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Summary
In this episode of CareLab, host Emilia Bourland welcomes back Dr. Joy Poskozim, a dental expert specializing in long-term care and homebound patients. Alongside co-host Brandy Archie, they discuss the crucial yet often overlooked aspects of denture care, oral hygiene, and the impact of dental health on overall well-being. The conversation highlights common issues with dentures, misconceptions about oral care, and practical solutions for caregivers and healthcare professionals.
Key Takeaway
- Denture Fit & Function: Ill-fitting dentures can lead to pain, poor nutrition, and social withdrawal, emphasizing the need for regular check-ups.
- Oral Hygiene Matters: Even without natural teeth, maintaining gum and tongue hygiene is critical for preventing infections like thrush.
- Denture Adhesive Best Practices: Proper application of denture adhesive ensures better fit and comfort throughout the day.
- Medical-Dental Disconnect: Some doctors recommend wearing dentures overnight for airway support, but this can lead to fractures and hygiene issues.
-
Person-Centered Care: In later stages of dementia, some individuals may refuse to wear dentures, and respecting their comfort is key to quality of life.
Transcript
Brandy Archie, OTD, OTR/L, CLIPP
Bye everybody.
Emilia Bourland
Hello, welcome to Care Lab. Okay, so we have a repeat guest here today, one that I'm extremely excited about. It is Dr. Joy Pascosum. Did I get it again?
Dr. Joy Poskozim
Bye!
Emilia Bourland
I'm never confident in that good, pat on the back for me, pat on the back for me. If you missed our first episode with Dr. Joy, you should absolutely go back and listen to it just as soon as you have finished downloading and listening to this episode. But if you don't know who she is, I'm gonna give you a little bit of an intro right now. So Dr. Joy is a dental director for several nursing care facilities. She educates staff as well as provides care to nursing home residents. She also makes.
Brandy Archie, OTD, OTR/L, CLIPP
Exactly.
Emilia Bourland
house calls in and around the Chicagoland area. And she's been in private practice for 25 years. She practices integrative health general dentistry at her office on the Northwest side of Chicago. She's been performing dental procedures on the homebound for over 16 years. And in 2017, she earned her dentistry and long-term care certificate from the University of Pacific Dental School. She has a fellowship with the Special Care Dental Association Geriatric Council in 2018 and is a certified dementia care practitioner as a
2021. So, know, street cred, way up. And as you can see, she's as you're going to hear, if you're not watching this right now, as you're going to hear, she's absolutely delightful to talk to and a wealth of knowledge. So very, very excited to have you back on. Thank you so much for being here, Dr. Joy.
Brandy Archie, OTD, OTR/L, CLIPP
You
Dr. Joy Poskozim
Thank you.
Dr. Joy Poskozim
my gosh, it's my absolute pleasure. Thank you for having me again.
Brandy Archie, OTD, OTR/L, CLIPP
Yes. Okay, now we did all the formalities. We gave you introduction. Time for the hard-hitting questions. So I'm pretty sure I haven't asked this icebreaker before. So if I have, forgive me and let's answer it anyway. I think in my experience, every healthcare professional has one bodily fluid or process that they just cannot deal with. Okay. Even though we deal with bodies and bodily processes all the time. So I want to know what is your one thing?
Dr. Joy Poskozim
Alright.
Emilia Bourland
Yeah.
Brandy Archie, OTD, OTR/L, CLIPP
that just grosses you out.
Dr. Joy Poskozim
It's not it honestly there's two things. Toes, toes, I could never be a podiatrist. God bless them. They are so needed, but that is not my line of jurisdiction. Not for me, not for me. And I also could never be like an ophthalmologist. Like I would be so I could not I don't think I could get over the fear of causing blindness like seriously.
Brandy Archie, OTD, OTR/L, CLIPP
Ooh, tell us.
Emilia Bourland
That end of the body is not for you.
You
Brandy Archie, OTD, OTR/L, CLIPP
Really?
Brandy Archie, OTD, OTR/L, CLIPP
Ehh... mhm.
Emilia Bourland
Mmm. Yeah.
Dr. Joy Poskozim
Do know what I mean? Like our eyes are so crucial for our living and everything that that is another part of the body that I, you know, props to the optometrist and the ophthalmologist out there because I couldn't do it. There you go.
Emilia Bourland
There you go.
Brandy Archie, OTD, OTR/L, CLIPP
See, I told you everybody had one. He was like right there. You already knew it. already knew it. Amelia, what you got? What's yours?
Dr. Joy Poskozim
Yeah, yeah.
Emilia Bourland
Mm-hmm. Mm-hmm.
You know, so like I can deal with blood. I have no problem with bowel movements. have, you know, there's pretty much even actually like, like, like mucus coming out of a trachea doesn't bother me anymore. No, actually like suctioning a trach, like so deeply satisfying. Doesn't bother me at all. But I still have a little thing about
about saliva. And I know this is on an episode with a dentist. I actually, I always thought I could never be a dentist because I wouldn't want to like be in someone's mouth with all of like the saliva, especially if they hadn't brushed their teeth or something like that. But it's
Brandy Archie, OTD, OTR/L, CLIPP
What is the difference between saliva and the stuff that's coming out of the tray?
