1
|
Ramos TMC, da Silva Alves ÁA, Apolinário TA, de Toledo FF, Gomes VE, Barbosa KGN, Sampaio AA, Ferreira RC. Challenges to conducting research on oral health with older adults living in long-term care facilities. BMC Oral Health 2024; 24:422. [PMID: 38580950 PMCID: PMC10998329 DOI: 10.1186/s12903-024-04204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The challenges to conducting oral health studies involving older people in long-term care facilities (LTCFs) must be debated. OBJECTIVE This study aimed to investigate researchers' perceptions and experiences while conducting an epidemiological survey on oral health among older individuals residing in LTCFs. METHODS A qualitative study was conducted involving six researchers who utilized field diaries to record their impressions during data collection through interviews (older individuals (or their proxies), caregivers, and LTCF coordinators) and oral examinations of the older people participants. Additionally, researchers responded to open-ended questions about their experiences. The collected material was subjected to content analysis by two researchers. RESULTS The themes that emerged from the analysis were institutional context, aspects affecting the operationalization of the study, and data collection oriented by the clinical-functional profile of the older people. According to the researchers' perceptions, LTCF coordinators demonstrated concern for the study's benefits for older adults and the preservation of institutional routines during the research process. Caregivers emerged as vital sources of information, guiding researchers in navigating the challenges posed by the physical and mental complexities of the older people participants, necessitating empathy, sensitivity, and attentive listening from the researchers. The organization of materials and a streamlined data collection process proved essential for optimizing time efficiency and reducing stress for participants and researchers. CONCLUSION The researchers recognized the important role played by LTCF coordinators and formal caregivers, underscoring the significance of empathetic methodologies and streamlined data collection processes in mitigating the challenges inherent to research conducted within LTCFs.
Collapse
Affiliation(s)
- Thayse Mayra Chaves Ramos
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Álvaro Augusto da Silva Alves
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thais Andrade Apolinário
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flávia Fonseca de Toledo
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Viviane Elisângela Gomes
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kevan Guilherme Nóbrega Barbosa
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Araújo Sampaio
- Department of Clinical, Pathology and Surgical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Raquel Conceição Ferreira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| |
Collapse
|
2
|
Cook N, Kelly A, Kanagasingam S, Tagiyeva N. Let us talk about it: An exploratory qualitative study of older adults' priorities for oral health in North West England. Gerodontology 2024; 41:28-39. [PMID: 36790065 DOI: 10.1111/ger.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/01/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The aim of this study was to explore oral health experiences and priorities in a diverse group of adults aged over 60 in North West England, an area with high oral health inequality. METHODS Participants were selected using purposive sample from multiple settings across the North West: community, primary dental care and residential care home. Data were collected between October 2018 and March 2019 and involved eight focus groups and three individual interviews with a total of 47 participants. The data were analysed using thematic analysis. RESULTS Four key themes were identified. The first was issues important to people over 60, which included the appearance of one's teeth, communication, continuity of care and the treatment experience. These were informed by two further themes, past experiences of treatment, which were not always favourable, and perceived barriers, such as accessing NHS dentistry, cost, physical access and oral care in institutional settings. The fourth, connected theme focussed on how oral healthcare messages for different audiences should be disseminated. CONCLUSIONS There are shortfalls in the provision of oral healthcare to older adults in the UK. Communication and continuity of care with a trusted oral healthcare provider are key priorities for this population. However, our participants felt that current public provision of dental services is not meeting their needs.
Collapse
Affiliation(s)
- Neil Cook
- School of Dentistry, University of Central Lancashire, Preston, UK
| | - Aengus Kelly
- School of Dentistry, University of Central Lancashire, Preston, UK
- Peninsula School of Dentistry, University of Plymouth, Plymouth, UK
| | | | - Nara Tagiyeva
- School of Dentistry, University of Central Lancashire, Preston, UK
- Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
3
|
Xue C, Al-Jassasi N, Thomson WM, Adam L, Smith MB. Oral self-care among dependent older New Zealanders. Gerodontology 2024; 41:9-16. [PMID: 36779586 DOI: 10.1111/ger.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES The objective of the study was to describe the occurrence and associations of oral self-care by dependent older New Zealanders. BACKGROUND Dependent older adults who require some level of assisted daily care have been shown to have poorer oral health than their independent counterparts, yet national estimates are lacking. MATERIALS AND METHODS A secondary analysis was conducted of data from New Zealand's 2012 Older People's Oral Health Survey, a national survey that interviewed and examined a representative sample of 2,218 dependent older adults living in aged residential care or receiving home-based care. Survey data were weighted for statistical analyses, and modelling was carried out using a modified Poisson approach. RESULTS Overall, 59.5% (95% CI: 55.1, 63.7) of participants brushed their teeth twice a day, with this rate higher among women, Asians and those without cognitive or physical impairment. Cleaning interdentally at least once a week was less common than brushing, at 25.9% (95% CI: 21.5, 30.9), and that proportion was significantly lower among those with higher dependency or who were cognitively or physically impaired. Almost 9 in 10 (87.8%; 95% CI 83.1, 91.4) used fluoride toothpaste, and adults of high socio-economic status had lower rates of fluoride toothpaste use. Only 15.0% (95% CI 12.4, 18.0) used mouthwash, with this being most prevalent in Pasifika. More than half of those who wore dentures also wore them at night. CONCLUSION Oral self-care was sub-optimal among dependent older New Zealanders. Improving the situation should be a high priority.
Collapse
Affiliation(s)
- Cindy Xue
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Noor Al-Jassasi
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - William M Thomson
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - Lee Adam
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - Moira B Smith
- Department of Public Health, Faculty of Medicine, Wellington School of Medicine, University of Otago, Wellington, New Zealand
| |
Collapse
|
4
|
Palmers EE, De Almeida Mello J, Janssens L, De Visschere L, Declerck D, Duyck J. Implementing an oral health policy in long-term care facilities for older adults in Flanders, Belgium: The Oral Health Care Track. Gerodontology 2024; 41:149-158. [PMID: 37254273 DOI: 10.1111/ger.12693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The oral health of care-dependent older people living in residential care facilities is generally suboptimal. To facilitate adequate daily oral care and timely referral to a dental professional, studies emphasise the need for sustainable, structured oral healthcare policies in aged care organisations. The effect of such interventions is often limited or uncertain owing to a lack of understanding of how effective the integration and implementation of the policy has been within the facilities. This study reports on the development of a method to adequately implement an oral healthcare policy in long-term care organisations for older adults. MATERIALS AND METHODS An intervention mapping protocol was used to develop a theory- and practise-based methodology. This step-by-step approach combined findings from a literature review, experiences from earlier projects and behaviour change theories in a multilevel programme. RESULTS Intervention mapping yielded a systematic programme for implementing an oral healthcare policy in aged care organisations. The Oral Health Care Track or "De Mondzorglijn" comprises seven phases, each subdivided into several tasks. The programme's implementation is guided by oral healthcare coaches. CONCLUSION By using intervention mapping, it was possible to combine behaviour change theories, information derived from needs assessment and earlier experiences into a comprehensive programme to improve the oral health and quality of life of older residents in residential care facilities. Further research is needed to evaluate the use of coaches in the implementation of the Oral Health Care Track.
