Diagnostic examination of elderly patients - PowerPoint Presentation

Slide1

Diagnostic examination of elderly patients

Dr.

Mensch

Károly

Ph.D

.

Oral

Diagnostics

2021

Slide2

Old person?

Based on a recommendation of the WHO

>65 years old in Hungary

>70

years old in the U.S.A and in Germany

Slide3

Definition

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

Slide4

The classification

of the British Society of Gerontology

-Aging

(45to59years)

-Elderly

(60to74years)

-Old

(75years)

-Very old (from age 90 years)

Slide5

Scientific

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

Slide6

Dental 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.

Slide7

Aging society

Slide8

Population

by

gender

and

age

Slide9

Steps

of oral diagnostics

main complaint

general

medical

history

extraoral

examination

intraoral examination

status

of teeth

(supplementary

examinations)

Slide10

main 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

Slide11

general 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

Slide12

The 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

Slide13

WE

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

Slide14

the 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

Slide15

the 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)

Slide16

the following sings may often accumulate

aggression

exaggerated

expectations

inflexible

way of thinking

Slide17

sociological aspects

the

classical family model collapsed

horizontal

relationships deteriorated

the

patient is becoming lonely

v

ertical

relationships have transformed

addictions

Slide18

Extraoral examination

a

reas

of the head and of the

neck

skin

lymph

nodes

TMI

Slide19

Slide20

Observation

of the face

c

olor

s

ymmetry

swellings

facial

expressions

muscle

tones

position

of lips

the

tone of the skin

Slide21

Observation of the neck

symmetry

swellings

Slide22

Observation - TMI

m

ovements

Divergence

during opening

of the

mouth

The

rate of opening

of the mouth

Slide23

Regionális nyirokcsomók

http://emberi-test.uw.hu/

Slide24

Lymph 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

Slide25

Peculiarities

of old age:

:

Always shake

hands with

the

patient

zetapress.hu

Slide26

Slide27

Slide28

angular

cheilitis

Slide29

Cheilitis

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

Slide30

intraoral 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

Slide31

Slide32

Chronic

mechanic noxa

-

elimination

Slide33

Potential

malignant

oral

disorders

Leukoplakia

Erythroplakia

Submucosus

fibrosis

Cheilitis

actinica

chronica

Lichen

oris

Discoid

lupus

erythematosus

Diskeratosis

congenita

Epidermolysis

bullosa

Krónikus

hyperplasticus

candidiasis

Slide34

Oral 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

Slide35

Oral l

ichenoid reaction

Slide36

Benign

tumors

Fibroma

Papilloma

Condyloma

Verruca

Vulgaris

Lipoma

Haemangioma

Slide37

Slide38

Slide39

Slide40

gerostomatological 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

Slide41

Slide42

Definition- 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

Slide43

Characteristics

of

focal

infections

Chronically infected areas

Asymptomatic or few symptomes

Encumbering the organisation via various mechanism

Open or closed focals

Slide44

Dental 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

Slide45

Dental 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

Slide46

Respiratory focal-deseases

Aspiration Pneumonia: Periodontopathogens: Actinobacillus, Eikenella, Fusobacterium: NOSOCOMIAL PNEUMONIA. Intubation, artifitial respiration: CHX prophylax

COPD: Case of Periodontitis: more common

Slide47

Oral

candidiasis

it is a member of the normal

microflora

Colonization

is

NOT

candidiasis

sign of

Candidiasis

:

pseudohyphae

,

hyphae

Slide48

Oral

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

Slide49

Candida 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

).

Slide50

Percentage 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)

Slide51

Local 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)

Slide52

Categorization

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)

Slide53

Erythematous

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

)

Slide54

multifactorial

lesions related to candida

infection

denture

related stomatitis

angular

cheilitis

median

rhomboid glossitis

Linear

gingival erythema (among HIV infected patients)

Slide55

denture

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)

Slide56

forms 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

Slide57

Denture related stomatitis

Slide58

Denture

related stomatitis

Slide59

a

ngular cheilitis

Slide60

Oral diagnostic measures

main

complaint

general

medical history

Extraoral examination

Intraoral examination

dental

status

(

supplementary

examination)

Slide61

Characteristics 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)

Slide62

Ratio

of total toothlessness in Hungary

24.1% of people over 65 years of age!

Slide63

Periodontal status

moderate

oral hygiene

excessive

replacements that are not properly supported dentally

traumatic

occlusion

Chronic

, often untreated periodontitis

Slide64

Gerostomatological

aspects of the treatment plan

Consider

the general condition

What

is the psychological status?

What is the sociological status?

Slide65

Felhasznált és javasolt irodalom:

Valamint Dr.

Kivovics

Péter c. egyetemi tanár

Gerosztomatológia

sajátosságai című előadása

Slide66

Thank

you

for

your

kind

attention

!