Oral health status of a group of elderly Canadian Inuit (Eskimo)

Tooth loss and dental caries in community-dwelling older adults in northern Manhattan

OBJECTIVE

To examine tooth loss and dental caries by sociodemographic characteristics from community-based oral health examinations conducted by dentists in northern Manhattan.

BACKGROUND

The ElderSmile programme of the Columbia University College of Dental Medicine serves older adults with varying functional capacities across settings. This report is focused on relatively mobile, socially engaged participants who live in the impoverished communities of Harlem and Washington Heights/Inwood in northern Manhattan, New York City.

MATERIALS AND METHODS

Self-reported sociodemographic characteristics and health and health care information were provided by community-dwelling ElderSmile participants aged 65 years and older who took part in community-based oral health education and completed a screening questionnaire. Oral health examinations were conducted by trained dentists in partnering prevention centres among ElderSmile participants who agreed to be clinically screened (90.8%).

RESULTS

The dental caries experience of ElderSmile participants varied significantly by sociodemographic predictors and smoking history. After adjustment in a multivariable logistic regression model, older age, non-Hispanic Black and Hispanic race/ethnicity, and a history of current or former smoking were important predictors of edentulism.

CONCLUSION

Provision of oral health screenings in community-based settings may result in opportunities to intervene before oral disease is severe, leading to improved oral health for older adults.

Active and inactive caries lesions in a selected elderly institutionalised French population

Various epidemiological investigations have shown the high prevalence and incidence of caries in geriatric populations. The aim of the present study was to evaluate the dental status and some salivary parameters of elderly French subjects institutionalised in a geriatric hospital. The study population included 117 subjects (31 males and 86 females) who were neither demented nor edentulous, with a mean age of 83.0 years (SD = 7.8). Crown and root caries were recorded according to a modified caries activity index on 17,442 surfaces (9 surfaces per tooth: 5 crown surfaces and 4 root surfaces). The 17,442 surfaces examined corresponded to 1,938 teeth. The mean number of teeth per subject was 16.6 (SD = 7.6), more teeth remaining in the mandible than in the maxilla. The 2,985 unsound root surfaces showed a high percentage of active lesions (31.2 per cent) and a low percentage of filled root surfaces (4.5 per cent). Crowns and roots also presented a high percentage of destroyed surfaces: 1,446 destroyed surfaces, 8.3 per cent of the examined surfaces. Salivary parameters (flow rate and buffer capacity) were also recorded. Stimulated salivary flow rate had a relationship with crown caries (linear regression and analysis of covariance), and buffer capacity with root caries (analysis of variance and covariance). The data illustrate critical treatment needs in French geriatric institutions. This situation, which appears to differ from previous reports in European and US elderly people, may be related to French specificities concerning oral health status and/or care policy, but also to the usually very old population.

Periodontal diseases: epidemiology

1. The interpretation of epidemiological data of periodontal disease is difficult, due to inconsistencies in the methodology used. It is not possible, therefore, to accurately assess if the prevalence of the periodontal diseases shows a world-wide decline. As long as the disease is assessed through accumulated clinical attachment loss, retention of the natural dentition in older ages entails increased prevalence in these cohorts. Contemporary epidemiological studies should ideally employ full-mouth examination of the periodontal tissues. Partial recording estimates are generally biased, especially when the prevalence of the disease is low. 2. Early-onset periodontitis is infrequent in all populations. Adult periodontitis is rather prevalent; however, advanced disease affects limited subfractions of the population (probably less than 10 to 15%). Although prevalence figures vary with race and geographic region, in most cases, the progression pattern of the disease seems compatible with the retention of a functional dentition throughout life. 3. Of a plethora of behavioral and environmental risk markers identified by multi-variate analysis, smoking and presence of certain subgingival microorganisms have been proven to be true risk factors. The same holds true for diabetes mellitus, a systemic condition that confers a risk for periodontal disease which is independent of the effect of other significant factors. 4. In certain cases, periodontal infections appear to have a systemic impact on the host. Most recent data indicate that periodontal disease may confer risk for coronary heart disease and pre-term low birth weight.