Collapse
Affiliation(s)
- Ellen E Palmers
- Department of Oral Health Sciences, Research Group Population Studies in Oral Health, KU Leuven, Leuven, Belgium
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Johanna De Almeida Mello
- Department of Oral Health Sciences, Research Group Population Studies in Oral Health, KU Leuven, Leuven, Belgium
- ELOHA (Equal Lifelong Oral Health for All) research group, Gerodontology, Oral Health Sciences, Ghent University, Ghent, Belgium
| | - Lynn Janssens
- Gezonde Mond, Flemish Institute for Oral Health, Flemish Agency for Care and Health, Ghent, Belgium
| | - Luc De Visschere
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- Gezonde Mond, Flemish Institute for Oral Health, Flemish Agency for Care and Health, Ghent, Belgium
| | - Dominique Declerck
- Department of Oral Health Sciences, Research Group Population Studies in Oral Health, KU Leuven, Leuven, Belgium
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Research Group Population Studies in Oral Health, KU Leuven, Leuven, Belgium
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Fogelholm N, Leskelä J, Manzoor M, Holmer J, Paju S, Hiltunen K, Roitto HM, Saarela RK, Pitkälä K, Eriksdotter M, Buhlin K, Pussinen PJ, Mäntylä P. Subgingival microbiome at different levels of cognition. J Oral Microbiol 2023; 15:2178765. [PMID: 36844899 PMCID: PMC9946326 DOI: 10.1080/20002297.2023.2178765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Oral health and declining cognition may have a bi-directional association. We characterized the subgingival microbiota composition of subjects from normal cognition to severe cognitive decline in two cohorts. Memory and Periodontitis (MINOPAR) include 202 home-living participants (50-80 years) in Sweden. Finnish Oral Health Studies in Older Adults (FINORAL) include 174 participants (≥65 years) living in long-term care in Finland. We performed oral examination and assessed the cognitive level with Mini Mental State Examination (MMSE). We sequenced the 16S-rRNA gene (V3-V4 regions) to analyse the subgingival bacterial compositions. The microbial diversities only tended to differ between the MMSE categories, and the strongest determinants were increased probing pocket depth (PPD) and presence of caries. However, abundances of 101 taxa were associated with the MMSE score. After adjusting for age, sex, medications, PPD, and caries, only eight taxa retained the significance in the meta-analyses of the two cohorts. Especially Lachnospiraceae [XIV] at the family, genus, and species level increased with decreasing MMSE. Cognitive decline is associated with obvious changes in the composition of the oral microbiota. Impaired cognition is accompanied with poor oral health status and the appearance of major taxa of the gut microbiota in the oral cavity. Good oral health-care practices require special deliberations among older adults.
Collapse
Affiliation(s)
- Nele Fogelholm
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Jaakko Leskelä
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Muhammed Manzoor
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Jacob Holmer
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Susanna Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Kaija Hiltunen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Hanna-Maria Roitto
- Department of Neurosciences, University of Helsinki, Helsinki, Finland.,Internal medicine and rehabilitation, Division of Geriatrics, Helsinki University Hospital Helsinki, Finland.,Population health unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Kt Saarela
- Department of Social Services and Health Care, Oral Health Care, Helsinki, Finland
| | - Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Kåre Buhlin
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Pirkko J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.,School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Päivi Mäntylä
- School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
6
|
Yang J, Wang A, Shang L, Sun C, Jia X, Hou L, Xu R, Wang X. Study on the Association Between Dietary Habits, Patterns and Frailty of the Elderly: A Cross-Sectional Survey from Communities in China. Clin Interv Aging 2022; 17:1527-1538. [PMID: 36247201 PMCID: PMC9556274 DOI: 10.2147/cia.s378138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to explore the effects of Chinese dietary habits and patterns on frailty among elderly people in Xi’an the community. We also sought to provide dietary suggestions for prevention of frailty. Methods A cross-sectional survey was conducted and participants were divided into three groups: non-frail group, pre-frail group, and frail group. Our sample included 100 individuals randomly selected from each group for the dietary survey. Information regarding general socio-demographic characteristics and the types and quantity of food intake in the past 3 days was collected by a questionnaire. Factor analysis was used to identify dietary patterns; multiple logistic regression analysis was used to explore the correlation between dietary pattern and frailty. Results (1) 1693 elderly individuals were screened. The prevalence of pre-frailty and frailty was 41.0% and 16.2%, respectively. (2) Two dietary patterns were defined: ordinary dietary pattern and high-fat dietary pattern. Compared with the high-fat diet, the intake of iron, vitamin E, polyunsaturated fatty acids, and legume protein was significantly lower in the ordinary diet (P < 0.05). (3) Multivariate regression analysis showed that the ordinary dietary pattern score was positively correlated with frailty, which was consistent after adjusting for confounding factors (P < 0.05). Conclusion The low-fat and low-protein diet was positively correlated with the risk of frailty. Appropriate increase in fat and protein intake can help improve the frailty of the elderly in China.
Collapse
Affiliation(s)
- Jie Yang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Anhui Wang
- Department of Epidemiology, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Lei Shang
- Department of Health Statistics, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Chao Sun
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Xin Jia
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Liming Hou
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Rong Xu
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Xiaoming Wang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China,Correspondence: Xiaoming Wang, Department of Geriatrics, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi’an, 710032, People’s Republic of China, Tel +86-29-84775543, Email
| |
Collapse
|
7
|
Aguirre Escobar GA, de Quezada RF, Escobar de González WY, Aguirre de Rodríguez KA, de Miguel ÁG, Rivas Cartagena FJ. Oral health profile status and treatment needs in the Salvadoran elderly population: a cross-sectional study. BMC Oral Health 2022; 22:247. [PMID: 35729598 PMCID: PMC9211789 DOI: 10.1186/s12903-022-02278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Older adults are a highly vulnerable group in their general health condition, including oral health that can be influenced by different factors, among them, changes in oral tissues inherent to the physiological processes of aging and by systemic condition. In El Salvador, it is a group that has received little attention at the public health level.
Objective To determine the profile of the oral health status and treatment needs of the elderly population in El Salvador.
