The prevalence and experience of oral diseases in Adelaide nursing home residents

Provision of domiciliary dental service to residential aged care facilities: A 3-year descriptive summary

AIM

This cross-sectional descriptive study described the oral health status and types of domiciliary dental treatment received by residents living in residential care after an oral health assessment (OHAT).

METHODS

Twenty-one facilities were recruited where consenting participants received OHAT followed by a referral for further domiciliary dental treatments. Data were captured and stored as Reach-OHT database where 2017-2019 data were analyzed.

RESULT

Overall, 88% of residents consented. 69.1% were referred for treatment after completion of OHAT. More than half had one or more caries; 40% showed sign of periodontal disease; a higher proportion of dentate participants had an unsatisfactory level of oral cleanliness. Of those received domiciliary dental treatment, diagnostic and preventive service was the combination most frequently provided. These comprised an average of 71.9% of total treatment provided across the 3-year period.

CONCLUSION

This study contributes to the understanding and knowledge around the provision of domiciliary dental services in residential care. A large number of older people in residential care can be assessed and treated through a domiciliary service pathway. As the vast majority of services provided were diagnostic, preventive, and restorative care, the feasibility of utilizing the skillset of the entire dental team should be explored.

Association between oral health and cognitive function among Chinese older adults: the Taizhou imaging study

BACKGROUND

We aimed to investigate the association between oral health and cognitive function in a sample of older adults from a Chinese rural community.

METHODS

The cross-sectional cognitive function of 677 individuals were assessed by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). A comprehensive profile of the oral health status was evaluated by questionnaire and clinical examination.

RESULTS

Multiple covariates-adjusted regression models demonstrated decayed teeth (DT) and decayed/missing/filled teeth (DMFT) were negatively associated with MoCA score (all p < 0.05). Calculus index (CI) and clinical attachment loss (CAL) were significantly associated with the lower MoCA, short-term memory and executive function score, respectively (all p < 0.05). Additionally, participants with missing teeth unrestored tend to get lower MMSE and MoCA scores (p < 0.05). The results also showed that increased DT and CI were modestly associated with higher odds of cognitive impairment (p < 0.05).

CONCLUSIONS

There is an association between oral health and global cognition. Poor periodontal status was strongly associated with worse global cognition performance, especially in the short-term memory and executive domain for the aging population.

Periodontitis as a Risk Factor for Alzheimer's Disease: The Experimental Journey So Far, with Hope of Therapy

Periodontitis and Alzheimer's disease (AD) exist globally within the adult population. Given that the risk of AD incidence doubles within 10 years from the time of periodontal disease diagnosis, there is a window of opportunity for slowing down or preventing AD by risk-reduction-based intervention. Literature appraisal on the shared risk factors of these diseases suggests a shift to a healthy lifestyle would be beneficial. Generalised (chronic) periodontitis with an established dysbiotic polymicrobial aetiology affects the tooth supporting tissues with eventual tooth loss. The cause of AD remains unknown, however two neurohistopathological lesions - amyloid-beta plaques and neurofibrillary tangles, together with the clinical history, provide AD diagnosis at autopsy. Historically, prominence was given to the two hallmark lesions but now emphasis is placed on cerebral inflammation and what triggers it. Low socioeconomic status promotes poor lifestyles that compromise oral and personal hygiene along with reliance on poor dietary intake. Taken together with advancing age and a declining immune protection, these risk factors may negatively impact on periodontitis and AD. These factors also provide a tangible solution to controlling pathogenic bacteria indigenous to the oral and gastrointestinal tract microbioes in vulnerable subjects. The focus here is on Porphyromonas gingivalis, one of several important bacterial pathogens associated with both periodontitis and AD. Recent research has enabled advances in our knowledge of the armoury of P. gingivalis via reproduction of all clinical and neuropathological hallmark lesions of AD and chronic periodontal disease in vitro and in vivo experimental models, thus paving the way for better future management.

A randomised clinical trial on the effect of oral antimicrobial sprays in institutionalised elders

OBJECTIVE

To compare the effectiveness of chlorine dioxide, chlorhexidine and placebo sprays in improving oral hygiene among institutionalised elders.

BACKGROUND

Available evidence suggests that oral sprays may be an effective alternative delivery method for plaque control; however, few studies have evaluated antimicrobial agents other than chlorhexidine.

