Oral Care for the Dependent Elderly
Oral Care System Oral Care Support Instrument
Oral Care Clinic
National Center for Geriatrics and Gerontology
36-3 Gengo, Morioka-cho, Obu, Aichi Japan 474-8511 (Phone)+81-562-46-2311 (Fax)+81-562-44-8518
The need for oral care for the dependent elderly As society ages, maintaining oral hygiene so that food can be chewed well and enjoyed is very important in terms of quality of life (QOL). Recently, oral care for the elderly has become a topic of increasing interest, yet many dependent elderly have difficulty brushing their own teeth. Moreover, since it is not easy for family members or caregivers to clean another person's teeth, the teeth of dependent elderly who cannot brush themselves are often simply left unclean. Recently, we are coming to a better understanding of how foreign bodies and bacteria in the mouth are related to aspiration pneumonia (a disease that occurs when foreign bodies or bacteria enter the lungs via the mouth) and endocarditis (a disease of bacterial proliferation in the heart), as well as the effects of mastication on senility and dementia. Of particular note is the solid scientific evidence that aspiration pneumonia, the leading direct cause of death among the elderly, can be prevented by thorough oral care. Preventing the development of these diseases through appropriate oral care, and maintenance of oral and general health, are goals of all of us involved in dental care. In November 1999, the Department of Dental Surgery at Chubu National Hospital, National Institute of Longevity Science (Now: National Center for Geriatrics and Gerontology , established the first oral care outpatient clinic in the nation. We have instructed many people in methods of systematic oral care, and the service has earned a good reputation. In addition to providing tooth-brushing instruction for the healthy elderly, we have also developed an oral care procedure (oral care system) using an electric toothbrush for the dependent elderly who have difficulty maintaining oral health by themselves. This project was funded by a 2000-2002 grant in aid for scientific research (longevity science general research project, chief researcher Yasunori Sumi) from the Ministry of Health, Labor and Welfare. The system we developed is quick, reliable, safe, inexpensive, effective, easy, and cleans the entire mouth. Furthermore, for people who require a higher level of care, such as those who cannot communicate well, dislike oral care provided by a caregiver, or have difficulty gargling so that this oral care system cannot easily be used, we have developed an oral care support instrument for the convenient and appropriate provision of oral care. These procedures are now being applied clinically with the aim of improving the QOL of both dependent elderly and their care providers. Yasunori Sumi, D.D.S., Ph.D. Director, Division of Oral and Dental Surgery, Department of Advanced Medicine National Center for Geriatrics and Gerontology, Japan
A quick review of the oral conditions of the dependent elderly Maintaining oral hygiene is very difficult for dependent elderly who cannot freely brush their teeth.
Entire mouth unclean.
Bits of food remaining
Patient with dementia
Patient whose left side is paralyzed from a stroke
The mouths of dependent elderly with dementia or paralysis are often not sufficiently cleaned, and food remains lodged in the mouth. Moreover, some elderly people leave dentures in their mouths for long periods. In such cases, the unclean dentures can foul the surrounding teeth or mucosa supporting the dentures. Unclean denture Swollen gingiva
Patient with multiple cerebral infarction
Contamination (dental plaque, bacteria) of the teeth may be difficult to identify just by looking, but staining with a dye can reveal how unhygienic some mouths actually are.
Specific oral care methods
It is difficult to determine how...
References: 1. Y. Sumi, Y. Nakamura, Y. Michiwaki. Development of a systematic oral care program for frail elderly persons Special Care Dentist 22:151-155, 2002 2. Y. Sumi, K. Nakajima, T. Tamura, M. Nagaya, Y. Michiwaki. Developing an instrument to support oral care in the elderly Gerodontol 20:3-8, 2003 3. 4. 5. 6. Sumi Y, Miura H, Michiwaki Y, Nagaosa S, Nagaya M: Colonization of dental plaque by respiratory pathogens in dependent elderly Archives of Gerontology and Geriatrics 2006; in press. Sumi Y, Miura H, Nagaya M, Michiwaki Y, Uematsu H: Colonization of the tongue surface by respiratory pathogens in residents of a nursing home - A pilot study. Gerodontology 2006; 23: 1-5. Sumi Y, Nakajima K, Tamura T, Nagaya M, Michiwaki Y: Developing an instrument to support oral care in the elderly. Gerodontology 2003; 20:3-8. Sumi Y, Kagami H, Ohtsuka Y, Kakinoki Y, Haruguchi Y, Miyamoto H: High correlation between the bacterial species in denture plaque and pharyngeal microflora. Gerodontology 2003; 20:84-87. 7. 8. Sumi Y, Miura H, Sunakawa M, Michiwaki Y, Sakagami N: Colonization of denture plaue by respiratory pathogens in dependent elderly. Gerodontology 2002; 19:25-29. Sumi Y, Nakamura Y, Nagaosa S, Michiwaki Y, Nagaya M: Attitudes to oral care among caregivers in Japanese nursing homes. Gerodontology 2001; 18:2-6.
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