Materials and methods Secondary cross-sectional analysis of data from the last oral health survey in 471 Salvadorans aged 60 years and older. The variables under study were: sociodemographics, brushing frequency, oral hygiene according to simplified oral hygiene index (OHI-S), caries experience according to decayed, missing, and filled teeth index (DMFT) modified with international caries detection and assessment system (ICDAS) criteria, periodontal status through the community periodontal index of treatment needs (CPITN), edentulism and treatment needs. Statistical analysis was conducted using chi-square test, ANOVA, z-test and linear regression (p < 0.05). Results The older adults presented poor oral hygiene, low brushing frequency, high tooth loss with an average of 16 missing teeth while one third presented total edentulism. Most of the older adults were categorized as having "poor or very Poor" oral hygiene. Almost all respondents presented some degree of periodontal disease and required restorative intervention. Conclusion The oral health status of elderly Salvadoran is poor. Furthermore, the development of public policies and specific oral health strategies aimed at this population is urgent.
Collapse
Affiliation(s)
- Guillermo Alfonso Aguirre Escobar
- Epidemiology and Public Health Program, University Rey Juan Carlos, 28933, Madrid, Spain. .,Research Center, Faculty of Dentistry, University of El Salvador, 01101, San Salvador, El Salvador.
| | | | | | | | - Ángel Gil de Miguel
- Department of Preventive Medicine and Public Health, University Rey Juan Carlos, 28933, Madrid, Spain
| | | |
Collapse
|
8
|
Julkunen L, Hiltunen K, Kautiainen H, Saarela RKT, Pitkälä KH, Mäntylä P. Oral disease burden of dentate older adults living in long-term care facilities: FINORAL study. BMC Oral Health 2021; 21:624. [PMID: 34876101 PMCID: PMC8650260 DOI: 10.1186/s12903-021-01984-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing number of older adults have natural teeth and are at high risk of oral diseases, which are induced by oral bacterial accumulation and proceed unnoticed and quietly. Our aim was (1) to examine the association of oral disease burden (ODB) with health and functioning among dentate long-term care residents, and (2) to find easily detectable signs for nurses to identify residents' poor oral health. METHODS In this cross-sectional observational study dentists examined 209 residents' oral status, and nurses assessed residents for their functioning and nutrition in long-term care facilities in Helsinki, Finland. ODB was defined by asymptotic dental score (ADS). Six clinical signs of residents' poor oral health were considered as potentially easy for nurses to detect: lesions on lips, teeth with increased mobility, lesions on oral mucosa, eating soft or pureed food, unclear speech, and needing assistance in eating. The association of these was tested with high ODB as outcome. RESULTS Participants were grouped according to their ADS scores: low (n = 39), moderate (n = 96) and high ODB (n = 74). ODB was linearly associated with coronary artery disease and poor cognitive and physical functioning: needing assistance in eating, poor ability to make contact, and unclear speech but not with other diseases including dementia or demographic characteristics. Furthermore, ODB was linearly associated with eating soft or pureed food. Of the six selected, easily detectable signs, having at least two positive signs gave 89% sensitivity to detecting high ODB. CONCLUSION Poor oral health was common and ODB accumulated among residents with poor functioning. Nurses may use a few easily detectable signs to screen residents' oral health when considering a resident's need for consultation with an oral health professional.
Collapse
Affiliation(s)
- Lina Julkunen
- Oral and Maxillofacial Diseases Outpatient Clinic, Helsinki University Hospital, Helsinki, Finland
| | - Kaija Hiltunen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Riitta K T Saarela
- Department of Social Services and Health Care, Oral Health Care, City of Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Mäntylä
- Institute of Dentistry, University of Eastern Finland, Yliopistonranta 1 B, P. O. Box 1627, 70211, Kuopio, Finland.
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|
9
|
Salih MA, Ali RW, Nasir EF. Oral health status and associated factors among Sudanese older adults: A cross-sectional study. Gerodontology 2021; 39:408-417. [PMID: 34859486 DOI: 10.1111/ger.12611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim was to assess the oral health status, prosthetic needs and the associated factors among older adults living in Khartoum State, Sudan. BACKGROUND Understanding the extent of the oral health problems and the associated factors in the older population is important for the determination of treatment needs and future planning of dental services. MATERIALS AND METHODS A cross-sectional study among individuals ≥60 years attending Health Care Centers. Two calibrated examiners examined participants according to the WHO oral health examination form for adults. DMFT, periodontal conditions, oral mucosal lesions, tooth wear, prosthetic status and prosthetic needs were reported. Risk indicators investigated include age, gender, socioeconomic status, general health, oral hygiene practices, tobacco use and utilisation for dental services. RESULTS Two hundred forty-nine older adults participated in the study, and 64.3% were males. The mean age was 68.4 years (SD ±6.7). The mean DMFT was 15.9 (SD ±9.1), with 85.3%, 94.8% and 19.3% of the participants having decayed, missing or filled teeth respectively. Periodontal pockets were present in 41.9%, mucosal lesions in 14.9% and tooth wear in 46.2% of the participants. Although only 5.2% were completely edentulous, 93.2% need prosthetic replacement. Risk indicators for poor oral health were being female, oral hygiene practices, frequency and reason of dental visits. CONCLUSION Old adults showed a high experience of missing and decayed teeth, periodontal inflammation and prosthetic treatment needs. Future oral health policies need to consider the different needs between men and women, exposure to risk factors and barriers to access dental care.
Collapse
Affiliation(s)
- Mayson Ahmed Salih
- Department of Prosthetic Dentistry, Faculty of Dentistry, University of Science and Technology, Omdurman, Sudan
| | - Raouf Wahab Ali
- Faculty of Dentistry, University of Science and Technology, Omdurman, Sudan
| | - Elwalid Fadul Nasir
- Preventive Department, College of Dentistry, King Faisal University, Alahsa, Saudi Arabia
| |
Collapse
|
10
|
Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312360. [PMID: 34886085 PMCID: PMC8656978 DOI: 10.3390/ijerph182312360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022]
Abstract
Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.
Collapse
|
11
|
Oral hygiene and health-related quality of life in institutionalized older people. Eur Geriatr Med 2021; 13:213-220. [PMID: 34313976 PMCID: PMC8860786 DOI: 10.1007/s41999-021-00547-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
Aim We evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities. Findings Only one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL. Message Oral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities. Purpose We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored. Methods This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants’ background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden. Results Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender. Conclusions Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents’ oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups.
