Developing an instrument to support oral care in the elderly

Homebound oral care for older adults: A qualitative study of professional carers' perspectives in Perth, Western Australia

OBJECTIVE

To examine professional support workers and case managers' (professional carers) perspectives of what promoted or compromised oral health care in homebound adults aged over 65 years in Perth, Western Australia and identify professional carers' need for support in this context.

BACKGROUND

Accessing dental services can be difficult to navigate and unaffordable for homebound older adults. Paid carers often play a substantial role in facilitating access to services yet there is limited qualitative evidence of the perspectives of these stakeholders.

METHODS

Given limited evidence in this area, this simple qualitative study was informed by constructivist grounded theory. Participants comprised 15 professional carers of homebound older adults. Transcripts were analysed to identify participant perceptions of key barriers and enablers to providing oral health care.

RESULTS

Barriers to clients accessing dental care included participants' uncertainty around navigating the dental system, low priority of oral health care, affordability and confusion around who was responsible to provide oral care. Enablers included participants supporting clients' autonomy around oral care, better integration of oral care into primary health care and education and opportunity for training for professional carers.

CONCLUSION

Ensuring oral health is part of primary health plans, clarifying roles and responsibilities around delivering oral health care to homebound older adults and training carers were key findings. Inter-sectoral collaboration between the dental and aged care sectors can benefit dental practitioners and professional carers in shared learning and has likely flow-on effects for homebound older adults.

Proof of concept design for a toothbrush with on-board vacuum to reduce oral aspirates

BACKGROUND

Over the course of brushing, aerosolised particles develop in the mouth. In individuals who do not have the ability to expel these oral aspirates, they can be inhaled and cause aspiration pneumonia. This article showcases a novel vacuum toothbrush, termed "ToothVac," and provides findings from its first human trial.

METHODS

The ToothVac device suctions saliva and aspirates during brushing, storing them in a removable reservoir at the bottom of the brush, to minimise the risk of inhalation and subsequent infection. Further descriptions of the various components of the ToothVac are included. This trial involved 18 participants who brushed using the ToothVac with the vacuum suction turned on and then off.

RESULTS

The volume of saliva produced was measured and compared. The ToothVac significantly reduced the amount of saliva that was produced by these participants when brushing.

CONCLUSION

The device has potential clinical potential in that it may reduce the risk of aspiration pneumonia and related lung infections. Potential future research may include clinical trials for specific indications or marketing for oral aspirate removal, as well as optimisation of brush design using injection moulding for scalable manufacturing.

Dental plaque control strategies for the elderly population: A scoping review

OBJECTIVE

To review the scientific literature and identify dental plaque control strategies focussed on elderly people that improve plaque indices.

DESIGN

Scoping review (Joanna Briggs protocol).

DATA SOURCES

Individual search strategies developed for six databases. The selection of the manuscripts in two phases: title and abstract review, and complete review.

ELIGIBILITY CRITERIA

Studies on interventions for plaque control in elderly people (60y+). Epidemiological studies and those focussed on caregivers, health professionals and periodontal maintenance therapies were excluded.

RESULTS

The initial search yielded 2803 studies, 26 were included. The results were classified into: exclusively chemical (10), educational (9), exclusively mechanical (6), and combined mechanical and chemical (1). The studies reported different types of interventions: sugarless chewing gum, chlorhexidine (CHX) in different preparations and concentrations, mouthwash based on essential oils, stannous/sodium fluoride dentifrice and lactoferrin/lactoperoxidase tablets. Additionally, conventional and alternative toothbrushes and professional brushing were tested. Educational interventions included oral hygiene guidance, verbal information, and demonstrations of dental and denture cleaning procedures, and lifestyle changes. Many studies have reported strategies that improve dental plaque indices but without statistical significance when compared to control groups. Promising results were found with the use of CHX, sugarless chewing gum, professional brushing and educational strategies with demonstration, but the results were not long-lasting.

CONCLUSION

The literature reports that mechanical, chemical and educational strategies have some efficacy in dental plaque control in the elderly population. The results should be viewed with caution, considering the type of intervention (isolated or combined) and the maintenance of the results obtained.

Dependence on others for oral hygiene and its association with hand deformities and functional impairment in elders with a history of leprosy

OBJECTIVE

To analyse the frequency of dependence on others for oral hygiene and its association with hand deformities, frailty and dependence on others for basic activities of daily living (BADL) among elders with a history of leprosy.

BACKGROUND

Dependence on others for oral hygiene has not been considered in multifunctional geriatric assessments.

