An ageing population poses dental challenges

Denture care attitudes, hygiene levels and oral mucosal lesions in complete denture wearers from a single-institution cross-sectional study

This study investigated denture care attitudes, dental visit habits, oral mucosal lesions, and hygiene levels in 118 complete denture users treated at a university dentistry faculty. Data on demographics, smoking, denture use duration, dentist visits, and hygiene habits were collected via a questionnaire. A specialist examined mucosal lesions and assessed denture hygiene level using the Budtz-Jorgensen and Bertram method. Categorical data were analyzed with Yates's correction, Pearson's chi-square, and Fisher-Freeman-Halton tests; multiple comparisons used the Bonferroni Corrected Z Test. Participants' mean age was 51.61. Most were non-smokers (55.1%), visited dentists only for complaints (44.9%), cleaned dentures daily (70.3%), and removed them at night (56.8%). Good hygiene was observed in 40.68%. Females cleaned dentures more frequently than males, and 96.3% of those with poor hygiene reported bad denture odor. This study revealed significant deficiencies in denture care habits and inadequate hygiene practices of participants in a university dentistry faculty clinic. Most participants visited dentists only for complaints and had bad habits such as sleeping with their dentures at night and using inappropriate denture hygiene habits. Promoting proper denture hygiene habits and emphasizing the importance of regular dental visits can contribute to better oral health.

Examination of oral health quality of life and patient satisfaction in removable denture wearers with OHIP-14 scale and visual analog scale: a cross-sectional study

BACKGROUND

Oral Health-Related Quality of Life (OHRQoL) is a term that encompasses conditions such as oral health status, living conditions, and function. OHQoL can change with the varying health conditions of the same individual. Many patients cannot afford implants or have anatomical limitations and therefore use traditional removable dentures. There are comparatively few studies investigating OHRQoL and denture satisfaction that include the patients' sociodemographic data, denture satisfaction and related questions.

AIM

This study aimed to investigate OHRQoL and patients' satisfaction with three types of dentures: upper and lower complete dentures, upper and lower partial dentures, and upper complete lower partial dentures.

METHODS

The study was conducted between January 2022 and June 2023, with 150 patients using removable dentures. Patients' age, gender, education level, place of residence, smoking status, reasons for tooth loss and visiting the clinic, type of denture and the duration of denture use were recorded. Oral Health Impact Profile (OHIP-14) and patient satisfaction with dentures as measured on a Visual Analog Scale (VAS) were used to assess patients' satisfactions with OHRQoL and dentures respectively. Descriptive statistics, the Shapiro-Wilk normality test, the Mann-Whitney non-parametric test and the Kruskal-Wallis test were used.

RESULTS

Statistically significant differences were found between gender, prosthetic type, usage duration and OHIP and VAS scores (p < 0.05). Women's OHIP scores were higher than men's, patients using complete dentures had higher scores than those using partial dentures in both jaws, those using dentures for less than 1 year had higher scores than those that had used them for more than 1 year. The analysis revealed no statistically significant differences in OHIP and VAS scores based on age, education level, and place of residence (p > 0.05).

CONCLUSIONS

Patients may find it easier to adapt to removable partial dentures compared to complete dentures. Therefore, in prosthetic planning, dentists should prioritize preserving existing teeth. Regardless of the type of prosthesis, patients adapt to their prostheses over time, leading to increased satisfaction with prolonged use. Since individuals do not have a habit of visiting the dentist when there is no known problem, dentists should encourage patients to attend regular dental check-ups.

Dentists' perceptions of providing care to community-dwelling older people

OBJECTIVES

This study explored the attitudes of New Zealand (NZ) general dental practitioners (GDPs) towards older adults living within the community and the barriers and difficulties caring for their oral health needs.

BACKGROUND

Adults are living longer and retaining teeth. Their dentitions are complex and alongside their dental needs, older adults often experience age-related systemic disease or decline. Ageism and stereotypical views of older adults impedes access to dental care. While there is some understanding of older adults and ageism from the perspective of dental students, there is a paucity of knowledge about dentists' management of this patient demographic.

MATERIALS AND METHODS

A mixed-methods survey questionnaire collected quantitative and qualitative data. Quantitative data were analysed descriptively followed by bivariate analysis. Qualitative data responses to open-ended questions were analysed thematically.

RESULTS

A total of 382 GDPs participated (response rate of 24%) and demonstrated positive attitudes and low levels of ageism towards older adults who they enjoyed treating. Confidence was positively related to clinical experience, and most dentists had engaged in gerodontology updates. Barriers to care for older adults were perceived to be beyond their control and mostly related to cost, chronic disease or age-related change. Consent processes could create difficulty and so collaboration with family or caregivers was important.

CONCLUSION

The GDPs displayed positive attitudes and confidence towards older adults who are a rewarding patient cohort. Gerodontology education during training and following graduation is critical to enhance oral health outcomes for older patients.

Dental teachers' perceptions about the status of geriatric dentistry in the dental curriculum: A qualitative exploration in the Indian context

BACKGROUND

The increasing geriatric population in India needs special attention from the oral health workforce. This study explores dental teachers' perceptions of the status of geriatric dentistry in the dental curriculum and the challenges of implementing geriatric dentistry curriculum in the present dental training sector in India from the trainers' (teachers) perspective.

METHODS

We utilised a qualitative approach, and four focus group discussions were conducted with/among various levels of academic teachers-Heads of Departments (n = 8), Board of Study members (n = 7), Deans (n = 5), Lecturers and Associate professors (n = 8). All discussions were audio-taped and transcribed. Data was analysed thematically, and coding was done using an inductive approach. Consensus on themes was achieved through deliberations.

RESULTS

Three themes were identified-Unique challenges in managing geriatric patients (bordering on Dental care, Attitude, Awareness, Social issues and dependency on family); Current issues with provision of geriatric care (Curricular concerns-Teachers' training, Students' training, Instructional content, timing of delivery; Students' and trainers' attitudes; Infrastructural issues) and Strategies for advancement (Sensitisation of policymakers, Collaboration with other agencies, Modification in course design, Improved educational strategies and Shift in patient care delivery).

CONCLUSION

Trainers perceived a strong need to develop geriatric competencies among dental students. A geriatric dentistry curriculum based on local needs could ensure the success and sustenance of change. Introducing specialisation in geriatric dentistry would ensure quality oral care for the rising geriatric population. Innovative teaching strategies, interdisciplinary training and the use of newer technologies could aid in improved teaching of geriatric dentistry.