Collapse
|
12
|
Krausch-Hofmann S, Tran TD, Janssens B, Declerck D, Lesaffre E, de Almeida Mello J, Declercq A, De Lepeleire J, Duyck J. Assessment of oral health in older adults by non-dental professional caregivers-development and validation of a photograph-supported oral health-related section for the interRAI suite of instruments. Clin Oral Investig 2021; 25:3475-3486. [PMID: 33196870 PMCID: PMC8137625 DOI: 10.1007/s00784-020-03669-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES An optimized oral health-related section and a video training were developed and validated for the interRAI suite of instruments. The latter is completed by professional non-dental caregivers and used in more than 40 countries to assess care needs of older adults. METHODS The optimized oral health-related section (ohr-interRAI) consists of nine items and a video training that were developed in consecutive phases. To evaluate psychometric properties, a study was conducted in 260 long-term care residents. Each resident was assessed by a dentist and by four caregivers (two who received the video training, two who did not). RESULTS Mean kappa values and percent agreement between caregivers and dentist ranged between κ = 0.60 (80.2%) for dry mouth and κ = 0.13 (54.0%) for oral hygiene. The highest inter-caregiver agreement was found for dry mouth with κ = 0.63 [95% CI: 0.56-0.70] (81.6%), while for the item palate/lips/cheeks only κ = 0.27 [95% CI: 0.18-0.36] (76.7%) was achieved. Intra-caregiver agreement ranged between κ = 0.93 [95% CI: 0.79-1.00] (96.4%) for dry mouth and κ = 0.45 [95% CI: 0.06-0.84] (82.8%) for gums. Logistic regression analysis showed only small differences between caregivers who watched the video training and those who did not. CONCLUSIONS Psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. Nevertheless, particularly the items based on inspection of the mouth require further refinement and caregiver training needs to be improved. CLINICAL RELEVANCE Valid assessment of oral health by professional caregivers is essential due to the impaired accessibility of regular dental care for care-dependent older adults.
Collapse
Affiliation(s)
- Stefanie Krausch-Hofmann
- KU Leuven Department of Oral Health Sciences, Population Studies in Oral Health, Kapucijnenvoer 7/a - box 7001, 3000 Leuven, Belgium
| | - Trung Dung Tran
- KU Leuven Department of Public Health and Primary Care, Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Kapucijnenvoer 35/a - box 7001, 3000 Leuven, Belgium
| | - Barbara Janssens
- Ghent University Department of Oral Health Sciences, Special Needs in Oral Health, Gerodontology, C.-Heymanslaan 10, entrance 25, 9000 Ghent, Belgium
| | - Dominique Declerck
- KU Leuven Department of Oral Health Sciences, Population Studies in Oral Health, Kapucijnenvoer 7/a - box 7001, 3000 Leuven, Belgium
| | - Emmanuel Lesaffre
- KU Leuven Department of Public Health and Primary Care, Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Kapucijnenvoer 35/a - box 7001, 3000 Leuven, Belgium
| | - Johanna de Almeida Mello
- KU Leuven LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8 - box 5310, 3000 Leuven, Belgium
| | - Anja Declercq
- KU Leuven LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8 - box 5310, 3000 Leuven, Belgium
- KU Leuven CESO, Center for Sociological Research, Parkstraat 45 - box 3601, 3000 Leuven, Belgium
| | - Jan De Lepeleire
- KU Leuven Department of Public Health and Primary Care, Academic Centre for General Practice, Kapucijnenvoer 33/j - box 7001, 3000 Leuven, Belgium
| | - Joke Duyck
- KU Leuven Department of Oral Health Sciences, Biomaterials/BIOMAT, Kapucijnenvoer 7/a - box 7001, 3000 Leuven, Belgium
| |
Collapse
|
13
|
Polychronakis N, Sykaras N, Polyzois G, Lagouvardos P. Removal of denture adhesives from PMMA and Polyamide denture base materials. J Appl Oral Sci 2021; 29:e20200448. [PMID: 33787729 PMCID: PMC8007087 DOI: 10.1590/1678-7757-2020-0448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/08/2020] [Indexed: 11/22/2022] Open
Abstract
Denture adhesives need complete removal due to their frequent replacement.
Collapse
Affiliation(s)
- Nick Polychronakis
- National & Kapodistrian University of Athens, School of Dentistry, Department of Prosthodontics, Athens, Greece
| | - Nikitas Sykaras
- National & Kapodistrian University of Athens, School of Dentistry, Department of Prosthodontics, Athens, Greece
| | - Gregory Polyzois
- National & Kapodistrian University of Athens, School of Dentistry, Department of Prosthodontics, Athens, Greece
| | - Panagiotis Lagouvardos
- National & Kapodistrian University of Athens, School of Dentistry, Department of Operative Dentistry, Athens, Greece
| |
Collapse
|
14
|
Tran TD, Lesaffre E, Verbeke G, Duyck J. Modeling local dependence in latent vector autoregressive models. Biostatistics 2021; 22:148-163. [PMID: 31233595 DOI: 10.1093/biostatistics/kxz021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 12/17/2023] Open
Abstract
We propose a Bayesian latent vector autoregressive (LVAR) model to analyze multivariate longitudinal data of binary and ordinal variables (items) as a function of a small number of continuous latent variables. We focus on the evolution of the latent variables while taking into account the correlation structure of the responses. Often local independence is assumed in this context. Local independence implies that, given the latent variables, the responses are assumed mutually independent cross-sectionally and longitudinally. However, in practice conditioning on the latent variables may not remove the dependence of the responses. We address local dependence by further conditioning on item-specific random effects. A simulation study shows that wrongly assuming local independence may give biased estimates for the regression coefficients of the LVAR process as well as the item-specific parameters. Novel features of our proposal include (i) correcting biased estimates of the model parameters, especially the regression coefficients of the LVAR process, obtained when local dependence is ignored and (ii) measuring the magnitude of local dependence. We applied our model on data obtained from a registry on the elderly population in Belgium. The purpose was to examine the values of oral health information on top of general health information.