MATERIAL AND METHODS

Edentulous elders with a history of leprosy who used complete dentures and resided in a former leprosy colony were classified as independent or partially/completely dependent on others for brushing their dentures or rinsing and for BADL, and as frail or robust. The presence of hand deformities was assessed by an occupational therapist.

RESULTS

28.4% and 14.9% were completely/partially dependent on others for brushing and rinsing, respectively. The dependence for BADL was observed in 21.6% and hand deformities in 17.6%. A higher odds of dependence for brushing/rinsing was found among elders who were dependent on others for BADL. Brushing dependence (61.5%) was more frequent among participants with hand deformities than those without this condition (21.3%) (OR: 6.8; 95% IC: 1.2-37.9; P = .028). There was no association between frailty and brushing (P = .068) or rinsing (P = .202) dependence.

CONCLUSION

Approximately one-third of elders have a dependence on others for brushing; a smaller proportion is dependent on others for rinsing. Older people who are dependent on others for BADL and who present hand deformities are more likely to be dependent on others for denture brushing and rinsing. Elders may perform oral self-care even when they present frailty.

Oral care help to maintain nutritional status in frail older people

The purpose of this study was to evaluate the effect of continuous oral care on the nutritional status of older people who require care using a 1-year randomized, controlled study. Fifty-three residents of a nursing home in Japan participated in this study. Subjects were randomly divided into two groups, an oral care intervention group and control group. The subjects in the oral care intervention group received professional oral care from a dentist three times a week over the course of 1 year. Body weight, body mass index (BMI), serum albumin, and high-density lipoprotein cholesterol (HDL-C) were measured as objective indicators of nutritional status at baseline and after 1 year, and compared between the groups. In the oral care group, no significant decline was seen in all indicators from the start to the end of the intervention, but in the control group there was a statistically significant decline in all indicators at the end of the year. These results suggest that the intervention of oral care alone can serve to maintain the nutritional status of older people who require care. Implementation of continuous oral care is an important task from the viewpoint of maintaining nutritional status in older people.

Hand Function and Oral Hygiene in Older Institutionalized Brazilians

OBJECTIVES

To evaluate whether the oral hygiene of institutionalized older people differs significantly between groups of participants with different degrees of hand function.

DESIGN

Cross-sectional study.

SETTING

Residents of a long-term institution of Porto Alegre, Brazil.

PARTICIPANTS

Forty-nine institutionalized older people. Subjects restricted to bed or with Mini-Mental State Examination (MMSE) scores less than 15 were excluded.

MEASUREMENTS

Dental (Silness and Löe Index) and denture plaque (Modified Ambjornsen Plaque Index) scores were assessed as a measure of oral hygiene. Hand functions were assessed using the Jebsen-Taylor and the Purdue pegboard tests. Participants were grouped according to their levels of hand function (regarded as good if test values were at the median or higher in the case of Purdue pegboard test and below the median in the case of Jebsen-Taylor test). Existence of differences between groups was checked using univariate analysis of variance, adjusting for age, sex and cognitive status according to MMSE.

RESULTS

Dentate participants with poor hand function according to the Dominant Hand Purdue test harbored significantly more dental plaque after adjustment for age, sex, and cognitive status. Complete denture wearers with poor hand function according to the Dominant Hand and Sum of Three Steps Purdue tests and the total Jebsen-Taylor test also had significantly more denture plaque after adjustment.

CONCLUSION

The results support the notion that hand function plays a central role in oral hygiene, mainly removal of dental and denture plaque, in institutionalized older people.

Colonization of dental plaque by respiratory pathogens in dependent elderly

Pneumonia can be a life-threatening infection, especially in the elderly, and it is a significant cause of morbidity and mortality. The purpose of this study was to assess the existence of oral infectious pathogens potentially causing the respiratory disease in the dependent elderly. The dental plaques of 138 dependent elderly were examined to identify microorganisms by the culture method. Twenty-one species of microorganisms were detected in the dental plaques in this study. In 89 cases out of 138 (64.5%), potential respiratory pathogens colonized in the dental plaques of the dependent elderly. The results of the present study revealed that bacteria that commonly cause respiratory infection colonized in dental plaques of the aged, dependent subjects. Therefore, dental plaques must be considered a specific reservoir of colonization and subsequent aspiration pneumonia in dependent elderly.

Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubate, Brazil

OBJECTIVES

To record self-reported hygiene habits, examine the oral conditions of a sample group of institutionalised elderly, and examine possible relationships between these habits and conditions.

DESIGN

Cross-sectional.

SETTING

All the institutions for the elderly in Taubaté, Brazil.

SUBJECTS

The entire population of these institutionalised elderly people (n = 553).