Indonesian dentists' views on providing oral health care for older adults

BACKGROUND

With demographic changes in aging populations, dentists require special care protocols to treat older adults with diverse and complex oral health needs and problems. Knowledge, positive attitudes, and sufficient practice experience are essential components for promptly treating older adults. However, many dentists encounter multiple barriers influencing their willingness to provide care for older adults. This study assessed Indonesian dentists' knowledge, attitudes, and practices (KAP) in providing oral health care (OHC) for older adults, including their willingness and barriers.

METHODS

A cross-sectional survey was conducted with 392 dentists employing an online questionnaire between April and June 2022. The respondents' KAP was categorised utilising a modified Blooms' cut-off point of ≥60%. Data were analysed using descriptive statistics, the x2 test, and logistic regression.

RESULTS

Most dentists demonstrated adequate knowledge (62.2%), a positive attitude (95.4%), sufficient practice experience (91.6%), and a high willingness (98%) to provide OHC services for older adults. However, 91.4% encountered barriers primarily related to interpersonal communication, disease complexity and polypharmacy, and patient functional status. Significant associations were found between dentists' attitudes toward practices and willingness to attend geriatric dentistry training with knowledge.

CONCLUSION

Implementation of continuing professional development (CPD) in geriatric dentistry, the inclusion of geriatric dentistry into the undergraduate curriculum, and enhancing clinic accessibility for older adults may improve dentists' preparedness and benefit the future provision of OHC for older adults in Indonesia.

Barriers and facilitators to accessing oral healthcare for older people in the UK: a scoping review

Introduction Access to dental services is a growing problem for older people in the UK. The aim of this scoping review is to identify the barriers and facilitators influencing older people's ability to access oral healthcare in the UK based on the existing literature.Methods The scoping review followed the framework proposed by Levac and colleagues (2010). Peer-reviewed literature was retrieved in April 2023 from Web of Science, Medline, PsycInfo and CINAHL for the period 1973-2023. After screening, data were extracted to identify barriers and facilitators mapped to individual, organisational and policy-level factors. The themes generated were used to identify gaps in the literature and policy recommendations.Results Overall, 27 studies fulfilled the inclusion criteria. Most studies published were from England; there was a large representation of opinion pieces. The main barriers and facilitators related to cost of services, perceptions of dentistry, availability of services and both the dental and social care workforce.Conclusion Multiple barriers exist surrounding access to dental care for older people. Various facilitators exist but not all are successful. More research needs to be carried out on older people's access to dental services in the community, particularly for the 'oldest old' and minority groups.

Key factors in the future of oral and dental health in Iran using scenario writing approach

BACKGROUND

Oral and dental health can significantly impact individuals' quality of life. The World Health Organization introduces oral health as one of the essential priorities of public health worldwide. Given the lack of studies on the future of oral and dental health in Iran, this study used a futures studies approach to identify the factors in oral and dental health in Iran through scenario writing.

METHODS

This study was conducted in three stages including the scenario writing approach, qualitative methods, and exploratory future research. First, potential variables affecting future oral and dental health systems were extracted through interviews. The focus group discussion determined the uncertainty and importance of the variables. Then, the cross-impact balance matrix was imported into the Scenario Wizard software to identify the different states of the scenario generator variables and compatible scenarios were extracted.

RESULTS

Seventy variables were extracted as key variables affecting the future of oral and dental health. Regarding the importance and uncertainty, seventeen variables scored higher and fell into policy and governance, economy and financing, social, service delivery, and technology, serving as five categories of scenario generators. Fifteen scenarios with weak consistency and three with strong consistency were obtained using the Cross-Impact Balance matrix in Scenario Wizard software.

CONCLUSION

The probability of a pessimistic scenario where all five categories of the scenarios were in the worst possible state was higher due to its consistency. The government's support policies and commitment to oral and dental health were two key factors in the future. Achieving an optimistic and favorable scenario for the future of the country's oral and dental health system depends on the government and policymakers in the health sector adopting a positive attitude towards the role of oral and dental health services in improving societal health. In this scenario, the five categories of the scenario generators were in the best condition.

Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation

Background

Most water fluoridation studies were conducted on children before the widespread introduction of fluoride toothpastes. There is a lack of evidence that can be applied to contemporary populations, particularly adolescents and adults.

Objective

To pragmatically assess the clinical and cost effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults, using a natural experiment design.

Design

Retrospective cohort study using routinely collected National Health Service dental claims (FP17) data.

Setting

National Health Service primary dental care: general dental practices, prisons, community dental services, domiciliary settings, urgent/out-of-hours and specialised referral-only services.

Participants

Dental patients aged 12 years and over living in England (n = 6,370,280).

Intervention and comparison

Individuals exposed to drinking water with a fluoride concentration ≥ 0.7 mg F/l between 2010 and 2020 were matched to non-exposed individuals on key characteristics using propensity scores.

Outcome measures

Primary: number of National Health Service invasive dental treatments (restorations/'fillings' and extractions) received per person between 2010 and 2020. Secondary: decayed, missing and filled teeth, missing teeth, inequalities, cost effectiveness and return on investment.

Data sources

National Health Service Business Services Authority dental claims data. Water quality monitoring data.

Primary outcome

Predicted mean number of invasive dental treatments was 3% lower in the optimally fluoridated group than in the sub/non-optimally fluoridated group (incidence rate ratio 0.969, 95% CI 0.967 to 0.971), a difference of -0.173 invasive dental treatments (95% CI -0.185 to -0.161). This magnitude of effect is smaller than what most stakeholders we engaged with (n = 50/54) considered meaningful.

Secondary outcomes

Mean decayed, missing and filled teeth were 2% lower in the optimally fluoridated group, with a difference of -0.212 decayed, missing and filled teeth (95% CI -0.229 to -0.194). There was no statistically significant difference in the mean number of missing teeth per person (0.006, 95% CI -0.008 to 0.021). There was no compelling evidence that water fluoridation reduced social inequalities in treatments received or missing teeth; however, decayed, missing and filled teeth data did not demonstrate a typical inequalities gradient. Optimal water fluoridation in England in 2010-20 was estimated to cost £10.30 per person (excluding original setup costs). Mean National Health Service treatment costs for fluoridated patients 2010-20 were 5.5% lower per person, by £22.26 (95% CI -£23.09 to -£21.43), and patients paid £7.64 less in National Health Service dental charges per person (2020 prices).

