ObjectiveThe aim of this study was to describe relationships between oral status, dysphagia and malnutrition in a hospitalised older people. BackgroundUndernutrition in older people is a major concern in geriatric hospital wards. Different factors can modify nutritional status like dysphagia or oral status. Materials and methodsAbout 159 consecutive inpatients (108 women, 51 men) were examined. Comprehensive gerontological data at baseline and nutritional status according to BMI, MNA and serum albumin concentration, dependency according to ADL scores, dietary intake, swallowing capacities and oral status were collected. Swallowing capacities and dietary intake were reassessed 1week after. ResultsMean age was 85.28 (SD 5.68). Seventy-seven patients were malnourished (MNA) and 34 had dysphagia. Oral treatment was necessary in 142 patients (89.30% of all population). Candidiasis was present in 17 patients and salivary flow reduction in 50. Patients with dysphagia had the lowest dietary intake. After 1week, patients with dysphagia were retested and dysphagia had abated in three of them. Dysphagia and undernutrition were associated (p<0.001), and both were related to candidiasis (p<0.001 and p<0.01). Dysphagia was also related to salivary hypofunction (p<0.001), loss of posterior occluding pairs (POPs; p=0.014), oral self-care dependency (p<0.001) and self-feeding dependency (p<0.001). Salivary hypofunction was related to candidiasis (p<0.001) and loss of POPs (p<0.05), and candidiasis to loss of POPs (p<0.01). ConclusionAlthough no causality can be demonstrated, poor oral health was strongly associated with malnutrition, emphasising the importance to develop oral care strategies and to incorporate a dental examination into comprehensive gerontological assessment.
ObjectivesTo analyse implant survival, prosthetic aftercare and quality of life (QoL) after stabilisation of complete dentures with mini-implants. BackgroundMany edentulous patients refuse implant therapy due to the expenses and fear of surgery. Studies on minimally invasive and low-cost mini-implants remain rare. Materials and methodsA total of 133 participating patients from nine private practices were evaluated via patient records, questionnaires and clinical examinations. Complications, maintenance, QoL questions and the German short version of the oral health impact profile (OHIP-G14) were analysed. ResultsAfter 7 to 61months, 15 of 336 maxillary implants and 11 of 402 mandibular implants had to be removed. In addition, four mandibular implants experienced fracture. The difference between the 4-year survival rates of 94.3% for the maxilla and 95.7% for the mandible was not statistically significant (p=0.581). All original 144 overdentures remained functional. The prosthetic interventions were typically limited to repairs of acrylic base fractures (about one in five patients), changes of plastic O-rings and relining procedures. The participants showed OHIP-G14 scores (median=2) that were comparable with those of patients with overdentures retained by conventional implants. ConclusionsMini-implant survival was similar to that of regular-diameter implants. Although some prosthetic aftercare was necessary, none of the overdentures had to be replaced. Prospective studies comparing conventional and mini-implants are warranted.
Background: There is growing international interest in identifying the effects of ageing on oral health and on appropriate strategies for managing oral disorders. The Japanese Society of Gerodontology (JSG), as the official representative of researchers and clinicians interested in geriatric dentistry in Japan, makes several recommendations on the concept of "oral hypofunction." Aims: This study proposes diagnostic criteria and management strategies to reduce the risk of oral hypofunction among older people. Conceptual Framework: We define oral hypofunction as a presentation of 7 oral signs or symptoms: oral uncleanness; oral dryness; decline in occlusal force; decline in motor function of tongue and lips; decline in tongue pressure; decline in chewing function; and decline in swallowing function. The criteria of each symptom were determined based on the data of previous studies, and oral hypofunction was diagnosed if the criteria for 3 or more signs or symptoms were met. Conclusions: We recommend that more evidence should be gathered from clinical studies and trials to clarify our diagnostic criteria and management strategies.