Collapse
Affiliation(s)
- Trung Dung Tran
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Kapucijnenvoer 35, B-3000 Leuven, Belgium and Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Universiteit Hasselt, B-3590 Diepenbeek, Belgium
| | - Emmanuel Lesaffre
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Kapucijnenvoer 35, B-3000 Leuven, Belgium and Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Universiteit Hasselt, B-3590 Diepenbeek, Belgium
| | - Geert Verbeke
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Kapucijnenvoer 35, B-3000 Leuven, Belgium and Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Universiteit Hasselt, B-3590 Diepenbeek, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Katholieke Universiteit Leuven, Kapucijnenvoer 7, B-3000 Leuven, Belgium
| |
Collapse
|
15
|
Krausch-Hofmann S, Palmers E, Declerck D, Duyck J. Development of practice guidelines for daily oral care in care-dependent older adults to complement the InterRAI suite of instruments using a modified Delphi approach. Int J Older People Nurs 2020; 16:e12351. [PMID: 33074589 PMCID: PMC7816227 DOI: 10.1111/opn.12351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 01/11/2023]
Abstract
Aim To develop practice guidelines for nursing assistants who provide daily oral care to older adults. Background The interRAI suite of instruments is internationally used in professional health care to assess the needs of care‐dependent older persons. An optimised oral health section was developed recently to identify care clients with poor oral health and hygiene. Internationally shared guidelines for daily oral care are needed to complement the optimised oral health section of the interRAI suite of instruments. Material and methods The modified Delphi approach started with the preparation of an initial draft. Subsequently, an online survey and a face‐to‐face discussion were conducted with international experts. Their feedback was used to revise the draft. Two additional online surveys were conducted with the experts to reach consensus agreement for each item of the revised version. The same group of experts was invited to the different study phases. Results The three surveys were completed by 26, 27 and 23 international experts, respectively. A group of 18 experts completed each survey, whereof a subgroup of 11 experts also took part in the face‐to‐face discussion. Experts were dental hygienists, dentists, nursing scientists, physicians and psychologists from 14 different countries. After the final survey, consensus agreement was reached for 54 of the 57 (94.7%) items, representing the final version of the guidelines. Conclusion Available evidence was combined with practical feedback from international experts to develop clear and concise practice guidelines for daily oral care in older adults. Implications for practice The guidelines will help to improve knowledge and reduce barriers of nursing assistants to provide daily oral care.
Collapse
Affiliation(s)
- Stefanie Krausch-Hofmann
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - Ellen Palmers
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - Dominique Declerck
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Biomaterials/BIOMAT, KU Leuven, Leuven, Belgium
| |
Collapse
|
16
|
Schmidt JC, Vogt S, Imboden M, Schaffner E, Grize L, Zemp E, Probst-Hensch N, Zitzmann NU. Dental and periodontal health in a Swiss population-based sample of older adults: a cross-sectional study. Eur J Oral Sci 2020; 128:508-517. [PMID: 33073429 DOI: 10.1111/eos.12738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 12/18/2022]
Abstract
In this cross-sectional study, the prevalences of tooth loss, prosthetic dental restorations, and probing pocket depths (PPD) ≥4 mm, and their relationship to sociodemographic factors, were investigated in older Swiss adults. There were up to 1,673 participants aged ≥55 yr in the fourth survey of the Swiss Cohort Study on Air Pollution And Lung And Heart Disease In Adults (SAPALDIA4). Missing teeth, prosthetic dental restorations, and PPD ≥4 mm were recorded in clinical examinations conducted by field workers and compared with self-reported information from questionnaires. Examination data showed that participants were missing five teeth on average, 74.8% had a prosthetic dental restoration, and 21.1% had PPD of ≥4 mm. The mean number of missing teeth and the prevalences of tooth loss, fixed dental prostheses, and removable dental prostheses were associated with age, education level, smoking status, and time since last visit to a dentist. Comparison of data obtained by field workers and that from self-reports show a high level of agreement for the number of missing teeth and the prevalence of removable dental prostheses, but a lower level of agreement for self-reports of fixed dental prostheses and periodontitis.
Collapse
Affiliation(s)
- Julia C Schmidt
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Sandra Vogt
- Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Medea Imboden
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute Basel, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Emmanuel Schaffner
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute Basel, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Leticia Grize
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute Basel, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Elisabeth Zemp
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute Basel, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology & Public Health, Swiss Tropical & Public Health Institute Basel, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nicola U Zitzmann
- Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
17
|
Petersen PE, Baez RJ, Ogawa H. Global application of oral disease prevention and health promotion as measured 10 years after the 2007 World Health Assembly statement on oral health. Community Dent Oral Epidemiol 2020; 48:338-348. [PMID: 32383537 PMCID: PMC7496398 DOI: 10.1111/cdoe.12538] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The WHO World Health Assembly established in 2007 a Resolution (WHA60.17) on oral health, which called upon countries to ensure that public health actions for disease prevention and health promotion are established. The objective of the present survey undertaken 10 years later (2017-2018) was to measure the application of such programmes for key population age groups in low-, middle- and high-income countries. METHODS Oral health focal points of ministries of health worldwide (n = 101) answered a structured questionnaire on existing national oral health systems and the actual public health activities. The response rate was 58.4%. The questionnaire was used to collect information about structural factors, country workforce, financial models, provision of preventive services and promotion for oral health, school health programmes, administration of fluoride, national oral health targets and oral health surveillance. The countries were classified by national income for analysis of data. RESULTS Coverage of population groups by primary oral health care and emergency care varied by national income. The gap between countries in delivery of preventive care was strong since low-income countries less often reported preventive activities than middle-income countries and particularly when compared to high-income countries. School oral health programmes were less frequent in low-income than other countries. Moreover, population methods of fluoridation and use of fluoridated toothpaste were unusual in low-income countries. Health education, mass communication and community events were often essential elements in health promotion. In disease prevention, many countries considered the link between oral health and general health conditions and intervention towards shared risk factors of NCDs. The health concern for the consumption of tobacco, unhealthy diet and sugars was particularly emphasized by high-income countries but less highlighted by low-income countries. Finally, while national oral health targets for children and surveillance systems were frequently reported by countries, similar systems for adolescents, adults and older people were rare. CONCLUSIONS The inequities between countries in oral disease prevention and health promotion were substantial. Limited financial resources for preventive care and health promotion; inadequate workforce for oral health, and insufficient coverage in primary health care were observed in low-resource countries. The results of the survey demonstrate the need for building effective oral health systems oriented towards oral disease prevention and health promotion.