Limitations

Pragmatic, observational study with potential for non-differential errors of misclassification in fluoridation assignment and outcome measurement and residual and/or unmeasured confounding. Decayed, missing and filled teeth data have not been validated. Water fluoridation cost estimates are based on existing programmes between 2010 and 2020, and therefore do not include the potentially significant capital investment required for new programmes.

Conclusions

Receipt of optimal water fluoridation between 2010 and 2020 resulted in very small health effects, which may not be meaningful for individuals, and we could find no evidence of a reduction in social inequalities. Existing water fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower National Health Service treatment costs. These relatively small savings should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.

Future work

National Health Service dental data are a valuable resource for research. Further validation and measures to improve quality and completeness are warranted.

Trial registrations

This trial is registered as ISRCTN96479279, CAG: 20/CAG/0072, IRAS: 20/NE/0144.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128533) and is published in full in Public Health Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

It's not just about the money: recruitment and retention of clinical staff in general dental practice - part 1: dentists

Increasing difficulties in recruitment and retention of dentists and dental care professionals in general dental practice in the UK is affecting delivery of NHS dental services. Reports of dissatisfaction among the general dental practice workforce indicate there is a significant risk to the future dental workforce supply which will affect access to dental care and worsen oral health inequalities. Understanding the factors related to job satisfaction and dissatisfaction of dental professionals would be useful in managing recruitment and retention issues and ensure a dental workforce exists which is able to meet the needs of the population. The aim of this literature review was to identify factors which contribute to job satisfaction and dissatisfaction of clinical staff in general dental practice. Database searching was conducted systematically through PubMed/Medline, Scopus, Ovid, and the National Grey Literature Collection. Part 1 of this two-part series discusses the factors relating to dentists. Twenty-two relevant articles were identified, which were qualitatively analysed using Herzberg's motivation-hygiene theory as an analysis tool. Target-driven and restrictive contractual arrangements are a major factor contributing to dissatisfaction of dentists, as well as time pressures, poor quality equipment, and unfair remuneration. Dental contract reform should aim to minimise factors contributing to dissatisfaction and increase factors which increase satisfaction, if sufficient numbers of dentists are to be persuaded to continue to provide state-funded dentistry.

Appointments Needed for Complete Denture for Frail Older Adults Residing in Long-Term Care Facilities: A Cross-Sectional Study

Frail older adults who reside in long-term care (LTC) facilities face multiple barriers in receiving dental care. In edentulous LTC patients, the fabrication of complete dentures (CDs) can present challenges, leading to an increase in procedural or post-insertion appointments. The aim of this cross-sectional study was to document the number of fabrication and post-insertion follow-up appointments for CDs in frail older adults residing in LTC facilities. Data were collected from electronic patient records (AxiUm) and the Index of Clinical Oral Disorder in Elders (CODE) software utilized by the University of British Columbia Geriatric Dentistry Program from 2002 to 2018. A total of 362 CDs were fabricated between 2002 and 2018 in 272 patients. The mean number of visits required was 4.13 and 4.32, with standard deviations (Std) of 1.45 and 1.25 needed to fabricate maxillary CDs and mandibular CDs, respectively. The mean number of follow-up visits was 1.04 for maxillary dentures and 1.09 for mandibular dentures, with an Std of 1.25 for both, similar to the results obtained for adult patients in community dental clinics. Several factors were found to be associated with an increased number of CD fabrication and follow-up visits. Pre-operative assessment of the patient's cognitive/physical status and intra-oral condition may indicate the estimated time needed to fabricate CDs.

Electrolysed oxidising water as a multi-purpose biocide in dental healthcare-A scoping review

OBJECTIVES

The objective of this scoping review was to map evidence of electrolysed oxidising water (EOW) as a biocide for dental applications of relevance to older people and identify research gaps.

BACKGROUND

EOW is an emerging, "green," and cost-effective biocide. There are no reviews on the landscape of EOW research as either an antiseptic or disinfectant in dental healthcare or its suitability for the oral healthcare of older people.

MATERIALS AND METHODS

The review follows the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Database searches (Google Scholar, PubMed, Web of Science, Ovid, Scopus and Science Direct) were undertaken using MESH terms and Boolean operators with no date restrictions, to identify full-text, original reports published in English-language peer-reviewed journals.

RESULTS

The search yielded 114 papers that met the inclusion/exclusion criteria. Dental applications of EOW include its use as an endodontic irrigant (39%); mouth rinse/surgical irrigant (21%); disinfectant for dental unit water lines (19%) and dental biomaterials (17%); and for antimicrobial efficacy, effects on oral tissues and on dental material properties. Most studies (83%) evaluated a single EOW formulation (acidic, moderately acidic or neutral) that was either generated at 'point-of-use' (POU; 72%), bottled ('ready-to-use', RTU; 24%) or from unspecified (3%) sources. Six reports evaluated storage-related parameters and 25 evaluated clinical applications; 89 were in vitro studies and one investigated the cost-effectiveness of POU EOW.

CONCLUSIONS

Neutral-pH, EOW is effective as an antimicrobial agent without deleterious effects on oral tissues. However, research on the impact of storage conditions, anti-Candida biofilm efficacy and mechanism of action against yeasts, long-term effects on denture materials and cost-effectiveness is required to establish the suitability of EOW as a multipurpose biocide for dental healthcare, including infection-control requirements relating to older people.

Interprofessional collaboration utilizing oral health therapists in nursing homes: Perceptions of oral health therapists and nursing home staff in Singapore

INTRODUCTION

Oral health therapists (OHTs) have the potential to increase the access to oral care for elderly residents in nursing homes (NHs).

AIMS

To evaluate the perceptions of NH staff and OHTs regarding the barriers and enablers toward oral care provision for elderly NH residents, and their perceptions toward interprofessional collaboration through the utilization of OHTs in NHs.

METHODOLOGY

Electronic surveys were completed by 231 direct care and 15 managerial staff from 15 NHs, and 103 OHTs. Factors influencing oral care provision, and aspects of awareness, capabilities, and willingness/interest toward collaboration were evaluated.

RESULTS

The OHTs and NH staff reported mutually positive responses toward interprofessional collaboration. The most frequently reported barriers by the NH staff were the lack of regular support from dental health professionals and inadequate knowledge and skills. The OHTs expressed willingness and competence in assisting the NH staff, but lacked regulatory and educational support.

CONCLUSION

OHTs have the potential to address the barriers faced by the NH staff, if adequately supported through policy and education. Oral health promotion in intermediate and long-term care sectors should take into account this potential for interprofessional collaboration through greater utilization of the skill-set of OHTs.

