Oral Health Care For Older People In Nsw

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ORAL HEALTHCARE FOR OLDERPEOPLE IN NSWA toolkit for oralhealth and healthservice providers

FOREWORDIn recent years there has been a trend for older people to retaina greater number of natural teeth as they age – a trend that willcontinue as younger generations age.These teeth may have had significant treatment over a lifetimeincreasing the risk of complications and requiring a higher level ofintervention and prevention. An increasing ageing society, with higherretention rates of natural teeth, will require new oral health promotionactions to be developed and implemented.Oral Health Care for Older People in NSW: a toolkit for oral healthand health service providers (The Toolkit) recognises that clinicalconditions in older persons share risk factors and cross disciplinebased boundaries because of their multifactorial nature. The Toolkitcontains oral health information that can be useful in encouraging apartnership approach to the oral and general health needs of olderpeople.CENTRE FOR ORAL HEALTH STRATEGYNSW Ministry of HealthLocked Mail Bag 961North Sydney NSW 2059Copyright NSW Ministry of Health 2014This work is copyright. It may be reproduced in whole or in part for study and training purposes subject to theinclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproductionfor purposes other than those indicated above requires written permission from the NSW Ministry of Health.The Toolkit is not intended to give information or guidance abouthow to diagnose or treat older adults. Rather, it is a guide on how toprevent and minimise health problems associated with older people.This document encourages: (i) shared responsibilities from allstakeholders; (ii) a commitment to best practice models based onevidence; and (iii) integration of oral health across programs andsectors of general health care and dental services.Mr John SkinnerDirector, Centre for Oral Health Strategy, NSW Ministry of HealthThis publication has been produced in collaboration with the Centre for Education and Research on Ageing, ConcordClinical School, the University of Sydney, and the Australian Dental Association, NSW BranchSHPN (COHS) 140449ISBN978-1-74187-090-9Professor Clive WrightAssociate Director, Centre for Education and Research on Ageing,Concord Clinical School, the University of SydneyDISCLAIMERThe information provided in this toolkit is evidence-based and current at the date of publishing. The NSWGovernment does not endorse any specific product brand.Daiquiri Design - www.daiquiridesign.com.auDr Deborah CockrellPresident, Australian Dental Association, NSW Branchpage i

CONTENTForeword iContent iiAcknowledgements and definitionsiii1.SECTION 1 - Introduction2.SECTION 2- Oral health and older people 512.1Determinants of oral health 62.2Impact of oral disease 72.2.1Impact on general health 82.2.2 Impact on daily living activities 82.2.3 Economic impact 92.3Oral health promotion 93.SECTION 3 - Preventive oral health messages for older adults103.15 messages for a healthy mouth 113.1.15 tips to eat well 113.1.25 tips to drink well 113.1.35 tips to clean well 123.1.45 tips to play well 133.1.55 tips to stay well 134.SECTION 4 -Oral problems and diseases 144.14.24.34.44.55Dental caries – 5 facts 15Periodontal diseases – 5 facts 15Xerostomia – 5 facts 15Trauma to the mouth – 5 facts16Oral cancer 17SECTION 5 - Oral health care aids Georgette Roumanos, Assistant Project Officer,Centre for Oral Health Strategy, NSW Ministry ofHealth Centre for Education and Research on Ageing,Concord Clinical School, the University ofSydney Dr Alan Deutsch, Montefiore Nursing Home,Randwick, Sydney Centre for Oral health Strategy, NSW Ministry ofHealthOther experts in the fields of oral health, agedcare, ‘general’ health, and health promotion Special thanks to Australian Dental Association, NSW Branch.Consultation: Mouth checks 22Oral health screening questions 23Marion Fisher, Outcomes Manager, Brain InjuryRehabilitation Directorate, Agency for ClinicalInnovation and Brain Injury RehabilitationResearch Group Kristy Bartlett, Professional Services Dietitian,Dietitians Association of Australia Claire O’Connor, Rehabilitation NetworkManager, Agency for Clinical Innovation Emma Campbell, Senior Speech Pathologist,Chronic and Complex Care, Nepean BlueMountains Local Health District Pip Taylor, A/Manager Speech Pathology,Westmead Hospital Prof Michael Woodward, Medical Director,Aged & Residential Care Services, HeidelbergRepatriation Hospital Drs Adel Matthias and Ranbeer Kaur, SpecialNeeds Dentistry, Sydney Local Health District Dr Keith Heap, Dental Health Officer, JusticeHealth and Forensic Mental Health NetworkSECTION 6 - Oral health checks 216.16.278Oral Health Care for Older People in NSW: a toolkitfor oral health and health service providers (TheToolkit) has been prepared by Jennifer Noller for:185.1Requirements for provision of dental care195.2Additional oral care 195.3Other toothbrushing aids 195.4Techniques 205.5Salivary aids 205.6Changed behaviours 205.6.1NSW Health guidelines 205.6.2 Physical restraint as a management strategy206ACKNOWLEDGEMENTS anddefinitions- Dr John Rogers, Principal Population OralHealth Advisor, Department of Health,Victoria- Adrienne Lewis, Project Director BuildingBetter Oral Health Communities, SA DentalService- Kristy Nixon, A/Manager, Health Promotion,SA Dental Service.Definitions:Primary prevention: prevention of the onsetof disease through risk education and healthpromotion.Secondary prevention: Preventing the progressionof disease.Oral health and health service providers: In thisdocument oral health and health service providersrefers to oral health and health professionals whoprovide oral health care and ‘general’ health careto older people. This terminology is consistentwith Alzheimer’s Australia, Dementia LanguageGuidelines.1Appendices 24References 31page iipage iii

