An investigation into denture loss in hospitals in Kent, Surrey and Sussex

The prevalence of denture loss within community residential settings

Introduction Denture loss prevalence in community settings is unknown and results in deteriorating residents' systemic and psychosocial wellbeing.Materials and methods An electronic survey was distributed nationally through professional networks to community residential settings.Results Of the 156 responses from community residential settings, 69% of settings experienced at least one denture lost in the last two years. Sixty percent of responders reported no dentures were labelled, only 64% had received training about how to care for dentures and 86% felt they would benefit from further training on mouth care. In addition, 68% of staff found arranging dental care for their residents challenging.Discussion Extrapolated data suggest that at least 10,205 dentures are lost annually in community residential settings and are never found, costing the NHS Business Service Authority more than £3 million. A high prevalence of denture loss in community residential settings is likely due to residents with multiple comorbidities and frailty. Remaking dentures poses financial, logistical, and patient challenges, which may result in patients being unable to wear a remade denture.Conclusion The prevalence of denture loss within community residential settings needs to be understood to encourage targeted interventions, inform stakeholders, and encourage workflows that will improve service delivery and patients' oral health-related quality of life.

Prevention of oral diseases for the older person (Part 2)

Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.

Digital denture scanning and 3D printing for residents in care homes: A feasibility study for pre-empting denture loss

OBJECTIVE

The aim of this study was to assess the feasibility of digitally scanning dentures and 3D printing replica dentures for care home residents. The study also investigated whether the process and replacement denture was acceptable to the resident.

BACKGROUND

Denture loss is a significant issue for people living in care homes and impacts on nutrition, quality of life and dignity. Denture loss is underreported, and care home residents have barriers to accessing dental care. The conventional process for remaking a denture can often take approximately 2 months with multiple clinical stages, often not feasible in adults with frailty and cognitive impairment. Scanning and 3D (3 dimensional) printing are increasingly used in dentistry, this rapidly evolving technology may provide an innovative solution to denture loss.

MATERIALS AND METHODS

A digital workflow was established using a handheld scanner and 3D printing technology. Care home residents wearing functional acrylic dentures were recruited. Dentures were scanned within the care home, and the scan was sent to a dental laboratory for 3D printing. The dentures were fitted at a subsequent visit, and semi-structured interviews were undertaken with the resident. Using thematic analysis, the feasibility of this pathway was assessed, and the use of digital scanning technology was explored.

RESULTS

Eight residents successfully had dentures scanned and replicated to a satisfactory standard. It took, on average, 10 minutes to scan a denture and 20 minutes to print the denture. All replica dentures were satisfactory to the resident. Qualitative data from semi-structured interviews showed that study participants were satisfied with denture replacements and the process. The 3 main themes that emerged were: the significance of dentures to the individual, satisfaction with the scanning process and general low self-esteem and fatigue.

CONCLUSIONS

This study has established a workflow for digitally storing dentures and replicating them satisfactorily. In the context of a care home setting, a scan of a denture can be used to provide a replacement denture if lost or broken. A large-scale study could follow now that the feasibility of this pathway has been demonstrated.

Current Denture Loss in Geriatric Facilities

Purpose: Denture loss is still being reported as a problem in geriatric facilities, although losses seem less frequent than in the last decade. However, there have been no reports that have examined recent losses of dentures in detail. The aim of this study was to clarify the actual situation of recent denture loss, together with the denture loss rate in Japan. Materials and methods: This retrospective study investigated the number of cases of denture loss, the denture loss rate for denture wearers, and the details of losses in geriatric facilities during the 1-year period from 1 April 2020 to 31 March 2021. Results: Eleven special elderly nursing homes and four group homes participated in this research. The number of residents from each was 315 and 40 and the number of denture wearers was 165 and 33, respectively (p < 0.001). The loss of dentures was found in one case from a special elderly nursing home and in one case from a group home. The loss rate for denture wearers was 1.01% in total, with 0.61% for special elderly nursing homes and 3.03% for group homes, with no significant differences between the two types of facilities. Conclusion: In geriatric facilities in Japan, the current 1-year denture loss rate for denture wearers was 1.01%. This seems to represent a considerable decrease when compared with the previous report. Further, proper denture management and staff efforts appear to have contributed to a reduction in denture loss against a background of promoting oral healthcare.

The impact of a quality improvement initiative to reduce denture loss in an acute hospital

Background Denture loss is a significant problem for patients admitted to hospital in the UK. Initiatives aimed at staff and patients have been introduced at many hospitals to try and reduce and solve this issue.Aim This investigation aimed to evaluate the impact of a quality improvement programme on denture loss at an acute hospital, including the reasons dentures were reported as lost or broken and who reported them.Method Information on dentures which were lost or broken was collected in an acute hospital between 2016-2021 and included the number of losses, the reason for the loss/breakage and who reported them. The number of complaints and financial reimbursement related to denture loss was also obtained from the trust for the same period.Results In total, 123 dentures were reported as lost or broken between 2016-2021. The most commonly reported reasons for loss were patient transfers between wards, being left on hospital trays, or when patients were sleeping. Patients or carers are more likely to report a lost denture compared to hospital staff. Reimbursement paid by the trust for denture incidents is much lower than the numbers reported.Conclusion Creating a single reporting pathway for denture loss and implementing methods to reduce denture loss led to an increase in the numbers of dentures reported as lost. This is likely to be attributed to an increased awareness of reporting pathways. Denture loss is a significant financial burden to the NHS, in addition to causing patients and families distress and is most likely under-reported in many hospitals.