Collapse
Affiliation(s)
- Poul Erik Petersen
- WHO Collaborating Centre for Community Oral Health Programmes and ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Ramon J Baez
- University of Texas Health Science CenterSan AntonioTXUSA
| | - Hiroshi Ogawa
- WHO Collaborating Centre for Translation of Oral Health SciencesNiigata UniversityNiigataJapan
| |
Collapse
|
18
|
Krausch-Hofmann S, Tran TD, Declerck D, de Almeida Mello J, Declercq A, Lesaffre E, De Lepeleire J, Duyck J. Assessment of oral health conditions presented in photographs - is there a difference between dentists and non-dental professional caregivers? BMC Oral Health 2020; 20:188. [PMID: 32620115 PMCID: PMC7333316 DOI: 10.1186/s12903-020-01171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Photographs can help non-dental professional caregivers to identify problems when inspecting the mouth of care-dependent older individuals. This study evaluated whether the assessment of oral health-related conditions presented in photographs differed between dentists and non-dental professional caregivers. Materials and methods One-hundred-and-seventy-nine photographs were taken from long-term care facility residents and from patients at the Department of Dentistry of a University Hospital. The following oral health aspects were depicted: denture hygiene, oral hygiene, teeth, gums, tongue and palate/lips/cheeks. Collection continued until for each oral health aspect a pool of photographs was available that showed conditions from perfect health and hygiene to severe problems. A segmented Visual Analogue Scale was applied to assess the conditions presented in the photographs. Each photograph was assessed by each participant of this study. The benchmark was established by three dentists with academic-clinical expertise in gerodontology, special needs dentistry and periodontology. For each photograph, they provided a collective score after reaching consensus. Photographs were assessed individually by 32 general dentists and by 164 non-dental professional caregivers. Linear mixed effects models and generalized linear mixed effects models were fitted and mean squared errors were computed to quantify differences between both groups. Results For the different oral health aspects, absolute distances from the benchmark scores were 1.13 (95%CI:1.03–1.23) to 1.51 (95%CI:1.39–1.65) times higher for the caregivers than for the dentists. The odds to overestimate the condition were higher for the caregivers than the dentists for oral hygiene (OR = 0.72, 95%CI = 0.62–0.84) and teeth (OR = 0.74; 95%CI = 0.61–0.88). The odds to underestimate the condition were higher for the caregivers than the dentists for gums (OR = 1.39; 95%CI:1.22–1.59) and palate/lips/cheeks (OR = 1.22; 95%CI = 1.07–1.40). Over all assessments, the variance in caregiver scores was 1.9 (95%CI:1.62–2.23) times higher than that for the dentists. Conclusion Small but significant differences were found between dentists and non-dental professional caregivers assessing oral health-related conditions presented in photographs. When photographs are used to aid non-dental professional caregivers with the oral health assessment, these visualizations should be complemented with comments to facilitate accurate interpretation.
Collapse
Affiliation(s)
- Stefanie Krausch-Hofmann
- KU Leuven Population Studies in Oral Health - Department of Oral Health Sciences, Kapucijnenvoer 7/a - box 7001, 3000, Leuven, Belgium
| | - Trung Dung Tran
- KU Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat) - Department of Public Health and Primary Care, Kapucijnenvoer 35/d - box 7001, 3000, Leuven, Belgium
| | - Dominique Declerck
- KU Leuven Population Studies in Oral Health - Department of Oral Health Sciences, Kapucijnenvoer 7/a - box 7001, 3000, Leuven, Belgium
| | - Johanna de Almeida Mello
- KU Leuven LUCAS - Centre for Care Research and Consultancy, Minderbroedersstraat 8 - box 5310, 3000, Leuven, Belgium
| | - Anja Declercq
- KU Leuven LUCAS - Centre for Care Research and Consultancy, Minderbroedersstraat 8 - box 5310, 3000, Leuven, Belgium.,KU Leuven CESO - Center for Sociological Research, Parkstraat 45 - box 3601, 3000, Leuven, Belgium
| | - Emmanuel Lesaffre
- KU Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat) - Department of Public Health and Primary Care, Kapucijnenvoer 35/d - box 7001, 3000, Leuven, Belgium
| | - Jan De Lepeleire
- KU Leuven Academic Centre for General Practice - Department of Public Health and Primary Care, Kapucijnenvoer 33/j - box 7001, 3000, Leuven, Belgium
| | - Joke Duyck
- Biomaterials/BIOMAT - Department of Oral Health Sciences, Kapucijnenvoer 7/a - box 7001, 3000, Leuven, Belgium.
| |
Collapse
|
19
|
Mendes MSS, Chester LN, Fernandes Dos Santos JF, Chen X, Caplan DJ, Marchini L. Self-perceived oral health among institutionalized older adults in Taubate, Brazil. SPECIAL CARE IN DENTISTRY 2020; 40:49-54. [PMID: 31912539 DOI: 10.1111/scd.12430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/01/2019] [Accepted: 10/21/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE/AIM To assess self-perception of oral health among institutionalized older adults in Taubate, Brazil. METHOD AND MATERIALS Demographics, oral, and systemic health data were collected from a sample of 89 institutionalized older adults. The Geriatric Oral Health Assessment Index (GOHAI) was applied to assess their self-perception of oral health. A linear regression model using GOHAI scores and considering age, BMI, gender, race, dry mouth, denture status, number of teeth, number of comorbid conditions, and number of medications as independent variables was generated. RESULTS Fifty-five percent were male, with an average age of 75.9 years (±9.1), 43.8% identified as mixed race, and 42.7% as white. The average BMI was 23.9 (±3.8), the average number of comorbid condition was 1.8 (±1.4), and the average number of daily medications was 6.2 (±3.6). The average number of teeth was 3.9 (±7.4), and 57.3% of the participants reported dry mouth sensation; 8.9% presented oral lesions, with denture stomatitis as the most common oral lesion (5.6%). The average GOHAI score was 31.1 (±3.7). Regression analysis showed a negative correlation between BMI and GOHAI scores (P = .032, R2 = 7.2%). CONCLUSIONS Self-perception of oral health was good and negatively correlated with BMI.
Collapse
Affiliation(s)
- Mariana S S Mendes
- Multi-professional Health and Palliative Care for the Elderly, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Jarbas Francisco Fernandes Dos Santos
- Department of Dentistry, University of Taubate, Taubate, Brazil.,Department of Dentistry, University of Vale do Paraiba, São José dos Campos, Brazil
| | - Xi Chen
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
| | - Daniel J Caplan
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
| | - Leonardo Marchini
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
| |
Collapse
|
20
|
Kiesswetter E, Keijser BJF, Volkert D, Visser M. Association of oral health with body weight: a prospective study in community-dwelling older adults. Eur J Clin Nutr 2019; 74:961-969. [PMID: 31767989 DOI: 10.1038/s41430-019-0536-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND To prevent involuntary weight loss in older people, the knowledge about factors affecting body weight (BW) is essential. Therefore, we aimed to investigate the longitudinal associations of multiple oral health aspects with BW in community-dwelling older adults. METHODS This analysis is based on prospective data with a 10-year follow-up of 657 Dutch community-dwelling older adults (age 66.4 ± 5.8 years, 54% female) from the Longitudinal Aging Study Amsterdam. Participants' characteristics, BW, and 12 oral health variables (teeth, dentures, nine oral problems, self-rated oral health) were assessed in 2005/07 and 2015/16. The association between oral health and BW was analyzed by mixed models and adjusted for demographic, socio-economic, smoking, health, and functional aspects considering data of both assessments. RESULTS Mean BW was 79.1 ± 13.3 kg at baseline (B) and 77.6 ± 13.8 kg at follow-up (FU). At baseline, 29.6% of the participants reported being edentulous (FU:34.4%) and 55.8% to wear dentures (FU:62.3%). Dental pain while chewing was the oral problem with the lowest (B:5.2%, FU:6.6%) and xerostomia with the highest prevalence at both examinations (B:24.3%, FU:30.0%). Most participants rated their oral status as healthy (B:65.2%, FU:66.9%). Neither edentulism and denture use nor oral problems showed a longitudinal association with BW. In contrast, self-rated oral health was associated with BW (b = 0.724, SE = 0.296, p = 0.015) after adjusting for multiple confounders. CONCLUSIONS In community-dwelling older adults self-rated oral health may indicate changes in body weight in the long term. Therefore, this simple measure could serve to identify a risk for weight loss and to initiate oral interventions in clinical practice.