SECTION 1 : INTRODUCTIONThe NSW population is ageing and there is a trendtowards the reduction in edentulism (completetooth loss and replacement with dentures).The consequences of increased tooth retentionin older adults, combined with an increasedproportion of people with complex medicalneeds in this age group, means new skills willbe required by oral health and health serviceproviders to manage these age-related disorders.What is the purpose of The Toolkit?The purpose of Oral Health Care for Older Peoplein NSW: a toolkit for oral health and health serviceproviders (The Toolkit) is to provide oral healthinformation, aids and resources for oral health andhealth service providers in NSW to encourage amulti-disciplinary approach to the integration oforal health into health promotion initiatives forolder people to help improve their oral healthstatus and quality of life. The main focus of TheToolkit is on primary and secondary prevention asshown in Figure 1.Figure 1: Focus of Oral Health Care for Older People in NSW: a toolkit for oral health and health serviceprovidersFocus of this documentSECTION darypreventionAt riskTargetedEarly stages of diseaseIndividualEarly interventionand treatmentChronic diseasemanagementWholeEstablished diseaseComplexconditionsSource: Adapted from Department of Health Victoria2Page 1Page 2

SECTION 1 : INTRODUCTIONThe Toolkit is one component of an aged carepackage for older people in NSW available fromthe Centre for Oral Health Strategy, NSW Ministryof Health. Other components include oral healthinformation that can be used by volunteer peereducators, and family carers and support workers.What is in The Toolkit?The Toolkit contains the following information:SECTION 1 : INTRODUCTIONWho should use The Toolkit?The Toolkit can be used by a broad section of oralhealth and health service providers who work witholder people in a variety of settings, includingcommunity programs or residential care. It can beused in different ways by oral health and healthservice providers and people with organisationwide responsibilities.theoretical models that support theimportance of oral health and its integrationinto ‘general’ health preventive and clinicalintervention that requires a multidisciplinaryapproach to addressing health issues of theelderly;Oral health service providers can use The Toolkitas a stand-alone resource that will give them a‘how to’ guide to minimising oral health decline inolder people. Health service providers can use theguide to integrate oral health care into strategiesthat minimise functional and health decline inolder people. preventive oral health messages for olderpeople;How can I use The Toolkit? important oral problems and conditions(dental caries, periodontal diseases,xerostomia, falls (potential trauma to themouth), oral cancer); and practical information that may help preventor minimise oral health problems associatedwith older people with functional or cognitivelimitations.The Toolkit does not provide or replace specificoral health advice required for an individual.The personal oral health needs and maintenanceregimes of older people vary considerablydepending on the makeup of the teeth, gums andmouth of an individual. Specific advice regardingthe oral health needs of an individual requiresan assessment by an oral health professional,especially where the person is frail or cognitivelyimpaired.The Toolkit uses boxes with ‘notes’ or ‘cautions’to highlight areas where specific issues shouldbe addressed thoughtfully in relationship tothe overall health and well-being needs of anindividual.Note: All dental practitioners are members ofthe dental team and where there is a structuredprofessional or referral relationship betweendental practitioners the dentist is the clinical teamleader.