Storage-related stability and antimicrobial efficacy of bottled, neutral-pH Electrolysed Oxidising Water

OBJECTIVES

Denture stomatitis is prevalent in older people and poses serious health risks. Ready-to-use (RTU) neutral-pH Electrolysed Oxidizing Water (EOW) is an effective environmental disinfectant used in residential care settings and geriatric wards. However, the influence of storage on stability and effectiveness for denture disinfection has not been established. This research investigated the storage-related stability and antimicrobial activity of RTU EOW, and its efficacy against Candida albicans biofilms formed on denture resin.

METHODS

The pH, oxidation/reduction potential (mV), available chlorine content (mg/L) and [HOCl] (mM) of RTU EOW (Envirolyte, New Zealand) solutions (n = 22) were measured from bottle opening to 28 days following storage at 4 °C, room temperature (RT) or 37 °C. Staphylococcus aureus and C. albicans cells were incubated in 80% EOW for contact times (CTs) up to 15 min and colony-forming units (cfu) determined. Minimum inhibitory concentrations (MIC90 EOW-HOCl) after CTs up to five minutes were determined for S. aureus and C. albicans reference strains and clinical isolates. C. albicans-denture resin disc biofilms were assessed after a five-minute CT with undiluted EOW by XTT-metabolic activity assay.

RESULTS

[HOCl] remained stable when RTU EOW was stored at 4 °C or RT for five months after manufacture. One-minute CT resulted in log10 cfu reductions of >6 for S. aureus and >5 for C. albicans. Mean MIC90 for five-minute CT was 37 µM (S. aureus) and 54 µM (C. albicans). Undiluted EOW reduced C. albicans biofilm metabolic activity by 86%.

CONCLUSIONS

RTU neutral-pH EOW is stable over five-months storage and is an effective denture disinfectant.

CLINICAL SIGNIFICANCE

The efficacy of the RTU neutral EOW against C. albicans isolates and biofilms formed on denture resin surfaces supports its use as a denture disinfectant and can inform future research to assess its potential for preventing denture-related oral Candida infections in the older population, especially in resource-limited communities.

The association between denture use and cardiovascular diseases. The United States National Health and Nutrition Examination Survey 2009-2018

Introduction

Poor dental health is associated with cardiovascular diseases (CVD). However, the relationship between CVD and denture use is currently unknown. This study aimed to investigate whether denture use is associated with CVD among American adults.

Methods

10,246 non-pregnant subjects aged 30-59 years from five cycles (2009-2018) of the United States National Health and Nutrition Examination Survey (NHANES) were included in this study. Participants who were observed by a dental examiner wearing denture/partial denture/plates were defined as denture users. CVD was defined as self-reported coronary heart disease, myocardial infarction, angina pectoris, stroke, and congestive heart failure. The association between denture use and CVD was analyzed using logistic regression with adjustment for potential cofounders.

Results

4.4% (95% CI, 3.9-5.0) participants had CVD, and 3.5% (95% CI, 2.8-4.5) participants were denture users. Denture use was associated with CVD [OR = 4.26, 95% CI (2.90-6.28), P < 0.01], which remained significant [adjusted OR = 1.82, 95% CI (1.15-2.88), P < 0.01] after adjustments for sociodemographic characteristics, smoking, alcohol use, drug addiction, body mass index (BMI), and abnormal medical conditions including gum problem, hypertension, diabetes, and hyperlipidemia. Women with dentures had significantly higher odds of CVD [adjusted OR = 2.13, 95% CI (1.10-4.11), P = 0.025].

Conclusion

In this nationally representative survey, denture use was associated with CVD. Denture use may be an unconventional risk factor for assessing CVD risks, especially in women. Future studies are required to investigate whether CVD and denture use is causally related.

The effect of clinical interventions on the oral health-related quality of life in older adults

This paper reviews the literature to assess the effectiveness of oral health interventions in influencing oral health-related quality of life (OHRQoL) in older adults. Clinical studies published in 2010 onwards reporting oral health interventions in older adults and subsequent changes in OHRQoL were systematically searched in Medline, Web of Science and EMBASE databases. Reporting followed Preferred Reporting Items for Systematic Review and Meta-Analysis criteria. Eligibility evaluation and data abstraction from eligible studies were guided by predefined PICO questions and bias assessment by the Quality in Prognosis Studies tool. The search retrieved 144 articles. Of the 20 articles that met the eligibility criteria, 45% (9) reported a statistically significant improvement in OHRQoL. The majority of studies were conducted in adults with complete edentulism (70%) and mainly focused on implant provision to support a removable prosthesis (30%). The search indicates the limited scope of current literature on geriatric dental interventions, focusing mainly on denture realignments, denture fabrication and implant placement. Although the majority of the oral health interventions focused on edentulism and removable prostheses, there are many areas of oral health interventions and their potential impact on OHRQoL in this demographic group that have yet to be explored.

Effect of Various Retentive Element Materials on Retention of Mandibular Implant-Retained Overdentures

This study aimed to examine the retentive characteristics of each retentive element material and the effects from thermocycling using the two implant-retained mandibular overdenture model. Two stud abutments and three retentive element materials; nylon, polyetheretherketone (PEEK) and polyvinylsiloxane (PVS) were used in this study. Four tested groups, with a total of 40 overdentures, were fabricated, including a Locator® abutment with nylon retention insert (NY), Novaloc® abutment with PEEK retention insert (PK), Locator® abutment with PVS retention insert (RL), and Novaloc® abutment with PVS retention insert (RN). The retentive force (N) was measured before thermocycling, and at 2500, 5000, and 10,000 cycles after thermocycling. Significant changes in the percentage of retention loss were found in the NY and PK groups (p < 0.05) at 6 and 12 months for the RL group (p < 0.05) after artificial aging. The RN group exhibited a constant retentive force (p > 0.05). The tendency of the percentage of retention loss significantly increased for PEEK, nylon, and PVS silicone over time. The results of the present study implied that retentive element materials tend to lose their retentive capability as a result of thermal undulation and water dispersion. Nylon and PEEK, comprising strong polar groups in polymer chains, showed a higher rate of retention loss than polyvinylsiloxane.