Collapse
Affiliation(s)
- Eva Kiesswetter
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Bart J F Keijser
- Research Group Microbiology and Systems Biology, TNO, Utrechtseweg 48, 3704HE, Zeist, The Netherlands.,Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
21
|
Krausch-Hofmann S, De Almeida Mello J, Declerck D, Declercq A, De Lepeleire J, Tran TD, Lesaffre E, Duyck J. The oral health-related section of the interRAI: Evaluation of test content validity by expert rating and assessment of potential reasons for inaccurate assessments based on focus group discussions with caregivers. Gerodontology 2019; 36:382-394. [PMID: 31274218 DOI: 10.1111/ger.12421] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/21/2019] [Accepted: 05/13/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To explore the failure of the oral health-related section of the interRAI (ohr-interRAI), this study investigated test content validity (A.) and reasons for inaccurate assessments (B.). BACKGROUND Poor oral health negatively affects quality of life and is associated with a number of systemic diseases. The interRAI instruments, internationally used for geriatric assessment, should accurately detect oral conditions that require care. Previous research showed that the ohr-interRAI and related precursor versions do not achieve this goal. MATERIALS AND METHODS (A.) A group of 12 experts rated completeness, relevance, clarity of wording and feasibility of the ohr-interRAI. Content validity indices were calculated per item (threshold 0.78). (B.) Focus group discussions with 23 caregivers were organized. A semi-structured question guide made sure that all topics of interest were covered. Qualitative content structuring analysis was applied after transcription. RESULTS (A.) Experts agreed on the relevance of the items on chewing, pain, gingival inflammation and damaged teeth. They regarded none of the items as worded clearly and only prosthesis use and pain were considered to be assessable by untrained caregivers. All experts agreed that the ohr-interRAI was incomplete. (B.) Focus group discussions revealed that in the care environment oral health had low priority. Aspects related to the ohr-interRAI itself and aspects related to the assessment situation impeded the oral health assessment. The approach of the caregivers to complete the ohr-interRAI was inappropriate to accurately detect oral care needs. CONCLUSIONS Findings challenge test content validity of the ohr-interRAI and reveal reasons for inaccurate assessments.
Collapse
Affiliation(s)
- Stefanie Krausch-Hofmann
- Department of Oral Health Sciences, KU Leuven Population Studies in Oral Health, Leuven, Belgium
| | | | - Dominique Declerck
- Department of Oral Health Sciences, KU Leuven Population Studies in Oral Health, Leuven, Belgium
| | - Anja Declercq
- Centre for Care Research and Consultancy, KU Leuven LUCAS, Leuven, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven Academic Centre for General Practice, Leuven, Belgium
| | - Trung Dung Tran
- Department of Public Health and Primary Care, KU Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Emmanuel Lesaffre
- Department of Public Health and Primary Care, KU Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Biomaterials/BIOMAT, Leuven, Belgium
| |
Collapse
|
22
|
Dentistry and nursing working together to improve oral health care in a long-term care facility. Geriatr Nurs 2018; 40:197-204. [PMID: 30528781 DOI: 10.1016/j.gerinurse.2018.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 01/06/2023]
Abstract
Inadequate oral care in long-term care (LTC) facilities compromises the quality of life of residents. This study assessed oral care knowledge of, and challenges experienced by, nurses and allied nursing staff (ANS) in a LTC facility in Canada. Dentists and nursing staff used the findings to implement strategies for improved care. Using a sequential mixed method design, data on oral care knowledge and practices were collected using self-administered questionnaires (n = 114) and focused groups (n = 39). Data were analyzed using descriptive statistics and thematic analysis. While participants (>80%) felt knowledgeable and confident in providing oral care, they desired improved skills to overcome resistive behavior, communication, and wanted adapted oral care materials. Implemented strategies included skills-acquisition workshop, oral care posters, and oral health champion. Overall, our interprofessional collaboration increased awareness of the need for oral care training, and implemented strategies to help nursing staff overcome barriers in providing care.
Collapse
|
23
|
The impact of a preventive and curative oral healthcare program on the prevalence and incidence of oral health problems in nursing home residents. PLoS One 2018; 13:e0198910. [PMID: 29894494 PMCID: PMC5997339 DOI: 10.1371/journal.pone.0198910] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 05/29/2018] [Indexed: 11/19/2022] Open
Abstract
AIMS To assess the impact of an oral healthcare program in nursing homes on the initial treatment backlog and residents' oral health stability. MATERIALS AND METHODS The study is a longitudinal cohort study in nursing home residents in Flanders, Belgium, to evaluate the oral healthcare programme Gerodent. The program consisted of: (1) the introduction of an oral healthcare team, (2) oral health education, (3) the implementation of oral health guidelines and protocols, and (4) regular visits of a mobile dental team. Data were extracted from the oral health records of 381 residents from 21 nursing homes who received treatments from the mobile dental team between October 2010 and March 2014 (mean follow-up period of 22.5 months). Oral health and treatment need between baseline and follow-up were compared. RESULTS The mean age at baseline was 82.4 years and the mean number of consultations per resident was 3.61 during the follow-up period. The proportion of residents with an oral treatment need was reduced from 65.9% to 31.3%. Among residents with natural teeth, there was significantly lower prevalence of caries (from 70.5% at baseline to 36.5% at follow-up; p<0.001), residual roots (from 54.2% to 25.1%; p<0.001), and need for fillings (from 31.9% to 17.1%; p<0.001) or extractions (from 64.3% to 31.6%; p<0.001). In the group with partial or full dentures (n = 223), 38.1% needed a repair, rebasing or renewal of their existing dentures at baseline and the respective figure at follow-up was 9.0% (p<0.001). In terms of oral health stability, 53% of the residents had no incident restorative and prosthetic treatment need throughout the follow-up period. A lower number of natural teeth at baseline (p<0.001) and a shorter follow-up period (p = 0.002) were associated with higher chances of oral health stability. CONCLUSION The oral healthcare program Gerodent significantly reduced the treatment backlog and contributed to a considerable proportion of residents being stable in terms of oral health without any incident treatment needs.