MATERIALS AND METHODS

A total of 228 elders across 11 nursing homes in Hong Kong were recruited into the clinical trial. Participants were randomly allocated into one of the following groups: 0.1% pH-balanced chlorine dioxide spray, 0.2% chlorhexidine spray or sterile water spray (placebo control), once daily. Dental plaque, gingival bleeding and other clinical oral health outcomes were assessed at baseline, 3 and 6 months. Participant acceptability of the interventions was assessed at the end of the clinical trial.

RESULTS

Review assessments were conducted for 135 elders at 6 months. Significantly greater reductions in plaque index scores were observed with the chlorhexidine spray (0.4) and chlorine dioxide spray (0.3) than the placebo spray (0.1). While significant reductions in gingival bleeding scores were observed within the chlorhexidine (7.4), chlorine dioxide (7.5) and placebo (5.3) sprays after 6 months, change scores were not significantly different between groups. Significantly greater increases in the levels of staining were observed in the chlorhexidine spray group (-0.1) than the chlorine dioxide (0.0) and placebo spray (0.0) groups.

CONCLUSION

Antimicrobial sprays were shown to be effective among institutionalised elders. Chlorine dioxide spray showed equivalent effects on dental plaque and gingival bleeding relative to the chlorhexidine spray over a 6-month period.

Oral health status of newly admitted residents living in residential aged care

BACKGROUND

It is important to understand whether older people are admitted into residential care with existing dental diseases or their oral health deteriorates while residing in residential care. There is, however, little research available exploring the oral health status of people newly admitted into residential care. Understanding this disease trend would lead to effective prevention and treatment strategies to be trialled and implemented prior to admission. In this cross-sectional study, we hypothesize that older people with one or more natural teeth might have poor oral health prior to admission to residential care.

METHOD

The study was carried out using the de-identified oral health assessment database of an established domiciliary oral health care program in metropolitan New South Wales, Australia. Four hundred and nine participants with mean participant age of 85.56 years from 13 facilities from 2015 to 2018 fulfilled the inclusion criteria for this study.

CONCLUSION

This study confirmed that dentate, newly admitted residents to residential care had pre-existing dental problems and oral health concerns. Almost half of the newly admitted residents had an unsatisfactory oral cleanliness score when examined in their residential care setting.

Which factors influence the oral health of nursing-home residents with cognitive and motor impairments?

Background

There is limited information available about the oral and denture hygiene and oral health of nursing-home residents with cognitive and motor impairments.

Aims

The purpose of this study was to identify factors influencing the oral and denture hygiene and oral health of nursing-home residents with cognitive and motor impairments.

Methods

The study was performed in nine nursing-homes in Germany. Sociodemographic and general data were collected for all participants (n = 150). The Clinical Dementia Rating (CDR) was used to identify the presence of dementia, and the Apraxia Screening Test (AST) was used to identify motor impairment. A comprehensive dental examination was also performed. This included the documentation of dental and denture status and the number of decayed, missing and filled teeth (DMFT). In addition, dental and denture hygiene were assessed using the Plaque Index (PI) and the Denture Hygiene Index (DHI). Univariate and multivariate regression models were used to analyse possible factors affecting the dependent target variables.

Results

In multivariate regression analysis, the factors that most strongly influenced greater PI were a lower number of medications taken (p = 0.018), poorer general health (p = 0.013) and the presence of dementia (p < 0.010). A more advanced age (p = 0.036) and longer nursing-home stay (p = 0.048) had a negative effect on the DHI. Furthermore, gender (p = 0.037, in favour of women), poorer general health (p = 0.003), presence of dementia (p = 0.003), and the absence of natural teeth (p = 0.028) influenced poorer oral health. The factors most strongly influenced greater number of missing teeth were a more advanced age (p = 0.021) and longer nursing-home stay (p = 0.015). In terms of fewer filled teeth, a shorter nursing-home stay (p = 0.002) was the factor most strongly influenced this.

Conclusions

Poorer general health and the presence of apraxia and cognitive impairment are the main determinants for poorer oral hygiene and oral health among nursing-home residents. A longer nursing-home stay also seems to be relevant for oral health and denture hygiene.

Interrater reliability and concurrent validity of oral/dental items in the resident assessment instrument minimum data set 2.0

OBJECTIVE

To examine interrater reliability and concurrent validity of oral/dental items in the Resident Assessment Instrument Minimum Data Set (RAI-MDS) 2.0.