(Scope of Practice Registration Standard, June2014)This manual is a hardcopy guide of The Toolkit.There is also a PowerPoint presentation thataccompanies the manual. The presentation can beused by oral health professionals to increase theoral health knowledge and skills of health serviceproviders.Note: A further set of resources is in preparationas an outcome of the Building Better Oral HealthCommunities Project, which is designed tosupport the home care workforce. For furtherinformation contact the SA Dental Service.Policy ContextOral health 2020: A Strategic Framework forAction in NSW3 sets the platform for oral healthaction in NSW into the next decade. The goals fororal health in NSW are to: Improve access to oral health services in NSW Reduce disparities in the oral health status ofpeople in NSW Improve the oral health of the NSW populationthrough primary prevention.The Toolkit is closely aligned with National andState strategic directions for oral health of olderpeople.All the resources contained within The Toolkitcan be found at ult.aspx.Implementing The Toolkit - turningknowledge into practiceThe Toolkit can be implemented in conjunctionwith: Best Care for Older People Everywhere: Thetoolkit 2012; Better Oral Health in Residential Careresources; Care of Older People Toolkit; Oral Health Promotion Tutorials; Oral health resources for older people by DrPeter King and The Australian Hygienists’Association of Australia SA Branch Inc; and other aged care health strategies.A comprehensive list of resources can be found inAppendix APage 3Page 4

SECTION 2 : ORAL HEALTH AND OLDER PEOPLEThe life-stage of older adulthood has considerablevariation depending on age and underlyinggenetic and medical conditions. Frailty, bothphysical and neurological, in older peoplerepresents the move from independence todependence.2.1 DETERMINANTS OF ORAL HEALTHThe complexity of older adults’ oral health statusis reflected in a range of determinants for oralconditions. Figure 2 demonstrates how thesedeterminants relate to the oral health status ofolder adults.4Ageing may mean an increase in the usage ofprescription and non-prescription medicinesthat have side effects. This can impact on oralhealth as well as reduced capacity to perform oralhygiene on a daily basis. The risk of periodontaldiseases also increases with age. Reduced incomeand affordability in retirement also increases therisk of oral disease.Figure 2: Determinants of oral health on older peopleEconomic,political alth & socialpolicySECTION 2:Oral health andolder peopleAccess toaffordable food& drinksAccess totransportAccessto timely,affordable &appropriateoral health careExposure tofluorideSocial, familyand communitycontextSocial &family normsregardingoral healthknowledge,attitudes,beliefs,values, skills &behaviourPeer groupsCulturalidentitySocial supportSocial capitalResidentiallocation & typeOral healthrelated literacyand behaviourIndividualfactorsDietAgeOral hygieneSexSmokingAlcoholGenetic &biologicalendowmentOral healthliteracyMedicalconditionsUse of oralhealth servicesMedications &adverse effectsSelf-esteemFunctional &cognitive statusSelf-efficacyBehaviourproblemsOral healthNutrition,swallowing &eating abilitiesSource: Adapted from Watt and Fuller5 and Chalmers 2001Page 5Page 6