Teaching of gerodontology to dental and dental hygiene therapy students in the UK

Introduction The demographic shift in the age profile of the UK is now well established. Older people have more complex requirements to maintain their oral health and appropriate training is required to provide good-quality oral and dental care. This research aimed to review the training in gerodontology currently being provided to undergraduate dental and dental hygiene therapy (DHT) students in the UK.Methods Quantitative data were generated through completion of an online questionnaire, emailed to the directors of dental education in each of the UK dental (n = 16) and DHT schools (n = 21). Data were analysed using IBM SPSS Statistics V26.Results There was a response rate of 37.5% from dental schools and 61.9% from DHT schools. Although gerodontology was being taught in every school that responded, it was only a standalone course in 16.7% of dental schools and 7.7% of DHT schools that responded. While all respondents reported a theoretical component, only 50% of dental schools and 53.8% of DHT schools reported providing clinical experience. Moreover, 33.3% of dental schools and 15.4% of DHT schools reported closely following the European curriculum guidelines in gerodontology.Conclusions The current training in gerodontology is not standardised across either dental or DHT schools in the UK and there seems to be a lack of awareness of the recommended European guidelines. The findings from this research demonstrate that future improvements in gerodontology training are still required for this to be achieved.

Memory decline in older individuals predicts an objective indicator of oral health: findings from the Sydney Memory and Ageing Study

Background

Growing evidence suggests that there is an association between poor oral health and cognitive function in late adulthood. However, most studies to date have relied on cross-sectional research methods that do not permit inferences about the temporality of any association. Moreover, the few longitudinal studies that do exist have typically relied on small samples and quite limited cognitive or oral health assessments. The aim of the present study was therefore designed to provide the first direct evaluation of whether cognitive function is predictive of poor oral health in older adults.

Methods

This longitudinal research included data from 339 participants aged 70 years or older from The Sydney Memory and Ageing Study (MAS), a large cohort of healthy community-dwelling older adults. Cognitive function was assessed using a battery of tests at baseline (Wave 1) in 2005 and six years later (Wave 4) in 2011. In 2015 (Wave 6), participants were assessed for oral health using the Oral Health Assessment Tool (OHAT), number of functional occluding pairs of natural teeth and sublingual resting saliva pH (SRSpH). Ordinal least squares regression analysis was used to model the effect of cognitive function on total OHAT score, and binomial logistic regression used for SRSpH and occluding pairs of functional teeth.

Results

Two models were tested. In the partially adjusted model, age, gender and years of education were included. The fully adjusted model additionally included medical conditions, general health, depression, smoking, alcohol consumption, functionality, and dental care utilization. The key finding to emerge was that a six-year change in memory (from Wave 1 to Wave 4) was associated with lower sublingual resting saliva pH at Wave 6 in partially (Odds Ratio (OR) = 0.65) and fully adjusted model (OR = 0.63).

Conclusions

This longitudinal study provides further evidence that a relationship between cognitive function and oral health exists, and also points to this relationship potentially being bi-directional, as previous evidence suggests. The findings from the study also suggest that older adults who present with greater than normal memory decline at an earlier point in life were more likely to experience poor oral health when this was evaluated at a later time-point, four years later.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02128-y.

Potential educational and workforce strategies to meet the oral health challenges of an increasingly older population: a qualitative study

INTRODUCTION

The demographic shift in the age profile of the UK is well established. Older people have more complex requirements to maintain their oral health.

OBJECTIVES

This research explored Gerodontology with influential and recognised UK experts in Dental Public Health, Dental Education and Gerodontology. Three main topics were explored: the dental challenges associated with the ageing population, the role of dental care professionals (DCPs) and the training of undergraduate dental professionals.

METHODS

Quantitative data from the literature were used to develop a topic guide for semi-structured interviews with a purposeful sample of nine participants. Initial analysis of the qualitative data was undertaken using NVivo V12 software and themes were identified. Final themes and subthemes were confirmed after a series of remote round table discussions.

RESULTS

Four themes and 14 subthemes were identified. These included disagreements and agreements, the challenges of providing dental care to the older adult population, and the delivery of dental care by the dental team and finally education. All participants had significant concerns about the oral and dental challenges of the older population.

CONCLUSIONS

The themes that emerged were complex and overlapping. Better utilisation of all members of the dental workforce was reported to be an essential approach, as was reorientation of existing care models with a focus on prevention. Regarding undergraduate education, the consensus was that the training was not adequate for both current and future needs.

Knowledge of nursing graduates on oral health care for older people in the long-term care

OBJECTIVES

Oral health self-care deteriorates in older adults due to a decreasing level of cognition increasing disability and/or a reduction in manual dexterity. Older adults in hospital care or residential care therefore increasingly need assistance for oral health care. There is an increase in dentate patients entering residential care due to advances in dentistry. It is suggested therefore that nurses in aged care increasingly need advanced knowledge to care for their older dentate patients to prevent and minimize progression of oral diseases, given the impact of poor oral health on general health. The current study was conducted to investigate the oral health care knowledge of nursing graduates across Aotearoa New Zealand.

METHODS

A cross-sectional study was conducted among third year nursing graduates in 18 nursing institutes in New Zealand. Oral health care knowledge and oral-systemic connection knowledge, and predictors of oral health care knowledge were investigated.

RESULTS

Total 148 students participated in the student's survey, making it 15% of 2020 graduates. The students' survey results suggested that nursing graduates have good basic oral health knowledge, however, their knowledge of the oral-systemic disease connection and the value of an examination of the oral cavity were poor.

CONCLUSION

The oral health care knowledge of nursing students and their ability to care for older adults relies on oral health care education in their nursing programs. A revision of curricula to improve oral health education in nursing programs is strongly recommended.

Hospitalization for Oral Health-Related Conditions of the Australian Ageing Population: Two Decades of Analysis

The burden of oral health care increases among older people, with a profound challenge in utilising dental services in primary dental care settings. This study aimed to analyse two decades of nationwide hospital separation patterns due to oral health-related conditions among older people. Ageing population data were obtained from the Australian Bureau of Statistics, including people aged 65 years and older. All principal diagnoses of oral health conditions (ICD-10-AM) were analysed in this study. The hospitalisation data included all separations of older people for the financial years 1998–1999 to 2018–2019. A total of 205,461 hospital separations were recorded for older people over a period of twenty-one years. More than 60% of these separations were collectively attributed to dental caries, disorders of teeth and supporting structures, diseases of the jaws, diseases of the pulp and periapical tissues. However, the average rate of separations per 10,000 people due to dental caries was the highest among the dental conditions (8.68). Furthermore, the remaining oral health-related conditions predict an annual percentage increase in the rate that would compromise their oral health quality of life. Dental caries and its sequela seem to be the leading cause for oral health-related hospital admissions in Australia for people aged 65 and older. This could be an indicator of the inadequacy of disease management in the primary dental care setting.

Nutrition and Frailty: Opportunities for Prevention and Treatment

Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future.