Objectives To identify significant risk factors associated with incidence of mortality and pneumonia in whole-community-based older inpatients resident in Japanese rural region. Methods Patients older than 65 years admitted between 1 April and 15 April 2010 to a core hospital located in a rural region were exhaustively recruited, and incidence of mortality and pneumonia during the 32-month follow-up period were evaluated. Independent variables at baseline measurement included age, gender, body mass index, Charlson comorbidity index, functional dependency, oral self-care ability index, number of remaining teeth, hyposalivation and nutritional status. Dependent variables were incidence of mortality and pneumonia. Survival and non-pneumonia curves were drawn using Kaplan-Meier analysis. Cox proportional hazards analysis was performed to identify the risk factors related to incidence of mortality and pneumonia. Results The survival rate of 46 patients (male/female: 11/35; mean age: 83.8 +/- 6.8 years) was 52.1%, and the incidence of pneumonia was 60.9%. Malnutrition and gender (male) were identified as significant risk factors for mortality (odds ratio [OR]: 8.18 and 4.90; 95% confidence interval [CI]: 1.77-37.3 and 1.50-16.0; P < 0.01 and <0.01, respectively). Loss of oral self-care ability and gender (male) were identified as significant risk factors for incidence of pneumonia (OR: 8.97 and 4.58; 95% CI: 1.70-47.4 and 1.50-14.0; P = 0.01 and <0.01, respectively). Conclusions Malnutrition and loss of oral self-care ability were significant risk factors for incidence of mortality and pneumonia, respectively. In response, supplying nutrition with appropriate diet and personalised oral care might contribute to reduction in mortality and prevention of pneumonia.
Objective To consider the role of family and friends in supporting oral care. Background People who live in care homes are susceptible to oral health problems, which can be detrimental to their health and personal and social well-being. External support from family members and friends has been indicated as being important for maintaining oral health for this vulnerable group of care home residents. Materials and methods Qualitative one-to-one interviews were undertaken with care home residents, in Cardiff, UK. Further interviews were undertaken with care home personnel with responsibility for oral health care in order to contextualise residents' interview data. Interviews were audio recorded, transcribed and analysed using a thematic approach. Results A total of 26 interviews were conducted with care home residents and four interviews with care home personnel, across five care homes. Three main themes emanated from the data relating to co-supporting oral care: supplying oral care products; accessing dental care and enabling self-management of oral care problems. There were no spouse caregivers; family and friends acted as co-supporters of oral care providing a link to residents' pre-care home lives by informing the care home personnel of their relatives' normal routines. An overarching theme "balancing roles - maintaining the equilibrium" emerged from the data reflecting the roles that both care home personnel and family and friends had in balancing the needs, care and well-being of the resident. Conclusion This study suggests that there are opportunities to improve oral health by providing support for family and friends of those people who are living in care, especially in relation to supplying oral care products, enabling self-management of oral care problems and accessing dental care.
Objective To assess the impact of non-endodontic factors like periodontitis and chronic disease medication (CDM) mostly affecting elderly people's health on the outcome of non-surgical root canal treatment (NSRCT). Background An increasing number of elderly people with high prevalence of marginal periodontitis and CDM benefit from adequate endodontic therapy, if irreversible pulpitis or apical periodontitis occurs. Only few data exist about the relevance of those non-endodontic factors on healing of endodontic lesions in a population 60 years or more. Material and methods Of 177 patients aged 60 years or more with 212 NSRCTs performed between the year of 2010 and 2013, complete documentation was available for 112 teeth in 93 participants. Mean time between baseline and last follow-up was 38.93 months. The primary endodontic factors studied were the periapical index (PAI) of periapical health, quality of the root canal filling and of coronal restoration, periodontal probing depth (PPD, mm) and tooth mobility (TM, 0-3). Secondary non-endodontic factors included the presence of marginal periodontitis and CDM, in particular antidiabetics, antihypertensives and anticoagulants. Statistical analyses were performed using Chi-square test statistics and logistic regression analysis. Results Periodontitis and CDM had no effect on endodontic outcome. Chronic intake of anticoagulants showed a significant association with endodontic outcome. Root-filled teeth with preoperative periapical lesions had a significantly higher rate of endodontic failure than those without preoperative lesion. The overall success rate of NSRCT was 87.1% with 81 healed teeth. Conclusion Periodontitis and CDM have no impact on the endodontic outcome of NSRCT in a population 60 years or more.
