary
>70
years old in the U.S.A and in Germany
Slide3Definition
of old age
Aging: it is a physiologica process, a cumulation of irreversible
processes
•
old age:
calendar
age or chronological age
b
iological
age
psychological
age
social
age
•
World
Health Organization:
middle
aged person: between 45 and 59 years
a
person between 60 and 74 years is elderly or „youngest old”
a
person between 75 and 89 years is old or „middle old”
a
person older than 90 years is very old, or „oldest old”
a
person: older than 100 years is a centennial
Székács B:
Geriátria-
az időskor gyógyászata. Semmelweis Kiadó, Budapest, 2005
Fejérdy
P, Nagy G, Orosz M:
Gerosztomatológia-
az időskor fogászata. Semmelweis Kiadó, Budapest, 2007
Slide4The classification
of the British Society of Gerontology
-Aging
(45to59years)
-Elderly
(60to74years)
-Old
(75years)
-Very old (from age 90 years)
Slide5Scientific
disciplines that study old aged people
Gerohygienics
: its aim is to ensure a valuable quality of life for old aged people.
- Gerontology
: studies the physiological changes of aging and of old
age.
- Gerontological
demographics: studies the ratio of old aged people in a given
population.
- Social
gerontology: Studies the interactions and relations of old aged people and
society.
-
Geriatrics:
(Medicine
specializing in old aged patients) studies the therapeutics of illnesses that are related to old age
Tompa A: Népegészségtani ismeretek. Semmelweis Kiadó, Budapest, 2008
Slide6Dental aspects:
GEROSTOMATOLOGY
:
It
is a medical discipline that specilizes in the dental treatment of old patients and it
takes anatomical, physiological, pathological and psychological aspects into consideration.
GEROPROSTHODONTICS:
It
is a branch of Prosthodontics that speciaizes in the preventional and therapeutical aspects of the dental treatment of old aged patients.
Slide7Aging society
Slide8Population
by
gender
and
age
Slide9Steps
of oral diagnostics
main complaint
general
medical
history
extraoral
examination
intraoral examination
status
of teeth
(supplementary
examinations)
Slide10main complaint
Did
the patient come volunarily or was it the influence of the family?
communication
problems
psychological aspects
lesions
of the mucous membrane often
occur
greater
incidence of perodontical involvement
loss of teeth
Slide11general medical history
:
Gerenarlly speaking:
Chronic illnesses
There
are several medicines (side effects)
Discrepancies
– Illnesses/medications
Common
error: confusing Xarelto with Xanax
involution
of organs or of organ systems
Slide12The most common illnesses
cardiovascular
diseases (hypertonia, arythmia, patient had had embolia, stroke,heart attack, pacemaker
COPD
Gastrointestinal diseases
Diabetes
Musculoskeletal
disorders (rheumatism, arthrosis, osteoporosis
)
cancerous
conditions
the
patient’s immune system is involved
Slide13WE
ALWAYS HAVE TO ASK SPECIFIC QUESTIONS RELATED TO THESE CONDITIONS
a
nticoagulant
bisphosphonate
patient
is allergic to penicillin, iodine, lidocaine, metals and to acrylic
Diabetes
Infectious
disease
Slide14the possible effect of old age to the psychological status
d
ementia
(past incident of brain involvment, due to involuton, side effects of medicines, alcohol consumption, BUT also due to physiological reasons
d
epression
paranoid
syndrom
somatoform
and conversion disorders
s
uicide
Slide15the dental aspects of developing psychological symptoms
Losing
teeth can be a psychological trauma (teeth are the organs of aggression – the toothless lion-; teeth can be a symbol of youth and health
climacteric
– development of symptoms
prosthetic
denture intolerance
abnormal
prosthetic denture tolerance
Glossodynia
, oropyrosis (typically in the case of female postmenopausal patients)
saliva
secretion malfunctions (hypo/hypersalivation, inadequate complaints)
Slide16the following sings may often accumulate
aggression
exaggerated
expectations
inflexible
way of thinking
Slide17sociological aspects
the
classical family model collapsed
horizontal
relationships deteriorated
the
patient is becoming lonely
v
ertical
relationships have transformed
addictions
Slide18Extraoral examination
a
reas
of the head and of the
neck
skin
lymph
nodes
TMI
Slide19Slide20Observation
of the face
c
olor
s
ymmetry
swellings
facial
expressions
muscle
tones
position
of lips
the
tone of the skin
Slide21Observation of the neck
symmetry
swellings
Slide22Observation - TMI
m
ovements
Divergence
during opening
of the
mouth
The
rate of opening
of the mouth
Regionális nyirokcsomók
http://emberi-test.uw.hu/
Slide24Lymph nodes -
is there an inflammation / Are there any tumors or metastases?
