Oral health status in a group of the elderly population residing at home

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.

Oral Health Assessment Tool (OHAT) deputized to informal caregivers: Go or no go?

OBJECTIVE

Investigating the usability of the Dutch version of the Oral Health Assessment Tool (OHAT-NL) with informal caregivers of community-dwelling older people with suspected dementia, without specific training.

MATERIALS AND METHODS

In accordance with guidelines for establishing the cultural equivalency of instruments, the OHAT was translated into Dutch. Fifteen informal caregivers of community-dwelling older people with suspected dementia and, as a reference standard, a dentist assessed the oral health of the older people using the OHAT-NL. The caregivers' scores were compared with the dentist's scores. The usability of the OHAT-NL was rated on a 10-point scale (0 = incomprehensible, and 10 = very user friendly) and investigated further through short structured interviews.

RESULTS

There were differences between the dentist's and caregivers' assessments of the individual categories of the OHAT-NL. The specificity of the need to visit an oral health care professional was 100.0%, while the sensitivity was 78.6%. The informal caregivers concluded that the tool made them more aware of different aspects of oral health. The tool was rated with a mean score of 7.7 (SD 1.7).

CONCLUSION

The OHAT-NL could be a useful tool for informal caregivers without specific training to indicate whether the person they care for should visit an oral health care professional.

Remote Management of Prosthodontic Emergencies in the Geriatric Population During the Pandemic Outbreak of COVID-19

The global pandemic outbreak of coronavirus disease 2019 (COVID-19) has put the world in a panic situation. It has been evident that the geriatric population is more susceptible to acquire this infection. Thus, due to this ongoing crisis, geriatric individuals cannot visit a dental operatory, and there is the possibility of their dental needs and emergencies to remain unattended. Partial or complete edentulism is very prevalent among the geriatric population, and prosthodontic management of these patients is essential for their well-being. However, the prosthesis can lead to various emergencies of the oral and its supporting structures. There are currently no available recommendations to address these prosthodontic emergencies in geriatric individuals during this pandemic period. Hence, the aims of this minireview were to discuss the common prosthodontic emergencies in the geriatric population and provide recommendations to manage these issues during the COVID-19 pandemic outbreak.

A crossectional investigation of the relationship between complementary health insurance and frequency of dental visits in 15 to 64 years old of Tehran population, Iran, a secondary data analysis (urban HEART-2)

Background

This study aimed to investigate the relationship between complementary health insurance and frequency of dental visits.

Methods

The present study was performed using the Urban Health Equity Assessment and Response Tool (Urban HEART). A cross-sectional study was conducted in Tehran (Iran) to assess inequalities in health status among different socioeconomic and ethnic groups, genders, geographical areas, and social determinants of health. Out of 20,320 records retrieved from the original study with dental information, 17,252 had both dental insurance and dental visit information. Complementary health insurance as the main independent variable had three categories (i.e., basic insurance, with complementary medical coverage, and with dental coverage). The frequency of dental visits during the last year as a dependent variable had also three categories (i.e., no visit, one, and two, or more dental visits in the last year). In this study, in addition to investigating the relationship between complementary health insurance and frequency of dental visits, potential covariates that may affect the mentioned relationship were evaluated in the regression model. Statistical analyses included simple and multiple multinomial logistic regression considering the sampling method and sampling weights.

Results

The meanage of 17,252 participants (Tehran citizens) was 39.36 years; 49.4%were women, 86.0%hadonly basicinsurance, 7.2% had complementary medical insurance, and 6.8% had complementary dental insurance. Of all subjects, 43.8% reported no dental visit, 26.1% reported one, and 30.1% reportedtwoor more dental visits during the lastyear. The frequency of dental visits was lower in people who had basic insurance than others such that that odds ratio (OR) was 0.73 (p-value < 0.001) for one visit and 0.68 (p-value< 0.001) for two or more visits in the last year. The frequency of dental visits was also positively associated with dental brushing, toothpaste use, high educational level, being married, having more than 20 teeth, and having dental pain.

Conclusion

Having dental insurance increases the frequency of dental visits but the association between dental insurance and dental visits was independently influenced by other predictors.

Missing Teeth and Prosthetic Treatment in Patients Treated at College of Dentistry, University of Dammam

The percentage of completely and partially edentulous patients and their prosthetic treatment at the Department of Substitutive Dental Sciences (SDS), College of Dentistry, University of Dammam, were investigated. Panoramic radiographs and medical records of adult patients (n = 479, mean age 45.9 years, and range 25-96 years) treated in 2011-2014 were examined. 6% of the patients were completely edentulous, 8% had single jaw edentulousness, and 74% were partially edentulous. Edentulousness was significantly correlated with age and the number of missing teeth was significantly higher among males (p < 0.026). Diabetes was significantly associated with complete edentulousness, single edentulous jaw (p value 0.015), and partial edentulousness (p value 0.023). Kennedy class III was the most frequent class of partial edentulousness in single and/or both jaws (p = 0.000). Patients having class I and/or class II were treated most often with removable partial dentures (RPD) (p = 0.000), while patients having class III were treated with fixed partial dentures (FPD). It was found that complete edentulousness increases in older age and the number of missing teeth was significantly higher among males. Kennedy class III was most common in both upper and lower jaw and was treated more often with FPD than with RPD.