Dr. Joy Poskozim
Yeah, that was my question!
Emilia Bourland
I don't know. I don't know. I'm not saying it's rational. I'm just telling you how I feel. It's not, it's not rational. I'm just telling you how I feel. And it's even like, I don't even mind actually saliva so much in the mouth anymore. It's, it's like after it's been spit out, I don't want to look at it then. It's a very specific time. And the longer I go, you know, the less it bothers me, but it was a serious concern for me when I
first thought about being an occupational therapist and being in OT school, I was like, I don't know how I'm going to handle this whole oral care thing because yuck. Yeah, I know. So weird.
Dr. Joy Poskozim
fascinating yeah and you know when I look at a dirty mouth and I'm like I gotta attack this like my mom said I was very fastidious when I was a kid and she was shocked that I wanted to be working like in a dirty environment you know what I mean and I'm like I think it's I think it's because I am or at least I was so fastidious that I got it I gotta clean more like cuz I just my mouth I want to clean everybody else's mouths
Brandy Archie, OTD, OTR/L, CLIPP
Yeah, yeah.
Emilia Bourland
Yeah, yeah.
Brandy Archie, OTD, OTR/L, CLIPP
You get to clean it up.
Emilia Bourland
Yeah, I mean, it's gotta be like just deeply satisfying to you. Yeah. All right. Mm-hmm.
Dr. Joy Poskozim
so you have no idea.
Brandy Archie, OTD, OTR/L, CLIPP
That's why there's something for everybody. And this is why I asked this question because when you're on the show, I'm like, I'm so glad for dentists and dental hygienists and for respiratory therapists, because mine is the mouth. It's not the mouth itself. It is the things that come out of the mouth. so whether it comes out the mouth or the trach, no, no, they're the same thing to me. Like, I don't want a suction or trach that's not satisfying. It's like, I don't want to do this, but I'm doing this anyway.
Dr. Joy Poskozim
I believe, yeah.
Emilia Bourland
Looks same kind of.
Emilia Bourland
Hahaha!
Brandy Archie, OTD, OTR/L, CLIPP
even like, you know, OTs help make sure people can brush their own teeth. And like, to this day, I still close my eyes at the moment that they're about to spit into the sink. Like we did all the stuff, they brush your teeth, they got all this stuff out and then they go to do like this. And I'm like, close eyes, open eyes. Okay. Continue. Like, I don't know what it is about that. I cannot deal with. So everything else is like fine. Bowel movements, pee, urine, blood, all the stuff, hair, anything, toes even.
Emilia Bourland
Okay.
Emilia Bourland
all the stuff.
Brandy Archie, OTD, OTR/L, CLIPP
Like, I've seen some real bad looking toes. And, you know, they gotta have socks and shoes on them. So, you know, this guy get done.
Emilia Bourland
yeah.
Dr. Joy Poskozim
They don't always. They don't always.
Brandy Archie, OTD, OTR/L, CLIPP
So, yeah, so thank you everybody for what you do, because somebody else probably can't do it. This is the bottom line in healthcare. So today, we had you on before and we had such a good conversation about so many things. But we wanted today to talk specifically about dentures.
Emilia Bourland
Mm-hmm. Mm-hmm.
Dr. Joy Poskozim
Yeah, yeah, well said, well said.
that.
Dr. Joy Poskozim
Yeah dentures are a real problem because and I was just having this conversation yesterday with somebody about the fact that as we age our dentistry ages as well, right? So you know so what we're putting in you know as a dentist what I'm putting in someone's mouth at let's say 42 you know the idea is this thing is you hopefully going to last and unfortunately not everything lasts for a lifetime.
Emilia Bourland
Mm-hmm.
Dr. Joy Poskozim
and that's unfortunate. And then we also have another problem where if someone is moving into a long-term care community that dentures get dropped, dentures get lost, dentures get broken. And so that really affects not only their ability to eat, but it also affects their socialization as well. And I had one patient that I had to take a lower partial denture from, lower denture, mind you, okay?
Brandy Archie, OTD, OTR/L, CLIPP
Yeah.
Brandy Archie, OTD, OTR/L, CLIPP
Yes.
Dr. Joy Poskozim
the person, the resident refused to eat with everybody else in the dining room until I got that thing back to her. So let me tell you, that was a rush job. I mean, she was eating, but she was not socializing. She literally kept herself in her apartment because she did not have her lower partial. I there's, mean, dentures are so huge on so many levels. And so I'm just gonna break it down.
Emilia Bourland
Mm-hmm.
Dr. Joy Poskozim
really quickly on the different types. So we've got, we've, go ahead, go for it.
Brandy Archie, OTD, OTR/L, CLIPP
Okay, hold on, before you do that, before you do that, I wanna just jump in and say like, it could really seem like what you're saying is like people are vain and they don't wanna be seen without their teeth. And that might be the reason, whatever. But research shows that if you eat by yourself, you're less likely to eat your full meal and you're less likely to eat well. And what happens when you don't get enough to eat, especially at an older age where your appetite and metabolism is already slower?