SECTION 2 : ORAL HEALTH AND OLDER PEOPLESECTION 2 : ORAL HEALTH AND OLDER PEOPLE2.2 IMPACT OF ORAL DISEASE2.2.1 Impact on general health2.2.2 Impact on daily living activitiesOral disease places a considerable burden onolder people, their families and the communityas shown in Figure 3. It affects individuals, theirgeneral health, functioning and quality of life,and the community through health system andeconomic costs. Poor oral health is linked to increased risk ofcardiovascular disease, stroke and aspirationpneumonia.7 Chronic oral infection can complicate themedical management of health illnesses,such as diabetes, chronic heart failure, andrespiratory diseases.7At the individual level, poor oral health can gobeyond infection and tooth loss and can includedestruction and degeneration of the tissues of themouth.9 Dental problems in older people are a commoncause of speech impairment, eating difficulties,pain when eating, and/or signs of mouthdiscomfort.7 Tooth loss, poorly fitting dentures and oralinfections can result in poor nutrition andpersistent mouth pain – they can affectappetite, food enjoyment and ability to chew,which impacts on food intake and foodselection.8Figure 3: Impact of oral disease in relation to older peoplePain and discomfortDental infectionImpact on daily livingactivity:General health impact:SpeechCardiovascular diseaseNutritionAspiration pneumoniaSleepNutritional statusBehaviourDiabetesSocialisation Oral diseaseRespiratory diseasesContinencePoor appearanceGeneral practitioner visitsLow self esteemHospital admissionsDecreased quality of lifeHealth system costs:High cost of treatment fordental disease Poor oral health affects people’s everydaylives by causing pain and suffering, disruptingsleep patterns, and affecting the ability to eatand speak, sleep well, socialise and feel happywith their appearance. This in turn affects selfesteem, social interaction, the ability to work,and reduced quality of life.10 Older people may also have a range of healthproblems or disabilities that impact on theirability to care for their own oral health, whichmay be related to issues associated with:- cognitive impairment (such as, dementia,Alzheimers)Poor oral hygiene significantly increases therisk of patients with swallowing impairments(dysphagia) developing pneumonia.8Note: If a person has any signs of oral disease ordysfunction that impact on their general healthand well-being they should be referred to theiroral health service provider.- functional limitations (such as, hand andupper limb function due to poor dexterity,pain and strength)- functional problems (such as, mouth andtongue movements and swallowingdifficulties).7 Dental difficulties and dry mouth (xerostomia)are two of the main causes of speechimpairment in older adults.8 Oral pain and difficulty with eating canaffect nutritional intake and body weight andtherefore skin integrity, strength and mobility,and continence.7 Chronic infection and oral pain may affectmood and behaviour, especially for peoplewith dementia who find it difficult to selfreport their pain and discomfort.7Note: If a person has a functional or cognitivedysfunction that impacts on their ability toperform oral health tasks they should be referredto the appropriate health service provider.Economic costs:Residential care costsIncreased burden tocommunitySource: Adapted from Rogers, 20116Page 7Page 8

SECTION 2 : ORAL HEALTH AND OLDER PEOPLE2.2.3 Economic impactIn 2010-12, total expenditure on dental servicesin Australia was 8.3 billion. Compared tothe broader health system, the total level ofexpenditure on oral health (either governmentor individually funded) has remained relativelyunchanged, averaging 6.09% of total healthexpenditure per year since 2004.112.3 ORAL HEALTH PROMOTIONThe key to maintaining and improving the oralhealth status of older people is the use of oralhealth promotion strategies that focus on: (i)dental characteristics; (ii) life characteristics ofolder adults; and (iii) quality of life issues.12Contemporary geriatric oral health promotion12needs to incorporate the treatment of oraldiseases and conditions with a strong focus onprevention strategies using multi-disciplinaryinvolvement of medical, health and dentalprofessionals in varied settings.13 The principlesof the Ottawa Charter can be utilized to developa geriatric oral health promotion matrix ofstrategies for older adults, as demonstrated inTable 1.14Table 1: Geriatric oral health promotion matrix for older adultsPrinciples of theOttawa ols and standardsDependentAdvocacyEnforcement ofstandardsBuild healthy publicpolicyAdvocacyCreate supportiveenvironmentsDental aidsFluoridation specific oralSpecific oral healthhealth informationinformationPrivate insurancePrivate insuranceDental aidsOral health educationPrivate insuranceStrengthen communityactionOral health educationOral health assessmentin general healthassessmentAssessment andscreening protocolsDental assessmentGuidelinesDirectoriesDevelop personal skillsPersonalised skilldevelopmentService provider skilldevelopmentSpecific interventions bydental professionalsService provider skilldevelopmentReorient health servicesMinimal dentalinterventionPreventionDomiciliary dental andportable servicesPublic and privatepreventive andtreatment regimesSECTION 3:Preventive oralhealth messagesfor older adultsSource: Adapted from Wright and Harrison, 200214Page 9Page 10