Background Descriptions of the older population's dentition status are usually limited to indicators such as the edentulous proportion, the mean number of restored and missing teeth, and the proportion with a functional dentition, with very few reports describing in detail the nature of the residual dentition. Objectives This study described the residual dentition among older New Zealanders living in residential aged care facilities. Material and Methods Using national data from the Older People's Oral Health Survey, we determined the residual dentition arrangement and Kennedy classification for each dental arch. Individuals were categorised according to their maxillary-mandibular dental configuration. Data were weighted to make the estimates generalisable to the source population. Results Among the dentate 45% of the 987 clinically examined participants, the most prevalent configuration was maxillary tooth-bounded saddles against a partially dentate lower (24.7%; 95% CI: 20.4, 29.7). More younger participants generally had less tooth loss experience and had higher prevalence of Kennedy Classes II, III and IV. There were few sex differences, although more females had a fully dentate arch. Marked ethnic differences were observed: Maori were up to eight times as likely to have only mandibular anterior teeth remaining. Upper dentures were worn more than their lower counterpart. Age, sex and ethnic characteristics were associated with particular residual teeth configurations. Conclusions Having various degrees of tooth loss was the norm, with the upper tooth-bounded saddles against any partially dentate lower combination most common, and limited to females. An edentulous maxilla opposed by some standing teeth was observed in over one-quarter of the population, and most common among Maori and those who were older. Maxillary prostheses were much more common than mandibular ones. Caring for dentate older people in aged residential care is likely to be complicated by the wide range of dentition configurations.
Background Poor nutritional status is a risk factor for the development of frailty. Likewise, oral health is independently associated with nutrition. The potential association between oral health and frailty in hospitalised elderly adults has, however, not previously been investigated. Objective To investigate the relationship between oral health and frailty in hospitalised elderly adults and to identify the predictors of frailty. Method A cross-sectional study of 168 geriatric inpatients >65 years old was performed from August to December 2016. Patients of non-English speaking background, with impaired cognition (MMSE <24), severe hearing or visual impairment or active delirium were excluded. Oral health, nutrition and frailty were assessed using previously validated tools, namely the Geriatric Oral Health Assessment Index (GOHAI), Mini Nutrition Assessment (MNA) and Reported Edmonton Frailty Scale (REFS). Other data collected included demographics, co-morbidities, level of education and smoking/alcohol history. Results On univariate analysis, the REFS score decreased with better nutritional status/higher MNA (P < 0.001) and better self-reported oral health/higher GOHAI (P = 0.023). Nutritional status accounted for 17% of variability in frailty assessment. On multivariate analysis, co-morbidities (P < 0.001), MNA (P < 0.001) and living in residential care (P < 0.001) were independent predictors of frailty. After adjusting for nutrition and co-morbidities, self-reported oral health was found to have an independent negative association with frailty (P = 0.019). Conclusion Poor self-reported oral health was found to be independently associated with frailty. Further research should be directed at whether interventions to maintain good oral health can prevent or slow the progression of frailty.
Objectives We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta-analysis, and assessed the robustness of evidence by trial sequential analysis (TSA). Background Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients. Methods Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross-referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed- or random-effects pairwise meta-analysis for per-protocol (PP), intention-to-treat (ITT) and best-case scenarios. TSA was used to control for risk of random errors. Results A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP- but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best-case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA. Conclusions For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART.
