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The maintenance of good oral hygiene is crucial in all patients, particularly patients with advanced disease. Poor oral hygiene can have physical, psychological, and social repercussions. Poor oral health may lead to other problems such as halitosis and dental caries. For patients in their terminal stage, poor oral hygiene may increase the risk of aspiration pneumonia. This chapter focuses on oral hygiene of terminally ill patients by providing an overview of oral hygiene assessment, maintenance of oral hygiene, and the importance of providing ample attention to the training of health care providers and carers on oral care and health. The core of this chapter is on the oral care practices and procedures which are necessary for caring and maintaining good quality life of patients with progressive disease. In this chapter, the frequency and the procedures of dental care such as toothbrushing, interdental cleansing, and chemical plaque control are discussed. Included as well are the proper procedures for taking care of the dentures used by these patients as well as the proper care of the oral mucosa of terminally ill patients.

In this chapter we will look briefly at the prevention needs of people with disabilities and people who are vulnerable and require special care dental services for reasons that may be social. Within this group there will be a spectrum of people with needs and dependencies. Not everyone described as belonging to a vulnerable group in this chapter would identify themselves as disabled; nevertheless, what they have in common are a range of factors that put their oral health at risk, make accessing dental care complicated, or make the provision of dental care complicated. These factors may include a ‘physical, sensory, intellectual, mental, medical, emotional or social impairment or disability, or more often a combination of these factors’ (GDC 2012). People with disabilities have fewer teeth, more untreated disease, and more periodontal disease when compared to the general population in the UK (Department of Health 2007). Good oral health can contribute to better communication, nutrition, self-esteem, and reduction in pain and discomfort, while poor oral health can lead to pain, discomfort, communication difficulties, nutritional problems, and social exclusion (Department of Health 2007). As discussed in previous chapters, the important risk factors for oral diseases include: high-sugar diets, poor oral hygiene, smoking, and alcohol misuse. They are also shared risk factors for chronic non-communicable diseases such as respiratory diseases, cardiovascular diseases, diabetes, and cancers. The basic principles and approaches for the prevention of oral diseases in disabled people and vulnerable groups are similar to those described in previous chapters; however, there is a need to recognize that the context, the circumstances, the settings, and the opportunities for prevention will be slightly different, depending on the groups. For example, some disabled people (e.g. people with learning disabilities) may be reliant on others, such as family, carers, health care workers, to support basic self-care and to access health services. Other vulnerable groups such as homeless people live independent lives but lack access to basic facilities such as drinking water, and a place to store toothbrushes and toothpaste.

This chapter adds to historical studies of artificial body parts by exploring the reciprocal relationship between fictional texts and the prosthesis industry in nineteenth-century Britain and America. Focussing primarily on prostheses—including artificial legs, dentures, and glass eyes—in relation to female users, it demonstrates that fictional writing was a key component of nineteenth-century prosthesis discourse. The chapter argues that literary stories provided practical advice for readers on the kinds of prostheses that should be avoided for both social and functional purposes. Women in particular were targeted as consumers who should pay special attention when choosing prostheses. Popular literary sources, often packaged as marriage plots, provided kinds of advertisements not for but against certain prostheses. Meanwhile, both entire fictional works and particular representational strategies were used by contemporary prosthetists interchangeably as means through which to subtly disparage the devices of opposing makers, reinforce the proprietary ownership of particular designs, or promote the concealing abilities of particular devices to female users.

In the early republic, Americans faced the challenge of replacing colonial networks of objects with bonds of citizenship. Material goods became increasingly politicized, including Gilbert Stuart’s Lansdowne portrait of George Washington, which celebrates the first president as a civilian leader. New object types brought citizens together at a continental scale, including engravings of Washington, engraved city views, and creamware, or queensware, dining goods. Yet George Washington’s dentures point to the tensions in establishing civility that continued to haunt the new nation. Constructed from teeth taken from Washington’s slaves, the dentures suggest the barbarity that Americans sought to repress in their new political republic.

Questions

In the course of performing a parotidectomy, you are having difficulty identifying the facial nerve. Which of the following would be least useful in identifying the nerve?

Following the posterior belly of digastric

Identifying the tip of the styloid process...

It is essential that dental students and practitioners understand the structure and function of the temporomandibular joints and the muscles of mastication and other muscle groups that move them. The infratemporal fossa and pterygopalatine fossa are deep to the mandible and its related muscles; many of the nerves and blood vessels supplying the structures of the mouth run through or close to these areas, therefore, knowledge of the anatomy of these regions and their contents is essential for understanding the dental region. The temporomandibular joints (TMJ) are the only freely movable articulations in the skull together with the joints between the ossicles of the middle ear; they are all synovial joints. The muscles of mastication move the TMJ and the suprahyoid and infrahyoid muscles also play a significant role in jaw movements. The articular surfaces of the squamous temporal bone and of the condylar head (condyle) of the mandible form each temporomandibular joint. These surfaces have been briefly described in Chapter 22 on the skull and Figure 24.1A indicates their shape. The concave mandibular fossa is the posterior articulating surface of each squamous temporal bone and houses the mandibular condyle at rest. The condyle is translated forwards on to the convex articular eminence anterior to the mandibular fossa during jaw movements. The articular surfaces of temporomandibular joints are atypical; they covered by fibrocartilage (mostly collagen with some chondrocytes) instead of hyaline cartilage found in most other synovial joints. Figures 24.1B and 24.1C show the capsule and ligaments associated with the TMJ. The tough, fibrous capsule is attached above to the anterior lip of the squamotympanic fissure and to the squamous bone around the margin of the upper articular surface and below to the neck of the mandible a short distance below the limit of the lower articular surface. The capsule is slack between the articular disc and the squamous bone, but much tighter between the disc and the neck of the mandible. Part of the lateral pterygoid muscle is inserted into the anterior surface of the capsule. As in other synovial joints, the non-load-bearing internal surfaces of the joint are covered with synovial membrane.