Like that's how we get muscle wasting. that's how it like is this cycling, spiraling, and that's how you get to failure to thrive. And so it's not about like forcing people to drink a bunch of insure. It's like get to the bottom of the problem. Actually ask and figure out like, she doesn't want to go down because she lost her dentures. Maybe I can solve that problem. We can get some new dentures or whatever. You know what I mean? So I just wanted to like elevate and highlight that as not just a vanity issue that you're like, mom, get over it. It's like, it has so many more.
Dr. Joy Poskozim
Failure to thrive.
Dr. Joy Poskozim
Well, yeah.
Dr. Joy Poskozim
Mm-hmm.
Brandy Archie, OTD, OTR/L, CLIPP
repercussions.
Dr. Joy Poskozim
Absolutely, beautifully said. Yeah, I could not agree more. And the different types of dentures, and this is a problem that I see a lot in the communities is that the caregivers and the CNAs, the certified nursing assistants and the nurses are not trained on the different types of dentures. And so we've got complete dentures. We've got an upper denture complete, lower denture complete, which means they're a dentureless. And more and more of these dentures are looking more and more realistic, right? They're not just chiclet teeth, right?
And so we can add a lot of traits to them. can shade, we can have one tooth little further out from another one. We can have a situation where the denture is also, and this is a big one now, especially in this day and age, are implant-supported dentures. And so the denture will come out at night and what a caregiver is expecting to see is a completely dentureless or no teeth on top.
And what they're now seeing are potentially four to six posts, which are actually called abutments that anchor the denture in place. And it can really be very scary to see these posts hanging out of the mouth. And if they're not trained, if they're not educated on what these things are, then they don't know they're supposed to brush those. In fact, it's even more important to brush those implant abutments than natural teeth, because natural teeth,
Brandy Archie, OTD, OTR/L, CLIPP
Mmm.
Dr. Joy Poskozim
Each tooth is its own organ and it also has a little STBC immune system to fight off. But implants don't have that capability. Even though they're titanium and they're inert, it's the reaction between the actual abutment and the gums that you can start getting inflammation. And bacteria can still live in between that abutment and the gums, because it's going to attach on the gums and wreak havoc around that implant.
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L, CLIPP
Mmm.
Dr. Joy Poskozim
So even more reason why those things have to be brushed.
Emilia Bourland
and
And okay, I have a question about this. like, does the implant, ultimately like where does the implant implant to? Is it in the bone? Like, is it seated in the bone? So like you don't want an infection potentially creeping up into the bone. Like that would be really bad. So those should get brushed.
Dr. Joy Poskozim
Yes.
Dr. Joy Poskozim
Yep. Yep.
Absolutely. So, definite need to be brushing those abutments. And a lot of times, mean, 99 % of the time they're called posts. I don't really care what they're called, quite honestly, as long as they know that they're supposed to be brushed. And then we also have partial dentures. And partial dentures are being made either from metal, a metal base called chrome, C-H-R-O-M-E chrome dentures, or they're plastic dentures. Or we also have flexi dentures, which are the lightest type of acrylic. They usually tend to be a little bit more transparent
Emilia Bourland
Mm-hmm. Mm-hmm.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Dr. Joy Poskozim
color and you can literally you can can flex them you can bend them and those are really nice there's only problem with the flexi dentures though is that we can't add teeth to them it's made in one shot and the acrylic that is used to add a tooth to a complete denture or to a partial denture if one tooth pops out or something happens and they lose a tooth and we need to add a tooth to a partial denture those flexi dentures we can't add to that we just don't have the technology that it's a it's
Emilia Bourland
that's interesting.
Dr. Joy Poskozim
static acrylic versus a flexible acrylic and the two don't mesh. So that is a problem and that's a conversation I have to have with families or the patient themselves that if they have a flexidenture and now all of a sudden they lose a tooth for whatever reason and we have to now incorporate that tooth into a removable appliance, they're going to have to have a whole new one. So there's a caveat with those flexidentures and it sucks.
Brandy Archie, OTD, OTR/L, CLIPP
Mmm.
Dr. Joy Poskozim
But yes, taking dentures out at night. One thing is also that's been happening lately. And I talked to with a pulmonologist from University of Illinois at Chicago about this. And it's true that more and more pulmonologists, more and more sleep physicians are recommending those that have removable appliances, partial dentures, complete dentures to keep them in their mouths at night when asleep.
because it keeps a better patent airway for those that have sleep apnea. Logical, right? You know, it can have less airway pressure, right? So less, you know, less problems with the sleep apnea, more compliance ideally, right? But ladies, those dentures, these dentures are not made to be worn at night. We are jaws shift, right? Our lower jaws are mandible.
Brandy Archie, OTD, OTR/L, CLIPP
Mmm. That makes sense.
Emilia Bourland
That makes sense.
Yeah.
Brandy Archie, OTD, OTR/L, CLIPP
Yeah.
Emilia Bourland
Yeah.
Emilia Bourland
Mm-hmm.
