Journal Reading Oral Medicine

COMPREHENSIVE MANAGEMENT OF ORAL FRAILTY IN

MULTIPLE SYSTEMIC DISEASE GERIATRIC PATIENT (CASE
REPORT)
NUR FAUZIANA HAYUNINGTYAS
160112200501
MARLYANA FAUZIA
160112220025
KHANSA AISYI RAHMAH
160112220026
BLANDINA TSANARAYYA AMARANTHA 160112220027
AMIRA ALIYA NURHADIATI HUSEIN
160112220028
SUPERVISOR :
DEWI ZAKIAWATI, drg., M.Sc., Sp.PM
 01
JOURNAL’S VALIDITY
Dentino: Jurnal Kedokteran Gigi

● SINTA 3 Journal (2016)

● Google Citations: 1337
● H-index 18
● I10-index 39
 02

BACKGROUND
Oral Frailty and Elderly

ELDERLY Metabolic Increased of

WHO: Age
over 60 yo
changes vulnerability

COMPREHENSI
Age Increased Oral
VE
predilection vulnerability manifestations
MANAGEMENT
of various
systemic
disease
 03

METHOD
 CASE REPORT
one of research designs where an
unforeseen or novel circumstance is
thoroughly described in a detailed report
of finding, clinical course, and prognosis
of an individual patient, assisted or
backed by review of literature of other
reported cases

The hierarchy of evidence based medicine

 04
CONTENT
 Patient Identity
● No history recurrent sore mouth
● Not brushed his teth for 3 days bcs
Name : - these complaints
Age : 64 year old ● Not regularly check up with the
Gender : Male dentist
● Lost 12kg in the past month bcs
inadeguate intake due to loss of
Anamnesis appetite
● Heavy smoker since 57 years ago (>40
cigarettes/day)
A 64-year-old male was referred to the Oral ● No history of alcohol and drug
Medicine Department from the consumtion
Cardiovascular Department Dr. Hasan Sadikin
General Hospital Bandung with chief
complaints of pain in swallowing, dry, and
sore mouth since 2 days ago.
 History of Current Disease Medical History

Uncontrolled type II diabetes mellitus (DM)

• Infective endocarditis (IE)
for five years
• Acute kidney injury (AKI)
• Thrombocytopenia related
to IE aggravated by drugs
(furosemide)
• Hyponatremia et causa Medication Consumed
hemodilution
• Hypokalemia • Furosemide • Calcium carbonate
(hypomagnesia) et causa • Digoxin • Lansoprazole
renal loss (furosemide) • Captopril • Paracetamol
• Respiratory failure • Calcium gluconate • Magnesium sulfate
• Electrolyte-fluid imbalance • Gentamycin • Bisoprolol
• Ampicillin-sulbactam • Ramipril
• Potassium chloride • Lactulose
 Extraoral Examination

• Submandibular lymph node right : • Gingiva :

lymphadenitis Multiple,diffuse,blackish-brown macules along
• Eye : icteric sclera the anterior upper and lower attached gingiva
• Lips : dry exfoliative and dry saliva
• Buccal mucosa :
at both corners of the lips 1. Scrapedoff white plaque leaving erythematous
area
2. Looked dry, mouth mirror sticking to the
Intraoral Examination tongue and buccal mucosa

• Oral hygiene : • Soft palate (palatum molle) until uvula :

Plaque + Retained tooth Irregular multiple major ulcers, surrounded by
Stains + Missing teeth erythema, well-demarcated with yellowish
Calculus + concave base and covered by thick yellowish-
Caries + green sputum
 Intraoral Examination

• Hard palate (palatum durum) :

Scrapedoff white plaque leaving
erythematous area

• Tongue :
1. Depapilated with debris accumulation on
dorsal
2. Scrapedoff white plaque leaving erythematous
area on the dorsal and ventral

• Saliva :
Frothyand absent of saliva at the floor of
mouth
 Objective Examination

Xerostomia was carried out using

the Challacombe scale3 (Table 1)
and showed moderate xerostomia
with six points
 Laboratory Examination

The laboratory investigations showed in Table 3.