BACKGROUND

RAI-MDS is a standardised instrument used in nursing to determine health status and nursing needs. The extent to which oral/dental items in the RAI-MDS describe dental treatment needs concerning oral health has been questioned.

MATERIALS AND METHODS

This study evaluated the interrater reliability (dentist vs. nurse) and validity of oral/dental items in the Swiss version of RAI-MDS 2.0 (areas: K-nutritional status, L-oral/dental status) using professional oral examinations as a benchmark. Data of 168 residents of five long-term care facilities in the canton of Zurich, Switzerland, were collected within 1 year between October 2017 and December 2018. The statistical evaluation used descriptive statistics and Cohen's kappa (95% CI).

RESULTS

RAI-MDS items K1a, chewing (κ 0.098, 95% CI: 0.004-0.19); K1c, pain (κ 0.039, 95% CI: -0.03 to 0.11); L1a, debris (κ 0.117, 95% CI: 0.02-0.21); L1c, dental status (κ 0.229, 95% CI: 0.12-0.34); L1d, dental disease (κ 0.129, 95% CI: 0.02-0.24); L1e, periodontal diseases (κ -0.005, 95% CI: -0.07 to -0.03); and L1f, daily cleaning (κ -0.031, 95% CI: -0.05 to -0.01) showed weak or no agreement, whereas L1b, denture status (κ 0.634, 95% CI: 0.52-0.75), showed substantial agreement.

CONCLUSION

Oral/dental items in RAI-MDS lack reliability and validity. Recognition of oral health situation/treatment needs by nursing staff does not seem to be possible with the current version of this tool.

Interaction between genetic factors, Porphyromonas gingivalis and microglia to promote Alzheimer's disease

In late-onset Alzheimer disease (AD) pathogenesis, genes, infections and immunity could be significant factors. We have reviewed if the keystone periodontal pathogen Porphyromonas gingivalis may affect genes and microglia (primary immune cells in the brain) to promote AD development. Genes for apolipoprotein, clusterin, CD33, triggering receptor expressed on myeloid cells-2 (TREM-2), tyrosine kinase binding protein (TYR-OBP), and complement receptors can affect microglia. Most of these genes can also be affected by P. gingivalis via its mastering of immune suppression. Besides, P. gingivalis can affect microglia directly in several ways. Taken together, genetic predisposition, P. gingivalis infection and microglia could promote neurodegeneration typical of that reported for AD.

Aspects of oral health and dementia among Swiss nursing home residents

BACKGROUND

Little empirical evidence of high levels of oral diseases of people in need of care and the impact of dementia is available. The resident assessment instrument minimum data set (RAI-MDS) is an evaluation tool for caregivers.

OBJECTIVE

The aim of this study was to show oral health of nursing home residents through RAI-MDS 2.0 data as a function of the cognitive impairment.

METHODS

A retrospective analysis of RAI-MDS (general, cognitive, oral health variables) of 357 long-term care facilities in Switzerland (data of 105,835 residents) was carried out. The final sample size was 7922 residents after applying the inclusion/exclusion criteria in four evaluation groups (no dementia, moderate, severe and incident dementia).

RESULTS

As dementia developed and severity increased over time, subjects often had fewer or no teeth and did not wear removable dentures. Chewing problems increased over time regardless of the dementia severity. Oral complaints increased over time in subjects with severe dementia, which in turn led to low body mass index (BMI) values (<23 kg/m²) and was associated with an higher risk of mortality.

CONCLUSION

This dataset provides an overview on dental aspects in patients with dementia in nursing homes. The accuracy of the assessment of a given dental situation by nursing staff is to be questioned. The results indicated an underdetection of oral illnesses by nurses.

Oral Health Status and Need for Oral Care in an Aging Population: A Systematic Review

Background. The world population is aging. This phenomenon is accompanied by an increase in the number of elderly with dementia, whose oral hygiene care is a challenge. Objective. This paper presents a literature review of oral health status and the need for oral care in people with dementia, as compared to people without dementia and also of the relationship between periodontal disease and cognitive impairment. Methods. A systematic review was conducted in PubMed, CINAHL, and the Cochrane Library. Fifty-six articles met the inclusion criteria and were consequently included for quality assessment and data extraction. Results. No significant differences were found between both groups with regard to the number of present teeth, DMFT Index, edentulousness/use of denture, and orofacial pain. Coronal/root caries and retained roots were more common in people with dementia than in those without dementia. Most of the participants with dementia presented gingival bleeding or inflammation and they suffered from the periodontal disease more than people without dementia. Conclusions. Poor oral health is a common condition among the elderly with dementia. The education process of caregivers might improve the oral health status of people with dementia. Finally, periodontal disease might contribute to the onset or progression of dementia.