Dr. Joy Poskozim
It's on a hinge joint, right? And so when we lean our head back, that jaw goes back. And so when we lay down, our teeth don't naturally mesh the way they same or occlude the same way we are when we're sitting up and we're eating. Those, they're one unit versus individual teeth that will shift and do their own thing with this is one unit that is across the entire palate, the entire roof of the mouth or across the lower arch.
Brandy Archie, OTD, OTR/L, CLIPP
Mmm.
Dr. Joy Poskozim
And even with partial dentures, yes, okay, I understand we don't want to collapse by it, we don't want to collapse airway, but at the same time, what I'm beginning to see with these patients wearing their dentures because their doctors told them to is I'm seeing more fractures. And so now these dentures have to be metal reinforced. I mean, can it be done? Yes, but in some situations, the fractures are not repairable and now they have to have a whole new denture made.
Brandy Archie, OTD, OTR/L, CLIPP
Mm.
Dr. Joy Poskozim
There's, once again, between medical and dental, there's a disconnect. just wear them, they're plastic. No, you're not fine. It can be a problem. And this is a, I'm really glad we're having this conversation, because it's something that we need to be focused on when it comes to, for dentists on one hand, in making a denture, you have sleep apnea, I'm gonna make sure when I make you this denture, it's metal reinforced, or it's gonna be a chrome denture to begin with.
Or, you know, for someone that, you know, has developed sleep apnea over time and has dentures, how can I, to prevent fracture, how can I reinforce this denture for you or should I make you another one a spare so that you have one just in case?
Emilia Bourland
Mmm. Mm-hmm.
Brandy Archie, OTD, OTR/L, CLIPP
How do you know if a denture is fractured? Is it like very clearly... It breaks! okay.
Dr. Joy Poskozim
it breaks in half, or...
Emilia Bourland
gotcha. It's not like a hairline thing. It's like.
Dr. Joy Poskozim
Yeah, so it either is going to be anterior, yeah, it's either going to be anterior posteriorly or horizontally, so laterally. Or a part of it, if you're wearing the denture like this, a part of it could just break off, right? So one part of the denture can actually just break off. And those are the easiest ones to fix because it's just like a third of it or something. But I have a great lab guy that, George, George Dental Lab.
I'm tooting his horn right now, because he's my guy. He's a miracle worker. And he can really work miracles and try to reestablish it by also adding additional support for that denture so it doesn't break again. But this is a problem. This is a problem. And then what happens is they wake up in the morning, your denture's already in your mouth. Fantastic, because now we've got a shift change.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm. I'm get them clean.
Dr. Joy Poskozim
So the assumption was, last shift already took the denture out to be cleaned, exactly. And now, you know, this denture hasn't been cleaned and now this denture is perpetually in the mouth. So we, yeah, we have to make sure that the denture is still cleaned.
Emilia Bourland
Okay, that was gonna be my question is like, it is so important to still have good oral hygiene and clean both the dentures and the mouth. Like a lot of times people think that because they have dentures, it's only the denture that needs to be cleaned. But really we still want to perform good oral care in the entire mouth, like clean the gums, clean the tongue, you know, rinse out those cheeks. That's so important as well.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Emilia Bourland
that if those dentures are in all the time, like one, so one, like there's that hygiene issue. But then the other question that I have about that is sometimes if dentures don't fit properly, people are actually, they can be at risk of getting wounds on their gums even because of the way it rubs. And so how, like, where does that come into this mix here as well with like 24 hour denture wear?
How are we supposed, like what's a way to kind of bridge that gap? Cause we want people to have open airways, but we also want their dentures to be cared for and to not break.
Dr. Joy Poskozim
Mm-hmm.
Dr. Joy Poskozim
Exactly, and it really falls down to the care plan, right? So if there's someone who's assisted living and they're there for other reasons other than memory care, they can be very specific about it. They can explain, they physically cannot remove their own dentures and clean them and clean their mouths, that the denture does have to come out at some point to be cleaned. And then with the mouth, the oral bee actually created a really neat
Brandy Archie, OTD, OTR/L, CLIPP
Mm.
Dr. Joy Poskozim
electronic toothbrush is called the Genesis. It's really cool and it's made for edentulous mouths. And the idea is we don't necessarily want to be just swabbing the mouth that cleans them. But what research has shown is that by actually brushing the soft tissue actually stimulates circulation to the gums and the gums are a muscle. And so by stimulating the gums, you are trying to maintain the gums as much as possible.
Brandy Archie, OTD, OTR/L, CLIPP
Mmm.
Dr. Joy Poskozim
to still allow those dentures to fit. So if someone can handle electric toothbrush, even if it's not the oral B, to still use that electric toothbrush for the inside of the mouth. Once again, it helps stimulate the gums. It brings a good blood circulation to the area. And in that blood is the oxygen and the nutrients and the white blood cells, the gums need to stay strong, right? The stronger the gums, the stronger the bone. The stronger the bone, the less resorption and these dentures will fit better longer.
So yes, excellent, excellent point. Just because someone is missing some teeth or missing all of their teeth or even just on one arch, that doesn't mean we don't continue the same type of oral care that we were providing prior to denture wear. Absolutely. And then, of course, there's a plethora of problems that comes with that too, right? So if they're not being taken out, the most common one, and we'll talk about source adjusted medics, I've got a great product for that.