Probiotics, Prebiotics, Synbiotics and Dental Caries. New Perspectives, Suggestions, and Patient Coaching Approach for a Cavity-Free Mouth

Probiotic therapy forms a new strategy for dental caries prevention. Probiotic microorganisms possess the ability to displace cariogenic microorganisms and colonize the oral cavity. They can produce various antimicrobial substances such as bacteriocins, bacteriocin-like peptides, lactic acid, and hydrogen peroxide. Dairy products may be ideal for probiotic administration in dental patients. Many other means have been proposed, primarily for those allergic to dairy components, such as capsules, liquid form, tablets, drops, lozenges, sweetened cakes, and ice creams. The last two forms can be used in a coaching approach for children and elderly patients who find it difficult to avoid sugary beverages in their daily routine and benefit from the suggestion of easy, cheap, and common forms of delicacies. In caries prevention, the concept of the effector strain is already considered an integral part of the contemporary caries cure or prevention strategy in adults. Adults, though, seem not to be favored as much as children at early ages by using probiotics primarily due to their oral microbiome’s stability. In this non-systematic review we describe the modes of action of probiotics, their use in the cariology field, their clinical potential, and propose options to prevent caries through a patient coaching approach for the daily dental practice.

The Modern and Digital Transformation of Oral Health Care: A Mini Review

Dentistry is a part of the field of medicine which is advocated in this digital revolution. The increasing trend in dentistry digitalization has led to the advancement in computer-derived data processing and manufacturing. This progress has been exponentially supported by the Internet of medical things (IoMT), big data and analytical algorithm, internet and communication technologies (ICT) including digital social media, augmented and virtual reality (AR and VR), and artificial intelligence (AI). The interplay between these sophisticated digital aspects has dramatically changed the healthcare and biomedical sectors, especially for dentistry. This myriad of applications of technologies will not only be able to streamline oral health care, facilitate workflow, increase oral health at a fraction of the current conventional cost, relieve dentist and dental auxiliary staff from routine and laborious tasks, but also ignite participatory in personalized oral health care. This narrative article review highlights recent dentistry digitalization encompassing technological advancement, limitations, challenges, and conceptual theoretical modern approaches in oral health prevention and care, particularly in ensuring the quality, efficiency, and strategic dental care in the modern era of dentistry.

Towards 3D Multi-Layer Scaffolds for Periodontal Tissue Engineering Applications: Addressing Manufacturing and Architectural Challenges

Reduced periodontal support, deriving from chronic inflammatory conditions, such as periodontitis, is one of the main causes of tooth loss. The use of dental implants for the replacement of missing teeth has attracted growing interest as a standard procedure in clinical practice. However, adequate bone volume and soft tissue augmentation at the site of the implant are important prerequisites for successful implant positioning as well as proper functional and aesthetic reconstruction of patients. Three-dimensional (3D) scaffolds have greatly contributed to solve most of the challenges that traditional solutions (i.e., autografts, allografts and xenografts) posed. Nevertheless, mimicking the complex architecture and functionality of the periodontal tissue represents still a great challenge. In this study, a porous poly(ε-caprolactone) (PCL) and Sr-doped nano hydroxyapatite (Sr-nHA) with a multi-layer structure was produced via a single-step additive manufacturing (AM) process, as a potential strategy for hard periodontal tissue regeneration. Physicochemical characterization was conducted in order to evaluate the overall scaffold architecture, topography, as well as porosity with respect to the original CAD model. Furthermore, compressive tests were performed to assess the mechanical properties of the resulting multi-layer structure. Finally, in vitro biological performance, in terms of biocompatibility and osteogenic potential, was evaluated by using human osteosarcoma cells. The manufacturing route used in this work revealed a highly versatile method to fabricate 3D multi-layer scaffolds with porosity levels as well as mechanical properties within the range of dentoalveolar bone tissue. Moreover, the single step process allowed the achievement of an excellent integrity among the different layers of the scaffold. In vitro tests suggested the promising role of the ceramic phase within the polymeric matrix towards bone mineralization processes. Overall, the results of this study demonstrate that the approach undertaken may serve as a platform for future advances in 3D multi-layer and patient-specific strategies that may better address complex periodontal tissue defects.

Incorporating oral health care education in undergraduate nursing curricula - a systematic review

Background

The recognised relationship between oral health and general health, the rapidly increasing older population worldwide, and changes in the type of oral health care older people require have raised concerns for policymakers and health professionals. Nurses play a leading role in holistic and interprofessional care that supports health and ageing. It is essential to understand their preparation for providing oral health care.Objective: To synthesise the evidence on nursing students' attitudes towards, and knowledge of, oral healthcare, with a view to determining whether oral health education should be incorporated in nursing education.

Methods

Data sources: Three electronic databases - PubMed, Scopus, and CINAHL.Study eligibility criteria, participants and interventions: Original studies addressing the research objective, written in English, published between 2008 and 2019, including students and educators in undergraduate nursing programs as participants, and conducted in Organisation of Economic Co-operation and Development countries.Study appraisal and synthesis methods: Data extracted from identified studies were thematically analysed, and quality assessment was done using the Mixed Methods Appraisal Tool.

Results

From a pool of 567 articles, 11 met the eligibility criteria. Findings documented five important themes: 1.) nursing students' limited oral health knowledge; 2.) their varying attitudes towards providing oral health care; 3.) the need for further oral health education in nursing curricula; 4.) available learning resources to promote oral health; and 5.) the value of an interprofessional education approach to promote oral health care in nursing programs.Limitations: The identified studies recruited small samples, used self-report questionnaires and were conducted primarily in the United States.

Conclusions

The adoption of an interprofessional education approach with a focus on providing effective oral health care, particularly for older people, needs to be integrated into regular nursing education, and practice. This may increase the interest and skills of nursing students in providing oral health care. However, more rigorous studies are required to confirm this. Nursing graduates skilled in providing oral health care and interprofessional practice have the potential to improve the oral and general health of older people.

The association between denture care and oral hygiene habits, oral hygiene knowledge and periodontal status of geriatric patients wearing removable partial dentures

Purpose:

This study aims to evaluate the association of the denture care with oral hygiene habits, knowledge and periodontal status geriatric patients wearing removable partial denture (RPD) and to compare the relationship between denture cleaning and tooth brushing frequency.

Patients and methods:

In total, 553 participants wearing RPD for at least 6 months and aged 65–86 years were asked to complete a questionnaire following the clinical examination. Chisquare analysis and Fisher’s exact test utilized to analyze the data.