INTERVENTION

The subjects were interviewed and underwent an oral examination.

MAIN OUTCOME MEASURES

Oral hygiene habits, oral conditions and statistical relationships between habits and oral conditions were recorded.

RESULTS

The average age of the subjects who knew their age (n = 364) was 74.9 years (+/-12.9), and 64.7% of the sample group were females. Denture-related stomatitis was found in 19.5%, impaired manual dexterity in 40%, dry mouth sensation in 36.3%, difficulty in performing oral hygiene in 20%, no oral hygiene-related orientation in 54.1%, no periodic oral examinations in 59.5%, and no tongue cleaning in 68.3% was declared. Among dentate subjects, 73.3% had periodontal disease, 54.7% had caries, 26% reported no toothbrushing, and 7.3% reported flossing. Of the denture wearers, 7% did not brush their dentures. Denture-related stomatitis showed a statistical relationship with impaired manual dexterity (p = 0.012) and an inverse statistical relationship with denture brushing frequency (p = 0.006). Periodontal disease showed an inverse relationship to flossing (p < 0.001) and tongue cleaning (p = 0.0026). Caries showed an inverse relationship with tooth-brushing (p = 0.043), flossing (0.022), proper oral hygiene orientation (p = 0.041) and periodical check-ups (p = 0.007).

CONCLUSION

Oral hygiene practices in this sample group were found to be inadequate, and statistically significant relationships were verified between the lack of good oral hygiene practices and the deleterious oral conditions.

The advantages of occupational therapy in oral hygiene measures for institutionalised elderly adults

OBJECTIVE

To investigate a new method in teaching and supervising tooth and denture brushing activities by employing occupational therapy techniques.

MATERIALS AND METHODS

Sixty-one residents, 44 women and 17 men, with an average age of 85.7 +/- 6.6 years (range 72-97 years) living in a Long-Term Care home (LTC) in Geneva were enrolled in a randomised controlled trial. They were divided at random into experimental (EG) and control groups (CG) with matched age and sex distribution. Two subjects passed away during the 3-month experimental period. Following medical history, plaque scores and tooth brushing habits were evaluated within the context of a comprehensive clinical assessment. Furthermore, a Mini Mental State and a vision test were taken. Based on the results of these health assessments both the EG and the CG were divided into an 'assisted' (IA) and an 'independent' (II) subgroup. In the EG, tooth brushing was initially taught and in the IA monitored and re-educated once a week by an occupational therapist. In contrast, the CG-IA group received a weekly placebo activity such as manicure by the same person.

RESULTS

From the individual movements taught and monitored by the occupational therapist, opening a tube of toothpaste (n.s.) and denture brushing (p < 0.05) were performed more independently after 3 months. Both the occupational therapy and the placebo activity led to a significant improvement in oral (p < 0.01 and 0.05) and in denture hygiene (p < 0.001 and 0.05). From all participants, the EG-IA subgroup presented the most significant amelioration in plaque (p < 0.01) and denture hygiene scores (p < 0.001). This group consisted mostly of subjects with an impaired cognitive state.

CONCLUSIONS

Despite the marked placebo effect, the results indicate that occupational therapy is particularly useful to improve the oral and denture hygiene in dependent and cognitively impaired LTC residents and may promote their autonomy in the execution of activities of daily life such as denture brushing.

High correlation between the bacterial species in denture plaque and pharyngeal microflora

OBJECTIVES

The morbidity and mortality of the dependent elderly that result from aspiration pneumonia are recognized as a major geriatric health problem. Most cases of bacterial pneumonia are initiated following colonization or superinfection of the pharynx by pathogenic bacteria, followed by aspiration of pharyngeal contents. A recent study revealed that bacteria, that commonly cause respiratory infection, colonized the dentures of dependent elderly. This suggests that denture plaque may function as a reservoir of potential respiratory pathogens to facilitate colonization on the pharynx. The purpose of this study was to determine the possible correlation between denture and pharyngeal microflora.

STUDY DESIGN

The denture and pharyngeal bacterial flora of 50 dependent elderly were examined, and the microorganisms identified by culturing. The agreement between the bacterial species in denture plaque and pharyngeal microflora was investigated using the Kappa method.

RESULTS

The microorganism species on the dentures and pharyngeal mucosa of the subjects had an agreement rate of 68.5%. The agreement rate for each of the bacterial species of the dentures and pharynx was also demonstrated to be high.

CONCLUSIONS

Dentures should be considered an important reservoir of organisations which could colonise the pharynx, and the importance of controlling denture plaque for the prevention of aspiration pneumonia cannot be overemphasized.