But just infection alone, the most common one is thrush, right? Canada. And Canada has, albicans has become a huge thing, at least in the latter part of last year. I haven't heard so much about it earlier this year, but there has been issues with Canada being spread, and it wasn't really thought of as something that could be really contagious.
Brandy Archie, OTD, OTR/L, CLIPP
Mmhmm.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Dr. Joy Poskozim
but at the same time in skilled nursing homes, skilled nursing facilities, we've seen an increase in Canada, which is really interesting. But at the same time, we also wanna make sure too that there's good hydration. Good hydration, as long as their mouths are moist, then there's a less chance of thrush being created and then surviving. So if one is well hydrated, there's less chance of that happening.
Emilia Bourland
Hmm.
Dr. Joy Poskozim
And it's unfortunate, there's a misconception that if someone is using denture adhesive, they're not gonna get thrush. No, no, this doesn't make it better or worse, but that is a completely wrong assumption. The thought is, it's because there's a better seal, there's less stuff of anything getting in there. It's not about anything getting in there, it's what's forming underneath, regardless if they're using adhesive or not. So that, you know, I wanna put that to rest right there.
Brandy Archie, OTD, OTR/L, CLIPP
Mm.
Emilia Bourland
Mm-hmm. Mm-hmm.
Dr. Joy Poskozim
So, you know, then I have to prescribe them to their nice statin, their medication, their antifungal to get rid of that. And then they can't be wearing their dentures for a while, which brings back that whole societal issue. And then, okay, do we change their meal plan? What do we do while this mouth is healing? And yeah, and then there's denture stomatitis, which is also inflammation of the, usually that happens in the roof of the mouth.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Dr. Joy Poskozim
But that can also happen with partial dentures too, that's on an upper arch. It can still happen where you have inflammation of the cells, where it becomes painful to wear the upper denture. And once again, it's because those, gums have been, you know, that soft tissue has been suffocated for so long that other opportunistic.
creatures, if you will, in our mouth will then take over and wreak havoc again. So there are some serious issues that occur because that thrush can travel down the throat. I'm sure you guys have probably seen that at least once in your professional careers. It's really bad. It can form around the lips. It's awful. And what I've also noticed too, one last thing, is that I noticed that physicians can see.
and nurse practitioners, PAs, can tell thrush, right? They know what thrush looks like. But they're not necessarily, the prescription is not necessarily for the right amount of time. So I've seen it that they'll do it for seven days and then I'll get called in because it's not working. So there's something has to be done. Well, it really should be for 10 days, not seven. Those extra 72 hours of being on that medication.
It has the thrush go away, but we want to make sure also to equally important that it stays away. So sometimes if, know, so I, I'll do is that I'll add an extra three days if it's like, you know, really, you know, I can get there in time and you know, there, you know, can do that. Or now I have to change the prescription that Medicare may not pick up. You know, they'll pick up the nice statin, but now I've got to switch this medication. And now that becomes a problem too, because the body, you know, has already, or the thrush has already rejected. It's, it's now one,
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Emilia Bourland
Mm-hmm.
Dr. Joy Poskozim
you know, level higher. And that could be a problem financially and for another other myriad of reasons. Now that dentures out even longer.
Brandy Archie, OTD, OTR/L, CLIPP
So let's say I'm a family caregiver and my person is in a care facility and they wear dentures. And they're always, they, meaning the staff is telling me that, yeah, yeah, we brush the dentures and all that good stuff, right? And so now I'm listening to this podcast and I'm queued into how important it is to make sure there's good oral care. And you've mentioned a lot of different disease processes that could be happening. And so like as a caregiver, how do I know something is happening? How do I know to ring the bell and say like,
hey, this doesn't, especially if my person can't just like tell me in all of their words, you know, like what are some signs or what should I be doing in order to make sure that this very neglected area often is getting the care it needs.
Dr. Joy Poskozim
Absolutely, that's a great question. So signs and symptoms with denture stomatitis, it is going to be pain. It's going to be pain where you're trying to put the denture in and it's almost like putting on a pair of shoes that are too small because that tissue has gotten inflamed now and the denture won't seem to fit appropriately. And so if you're putting it in for them and you notice that it's just not fitting right, and it did yesterday.
Brandy Archie, OTD, OTR/L, CLIPP
Yeah.
Dr. Joy Poskozim
you know, then we need to be looking at the roof of the mouth. We need to be seeing what's going on there. And then we need to prescribe an antibiotic. that, you know, fortunately, a broad spectrum antibiotic, if they're not allergic, a maxicillin, you know, is a great way to go, or, you know, so on and so forth if they are. When it comes to thrush, it is gonna look like a really thin oatmeal. It's got that grayish color to it. And you can scrape it off.
And either you're gonna get bleeding underneath or you're gonna see it actually growing right back. Like it will start to just reform as you're scraping it off. And if it's been there, yeah, if it's been there long enough, if it's been there long enough, then you will have bleeding because it really has now impacted the soft tissue going through the layers of the soft tissue and it has caused a major problem.