Oral health status of a population of community-dwelling older Canadians

A sample of 170 responsive residents of seniors housing centres in Winnipeg, Canada, were studied, (>65 years, mean 82 years), with the objectives of relating their dental state to their perception of need and uptake of service. Only 6% rated their oral health as poor, 46% reported a dental visit within the previous year and 68% felt they needed dental treatment. A lack of perceived need (88%) was the primary reason why dental care was not sought more frequently. Hygiene practices revealed that only 7% brushed < 1 time/day, 60% never flossed, 14% cleaned their dentures <1 time/day, and 42% slept with their dentures. Dental histories showed that examination (94%), prosthodontic treatment (76%), and restorative services (65%) were the most commonly sought treatments. Perceived dental needs included prosthodontic treatment (39%), periodontal/prophylactic treatment (10%), restorative treatment (9%) and pain relief (9%). Study subjects had 2.8 decayed teeth, a DMFT of 25.1, and a Root Caries Index of 38%. CPITN scores of 3 or 4 in at least one sextant were found in 80% of subjects. Of the 41% edentulous, all wore complete dentures but 15% of complete upper dentures and 51% of complete lower dentures fitted poorly. Of the partial dentures, 20% fitted poorly. Soft tissue anomalies were seen in 67% of subjects and 47% had TMJ anomalies. Overall, 77% of edentulous subjects and all dentate subjects required some dental treatment even though 46% had seen a dentist within the preceding year. It is concluded that appropriate management of such people needs further attention.

Periodontal conditions in medically compromised elderly subjects: assessments of treatment needs

Periodontal conditions were studied in 42 dentate elderly subjects (mean age, 84.1 +/- 8.0 years). None of them had received recent dental care or was routinely seen by a dentist. Overall, they had 20.2 +/- 7.1 teeth (range, 6-32). The CPITN was used to assess periodontal status. Twenty-nine percent of all sextants were either edentulous or had only one remaining tooth. The overall oral hygiene was poor (Plaque Index, 1.8 +/- 0.5) and gingival inflammation severe (Gingival Index, 1.9 +/- 0.8). Significant correlations were found between: Gingival and Plaque Indices (r = 0.82, p < 0.001), and pocket depth and Gingival Index (r = 0.38, p < 0.05). Plaque Index was negatively correlated to the number of remaining teeth (r = -0.43, p < 0.050). Age and remaining teeth were negatively correlated (r = -0.38, p < 0.05). Thirty percent of the posterior sextants had a CPITN score of "4," and 75% of the posterior sextants had at least one site with a pocket depth 4 mm. Only 2.9% of all sites demonstrated pocket depth 6 mm and these sites were distributed among 67% of the subjects. The CPITN index was correlated to the mean pocket depth for the various sextants, the correlation varying between r = 0.67, p < 0.001 (upper right posterior) and 0.36, p < 0.05 (upper left posterior) sextants. The total manpower estimated to complete initial therapy for 42 patients was approximately 63 hours by a dentist and 85 hours by a dental hygienist.

Epidemiology of root caries

Many epidemiological studies have been conducted on a variety of populations. Unfortunately, comparison of the prevalence data, and to a lesser degree of the incidence data, between the various studies is of little use due to the lack of standardised diagnostic criteria, reporting methods and population diversity. In the few incidence studies which have been conducted around 30-40% of people developed root caries, although many adults in the population appear to have been affected by root caries. Many risk factors associated with the occurrence of root caries have been identified and these include oral, medical, mental, behavioural and psychosocial conditions.

Medical and dental status of a culture in transition, the case of the Inuit elderly of Canada

The medical and dental status, and drug utilisation patterns of Canadian Inuit elders (60+ years) were evaluated. Inuit elders averaged 6.3 medical conditions per person, primarily nervous systems-sense organ deficits, respiratory problems and systemic infections. The mean number of drugs being used was 2.5 per person, primarily analgesics, bronchodilators and antibiotics. Poorly fitting dentures, and high levels of tooth decay, periodontal disease, soft tissue and TMJ anomalies were documented. Compared to older southern Canadians, the medical and dental findings for these Inuit elders were different. Drug utilisation rates were consistent with older southern Canadians, but different drugs were taken.