Collapse
|
24
|
McAnulla A, Reid B, Zieba M. Developing an integrated resource to promote oral health in nursing homes. Nurs Older People 2018; 30:25-28. [PMID: 29480656 DOI: 10.7748/nop.2018.e1019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 11/09/2022]
Abstract
Public health is the responsibility of every nurse and nursing practice should adopt a life course approach to the promotion of health and well-being. This approach requires a renewed focus on health promotion interventions aimed at older people, including those resident in nursing homes. The oral health status of older people in nursing homes has been reported as suboptimal, predisposing them to poorer health-related quality of life. Interventions focusing on knowledge and behaviours related to oral health management for nurses, other caregivers and older people have the potential to improve the provision of oral care. This article discusses a project undertaken by a team of preregistration nursing students to plan and develop an integrated oral health promotion resource for older people in nursing homes. Healthy Smile, Healthy Me comprises a poster called five steps for oral hygiene and an oral health box. Initial feedback from a pilot of the resource in a nursing home is encouraging and research is planned to explore the feasibility, acceptability and efficacy of the resource.
Collapse
Affiliation(s)
| | - Bernie Reid
- School of Nursing, Ulster University, Northern Ireland
| | | |
Collapse
|
25
|
Andersson M, Wilde-Larsson B, Carlsson E, Persenius M. Older people's perceptions of the quality of oral care in short-term care units: A cross-sectional study. Int J Older People Nurs 2018; 13:e12185. [PMID: 29363883 DOI: 10.1111/opn.12185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is a lack of knowledge about oral care among older people living in short-term care (STC) units and how the quality of oral care provided by nursing staff is perceived by the older people. AIM To (i) describe person-related conditions among older people in STC, (ii) describe and compare perceptions of the quality of oral care (including perceptions of care received and the subjective importance of such care), within and between older people who have the ability to perform oral self-care and those who are dependent on help with oral care and (iii) examine the relationship between person-related conditions and the quality of oral care. METHODS A cross-sectional study was conducted with 391 older people in STC units in Sweden based on self-reported questionnaire and clinical assessments. RESULTS The older people were assessed as having normal oral health (2%), moderate oral health problems (78%) or severe oral health problems (20%). When comparing older people's perceptions of quality of oral care in terms of perceived reality and subjective importance, significant differences appeared within and between groups. Psychological well-being had a significant relationship with perception of the quality of oral care (both perceived reality and subjective importance), and gender and oral health status had a significant relationship with subjective importance. CONCLUSIONS Older people's perceptions of areas for improvement regarding quality of oral care is a new and important knowledge for nursing staff in STC units. Older people want personalised information regarding oral health and oral care. Registered Nurses who take the responsibility in nursing care for older people's oral health may avoid unnecessary suffering by older people caused by oral health problems. IMPLICATIONS FOR PRACTICE Older people's perspective is an important component for quality work and might lead to improvements in the quality of oral care in STC.
Collapse
Affiliation(s)
- Maria Andersson
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Bodil Wilde-Larsson
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Public Health Studies, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Eva Carlsson
- Faculty of Health and Medicine, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Mona Persenius
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
26
|
Schwindling FS, Krisam J, Hassel AJ, Rammelsberg P, Zenthöfer A. Long-term success of oral health intervention among care-dependent institutionalized seniors: Findings from a controlled clinical trial. Community Dent Oral Epidemiol 2017; 46:109-117. [DOI: 10.1111/cdoe.12335] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics; University Hospital Heidelberg; Heidelberg Germany
| | - Alexander J. Hassel
- Department of Prosthodontics; University Hospital Heidelberg; Heidelberg Germany
| | - Peter Rammelsberg
- Department of Prosthodontics; University Hospital Heidelberg; Heidelberg Germany
| | - Andreas Zenthöfer
- Department of Prosthodontics; University Hospital Heidelberg; Heidelberg Germany
| |
Collapse
|
27
|
Kossioni A, McKenna G, Müller F, Schimmel M, Vanobbergen J. Higher education in Gerodontology in European Universities. BMC Oral Health 2017; 17:71. [PMID: 28351394 PMCID: PMC5371193 DOI: 10.1186/s12903-017-0362-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/11/2017] [Indexed: 11/27/2022] Open
Abstract
Background The rapid aging of the European population and the subsequent increase in the oral care needs in older adults necessitates adequate training of dental professionals in Gerodontology (Geriatric Dentistry). This study was designed to investigate the current status of Gerodontology teaching amongst European dental schools at the undergraduate, postgraduate and continuing education levels. Methods An electronic questionnaire was developed by a panel of experts and emailed to the Deans or other contact persons of 216 dental schools across 39 European countries. The questionnaire recorded activity levels, contents and methodology of Gerodontology teaching as part of dental education programs. Repeated e-mail reminders and telephone calls were used to encourage non-responders to complete the questionnaire. Results A total of 123 responses from 29 countries were received (response rate: 56.9%). Gerodontology was taught in 86.2% of schools at the undergraduate level, in 30.9% at the postgraduate level and in 30.1% at the continuing education level. A total of 43.9% of the responding schools had a dedicated Gerodontology program director. Gerodontology was taught as an independent subject in 37.4% of the respondent schools. Medical problems in old age, salivary impairment and prosthodontic management were the most commonly covered topics in Gerodontology teaching. Clinical teaching took place in 64.2% of the respondent schools, with 26.8% offering clinical training in outreach facilities. Conclusions The vast majority of European dental schools currently teach Gerodontology at the undergraduate level. More training opportunities in oral care of frail elders should be offered, and more emphasis should be placed on interdisciplinary and interprofessional training, educational collaborations, and the use of modern technologies. Dedicated postgraduate Gerodontology courses need to be developed to create a significant number of specialized dentists and trained academics. Electronic supplementary material The online version of this article (doi:10.1186/s12903-017-0362-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anastassia Kossioni
- Division of Gerodontology, Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Thivon 2 Goudi, Athens, 11527, Greece.
| | - Gerry McKenna
- Centre for Public Health, Royal Victoria Hospital, Queens University Belfast, Belfast, Northern Ireland
| | - Frauke Müller
- Department of Gerodontology & Removable Prosthodontics, University of Geneva, Geneva, Switzerland
| | - Martin Schimmel
- Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | |
Collapse
|
28
|
Hoeksema AR, Spoorenberg SLW, Peters LL, Meijer HJA, Raghoebar GM, Vissink A, Wynia K, Visser A. Elderly with remaining teeth report less frailty and better quality of life than edentulous elderly: a cross-sectional study. Oral Dis 2017; 23:526-536. [DOI: 10.1111/odi.12644] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/30/2016] [Accepted: 01/16/2017] [Indexed: 01/11/2023]
Affiliation(s)
- AR Hoeksema
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - SLW Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - LL Peters
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - HJA Meijer
- Departments of Oral and Maxillofacial Surgery and Fixed and Removable Prosthodontics; Dental School; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - GM Raghoebar
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - A Visser
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| |
Collapse
|