SECTION 3 : PREVENTATIVE ORAL HEALTH MESSAGES FOR OLDER ADULTSA healthy mouth is essential for generalhealth and wellbeing, enabling individuals tocommunicate effectively, and to eat and enjoy avariety of foods. It is important for overall qualityof life, self-esteem and social confidence.15CAUTION: If a person’s food intake is of concerna referral to an Accredited Practicing Dietitionshould be undertaken to ensure any issues ofmalnutrition are addressed.Oral health care involves the consideration of theareas and conditions listed below:1. lips3. gums and mucosal tissues4. saliva5. natural teeth7. oral cleanlinessThere is a standard protective oral hygiene routinefor older people based on the best ways (the bestevidence base) to maintain a healthy mouth.There are 5 easy to remember messages that area simple guide to having a healthy mouth andmaintaining good health.Fluoride in tap water helps to strengthen teethand reduce acid that initiates tooth decay. Sugaris the source of bacterial energy in causing toothdecay Drink tap water daily – in most places in NSWtap water contains fluoride. Drink water after meals and snacks, and aftertaking medications (especially if they havebeen crushed and mixed with a sweetener). Keep the mouth moist by frequently rinsing orsipping with water. Avoid sugar in tea and coffee and reduce theintake of caffeine drinks. Limit the intake of acidic and sugary drinks(like fruit juice, soft drink and cordial). Clean Well Play Well Stay Well.3.1.1 5 tips to Eat WellPoor oral hygiene allows the bacteria in dentalplaque to produce acids and other substancesthat damage teeth, gums and surroundingbone. The daily removal of dental plaque andmaintenance of sound dental health practices arethe key aspects to preventing oral diseases.People who wear dentures are at risk ofdeveloping fungal infections. Fungal infectionscan be associated with: wearing dentures at night;poor cleanliness of dentures; denture plaque;deterioration to the denture resin; diet; and preexisting general health factors, such as diabetes.Further, a scratched denture can be a source ofirritation and increase the risk of oral infections. Clean dentures daily with a denture brush andliquid soap to remove plaque from all surfaces,then rinse well under running water. Do not use toothpaste as it is abrasive and candamage the denture surface. Hold the dentures carefully while brushing,and clean them in a bowl of water placed in asink to protect from breakage if dropped. Brush morning and night, using a softtoothbrush on gums, tongue and teeth. Use a pea-size amount of standard fluoridetoothpaste. Spit out residue toothpaste but do not rinsethe mouth after brushing. This allows thefluoride to pass effectively into the teeth.Brush gums and tongue with a standardtoothbrush to remove plaque in the mouth. Remove dentures overnight and store in coldwater. This allows gum tissue to rest. Replace a toothbrush: (i) when the bristlesbecome shaggy; (ii) every three months;and (iii) following an acute infection, suchas thrush. This helps to prevent harm to themouth. Use dental floss and interdental brushes (withcare) to remove debris from between teeth.3.1.2 5 tips to drink well Eat Well Drink WellDenturesNatural teeth6. dentures3.1 5 MESSAGES FOR A HEALTHY MOUTH3.1.3 5 tips to clean wellTooth brushing with a fluoride toothpaste isthe most effective and economical method ofphysically removing dental plaque from gums,tongue, teeth and/or dentures. Fluoride protectsnatural teeth by remineralising and strengtheningtooth enamel.2. tongue8. dental pain.SECTION 3 : PREVENTATIVE ORAL HEALTH MESSAGES FOR OLDER ADULTSTooth decay is related more to the frequencyof sugar intake, than the total amount of sugareaten. Reduce the frequency of eating sticky andsugary foods – limit biscuits, cakes, sweets andother sugary foods. Eat a variety of nutritious snacks daily, likefruit, nuts and yoghurt. Care should be takenby people with dentures if eating nuts. Eat from each food group (vegetables, fruits,dairy, meat, cereals/grains) to support oral andgeneral health. Eat fresh, crunchy foods like apples, celeryand carrots. Slicing these foods can make foreasier eating. Eat meals or snacks containing milk or cheeseto help reduce acid that causes tooth decay.Page 11CAUTION: If a person is on a special diet or hasfluid intake restrictions they must comply withmedical advice regarding water intake.CAUTION: If a person is at risk of dehydrationthey should be referred to the appropriate healthservice provider.Page 12

