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Mary Perkins is 72 years old and was diagnosed with Alzheimer’s Disease 7 years ago. She requires assistance with bathing, toileting, and dressing. She can feed herself, but she needs to be reminded to do so. She is able to walk quite well. She lives in her home of 50 years with her daughter and granddaughter. An aide is present for 8 hours during the day. Her daughter and granddaughter share evening responsibilities including meal preparation, getting Mrs. Perkins cleaned and ready for bed, and redirecting her back to bed if she roams at night.
Mrs. Perkins medical health has been otherwise good. She has Hypertension, Hyperlipidemia and Hypothyroidism. Her medications include:
Mrs. Perkins’ primary care clinician retired last year, and the family had difficulty locating a new source of care. When you finally do see her as a new patient, her oral examination reveals the following:
Robert Henry, DMD, MPH
Which of the following is the most plausible explanation for Mrs. Perkins’ oral appearance?
Mrs. Perkins is referred to a dentist. In three office visits, the plaque and tarter are removed. With root planing, use of oral doxycycline, chlorhexidine rinse, and good oral hygiene her periodontitis comes under control. The dentist and her staff also provide the family with instruction on how to provide effective daily oral care.
How should Mrs. Perkins’ family be instructed to brush her teeth?
Mrs. Perkins declines gradually over the next 4 months. She breaks her arm in a fall and suffers a bout of diverticulitis that requires hospitalization. Caring for her at home in her weakened state has become increasingly difficult for her family, and the decision is made to pursue placement in a nursing home. It is important to the family that she continues to receive good oral care in the nursing home so that she does not lose the benefit of all of the progress they have made.
Which of the following is true concerning the maintenance of good oral health in nursing home residents?