The patient was also tested with anti-CMV IgM
and IgG to rule out the possibility of
cytomegalovirus infection
Radiology Examination
 Diagnosed

• Exfoliative cheilitis
• Acute pseudomembranous candidiasis
• Aphthous-like ulcer
• Moderate xerostomia
• Smoker’s melanosis
Case Management

01 02 03

ACUTE APTHOUS-LIKE MODERATE

PSEUDOMEMBRANOUS ULCER XEROSTOMIA
CANDIDIASIS

treated with chlorine dioxide

treated with 0.12% chlorhexidine (ClO2)-zinc mouthwash three
digluconate mouthwash three times a day times a day
Case Management

04 05 06

EXFOLIATIVE CHEILITIS POOR ORAL HYGIENE CARDIOVASCULAR

SURGERY

apply a thin layer of 100% instruction included advised to do mouth

petroleum jelly three times a brushing the teeth and preparation
day tongue two times a day
 2 day follow up

Oral cavity looked cleaner than before

but still felt the same complaints as at
the first visit

Advised

• Brush teeth
• Take topical medications routinely
1. 0.12% chlorhexidine digluconate 30-60
minutes before meals
2. ClO2-zinc mouthwash 30-60 minutes
after meals
3. 100% petroleum jelly
 7 day follow up

● Complaints of dry mouth persist

due to fluid restriction

● The burning sensation and pain in

swallowing had subsided

Advised

Topical medications were still being

used
 10 & 14 day follow up

● After the 10th and 14th days of follow-up

almost all the complaints disappeared

● Scaling, restoration of the carious teeth and

teeth extraction had been done

Advised

• Remained in fluid restriction and was

scheduled to undergo cardiovascular surgery
next week.
• Still used topical medications routinely
 1 month follow up
● No complaints of dryness and pain in the
oral cavity.
● A week before the patient underwent
cardiovascular surgery successfully
● There was no fluid restriction anymore and
planned to be discharged from the hospital.
Advised
● Maintain oral hygiene
● Eat a balanced nutritious diet
● Regularly drink enough water
● Apply 100% petroleum jelly on his
lips
 05
DISCUSSION
Infectious Endocarditis & Acute Kidney Injury (AKI)

Inflammation of Rapid or abrupt decline in

endocardium kidney function

Subsequent dysregulation of
Wide array of manifestations the body electrolytes &
and sequelae abnormal retention of
nitrogenous waste

Caused by bacteria; gram- No clinical symptoms >

positive streptococci, diagnosed from routine
staphylococci, enterococci laboratory blood test
Oral Frailty & Type 2 Diabetes Mellitus (T2DM)
Frailty: Identifiable state of
older adults with greater
vulnerability
Oral frailty: Decrease in oral
function together with
decline in cognitive and
physical function
Results to poor oral health >
influence eating habits &
food preferences > impact
on diet quality
90% cases of diabetes
Response to insulin
diminished > insulin
resistance
Effect to oral condition:
movement disorders, taste
disturbances, dry mouth,
burning mouth syndromes,
swallowing problems
 12 KG WEIGHT
LOSS OF APETITE
LOSS

Chronic oral mucosal pain

Acute
Oral ulceration
inflammation
LOSS OF APETITE
Bad habit Smoking

Systemic compliants
 complex and varied condition, characterized by damage or
ORAL ULCERATION destruction in the integrity of the oral epithelium, followed
by loss of the underlying connective tissue, resulting in a
crateriform appearance
 Increase of IgG and
CMV ORAL ULCERS
appearance of IgM
 SMOKING

Histological Systemic
Clinical Changes
changes Condition

● Thinner oral epithelium ● Aggravative systemic disease

● Excess melanin deposits
● Loses elasticity & athropies ● Candidiasis
● Smokers melanosis
 DENTAL
QUESTIONNARE
 TREATMENT

Mouth Preparation Pharmacological Cardiovascular

for Cardiovascular Therapy Surgery
Surgery

● Scalling & Root ● ClO2-Zinc mouthwash

Planing ● Chlorhexidine mouthwash
● Caries removal and ● Petrolleum jelly
restoration
● Tooth extraction
 ClO2-Zinc Mouthwash

Chlorine Dioxide → normal pH → not

good for candida

Zinc-asetate → maintains moist condition

 Chlorhexidine

CHX → strong base pH → bacteriostatoc,

bactericidal, fungicidal, fungistatic,
viruskilling

Petroleum Jelly

Moisturizer
 135,789
Mars is full of iron oxide dust

+25% $120
Earth is the planet with life Venus has a toxic atmosphere
LEARNING PROCESS

Mercury is the smallest Earth is the third

planet of them all planet from the Sun

STAGE 2 STAGE 4

STAGE 1 STAGE 3
The Moon is Earth’s Ceres is located in the
only natural satellite main asteroid belt
HEALTH ADMINISTRATION SUBJECTS