Effect of Patient's Personality on Satisfaction with Their Present Complete Denture and after Increasing the Occlusal Vertical Dimension: A Study of Edentulous Egyptian Patients

Complete denture wearers often find it difficult to accept a new denture. Personality traits are among the factors that possibly affect patient satisfaction with a complete denture. Our aim was to investigate the influence of patients' personality on satisfaction with their present denture and after an increase in the occlusal vertical dimension (OVD). Sixty edentulous patients with complete dentures (22 men and 38 women, mean age 66 years, and range 50–75 years) participated in the study. The age of their complete dentures ranged from 5 to 16 years. Patients' personalities were evaluated using the Arabic version of the Eysenck Personality Questionnaire. Their satisfaction with their dentures before and after restoration of the OVD and relining of the mandibular denture was evaluated using two questionnaires (I and II), Patients with a high score of neuroticism were less satisfied with their original dentures and after relining and an increase of OVD compared with patients with an average score in that trait. The personality trait of psychoticism was significant to patients' acceptance of an increase in OVD; that is, patients with a high score were less satisfied with their dentures after increase of OVD than patients with an average score. It is concluded that personality traits affect patients' acceptance of their complete dentures.

Coincidence of calcified carotid atheromatous plaque, osteoporosis, and periodontal bone loss in dental panoramic radiographs

PURPOSE

This study was performed to assess the correlation of calcified carotid atheromatous plaque (CCAP), the mandibular cortical index, and periodontal bone loss in panoramic radiographs.

MATERIALS AND METHODS

One hundred eighty-five panoramic radiographs with CCAP and 234 without this finding were evaluated by 3 observers for the presence of osseous changes related to osteoporosis and periodontal bone loss. Chi-squared and Mann-Whitney U tests were used to compare the two groups for an association of CCAP with the mandibular cortical index and periodontal bone loss, respectively.

RESULTS

There was a statistically significant coincidence of CCAP and osseous changes related to osteopenia/osteoporosis, with a p-value <0.001. There was no statistically significant coincidence of CCAP and periodontal bone loss. When comparing the 2 groups, "With CCAP" and "Without CCAP", there was a statistically significant association with the mean body mass index (BMI), number of remaining teeth, positive history of diabetes mellitus, and vascular accidents. There was no statistically significant association with gender or a history of smoking.

CONCLUSION

This study identified a possible concurrence of CCAP and mandibular cortical changes secondary to osteopenia/osteoporosis in panoramic radiographs. This could demonstrate the important role of dental professionals in screening for these systemic conditions, leading to timely and appropriate referrals resulting in early interventions and thus improving overall health.

Tooth loss and periodontitis in older individuals: results from the Swedish National Study on Aging and Care

BACKGROUND

Due to the increasing number of older people, there is a need for studies focused on this population. The aims of the present study are to assess oral and systemic conditions in individuals aged 60 to 95 years with access to dental insurance.

METHODS

Probing depths (PDs), tooth loss, alveolar bone levels, and systemic health were studied among a representative cohort of older individuals.

RESULTS

A total of 1,147 individuals in young-old (aged 60 or 67 years), old (aged 72 or 78 years), and old-old (aged ≥81 years) age groups were enrolled, including 200 individuals who were edentulous, in this study. Annual dental care was received by 82% of dentate individuals. Systemic diseases were common (diabetes: 5.8%; cardiovascular diseases: 20.7%; obesity: 71.2%; elevated C-reactive protein [CRP]: 98.4%). Serum CRP values were unrelated to periodontal conditions. Rates of periodontitis, defined as ≥30% of sites with a distance from cemento-enamel junction to bone of ≥5 mm, were 11.2% in women in the young-old age group and 44.9% in men in the old-old age group. Individuals in older age groups had a higher likelihood of periodontitis defined by bone loss and cutoff levels of PD ≥5 mm (odds ratio: 1.8; 95% confidence interval: 1.2 to 2.5; P <0.01). A total of 7% of individuals in the old-old age group had ≥20 teeth and no periodontitis. Systemic diseases, dental use, or smoking were not explanatory, whereas age and sex were explanatory for periodontitis.

CONCLUSIONS

The prevalence of periodontitis increased with age. Sex seems to be the dominant explanatory factor for periodontitis in older individuals. Despite frequent dental visits, overall oral health in the oldest age cohort was poor.