August 4, 2016

Dental Problems that Could Lead to Accident or Injury in Older Patients

VHSO

by Gretchen Gibson, DDS, MPH

Most discussion regarding dental problems revolves around being able to eat, speak and even smile. These issues are key to a good quality of life. However, a recent article published by a group of dentists in Japan highlights the fact that dental problems can also be associated with accidents, especially in patients who suffer from dementia.

Patients in the later stages of dementia often cannot tell us if there are oral health issues that need to be addressed. These dental issues also have the potential to be responsible for painful and possibly life threatening accidents if not discovered and remedied. Kobayashi, et al (2016) looked a cohort of patients with dementia, which were referred to their hospital dental practice for evaluation as part of a swallowing disorder team. For these patients, they found that nearly 24% were positive for dental risk factors that could lead to painful incidents or accidents. These issues included:
• Teeth that were very loose and at a risk for falling out during daily eating or care, leading to choking and aspiration.
• Dental prostheses that were so loose that they would easily dislodge and could choke or impale the patient while they were trying to use them;
• Sharp broken teeth or sharp prostheses that could lacerate the patients mouth
• Recurrent temporomandibular joint dislocation, which is very painful
• Biting on edentulous gums with teeth on the other ridge, causing injury

In many long term facilities, it is staff that is responsible for the ongoing oral evaluation. The issues listed above can lead to painful and even life threatening incidents and it is important to keep them in mind when evaluating the patient. Look for:
• Teeth that are very loose and easily move when you touch them with your finger, or the patient can easily move with their tongue
• Dentures that have pieces missing along the borders with sharp edges
• Partial dentures that have wires that are sticking out too far or are broken, or metal/plastic sharp edges
• Partial dentures that are so loose that patients constantly flip them around in their mouth, often using their tongue
• Serious injuries to their edentulous gums from chewing on them
• Painful episodes when their jaw pops out of place or locks open while they are trying to eat

These are issues that need to be brought to the attention of a dental provider to address and reduce the likelihood of painful or serious injury. There are many ways that poor oral health and oral care can negatively affect a patient’s quality of life. For patients with dementia, it is often left to the caregiver to identify these risks through vigilance before an accident can happen.

References:

Kobayashi N, Soga Y, Maekawa K, Kanda Y, Kobayashi E, Inoue H, Kanao A, Himuro Y, and Fujiwara Y. Prevalence of oral health-related conditions that could trigger accidents for patients with moderate-to-severe dementia. Gerontology.2016 May 21
http://onlinelibrary.wiley.com/doi/10.1111/ger.12235/epdf