Older People Living in Nursing Homes: An Oral Health Screening Survey in Florence, Italy

The oral health state plays an important role in the concept of 'elderly frailty', since institutionalized older people are prone to suffering from bad oral conditions. The aim of this study is to assess the state of oral health in the older residents of nursing homes and to measure its potential association with the cognitive state, the degree of functional autonomy, and the malnutrition risk. Methods: We enrolled 176 subjects from 292 residents in five nursing homes in Florence. For each subject, we performed the Malnutrition Universal Screening Tool, the Pfeiffer test, the Minimum Data Set-Long Form, a dental examination, and the Geriatric Oral Health Assessment Index questionnaire. The results show that the oral condition was poor in 43.8% of cases, medium in 38.1%, and good in 18.2%. A worse oral health state was significantly associated (p < 0.05) with a worse cognitive state and with a higher dependency in daily living activities. The malnutrition score among the older people was unrelated to the oral health condition (p = 0.128). It can be concluded that the oral health condition in older institutionalized subjects is an open challenge for the public healthcare system, since the maintenance of adequate good oral health is an essential element of good physical as well as cognitive and psychological health.

A nationwide survey of confidence and knowledge of assessment and management oral conditions amongst a sample of physicians, United Kingdom

Objective

This study aimed to assess current confidence and knowledge of oral conditions amongst a sample of UK physicians and doctors in training programmes using a web-based survey.

Results

131 survey responses were analysed for doctors from FY1 to consultant grade working within medical specialties. 36.6% and 35.9% of those surveyed expressed that they felt confident diagnosing and managing oral conditions respectively. The median knowledge score was 60%; 65.6% correctly identified the image that demonstrated a squamous cell carcinoma. 91.6% reported that they felt they needed additional training in the diagnosis and management of oral conditions. Neither confidence nor knowledge were affected by grade, specialty, or region of practice.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4359-0) contains supplementary material, which is available to authorized users.

Oral health for an ageing population: the importance of a natural dentition in older adults

Despite progress in dentistry, tooth loss in old age is still a reality, even more so in long-term-care residents. However, recent trends indicate that natural teeth are lost later in life. Functional decline and age-related pathologies have to be considered in oral health care for this vulnerable population. Retaining and restoring teeth and oral function in elders is important. Tooth loss significantly impairs masticatory performance, which cannot be fully restored by prosthodontic means. Hence an unconscious change in food intake occurs, often involving malnutrition and withdrawal from common meals. Poor oral appearance and bad breath may further impede social activities. Although a chewing activity may be beneficial for cognitive function, natural teeth can present a considerable risk for fragile elders, in whom aspiration of biofilm can lead to pneumonia and death. The presence of natural teeth is also correlated with higher life expectancy, but socio-economic confounding factors have to be considered. When evaluating oral health in the elderly population, standards and priorities for reporting oral health outcome measures have to be defined. Anatomical indicators such as the number of natural teeth or the presence of prostheses might be one option for reporting. However, functional indicators such as masticatory performance and patient-centred outcome measures may be more relevant. In conclusion, there is an overwhelming body of evidence that maintaining a healthy natural dentition in old age is beneficial from a structural, functional and psycho-social point of view.

Correlation between dental conditions and comorbidities in an elderly Japanese population: A cross-sectional study

The purpose of this study was to investigate the correlation between dental conditions and comorbidities in an elderly population in Japan.A database constructed using data obtained from 12 nursing homes in Japan was used in this study. The study period ranged from January 2014 to December 2015, and elderly individuals with dental and other medical records were included in the analysis. Linear regression models were used to analyze univariate and multivariate correlation between dental conditions, comorbidities, and other sociodemographic/clinical backgrounds.After excluding individuals with missing data, 289 elderly individuals (107 men and 182 women; mean age, 85 years) were included in the analysis. These individuals had an average of 11.6 teeth, and the number decreased with older age (P < .001). The average number of decayed teeth was 1.4. A total of 116 subjects (40.1%) had dementia. In terms of comorbidities, dementia was not significantly associated with the number of present teeth (P = .56), but it was associated with the number of decayed teeth (P = .018). This association was also observed after adjusting for confounding variables in the multivariate regression analysis (P = .030).The number of decayed teeth was associated with dementia. While causality cannot be inferred from these observational results, the findings indicate that dental health could represent a marker of impending dementia, and probably represent a marker of general health status in the elderly population. Additional longitudinal studies are highly desirable to understand the causal relationships between dental conditions and comorbidities.