Emilia Bourland
That's crazy.
Dr. Joy Poskozim
So yeah, so that's what you're gonna be looking for, where you have this, it's not plaque, it is gonna be a little bit thicker than that. And it is, like I said, it's got this grayish, yellowish hue, but most importantly, the chief sign is that if you scrape it off and you see bleeding underneath and you know that you didn't apply that much pressure, right? It's probably thrush and we need to get a prescription stat.
Emilia Bourland
Besides those bacterial or infectious processes, two, there are other things probably that family caregivers can look out for in terms of dentures and oral health. One of the things that I'm always looking for are things related to goodness of fit. So if that...
if that denture seems to be like jiggling around when they're trying to talk or they're trying to eat or like, can you give some other examples of some of those other like really foundational things that we need to be on the lookout for?
Dr. Joy Poskozim
Absolutely. So with women, we lose oral bone at a 20 % faster rate than men. So if an upper complete denture is made without any implant supports, then that denture six months later is already going to start to have some mobility issues. The first thing that I always do, because it's cheapest and actually most effective, is denture adhesive. And quite honestly, I don't care what brand. If you find one that you like, awesome. But
Emilia Bourland
Wow.
Dr. Joy Poskozim
I would make sure that it says free on top, on the box. It's not gonna say zinc free, but there is a whole big lawsuit on that. So it has to, but it's gonna say free. It should not say original. The original is still being sold. Don't ask me why. But there was a huge research that was done, many, many, many, many participants that shows that zinc, especially on the roof of the mouth, can travel north.
and can actually trigger some Alzheimer's or dementia-like symptoms. it's zinc toxicity, yes. So yeah, so if you're wearing a low-adenture, the chances of this happening are slim to none. If you're not using it every day for the upper, eh, probably not gonna happen. These are people that have the complete upper denture, they've been using the adhesive for years and years and years and years. It works for them, awesome. We wanna make sure that it says,
Emilia Bourland
Wow, I did not know that.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Dr. Joy Poskozim
free on the box and that and all of them, all the brands are going to have that. They have to, they're required. If you don't see anything on the box that's not a brand you should be buying because you don't know or you can be looking at the ingredients and if you see zinc in it and if you know your mom is wearing an upper complete denture that she uses all the time, probably not the product to buy. They are the same price. It's not going to be any more expensive and they're readily available. So yeah, so thank you for bringing that up. And but like I said, denture adhesive,
Brandy Archie, OTD, OTR/L, CLIPP
Mm.
Dr. Joy Poskozim
really does work. It really solves a lot of problems that I see, but it also is imperative that they know how to use it. When denture adhesive first comes out, it's not sticky. So if I'm going to be putting it inside a denture, let's say it's a lower denture, you can't just hand it to the person, have them click it and put it into their mouth and expect it to work. It doesn't work like that. It actually has to be pressed down bilaterally.
And you can either, know, so sometimes for the patient, depending, and I'll have them in front of the mirror and I'll tell, do, I'm going to tell them what I'm going to do. Hey, mom, I'm going to put the denture in your mouth. Now I'm going to hold it in place for you and then I'll do it. Right. And I want to hold it for a good 30 seconds. I want that adhesive to engage because that is a spot that I want it in and, it's only going to go in one way. Right. I mean, we can't, we can't screw that up. So we're going to, we're going to put it in and we're going to hold it bilaterally and we're going to be going, I go back and forth.
Brandy Archie, OTD, OTR/L, CLIPP
Mmm.
Dr. Joy Poskozim
to make sure that stuff really does engage. It's going to, it's going to.
Emilia Bourland
So you're like to like describe a little bit for view. So you're putting your fingers on both sides of the denture and kind of like going back and yeah, and going back and forth across the top of like the molars to the front, like kind of the molars to front. Gotcha. Okay.
Dr. Joy Poskozim
both sides of the mouth, I'm pushing on the top of the teeth and I'm going back and forth across the top of the teeth. Yes. Yeah, I don't want to be touching the front teeth because that can tip it in the back, right? So I want to be touching the sides and I'm going to be pressing on the actual teeth, usually with two fingers on each side and equal pressure. And I'm going back and front, back and front. I, know, a good 30 seconds. You want that adhesive to engage.
Brandy Archie, OTD, OTR/L, CLIPP
Mmm.
Dr. Joy Poskozim
It will engage by the heat in the mouth. So, and then I also tell the families, the loved ones, the caregivers that not to give them anything to eat or drink for at least five minutes. Let that really engage. Now you've got that nice seal and now you're gonna have a lot better quality of a day. It will last longer and it's not like they're gonna be taking it out mid breakfast because, oh, well this adhesive isn't working anymore.
how we're putting it in. And it's the same thing with the upper two. You know, I'm either gonna be, you know, eye eye level with them, knee to knee, and doing it for them, or I'll be behind them. I like to do it in a mirror so they can see what I'm doing. And then once again, I'm putting the adhesive in. Now, I wish I had a denture on me. But basically, so imagine an upper complete denture on the inside. How am I gonna apply the adhesive? I'm gonna apply the adhesive around the border
on the inside, I'm going to do a little bit on the back to have a back seal about a half an inch from that back seal because I don't want it to spread out and then they gag. So I'm going to be all around the inside, about a half inch, I'm doing this. But now I also want to engage the palette and this is not often done. I am going to be making a cross or a T on the inside and you're thinking, God, that's a lot of adhesive.