Objectives To describe the validation of a new 27-item ageism scale for dental students in Greece. Background A new ageism scale for dental students has been developed by American and European Gerodontology educators and was preliminary validated in the United States. Methods The scale was translated into Greek and administered to 8th- and 10th-semester dental students in Athens. Principal components analysis was used to explore the internal structure of the measure; internal consistency reliability was assessed using Cronbach's alpha coefficient; corrected item-total correlations were calculated to decide which low contributing items should be removed from the scale; and discriminant validity was tested investigating variation in relation to demographic and educational factors. Results A total of 152 students responded to the questionnaire. The Principal component analysis offered a 15-item scale distributed into four factors that accounted for 56.4%, of the total variance, produced stronger factor loadings, a comparable amount of overall component variance and logical sets of components. The four factors produced were values/ethics about older people (four items, alpha = 0.71), patient compliance (four items, alpha = 0.72), barriers to dental care (four items, alpha = 0.57) and dentist-older patient interaction (three items, alpha = 0.64). Discriminant validity revealed statistically significant differences in factors and items related to semester of studies, gender and family's permanent residence. Conclusion The preliminary validation of the Greek version of the ageing scale for dental students revealed a 15-item questionnaire that demonstrated acceptable validity and reliability and could be further tested in larger samples.
Objective The purpose of this project was to develop evidence-based clinical practice guidelines (CPGs) for the management of oral health (OH) for patients with Parkinson's disease (PD). Background Individuals with PD have significantly poorer OH than the general population. Poor OH is a risk factor for systemic diseases, including cardiovascular disease, diabetes, and respiratory infections. Materials and Methods After an extensive literature review was completed, available evidence was evaluated for inclusion in the initial draft of the guidelines. The draft was then reviewed for content validity by experts in the areas of dentistry, dental hygiene and neurology using the Delphi method. After consensus among the content experts, final guidelines were completed. The final CPG was presented to individuals with PD and their caregivers at a support group. Participants were asked to review the information in the guidelines for 2 weeks and then submit a survey regarding the usefulness of the CPG. The CPG was also evaluated by practicing nurse practitioners (NPs) and dental hygienists using the AGREE II tool. Results Twenty people from the PD support group participated in the educational intervention, and surveys were received from 14 participants. Overall, participants agreed or strongly agreed with each statement related to the applicability and usefulness of the guidelines. The CPG was evaluated using the AGREE II tool, and scores were >80% in all domains with an overall score of 97.1%. Conclusion Development of these guidelines represent an initial step in improving the oral health and overall health of individuals with PD.
Objectives To explore the relationship between functional dentition and nutritional status among Thai older adults, and the role of nutrient intake in this association. Background Evidence on the interplay between tooth retention, diet and nutritional status is still inconclusive, with most evidence coming from Western countries. Methods Seven hundred and eighty-eight Thai adults, aged 60+ years, living in Phetchaburi Province, Thailand, participated in this cross-sectional study. Data were collected through questionnaires, body measurements and dental examinations. Being underweight (Body Mass Index 25) were the two outcome measures. Functional dentition was defined as having 10+ functional tooth units. The association of functional dentition with each outcome was assessed in regression models adjusted for sociodemographic factors, behaviours, chronic conditions and total energy intake. The role of various nutrients in explaining the above associations was quantified via the per cent attenuation in the coefficient for functional dentition. Results Functional dentition was associated with being underweight but not with being overweight/obese. After adjustments, participants with functional dentition were 61% (prevalence ratio: 0.39, 95% CI: 0.16, 0.95) less likely to be underweight than those with neither functional dentition nor dentures. In addition, participants with functional dentition had significantly greater intake of dietary fibre and thiamine (Vitamin B-1) than those with neither functional dentition nor dentures. The two nutrients explained a small part of the association between functional dentition and being underweight. Conclusion Having a functional dentition was negatively associated with being underweight. The consumption of dietary fibre and thiamine explained a small part of this association.