Dental services use before and after inpatient admission among privately insured adults in the United States

BACKGROUND

Oral health has been connected to worse outcomes among hospitalized patients, but access to oral health care services in the hospital setting is limited. It is unknown how a hospital admission affects subsequent dental services use.

METHODS

The authors conducted a retrospective analysis of insurance claims data from a national private insurer. Patients were included if they were admitted to the hospital and had visited a dentist at least once in the year before or after admission. Total number of dental visits, as well as Code on Dental Procedures and Nomenclature codes associated with these visits in the year before and after a hospital stay, patient demographic characteristics, hospital admission diagnosis, and length of stay were recorded. Differences in dental services use before and after the hospital stay were calculated.

RESULTS

In total, 107,116 patients met inclusion criteria. There were fewer dental visits after admission (mean [standard deviation {SD}] 1.6 [1.7] than before admission (mean [SD] 1.9 [1.8]; P < .0001). Fewer procedures were recorded in the year after discharge (mean [SD] 7.0 [11.4] total Code on Dental Procedures and Nomenclature codes versus 8.5 [12.5] in the year before admission; P < .0001). The number of diagnostic and restorative services delivered was higher after admission, and the number of periodontic, endodontic, oral surgery, and prosthodontic services decreased (overall Pearson χ², P < .0001).

CONCLUSIONS

Patients are less likely to visit a dentist after a hospital stay, although impact on oral health is unknown.

PRACTICAL IMPLICATIONS

Hospitalization may contribute to already existing oral health disparities. Hospital teams and dentists should work together to enhance access to oral health care after hospital admission.

Family perceptions of mouth care for assisted living residents with dementia: Implications for care

Mouth care is an important component of care for persons with dementia in assisted living (AL). However, there is little information about family member knowledge, beliefs, and experiences with resident oral health. Family perceptions and involvement in care may impact oral and systemic health for AL residents. Therefore, semi-structured interviews to assess these domains were conducted with 23 adult family members of AL residents with dementia, from 9 AL communities. Thematic analysis found that families identified (1) the centrality of oral health to well-being; (2) organizational influences on mouth care; (3) mouth care in the context of dementia; and (4) collaboration to facilitate mouth care. Family perspectives can provide useful guidance for collaborative interventions that support oral health and mouth care in AL.

Behavior of 4 types of paper with printed QR codes for evaluating denture marking in conditions of extreme heat

STATEMENT OF PROBLEM

Quick response (QR) codes are a fast and efficient technology for linking and accessing identifying information, and their use has been proposed in forensics. The heat resistance and esthetics of denture marking methods (DMMs) have been recommended by the American Dental Association (ADA), but studies on these aspects of printed QR codes are lacking.

PURPOSE

The purpose of this study was to determine the optimal printed material with QR codes for implementation as a DMM adjusted to the recommendations of the ADA.

MATERIAL AND METHODS

The behavior of 4 types of paper, bond paper, fiberglass filter paper, ultralong hydroxyapatite nanowire paper, and polyolefin and silica paper with printed QR codes was analyzed. They were exposed to temperatures between 100 °C and 1000 °C in a heat muffle for 1 hour. Each specimen was subjected to both a morphological and a thermogravimetric analysis (TGA) and scanned by using 3 different smartphones.

RESULTS

The scans were positive for bond paper (33.3%), fiberglass fiber paper (50%), ultralong hydroxyapatite nanowire paper (100%), and polyolefin and silica paper (70.4%). The TGA revealed continuous decomposition curves (average 16.5 minutes at 624 °C).

CONCLUSIONS

Printed QR codes on ultralong hydroxyapatite nanowire paper appear to be suitable as information reservoirs, even surviving incineration, and may be implemented as a DMM conforming to the ADA recommendations.

O cuidado de enfermagem no acondicionamento da prótese dentária de idosos hospitalizados

Resumo Objetivo Compreender como é desenvolvido o cuidado de enfermagem no acondicionamento da prótese dentária de idosos hospitalizados. Métodos Trata-se de uma pesquisa descritiva e qualitativa. A coleta de dados foi realizada no período de setembro a outubro de 2018, por meio de entrevistas com 35 profissionais que compunham a equipe de enfermagem dos setores da unidade de terapia intensiva e da enfermaria de um hospital universitário de Salvador, Bahia, Brasil. Os dados foram analisados por meio da técnica de Análise de Conteúdo Temática. Resultados Foi possível compreender que há um descompasso no cuidado com as próteses dentárias, pois houve relato de divergente formato de acondicionamento entre os profissionais e ainda insuficiente registro sobre essa assistência. Foi possível perceber um aspecto positivo quando, pela ausência de material para guarda da prótese, houve estímulo para uma adaptação ao cuidado, que permitiu a diminuição de perdas da prótese no ambiente hospitalar. Conclusão O cuidado da equipe de enfermagem com a prótese dentária de idosos hospitalizados apresenta lacuna, sinalizando uma necessidade de maior atenção nesse instrumento de reabilitação do idoso.

Oral hygiene and mouth care for older people in acute hospitals: part 2

Acute hospital admission provides an excellent opportunity to address poor oral health in older people, a group rarely seen by dental professionals and for who oral health activity in hospital is inconsistent and generally suboptimal. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presented the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. The second article explores clinical recommendations. A change in philosophy is needed to embed oral care as an essential component of holistic practice. More research is needed to determine the best ways to assess and treat oro-dental problems in older people, and promote and restore their oral health in hospitals. Great potential exists to innovate and develop new ways of providing care to this group.