And yes it is, but if it's gonna last eight to 10 hours, awesome. You don't only just want to engage where the teeth used to be, you want to engage the palate. That is so important. And because these are denture wearers, their gag reflex is probably, it's been dramatically reduced. So what you can do then is, and I will tell them what I'm doing, I put a thumb up there. I'm gonna put a thumb up there, ha ha ha.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Emilia Bourland
Mm-hmm.
Dr. Joy Poskozim
to make sure that adhesive engages. I've got a very high, narrow pallet. And so for me, I'm going up there pretty far. I wanna make sure once again that adhesive engages. Way less chance of that thing rocking and rolling, no matter how old that denture is. Yes, once again, you're going through a lot of it, but your chances are if you're getting those rub sores,
are back to what you the original question the back the chance of that happening is slim to none at that point and no matter how much weight is lost up to a certain point they you know if someone's hospitalized for example or they're on a denture diet then they are you know they're more able to to have that denture last longer and not just last longer time wise but in the day as well.
how long then that denture will at least stay in the mouth? Can we get two meals? Can we get three meals out of this? Fantastic. Then you're actually not, you're probably at the end of the day, instead of having to reapply, you've used the same amount. So I can't stress that enough. Those are for complete dentures. For partial dentures, really depends on the design of the denture, which could be a whole nother conversation. But it really is where you want to apply it. Another thing too that you want to be looking at is
Emilia Bourland
Mm.
Dr. Joy Poskozim
when it comes to partial dentures, if they're jiggling, so they have some teeth and this thing is hooked around teeth, take a look at the hooks every once in a while to make sure that they're there. They're called clasps, C-L-A-S-P-S, clasps, and they're around, right? So they kind of circle around the teeth. They can break. They can break off, especially if they're acrylic, especially if they're plastic. So if you notice that a partial denture is starting to jiggle a little bit, did we lose a tooth?
Emilia Bourland
Mm-hmm.
Dr. Joy Poskozim
Did we, you know, has one of the clasps broken off? You know, did we lose a tooth on the denture? Did we lose a tooth in the mouth? You know, has a tooth broken off? And so therefore that retention is no longer there. Take a look at, you know, the denture every once in a while when you're cleaning it and make sure, you know, if you see something that, you know, that should look like a hook and it's broken off and it's got this maybe sharp edge, you know, they're complaining they don't want to put it in. Well, maybe that's the reason why it hurts them because
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Dr. Joy Poskozim
the metal clasp that they've had this denture for 35 years eventually gave way. Easy fix, easy fix. We don't need to reinvent the wheel. I take an impression, I bring it to the lab and the lab will apply a new clasp for me. Or if one of the teeth break off, it happens. The adhesive gives away, that's okay. The actual acrylic adhesive gives away. That's fine, they'll put a new tooth in, not a big deal.
Emilia Bourland
Mm-hmm.
Dr. Joy Poskozim
they will be without their denture for three days, five days a week, depending on what labs the dentist can use. But at the same time, these are easy, relatively inexpensive fixes. And so, no one should feel that, my God, I don't have X amount of dollars to get my mom a whole new denture. Chances are, it's a simple thing like that, you don't, and it's a 10th of the price to get that fixed for them. And then one last thing about stores.
There is an awesome product. They don't know me from Adam, so it's not like I'm getting anything for this, but there's a great product that is now sold on Amazon. Say what you want about Amazon. There's a great product. It's called Coracane. I will spell it out. C-O-R-A-C-A-I-N-E, Coracane. It comes in a white tube and it's got cane in it, right? So it's like benzocane. if you've, you know, like...
children, you know, they're teething and you put the benzocaine on, it's slightly stronger than that. That's why it's different. It's got some aloe in it, it's got some anti-inflammatories, but it does have that little bit of numbing agent. So it is wonderful. Now that I've taught the family how to properly apply the denture adhesive, there's nothing wrong with the denture, right? They've lost some weight, but there's nothing wrong with the denture. The denture adhesive is working, but they still have that sore in their mouth. I'll tell them to put that stuff in the denture.
along with the adhesive and then put it in and to hold it in place. If it's being held, if it's not moving around, that sore shouldn't hurt that much. If it's a big enough sore, if it's an actual blister, then you're gonna have to wait for that to heal because that's not gonna heal on its own. It's gonna need that air to really heal warm saltwater rinses if possible. But you can actually apply the coracane on that sore on itself and just rub it in like skin lotion. That stuff works amazingly well.
Brandy Archie, OTD, OTR/L, CLIPP
So question, I have a question, one last question. And it is, like I know as a person, I'm supposed to go see the dentist twice a year. That's like my preventative maintenance thing. Is there a different set of recommendations for somebody who's a denture wearer? Because what I hear you saying is, you know, if we catch things early, we can keep problems from happening, whether that's something going on in the mouth or there's a small break or change to the denture. It could be fixed before, unless you keep using it and then you break it all the way and now you need a new one.