inflammatioon
Tumor/
Metastasis
acute
Chronicus
painful
Not
painful
mobile
immobile
It
feels warm
It
feels cold
Slide25Peculiarities
of old age:
:
Always shake
hands with
the
patient
zetapress.hu
Slide26Slide27Slide28angular
cheilitis
Slide29Cheilitis
angularis
Erythema of the
corner
of
the
mouth, inflammation of the mouth, with cracks in the contact areas
It is often superinfected with Staphylococcus aureus or other bacteria
Faulty denture - low bite height
Iron
deficiency anemia, vitamin deficiency
c
an promote its development
It is likely that saliva leaking from the mouth sustains the infection
Th:
Pimafucort
creme
Slide30intraoral examination
normal
lighting
observe
with your own eyes
IN
THE CASE OF EVERY NEW PATIENT or in case of RECALL
alteration
from a healthy individual ( changes of skin, multiplication of tissues, lack of tissues, assymmetry, it does not hurt)
if
the patient’s condition does not improve for 2 weeks
byopsy
Documentation
Slide31Slide32Chronic
mechanic noxa
-
elimination
Slide33Potential
malignant
oral
disorders
Leukoplakia
Erythroplakia
Submucosus
fibrosis
Cheilitis
actinica
chronica
Lichen
oris
Discoid
lupus
erythematosus
Diskeratosis
congenita
Epidermolysis
bullosa
Krónikus
hyperplasticus
candidiasis
Slide34Oral l
ichenoid reaction
the
clinical image is similar
only
in the oral cavity
abnormal
histology
often
only on one side
there
are 3 types
known :
contact hypersensitivity lesion (e.g.: amalgam,SLS)
OLR
lesion induced by medicine
Graft-versus-host
reaction
Slide35Oral l
ichenoid reaction
Slide36Benign
tumors
Fibroma
Papilloma
Condyloma
Verruca
Vulgaris
Lipoma
Haemangioma
Slide37Slide38Slide39Slide40gerostomatological aspects of intraoral examinations
Quantity
and quality of saliva (involution of the salivary gland)
oral
hygiene
clinical
anatomical factors
quality of the underlying bone of the oral mucosa (involution of the mucous membrane
vulnerable, patient complains, the submucosal layer becomes thinner
the load bearing capacity decreased)
Evaluation
of prosthetically significant phenomena
FOTOT KÖNYVBŐL
Slide41Slide42Definition- Focal infection
An acute or chronic infection in which bacteria are localized in some region of the body, as the tonsils or the periodontal tissue, from which they or their metabolites or toxines may spread to some other organ or structure of the body causing secunder diseases
Slide43Characteristics
of
focal
infections
Chronically infected areas
Asymptomatic or few symptomes
Encumbering the organisation via various mechanism
Open or closed focals
Slide44Dental Focuses
Open focuses
Caries lesions: microorganism from the caries surface can pass into the blood-stream via micro-traumas
Gingivitis, periodontitis: OPEN focuses
Alveolitis: bacteria can pass into the blood-stream from destructed and infected coagulum
Slide45Dental Focuses
Closed focuses:
Necrosis of pulp
Periapical lesions
Incomplete root-canal fillings (theoretically every root canal treated teeth are focus, we have to reflect the case.. )
Radix relicta
Residual cyst
Impacted teeth with follicular cyst
Slide46Respiratory focal-deseases
Aspiration Pneumonia: Periodontopathogens: Actinobacillus, Eikenella, Fusobacterium: NOSOCOMIAL PNEUMONIA. Intubation, artifitial respiration: CHX prophylax
COPD: Case of Periodontitis: more common
Slide47Oral
candidiasis
it is a member of the normal
microflora
Colonization
is
NOT
candidiasis
sign of
Candidiasis
:
pseudohyphae
,
hyphae
Slide48Oral
candidiasis-
IMPORTANT
it is a "trendy" topic
There are more and more cases around the world
it
often
appears
!
is the
pseudomembranous
form the most common
?
it is the most common fungal infection in the world
It
has
stomatooncological
aspects
Slide49Candida strains
C.
albicans
(
member of the normal
microflora
!)
C
.
tropicalis
, C.
krusei
, C.
glabrata
,
C.parapsilosis
(
especially
common
in
childhood
),
C
.
guilliermondii
(
typically occurs among people infected with HIV
).