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff

OBJECTIVE

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs.

BACKGROUND

Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate.

MATERIALS AND METHODS

This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care.

RESULTS

The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF.

CONCLUSION

This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services.

Oral health of community-dwelling older Australian men: the Concord Health and Ageing in Men Project (CHAMP)

BACKGROUND

The Concord Health and Ageing in Men Project (CHAMP) is a cohort study of the health of a representative sample of Australian men aged 70 years and older. The aim of this report is to describe the oral health of these men.

METHODS

Oral health was assessed when the men were all aged 78 years or older. Two calibrated examiners conducted a standardized intraoral assessment. Descriptive data were analysed by statistical association tests. Participants were excluded from the collection of some periodontal assessments if they had a medical contraindication.

RESULTS

Dental assessments of 614 participants revealed 90 (14.6%) were edentate. Men had a mean of 13.8 missing teeth and 10.3 filled teeth. Dentate participants had a mean of 1.1 teeth with active coronal decay. Those in the low-income group had a higher rate of decayed teeth and lower rate of filled teeth. Thirty-four participants (5.5%) had one or more dental implants, and 66.3% relied on substitute natural teeth for functional occlusion. Of those with full periodontal assessments; 90.9% had sites with pocket depths of 3 mm or more, 96.6% had sites with CAL of 5 mm or more, and 79.7% had three or more sites with GI scores of 2 or more.

CONCLUSIONS

There was a high prevalence of periodontal diseases and restorative burden of dentitions, which suggests that greater attention needs to be given to prevention and health maintenance in older Australian men.

Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues

BACKGROUND

The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published.

OBJECTIVE

To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues.

METHODS

A literature search was conducted in the databases PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. A critical appraisal of the included studies was performed with the Newcastle-Ottawa scale (NOS) and Delphi list.

RESULTS

The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia.

CONCLUSIONS

The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow.

SCIENTIFIC RATIONALE FOR STUDY

With the aging of the population, a higher prevalence of dementia and an increase in oral health problems can be expected. It is of interest to have an overview of the prevalence of oral problems in people with dementia.

PRINCIPAL FINDINGS

Older people with dementia have multiple oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, mucosal lesions, and reduced salivary flow.

PRACTICAL IMPLICATIONS

The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.

Residential age care and domiciliary oral health services: Reach-OHT-The development of a metropolitan oral health programme in Sydney, Australia

OBJECTIVE

To describe an oral health care programme for older people in Residential Aged Care Facilities (RACFs) to improve access to care and support facilities.

INTRODUCTION

Different models of residential care have been proposed, but few have been comprehensive (providing on-site health promotion and service delivery) or sustainable.

METHODS

A partnership model of oral health care, with dental services plus oral health education, was integrated into the community outreach services of a metropolitan hospital department of aged care. The programme provided annual oral health education and training to staff, and on-site dental care to 10 (RACFs).

RESULTS

None of the RACFs had received organised education or on-site dental service care prior to the programme. At the completion of the third year of the programme, 607 residents (75% of the total bed capacity for the 10 RACFs) had received an annual oral health assessment, and 271 (46.5%) had received on-site dental care. More than 120 nursing and allied health staff had received education and training in oral health support to residents. Oral cleanliness, the proportion not experiencing dental pain and referral for additional care decreased significantly over the period, but dental caries experience and periodontal conditions remained a concern.

CONCLUSIONS

Sustainable domiciliary oral health services and oral health education are feasible and practical using a partnership model within the Australian health system. Adaptability, continuity and the use of oral health therapists/dental hygienists in the coordination and management of the programme further contribute to viability.

