Yaşlı Bireylerde Koruyucu Ağız Sağlığı Bakımı
Özet
Yaşlı bireylerde koruyucu ağız sağlığı bakımı, sistemik hastalıkların önlenmesi ve yaşam kalitesinin artırılması açısından kritik bir öneme sahiptir. Yaşlanma ile birlikte tükürük akışının azalması, el becerilerinin zayıflaması ve karbonhidrat ağırlıklı beslenme gibi faktörler dental plak birikimini ve Candida gibi enfeksiyon risklerini artırır. Mekanik temizlik, özellikle elektrikli diş fırçaları ve protez bakımı ağız sağlığının temelini oluştururken; klorheksidin gibi kimyasal ajanlar bakteri yükünü azaltmada etkili birer yardımcıdır. Diş çürükleri, kök çürükleri ve dental erozyonun önlenmesinde florür kullanımı ve asidik gıdaların sınırlandırılması önerilir. Ağız kuruluğu (kserostomi) ve yanan ağız sendromu yaşlılarda sık görülmekte olup, yeterli su tüketimi ve mukozanın nemlendirilmesiyle kontrol altına alınabilir. Ayrıca tütün ve alkolün kısıtlanması, iyi bir ağız hijyeni sağlanması ağız kanseri ve alveolar kemik kaybı riskini önemli ölçüde azaltır. Yaşlı popülasyonda koruyucu hizmetlerin planlanması bireysel ihtiyaçlara göre yapılmalı, bakıcılar ve ağız sağlığı ekipleri bu süreçte aktif rol oynamalıdır.
Preventive oral health care in elderly individuals is of critical importance for preventing systemic diseases and improving quality of life. Factors such as decreased salivary flow, weakened manual dexterity, and carbohydrate-heavy diets with aging increase dental plaque accumulation and risks of infections like Candida. While mechanical cleaning, especially electric toothbrushes and denture care, forms the cornerstone of oral health, chemical agents like chlorhexidine are effective aids in reducing bacterial load. The use of fluoride and limiting acidic foods are recommended to prevent dental caries, root caries, and dental erosion. Dry mouth (xerostomia) and burning mouth syndrome are common in the elderly and can be managed through adequate water consumption and mucosal moisturization. Furthermore, restricting tobacco and alcohol, alongside maintaining good oral hygiene, significantly reduces the risks of oral cancer and alveolar bone loss. Planning preventive services for the elderly population must be tailored to individual needs, with caregivers and oral health teams playing an active role in this process.
Referanslar
Paster BJ, Boches SK, Galvin JL, et al. Bacterial diversity in human subgingival plaque. J Bacteriol, 2001;183(12):3770-3783. https://doi.org/10.1128/JB.183.12.3770-3783.2001
Ellepola A, Samaranayake L. Oral candidal infections and antimycotics. Crit Rev Oral Biol Med, 2000;11(2):172-198. https://doi.org/10.1177/10454411000110020301
Meurman JH, Sanz M, Janket S-J. Oral health, atherosclerosis, and cardiovascular disease. Crit Rev Oral Biol Med, 2004;15(6):403-413. https://doi.org/10.1177/154411130401500606
Meurman JH, Hämäläinen P. Oral health and morbidity–implications of oral infections on the elderly. Gerodontology, 2006;23(1):3-16. https://doi.org/10.1111/j.1741-2358.2006.00102.x
Scannapieco F, Papandonatos G, Dunford R. Associations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol, 1998;3(1):251-256. https://doi.org/10.1902/annals.1998.3.1.251
Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc, 2002;50(3):430-433. https://doi.org/10.1046/j.1532-5415.2002.50106.x
Davies R. The rational use of oral care products in the elderly. Clin Oral Investig, 2004;8(1):2-5.DOI 10.1007/s00784-003-0234-3
Koeman M, van der Ven AJ, Hak E, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med, 2006;173(12):1348-1355. https://doi.org/10.1164/rccm.200505-820OC
Twetman S, Axelsson S, Dahlgren H, et al. Caries‐preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand, 2003;61(6):347-355. https://doi.org/10.1080/00016350310007590
Twetman S, Petersson LG, Axelsson S, et al. Caries‐preventive effect of sodium fluoride mouthrinses: a systematic review of controlled clinical trials. Acta Odontol Scand, 2004;62(4):223-230. https://doi.org/10.1080/00016350410001658
Meurman JH, Odont D, Sorvari R, et al. Hospital mouth‐cleaning aids may cause dental erosion. Spec Care Dentist, 1996;16(6):247-250. https://doi.org/10.1111/j.1754-4505.1996.tb01548.x
Donnelly JP, Bellm LA, Epstein JB, et al. Antimicrobial therapy to prevent or treat oral mucositis. Lancet Infect Dis, 2003;3(7):405-412. https://doi.org/10.1016/S1473-3099(03)00668-6
Janket S-J, Jones J, Rich S, et al. The effects of xerogenic medications on oral mucosa among the Veterans Dental Study participants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007;103(2):223-230. https://doi.org/10.1016/j.tripleo.2006.05.013
Grushka M, Ching V, Epstein J. Burning mouth syndrome. Taste and Smell 2006;63:278-287. https://doi.org/10.1159/000093766
Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol, 2009;45(4-5):309-316. https://doi.org/10.1016/j.oraloncology.2008.06.002
Salaspuro MP. Acetaldehyde, microbes, and cancer of the digestive tract. Crit Rev Clin Lab Sci, 2003;40(2):183-208. https://doi.org/10.1080/713609333
Schmitter M, Rammelsberg P, Hassel A. The prevalence of signs and symptoms of temporomandibular disorders in very old subjects. J Oral Rehabil, 2005;32(7):467-473. https://doi.org/10.1111/j.1365-2842.2005.01449.x
Sato H, Österberg T, Ahlqwist M, et al. Association between radiographic findings in the mandibular condyle and temporomandibular dysfunction in an elderly population. Acta Odontol Scand, 1996;54(6):384-390. https://doi.org/10.3109/00016359609003556
Ohlmann B, Rammelsberg P, Henschel V, et al. Prediction of TMJ arthralgia according to clinical diagnosis and MRI findings. Int J Prosthodont, 2006;19(4):333.
Curtis AW. Myofascial pain-dysfunction syndrome: the role of nonmasticatory muscles in 91 patients. Otolaryngol Head Neck Surg, 1980;88(4):361-367. https://doi.org/10.1177/019459988008800408
Barmes DE. Public policy on oral health and old age: a global view. J Public Health Dent, 2000;60(4):335-337. https://doi.org/10.1111/j.1752-7325.2000.tb03345.x
Meurman JH, Kari K, Äikäs A, et al. One‐year compliance and effects of amine and stannous fluoride on some salivary biochemical constituents and oral microbes in institutionalized elderly. Spec Care Dentist, 2001;21(1):32-36. https://doi.org/10.1111/j.1754-4505.2001.tb00221.x
World Health Organization, Oral health in aging societies. Integration of oral health and general health. Geneva: WHO Press; 2006.
Peltola P, Vehkalahti MM, Simoila R. Effects of 11‐month interventions on oral cleanliness among the long‐term hospitalised elderly. Gerodontology, 2007;24(1):14-21. https://doi.org/10.1111/j.1741-2358.2007.00147.x
Hatakka K, Ahola AJ, Yli-Knuuttila H, et al. Probiotics reduce the prevalence of oral Candida in the elderly—a randomized controlled trial. J Dent Res, 2007;86(2):125-130. https://doi.org/10.1177/154405910708600204