Results:

A significant relationship was found between the frequency of smoking, denture age, overnight denture wearing, denture stomatitis and denture cleaning (p<0.05). 54.10% of the participants reporting that they did not have information about denture care had poor denture cleaning. Among patients brushing once per day, 26.34% had a good level of denture cleaning; whereas, this was 39.40% for those brushing three times in a day.

Conclusion:

The type of advice (verbal or written) and oral hygiene habits demonstrated a more significant impact on the cleaning level of dentures than the socioeconomic level, smoking, overnight use, denture age. The success of denture maintenance might depend on the patients’ knowledge of denture care and hygiene habits and geriatric patients’ motivation.

Stomatological disorders in older people: An epidemiological study in the Brazil southern

BACKGROUND

The aim of this retrospective, cross-sectional and observational study was to perform a survey of the stomatological conditions of elderly patients seen in a period of 40 years at a Stomatology Service in Southern Brazil.

MATERIAL AND METHODS

A total of 24,347 medical records were reviewed, of which 5,063 belonged to elderly patients aged 60 to 97 years. The stomatological conditions, systemic conditions, and smoking and alcohol drinking habits as well were recorded.

RESULTS

The mean age of the patients was 69.29 years, 67.1% were female and 32.9% were male. Variations of normality accounted for 44.5% of the cases. The most prevalent disorders were fungal infections (26.1%), reactive inflammatory lesions (24.6%), burning mouth syndrome (14.9%), benign neoplasms (12.4%), autoimmune disorders (12.3%), premalignant lesions (10.2%) and malignant epithelial neoplasms (7.2%). Regarding biopsied lesions, squamous cell carcinoma was the most prevalent at 30.2%, followed by hyperplasic lesions (28.2%).

CONCLUSIONS

Knowledge of these physiological and pathological conditions in the oral cavity of the older people is essential for early diagnosis and preventive and therapeutic measures when necessary.

Yeast Species in the Oral Cavities of Older People: A Comparison between People Living in Their Own Homes and Those in Rest Homes

Oral candidiasis is prevalent among older people due to predisposing factors such as impaired immune defenses, medications and denture use. An increasing number of older people live in rest home facilities and it is unclear how this institutionalized living affects the quantity and type of fungi colonizing these people's oral cavities. Smears and swabs of the palate and tongue and saliva samples were taken from participants residing in rest homes (RH; n = 20) and older people living in their own homes (OH; n = 20). Yeast in samples were quantified and identified by culturing on CHROMagar Candida and sequencing the ITS2 region of rDNA. A higher proportion of RH residents had Candida hyphae present in smears compared to OH participants (35% vs. 30%) although this difference was not statistically significant (p = 0.74). RH residents had, on average, 23 times as many yeast per mL saliva as OH participants (p = 0.01). Seven yeast species were identified in OH samples and only five in RH samples, with Candida albicans and Candida glabrata being the most common species isolated from both participant groups. The results indicate that older people living in aged-care facilities were more likely to have candidiasis and have a higher yeast carriage rate than similarly aged people living at home. This may be due to morbidities which led to the need for residential care and/or related to the rest home environment.

Oral health status of long-term care residents in Canada: Results of a national cross-sectional study

OBJECTIVE

To describe the oral health and oral prosthetic status of long-term care residents in four Canadian provinces.

BACKGROUND

Oral health can have significant impact on the health and quality of life of older adults. Seniors in long-term care are highly dependent on care staff for basic activities of daily living and are at risk for poor oral health.

MATERIALS AND METHODS

Five hundred and fifty-nine randomly selected residents were examined from thirty-two long-term care homes in Alberta, Manitoba, Ontario and New Brunswick, Canada. Four experienced registered dental hygienists, one in each province, completed a standardised oral health examination with each participant, examining lip health, breath odour, saliva appearance, natural teeth count, gingival inflammation, tooth and jaw pain, denture status, mucosal status and oral health abnormalities.

RESULTS

Of the examined residents, 57.6% were dentate, with an average of 16.4 (SD = 8.0) teeth. Most dentate residents had moderate or severe inflammation on at least one tooth (79.6%). Sixty per cent of residents wore dentures, and 43.2% of edentulous residents had poor hygiene of their dentures. Nine per cent of residents required urgent dental treatment for oral health problems such as broken teeth, infection, severe decay and ulcers.

CONCLUSION

This study provides an estimate of the prevalence of oral health problems in residents living in long-term care homes across Canada and indicates that improvement in oral health care is needed. Future work on development strategies aimed at optimising oral health for long-term care residents is required.

External cervical resorption: part 2 - management

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults athospital admission

BACKGROUND

Malnutrition in patients admitted to hospital may have detrimental effects on recovery and healing. Malnutrition is preceded by a state of malnutrition risk, yet malnutrition risk is often not detected during admission. The aim of the current study was to investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission.

METHODS

A cross-sectional was study conducted in 234 older adults (age ≥ 65 or ≥ 55 for Māori or Pacific ethnicity) at admission to hospital in Auckland, New Zealand. Assessment of malnutrition risk status was performed using the Mini Nutritional Assessment Short-Form (MNA®-SF), dysphagia risk by the Eating Assessment Tool (EAT-10), muscle strength by hand grip strength and cognitive status by the Montreal Cognitive Assessment (MoCA) tool.

RESULTS

Among 234 participants, mean age 83.6 ± 7.6 years, 46.6% were identified as at malnutrition risk and 26.9% malnourished. After adjusting for age, gender and ethnicity, the study identified [prevalence ratio (95% confidence interval)] high dysphagia risk [EAT-10 score: 0.98 (0.97-0.99)], low body mass index [kg/m²: 1.02 (1.02-1.03)], low muscle strength [hand grip strength, kg: 1.01 (1.00-1.02)] and decline in cognition [MoCA score: 1.01 (1.00-1.02)] as significant predictors of malnutrition risk in older adults at hospital admission.

CONCLUSION

Among older adults recently admitted to the hospital, almost three-quarters were malnourished or at malnutrition risk. As the majority (88%) of participants were admitted from the community, this illustrates the need for routine nutrition screening both at hospital admission and in community-dwelling older adults. Factors such as dysphagia, unintentional weight loss, decline in muscle strength, and poor cognition may indicate increased risk of malnutrition.

Dental care for the elderly through a Capped-fee funding model: Optimising outcomes for primary government dental services

OBJECTIVE

The objectives of this study were to (i) compare a Capped Payment formula for adults, to the fee-for-service model and the New South Wales Government services payment model; (ii) identify the presenting oral health needs of a 65+ years of age cohort during the period January 2011 to March 2015.

BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD

Australia faces an ageing population with the vast majority accessing free market dental care, whilst the poor access Government services. This cohort retains most of their dentition increasing demand on Government services.

MATERIALS AND METHODS

The analysis of New South Wales Government adult de-identified patients' record unit data was from 2011 to 2015, for the three payment models and undertaken in three stages; (i) development of the Capped Payment Model; (ii) evaluation of twenty (20) case studies of adults 65+ years of age; (iii) analyse the cost efficiency of the three payment models.

RESULTS

This study found that the Government model was the most cost effective. The Capped-fee model performed less efficiently, particularly in the 75+ age group, with the fee-for-service model generally more costly. It was $2580 (85%) more costly for the 65-74 age cohort, and $4619 (66%) for the 75+ age cohort.

CONCLUSION

Policy makers in partnership with Government and private service providers should seek to develop partnerships with Government, private services and universities, scope opportunities in applying a Capped-fee funding model, and one that helps address the oral needs of the elderly.

Aspects of Malpractice in Prosthodontics

Crowns, fixed partial dentures, and removable dentures are the popular prosthetic dental restorations in current dental practice. Prosthodontic rehabilitation of the mouth, particularly in advanced and complex cases, requires careful planning, adequate clinical skills, and exacting technical standards. While a successful outcome is the ultimate goal for any prosthodontic treatment, complications, injuries, dissatisfaction, and/or failure may occur. When such events develop as a result of negligence or violation of standards of care, they are considered under the term of malpractice and may incur ethical and medico-legal implications. This paper reviews and highlights some aspects of malpractice in prosthodontics. The current state of prosthodontic malpractice on a global level will also be evaluated. Standards of prosthodontic care, current literature of prosthodontic malpractice, where and how prosthodontic malpractice occurs, and recommendations for the future are presented. A thorough understanding of what is quality prosthodontic care and what disrupts this care can be a useful guard against professional litigation and may protect patients from poor quality of dental prosthetic care.

Edentulism and associated factors among community-dwelling middle-aged and elderly adults in China

OBJECTIVE

To investigate the prevalence of self-reported edentulism and its associated risk factors among community-dwelling adults aged 45 years and older in China.

MATERIALS AND METHODS

Data from the national baseline survey (2011-2012) of the China Health and Retirement Longitudinal Study (CHARLS) were used for this study (N = 17 167). Bivariate and multivariate logistic regressions were conducted to assess the predictors of edentulism. Models 1 and 2 were based on the whole sample. Models 3 and 4 were based on the subsample (N = 9933) from whom anthropometric and blood biomarker data were available.

RESULTS

The prevalence of edentulism was 8.64% among Chinese adults aged 45 and above. As shown by Model 1, older age was a robust predictor for edentulism (odds ratio [OR] = 3.81 for people aged 55-64; OR = 11.22 for people aged 65-74; OR = 24.05 for people aged 75 and above). Other factors positively associated with edentulism included being female (OR = 1.25), rural residence (OR = 1.30), asthma (OR = 1.48), depression (OR = 1.20), reduced physical function (OR = 1.37) and current smoking status (OR = 1.36). People with higher educational levels (OR = 0.75 for people who can read and write; OR = 0.64 for people who obtained a junior high school education or above) and better-off economic status (OR = 0.80) were less likely to be edentate. The association between edentulism and age, educational level, economic status and physical function remained significant in Model 3, and in addition, being underweight appeared as another strong predictor (OR = 1.93).

CONCLUSIONS

The estimated prevalence of edentulism and the identified associated factors will provide epidemiologic evidence for future research and interventions in the target population in China.

Designing for Safety: Implications of a Fifteen Year Review of Swallowed and Aspirated Dentures

Objectives

Dentures are worn by around 20% of the population, yet if they become displaced they may enter the gastrointestinal or respiratory system, sometimes with grave consequences. The aim of this study was to review recent published literature in order to identify the epidemiology of patients and characteristics of swallowed and aspirated dental prostheses, and propose strategies to minimise these risks.

Material and Methods

A fifteen year retrospective of published case series and case reports was carried out. Photographs, radiographs and descriptions of the dental prostheses were gathered, as well as the patient’s presenting complaint, the anatomical site where the denture was caught and the procedure required to remove the denture.

Results

Ninety one separate events of swallowed or aspirated dentures were identified from 83 case reports and series from 28 countries. Average age was 55 years, and these were 74% male. Photographs were retrieved for 49 of these dentures. Clasps were present in 25 of the dentures. There was no significant difference between clasped and unclasped dentures for perforation rates, need for open surgery and spontaneously passed dentures.

Conclusions

We discuss the implications of this study regarding denture designs, specifically the importance of using a radiopaque acrylic, using clasps when required even if there is a risk of aspiration, advising patients to return if a denture is loose or damaged, and finally that all patients who wear a denture are at risk of aspiration and swallowing events, and associated morbidity and mortality.

Burden of poor oral health in older age: findings from a population-based study of older British men

OBJECTIVES

Evidence of the extent of poor oral health in the older UK adult population is limited. We describe the prevalence of oral health conditions, using objective clinical and subjective measures, in a population-based study of older men.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A representative sample of men aged 71-92 years in 2010-2012 from the British Regional Heart Study, initially recruited in 1978-1980 from general practices across Britain. Physical examination among 1660 men included the number of teeth, and periodontal disease in index teeth in each sextant (loss of attachment, periodontal pocket, gingival bleeding). Postal questionnaires (completed by 2147 men including all participants who were clinically examined) included self-rated oral health, oral impacts on daily life and current perception of dry mouth experience.

RESULTS

Among 1660 men clinically examined, 338 (20%) were edentulous and a further 728 (43%) had <21 teeth. For periodontal disease, 233 (19%) had loss of attachment (>5.5 mm) affecting 1-20% of sites while 303 (24%) had >20% sites affected. The prevalence of gingival bleeding was 16%. Among 2147 men who returned postal questionnaires, 35% reported fair/poor oral health; 11% reported difficulty eating due to oral health problems. 31% reported 1-2 symptoms of dry mouth and 20% reported 3-5 symptoms of dry mouth. The prevalence of edentulism, loss of attachment, or fair/poor self-rated oral health was greater in those from manual social class.

CONCLUSIONS

These findings highlight the high burden of poor oral health in older British men. This was reflected in both the objective clinical and subjective measures of oral health conditions. The determinants of these oral health problems in older populations merit further research to reduce the burden and consequences of poor oral health in older people.