Dr. Joy Poskozim
Go for it!
Brandy Archie, OTD, OTR/L, CLIPP
So to me it sounds like when you, I would probably want, remember the person who doesn't like spit, I would want somebody else to look on a regular basis. I don't wanna see the denture, just wanna give it to you, you put it in. So is there like a different like frequency in which you would want somebody who has denture to get checked out or how do you feel about that?
Emilia Bourland
That's a really good question. Yeah.
Dr. Joy Poskozim
Excellent question. Yeah, that's an excellent question. So for someone with a partial denture, as long as they have teeth, they're being seen at least twice a year period. Yeah, so for someone that is a dentureless, I have no problems seeing them yearly. Because I want to make sure there's nothing wrong with the mouth. I want to make sure there's nothing wrong with the denture. I want to make sure the denture adhesive, if being used, is being applied correctly. I want to see them, especially if they have been hospitalized recently and they've dropped a few pounds.
I wanna make sure that we may need, prior to that, they might just, a quick boom, boom, boom, adhesive done, great, now it's not working anymore, they've lost weight. So that's when I show them my trick, if you will, on undoing an upper complete. So yes, so I will see them yearly unless of course, the staff or the family member is saying, hey, things aren't working so great right now, can you come see it? But generally speaking, it's once a year, it's once a year.
Brandy Archie, OTD, OTR/L, CLIPP
Yeah. Okay.
Emilia Bourland
So interesting. just love everything about learning about the mouth and dentition and how all these things work. Because as nerdy as that seems, it's such an important part of our lives. And not just because of nutrition. Like obviously, ding, ding, ding, we consume food through our mouths. And so we need that to be.
as easy and as a positive experience as possible, but also because it does have that huge impact on us socially and our ability at like and socialization leads to all kinds of other benefits. Fun fact, research demonstrates that people with regular social engagement are less likely to have ability. They're less likely to fall. They're less likely to have cognitive decline.
not to go too far down that pathway, but like it just goes to show that something that we think of as this isolated silo of the body, like this thing that we only think about in this one context, has such huge ramifications for the rest of our health and wellbeing. So it's like infinitely fascinating to me.
Dr. Joy Poskozim
Thank you. Well, yeah, and there has been amazing research that shows the more teeth we have, less the lower obviously lifestyle, you know, situations aside, the more teeth we have, the less chance of, you know, Alzheimer's specifically, we can prolong Alzheimer's more. And this includes denture wearers. So if they're wearing the dentures, then they're still able to eat okay, the circulation is still happening. We're cleaning the mouth out.
and then we can stave off that problems with brain health. It's amazing. One last thing I wanted to bring up though, if we have the time is there are those that are in mid to late stage, usually it's Alzheimer's, but it can be one of the other dementias as well, where our loved one has stopped wearing their denture. They just don't want it in their mouth anymore. That is a really tough conversation to have with the family.
because you know, know, Dr. Joy, is there anything you can do so that we can have mom wear her denture? And you know what, sometimes less is more. If she has decided that she doesn't want to wear her denture anymore and she's able to eat okay on a pureed diet because she doesn't care anymore, then you know what? Then I don't care either.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Dr. Joy Poskozim
And yes, it's gonna be tough to look at mom without her teeth in because for all of her life, all of your life, you have seen her in a certain way, but this is a new stage of her life. And we're just gonna have to accept the fact that mom no longer wants to wear her dentures. I've seen them more often than not. And we have to adjust the meal plan and so on and so forth to make sure that she's getting her nutrients. But at the same time, if she's happy, guess what? So am I.
Emilia Bourland
Mm.
Emilia Bourland
Mm-hmm.
Dr. Joy Poskozim
And that's what's really important to me is what is the quality of life for the patient. And once again, if the patient is perfectly comfortable and doesn't care at all that the denture is in the mouth, then that's the path we're going to be going down. And that's okay. That is absolutely okay.
Emilia Bourland
And that's what person-centered care is all about, right?
Dr. Joy Poskozim
Absolutely. Yeah. So there you go. I just wanted to make sure we got that in who.
Brandy Archie, OTD, OTR/L, CLIPP
Thanks. Yep.
Brandy Archie, OTD, OTR/L, CLIPP
Mm-hmm.
Emilia Bourland
Well, Dr. Joy, you are, I mean, I cannot believe how much knowledge is in your brain. It's absolutely incredible. We're so thrilled that you came back again to share more with us on Care Lab. And I hope that you come back again, because I think there are an infinite number of topics that we can cover related to oral health and how it relates to the rest of the body and quality of life. So I hope that you come back and see us again. Listener, if you made it to the end of this podcast,
Please make sure that you follow, like, subscribe. Please share this, download an episode, share it with someone else who you think could benefit from the information. And that helps us to reach more people and we really appreciate that. Until next time, we will see you right here on CareLab. Bye.
Brandy Archie, OTD, OTR/L, CLIPP
Bye everybody.
Dr. Joy Poskozim
Bye.
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