Objective To examine the effectiveness of tailored xerostomia and nutritional 6-month interventions on xerostomia among home care clients aged 75 years or over who were malnourished or at risk of malnutrition. Background A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and oral health. Medical conditions, polypharmacy, dehydration and malnutrition are often underlying causes of xerostomia. Materials and Methods The data are based on the NutOrMed study with a dietary intervention group of 119 patients and control group of 97 patients. In-home interviews were carried out by home care nurses, nutritionists, dental hygienists and pharmacists and tailored interventions by nutritionist and dental hygienists. Xerostomia intervention included individual counselling on dry mouth care and was applied to all those suffering occasionally or continuously from xerostomia (57%, n = 66) in the intervention group. Nutritional intervention was applied to all participants in the intervention group, and it included instructions on increasing the number of meals, energy, protein intake and liquid intake. Results Among participants who received both interventions, xerostomia decreased by 30% and malnutrition or risk of malnutrition decreased by 61%. The interventions were highly significant (OR 0.1, 95% CI: 0.06; 0.2) in reducing xerostomia. Conclusions Home care clients suffering from xerostomia profited significantly from tailored xerostomia and dietary interventions. Evaluation and treatment of xerostomia are important among older persons who are malnourished or at risk of malnutrition as a part of a comprehensive health intervention to improve their nutrition and oral health.
Objective: Parkinson's disease (PD) is a common condition in elderly people and can adversely affect oral health (OH). However, the subjective burden of oral symptoms on the quality of life (QoL) of patients with PD is largely unknown and needs to be better understood. The objective of this study was to explore self-assessed dental care in patients with PD, including the ability to perform oral hygiene, self-assessed xerostomia, drooling and dysphagia problems, and the impact on OH-related QoL. Materials and methods: A questionnaire was completed by 100 patients with PD in Germany recruited from PD support groups, and included self-assessment of dental care, the Oral Health Impact Profile (OHIP-14) score, the levodopa equivalent daily dose, the Movement Disorder Society Unified Parkinson's Disease Rating Scale-II and the leading OH-related symptoms. Results: Participants experienced xerostomia (49%), drooling (70%) and dysphagia (47%) and suffered from a limited ability to perform oral hygiene (29%). The oral symptoms xerostomia, drooling and dysphagia impaired the OH-related QoL [OHIP total score 14.6 (9.7)-16.8 (11.4) compared to 11.3 (9.9) in participants without symptoms]. In total, 91.8% of participants had their own dentist. Only 6.1% of participants with xerostomia received advice regarding management. Conclusion: In this study, patients with PD suffered from OH-related symptoms (xerostomia, drooling, and dysphagia) that impaired their OH-related QoL. Participants felt that they received adequate dental health care; however, dental advice regarding management of PD-related OH problems was often lacking.
ObjectivesTo investigate clinical oral disease and its association with cognitive function and dependency among older New Zealanders in residential aged care. Material and methodsNational survey of oral health in aged residential care throughout New Zealand. We classified residents into 1 of 3 levels of care: low dependency care (or assisted living); high dependency care; or specialist dementia care/psychogeriatric care. The Abbreviated Mental Test characterised cognitive function as unimpaired (scores of 7-10), moderately impaired (4-6) or severely impaired (0-3). Intra-oral examinations were conducted, along with a computer-assisted personal interview. ResultsMost of the 987 clinically examined participants were either at low or high dependency care level, with another 1 in 6 in psychogeriatric care. Almost half overall had severely impaired cognitive function. Just under half of the sample had 1 or more natural teeth remaining. Negative binomial regression modelling showed that the number of carious teeth was lower among women and higher among those who were older, those with more teeth and in those with severely impaired cognitive function. Oral debris scores (representing plaque biofilm and other soft deposits on teeth) were higher in men, those with more teeth, and in those with severely impaired cognitive function. ConclusionsImpaired cognitive function is a risk indicator for both dental caries and oral debris in aged residential care.