CODE COURSE TITLE CREDITS

001 Mercury is the closest planet to the Sun 10

002 Venus is the second planet from the Sun 8

003 Earth is the third planet from the Sun 4

004 Despite being red, Mars is very cold 3

005 Jupiter is the biggest planet in the Solar System 3

687,789
Big numbers catch your audience’s attention
DAILY ACTIVITIES
MERCURY MOON
Mercury is the closest The Moon is Earth’s only
planet to the Sun natural satellite

CERES SATURN
Ceres is located in the Saturn is a gas giant and
main asteroid belt has several rings

SUN MARS
The Sun is the closest Despite being red, Mars
star to Earth is actually a cold place
SKILLS THAT WILL BE ACQUIRED
Mercury is the smallest
1 MERCURY planet in the Solar System
NEW SKILLS

Earth is the beautiful planet

2 EARTH where we all live on

Venus has a beautiful name,

3 VENUS but also high temperatures

Saturn is the second-largest

4 SATURN planet in the Solar System
A PICTURE IS WORTH
A THOUSAND WORDS
COURSE STRUCTURE
26% 19%
MERCURY MARS
Mercury is the closest Despite being red,
planet to the Sun Mars is very cold

23% 32%
JUPITER EARTH
Jupiter is the biggest Earth is the only planet
planet of them all that harbors life

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STUDY CALENDAR

MAY
M Tu W Th F EXAMS
Mercury is the closest
2 3 4 5 6 planet to the Sun and the
smallest of them all
9 10 11 12 13

16 17 18 19 20
PRACTICES
23 24 25 26 27 Earth is the third planet
from the Sun and the only
30 31
one that harbors life
“This is a quote, words full of
wisdom that someone
important said and can make
the reader get inspired.”
—SOMEONE FAMOUS
HEALTH ADMINISTRATION CENTERS

EARTH
Earth is the third planet
from the Sun and the only
one that harbors life in the
Solar System
OPEN TO WORK
EARTH
Earth is the beautiful planet
where we all live on

SATURN
Saturn is the second-largest
planet in the Solar System

MARS
Despite being red, Mars is
actually a cold place
ASSIST OTHER DENTAL WORKERS

79% 44% 67% 21%

DENTIST THERAPIST HYGIENIST SURGEON

Despite being red, Earth is the Saturn is a gas The Sun is the star
Mars is actually a beautiful planet giant and has at the center of the
very cold place where we all live on several rings Solar System
PILLARS OF DENTAL CARE

EARTH NEPTUNE
Earth is the planet Neptune is very far
where we all live on away from the Sun

MARS SATURN
Despite being red, Saturn is a gas giant
Mars is a cold place and has several rings

JUPITER
Jupiter is the biggest
planet of them all
NECESSARY SKILLS

39% 67%
VENUS MERCURY
Venus is the second Mercury is the
planet from the smallest planet
Sun

78% 43%
MARS JUPITER
Mars is full of iron Jupiter doesn’t have
oxide dust a solid surface
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COMPARISON: STUDY PROGRAMS

PROGRAM 1 PROGRAM 2 PROGRAM 3

Earth is the third Despite being red, Jupiter doesn’t have
DESCRIPTION planet from the Sun Mars is very cold a solid surface

MODALITY On-site Online On-site

DURATION 650h 345h 560h

PRICE $4,500 $2,100 $3,200

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 Journal Reading Oral Medicine

COMPREHENSIVE MANAGEMENT
OF ORAL FRAILTY IN MULTIPLE
SYSTEMIC DISEASE GERIATRIC
PATIENT (CASE REPORT)

Here is where your presentation begins

 Journal
Reading Oral
Medicine
COMPREHENSIVE MANAGEMENT
OF ORAL FRAILTY IN MULTIPLE
SYSTEMIC DISEASE GERIATRIC
PATIENT (CASE REPORT)
CASE MANAGEMENT

MARS MERCURY EARTH

Despite being red, Mercury is the closest It’s the third planet
Mars is actually a cold planet to the Sun and from the Sun and the
place. It’s full of iron the smallest in the one that harbors life in
oxide dust Solar System the Solar System
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TABLE OF CONTENTS

01 02
INTRODUCTION LEARNING
You can describe the You can describe the
topic of the section here topic of the section here

03 04
SKILLS OPPORTUNITIES
You can describe the You can describe the
topic of the section here topic of the section here
WHAT DOES A DENTAL ASSISTANT DO?
MERCURY
Mercury is the closest planet
to the Sun and the smallest
one in the Solar System—it’s
only a bit larger than the Moon
VENUS
Venus has a beautiful name
and is the second planet from
the Sun. It’s hot and has a
poisonous atmosphere