Slide50Percentage of the presence of Candida
albicans
in the oral cavity of different groups
Vizsgált csoportok
C. albicans százalékos előfordulása
Újszülöttek
45%
Egészséges gyermekek
45-65%
Egészséges felnőttek
30-45%
Kivehető fogpótlást viselők
50-65%
Rövid/hosszú távú ápolásra szorult betegek
65-88%
Akut leukémiás páciensek kemoterápiás kezelés alatt
90%
HIV-infected
patients
90%
the
examined
groups
Percentage
of C.
albicans
newborns
45%
Healthy
children
45-65%
Healthy
adults
30-45%
those who wear removable dentures
50-65%
Patients in need of short / long term care
65-88%
Acute leukemia patients undergoing chemotherapy
90%
HIV-infected
patients
90%
(
Patil
et
al
. 2015)
Slide51Local and systemic factors predisposing to oral
candidiasis
Local
Systemic
Poor
oral
hygiene
Smoking
application
of
topical
steroid
Immature or altered mouth flora
Atrophic
mucosa
Decrease / deterioration in the amount and / or quality of saliva
Removable
denture
Oral
lesions
,
e.g
.
leukoplakia
Immunosuppressive
treatments
Immunosuppressive
Disorders
Infancy
and old
age
Tumor
diseases
Endocrine
Diseases
- Diabetes
Malnutrition
Broad
spectrum
antibiotic
treatment
anemias
(
Patil
et
al
. 2015)
Slide52Categorization
of
oral
Candidiasis
Primary
forms
Secondary
forms
Acute
:
Pseudomembranous
Erythematosus
oral manifestation of systemic
mucocutaneous
candidiasis
:
Familial
mucocutaneous
candidiasis
Diffuse
chronic
mucocutaneous
candidiasis
Familial
chronic
mucocutaneous
candidiasis
Chronic
granulomatous
lesions
Candidiasis
endocrinopathy
syndrome
AIDS
DiGeorge
syndrome
Severe
combined
immunodeficiency
Chronic
:
Erythematosus
Pseudomembranus
Hyperplastic
(
It is prone to malignancy
)
-”
with
plaques
” („
Candida
leukoplakia
”)
-
Nodular
Multifactorial
lesions associated with Candida infection
:
Dental
stomatitis
Angular
cheilitis
Median
rhomboid
glossitis
Linear
gingival
erythema
(
It occurs among the HIV infected
)
(
Patil
et
al
. 2015)
Slide53Erythematous
form
Most
common
in
adulthood
Synonym
:
atrophic
form
:
depapillated
tongue
,
erythema
on
the
tongue
,
red
mucosa
Most common: among denture wearing patients
:
denture
stomatitis
(
sometimes
angular
cheilitis
, median rhomboid glossitis
)
Slide54multifactorial
lesions related to candida
infection
denture
related stomatitis
angular
cheilitis
median
rhomboid glossitis
Linear
gingival erythema (among HIV infected patients)
Slide55denture
stomatitis
among 65% of patients who wear dentures
this is a chronic, atrophic / papillary form
,
often without complaints, but also with serious complaints
"image" of
Acrylate
base sheet on the mucous membrane
Key Factors: Improperly Fit Dentures, Poor Oral and Dental Hygiene, Colonization of Candida
albicans
Treatment: Dental cleaning,
polyenes
, azoles, CHX, (topical agents are preferred)
Slide56forms of
denture
stomatitis
Newton
Type
1 :
local, mild inflammation, tiny
hyperaemic
spots
Newton
Type
2 :
diffuse hyperemia in the extent of the denture base
Newton
Type
3 :
a granular type that typically manifests in the middle of the palate
Slide57Denture related stomatitis
Slide58Denture
related stomatitis
Slide59a
ngular cheilitis
Slide60Oral diagnostic measures
main
complaint
general
medical history
Extraoral examination
Intraoral examination
dental
status
(
supplementary
examination)
Slide61Characteristics of the oral condition of the elderly Hungarian population
loss
of teeth in extensive areas
a large number of people are totally
toothless
tooth replacement is only
moderate
premature
tooth loss due to pathological causes
major
periodontal involvement
Kivovics
, P.,
Csadó
,.
K.:Systems
for the Provision of Oral Health Care in the Black
Sea
Countries
. Part 7. Hungary
ORAL HEALTH AND DENTAL MANAGEMENT IN THE BLACK SEA COUNTRIES
9:(4)pp. 193-198.(2010)
Slide62Ratio
of total toothlessness in Hungary
24.1% of people over 65 years of age!
Slide63Periodontal status
moderate
oral hygiene
excessive
replacements that are not properly supported dentally
traumatic
occlusion
Chronic
, often untreated periodontitis
Slide64Gerostomatological
aspects of the treatment plan
Consider
the general condition
What
is the psychological status?
What is the sociological status?
Slide65Felhasznált és javasolt irodalom:
Valamint Dr.
Kivovics
Péter c. egyetemi tanár
Gerosztomatológia
sajátosságai című előadása
Slide66Thank
you
for
your
kind
attention
!