SECTION 3 : PREVENTATIVE ORAL HEALTH MESSAGES FOR OLDER ADULTS3.1.4 5 tips to play well3.1.5 5 tips to Stay WellAs with maintaining general health, exerciseis important. Exercises for stronger cheek andtongue muscles and a healthy saliva flow help tomaintain a moist mouth,as shown in Figure 4. Put air in the cheek and slide the mouth fromside to side to exercise facial muscles (A).Visit a dental professional regularly, even if youwear dentures. Everyone has different needs:talk with your oral health professional abouthow frequently you need to visit for a checkup. Run the tongue around the inside of the cheekto exercise the tongue muscles (B).Protect the body from the sun with sunscreen,lip block, a hat, clothing, sunglasses. Use sugarless medicines, where possible. Massage the sides of the face using a circularmotion to improve saliva flow (C). Use walking frames and do balancing exercisesto reduce falls. Exercise facial and lip muscles by “oo” and“ee” movements of the lips. Mouth rinses and tongue cleaning may helpkeep your breath fresh.Limit alcohol and don’t smoke or chewtobacco - contact the Quitline 131 848 or aGeneral Practitioner, dental professional orpharmacist to help with quitting.CAUTION: If a person has problems with lipor tongue function they should be referred toan appropriate health service provider beforecarrying out an exercise program at home.Note: Older people may be at risk of vitaminD deficiency, which can increase the risk offractures.Refer to the Australian Cancer Council forguidance in finding the balance between sunprotection and exposure for health.Figure 4: Mouth and cheek exercises(A)(B)(C)(A) Facial exercises(B) Tongue exercises(C) Salivary glandsSource: “Oral health exercise” for vibrant seniorlife.iiCourtesy Chiyoko Hakuta & Kitahara Minoru. Department ofOral Health Promotion, Graduate School, Tokyo Medical andDental University, Tokyo: Japan, 2008Page 13SECTION 4:Oral problemsand diseasesPage 14

SECTION 4 : ORAL PROBLEMS AND DISEASESOral diseases and conditions are progressiveand cumulative. If untreated they become morecomplex and costly over time. Some of the mostimportant problems of the mouth are:SECTION 4 : ORAL PROBLEMS AND DISEASES4.2 PERIODONTAL (GUM) DISEASES – 5FACTS4.4 FALLS (POTENTIAL TRAUMA TO THEMOUTH) – 5 FACTS Gum diseases have been associated withgeneral health problems such as, diabetes andincreased risk of cardiovascular disease. The major local cause of gum disease is dentalplaque, which is the sticky, colourless filmcontaining bacteria, food debris and salivaryproducts that build up on all surfaces of theteeth, dentures, gums and tongue.Falls are the leading cause of injury-relatedhospitalisations in NSW, accounting for around30% of all such hospitalisations. In 2012-13, therewere 56,609 fall-related hospitalisations of NSWresidents. Older people have the highest rates offall-related hospitalisations: almost 66% (37,126hospitalisations) as demonstrated in Figure 5.1. Dental caries (tooth decay)2. Periodontal (gum) diseases3. Xerostomia (dry mouth)4. Trauma to the mouth (broken teeth)5. Oral cancer.Dental caries and periodontal diseases havehistorically been considered among the mostimportant global oral health burdens16; these arelargely preventable and reversible if identifiedand managed early.17 Oral diseases can besignificantly reduced through: changes in diet;daily oral hygiene; quitting smoking; reducingalcohol consumption; limiting sugary and acidicbeverages; access to fluoridated water andfluoride toothpaste; and changes in oral healthbehaviour.18 Bacteria found in dental plaque cause irritationof the gums that support the teeth. This canlead to inflammation and infection that candestroy gum and underlying bone. When dental plaque is not removed it mayharden into calculus (tartar), which can onlybe removed by a dental professional. Periodontal diseases are highly associatedwith smoking and excess alcohol use.Older adults may be more at risk of fallsbecause of visual and hearing impairments. Poor nutritional status and illness can be acause of muscle loss, which may result indecreased mobility, instability and falls.27 Older people who are frail and confused are atgreater risk of falls, and functional decline andcognitive decline.28 Medications may be implicated in olderpatients presenting with falls, confusion andincontinence.29Fall-related hospitalisation rates increased from1992-93 to 2012-13 by almost 53% in people aged65 or older.25 Older people are more likely to suffer fromchronic illnesses and experience acute healthproblems, such as cardiovascular disease, fallsand fractures.26Figure 5: Falls related injury: overnight stay hospitalisationsFall-related injury: overnight stay hospitalisations by sex, personsof all ages and 65 years and over, NSW 1992-93 to 2011-124.1 DENTAL CARIES (TOOTH DECAY) - 5FACTSTooth decay is a diet and oral hygiene relateddisease that affects the teeth and causes pain. Tooth decay is the destruction of toothstructure and can affect both the enamel,which is the outer coating of the tooth, andthe dentine or inner layer of the tooth. There are four main criteria required for toothdecay: a tooth (enamel or dentine), cariescausing bacteria, fermentable carbohydrates(such as sucrose), and time.19 Tooth decay occurs when foods containingsugars and carbohydrates (such as, breads,cereals, soft drinks, fruits, cakes and sweets)pass over or are left on the teeth. Bacteria in the mouth digest these foodsproducing acids. The bacteria, acid, fooddebris and saliva combine to form plaque,which clings to the teeth and the acids quicklydissolve the minerals from the tooth enamelsurface of the teeth. If this cycle continues without opportunity toreplenish the minerals (which fluoride does)then a cavity may form in a tooth. Rate per100,000population35004.3 XEROSTOMIA (DRY MOUTH) – 5 FACTS 3000Ageing may be associated with reduced salivaand salivary gland hypo-function, and reducedsalivary flow.202500 Use of medications is associated with anincreased incidence of dry mouth.2000 Saliva has antibacterial properties. When thequantity and quality of saliva is reduced oraldiseases can develop very quickly. Sugar-freechewing gum may assist in promoting saliva. Dry mouth is uncomfortable, unpleasant andcan impair taste, chewing, swallowing andspeech. It is associated with rapid dental decayin those with salivary gland hypo-function. Dry mouth is linked with increased risk ofaspiration pneumonia. Regular mouth carefrom a dental professional has been shown toreduce pneumonia in older patients.21, 22, 23, 24

3. SECTION 3 - Preventive oral health messages for older adults 10 3.15 messages for a healthy mouth 11 3.1.15 tips to eat wellcare, 'general' health, and health promotion 11 3.1.25 tips to drink well 11 3.1.35 tips to clean well 12 3.1.45 tips to play well 13 3.1.55 tips to stay well 13 4.

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