The condition of oral mucosa in the elderly (over 65 years) of Lublin

Mucous membrane defense mechanisms are impaired with age, both immunologically and physically. This decreases oral mucosa regenerative capability and results in greater susceptibility to injuries and microbial and fungal colonization. Pathological changes of the mucous membrane should be diagnosed and treated early, as some may develop into cancerous changes. Therefore, regular dental check-ups are essential, especially in old age. The aim of the study was to assess the condition of the oral mucosa in seniors residing in either Lublin Nursing Homes (LNH) or in home care. The study was conducted among 240 people over the age of 65: 117 LNH residents and 123 seniors living independently. The assessment of oral mucosa was conducted via clinical examination so as to see evidence of pathological change. On the base of the performed examination, pathological changes of the oral mucosa were observed in 43.59% of all LNH residents and in 34.96% of all seniors living in home care (independently). In both groups, atrophic glossitis, candidiasis (in susp.) and stomatitis prothetica were most frequently noted. Hence, it can be said that the condition of the oral mucosa of the examined seniors from Lublin is unsatisfactory.

Physical, mental and cognitive disabilities in relation to utilization of dental care services by nursing home residents

OBJECTIVE

The main purpose of this study was to investigate factors affecting dental care utilization among nursing home residents in Jordan.

METHODS

A total of 221 subjects with a mean age of 62.4 years (121 males and 100 females) taken from among nursing home residents across Jordan were recruited and composed a convenience sample for this study. The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Tinetti Assessment Battery for gait and balance (TAB), Disability of Arm, Shoulder, and Hand test (DASH) were administered and oral health status was assessed for all subjects and examined as expected correlates of dental care utilization among nursing home residents.

RESULTS

The response rate was about 88%. One-third of residents suffered from total edentulism and most of the remaining dentate residents exhibited periodontal disease (90%). Of the dentate sample, 90% of residents had bleeding upon probing, 85% were diagnosed with tooth mobility, 88% had presence of dental calculus, and 30% were diagnosed with root caries. Of the denture wearers, 59.1 % reported having soreness with their dentures and 32% of denture wearers reported having poor quality dentures. MMSE score, suffering from tooth sensitivity and having diabetes mellitus were identified to be indicators for utilization of dental care services among the study population.

CONCLUSION

Regular oral care, assessments, and rehabilitation services are considered to be limited for nursing home residents in Jordan. Based upon these findings, future interventions should address oral health among nursing home residents in Jordan.

Self-awareness of "Gum Disease" Among US Adults

BACKGROUND

To assess the extent of self-awareness of gum disease among adults in the United States.

METHODS

Data were from the 2009-2012 National Health and Nutrition Examination Survey. The outcome variable is self-awareness of gum disease. Multivariate logistic regression models were used to examine the relationship between self-awareness and clinically diagnosed periodontitis. The analytical sample included 6876 participants.

RESULTS

Among those participants (30 years or older) who were classified as having periodontitis, 27% (95% confidence interval [CI], 24.4-29.8) were self-aware of the disease (positive predicted value = 25%). Of those who self-reported having gum disease, 14.1% had a diagnosis of periodontitis (sensitivity = 75%). Older adults were less likely to be aware of gum disease (P < .05). Non-Hispanic blacks (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.53-0.85) were less likely to be aware of the disease than non-Hispanic whites. Adults with diabetes (AOR = 1.61; 95% CI, 1.25-2.06), or with lung disease (AOR = 1.61; 95% CI, 1.25-2.08), or current smokers (AOR = 1.72; 95% CI, 1.29-2.31) were more likely to be aware of the disease.

CONCLUSION

The study showed that self-awareness of gum disease among adults was low. Our study findings suggest that there is a great need to improve oral health knowledge and awareness among the adult population in the United States.

Oral health and orofacial pain in older people with dementia: a systematic review with focus on dental hard tissues

Objective

The aim of this review was to provide a systematic overview including a quality assessment of studies about oral health and orofacial pain in older people with dementia, compared to older people without dementia.

Methods

A systematic literature search was performed in PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. The quality assessment of the included articles was performed using the Newcastle-Ottawa Scale (NOS).

Results

The search yielded 527 articles, of which 37 were included for the quality assessment and quantitative overview. The median NOS score of the included studies was 5, and the mean was 4.9 (SD 2.2). The heterogeneity between the studies was considered too large to perform a meta-analysis. An equivalent prevalence of orofacial pain, number of teeth present, decayed missing filled teeth index, edentulousness percentage, and denture use was found for both groups. However, the presence of caries and retained roots was higher in older people with dementia than in those without.

Conclusions

Older people with dementia have worse oral health, with more retained roots and coronal and root caries, when compared to older people without dementia. Little research focused on orofacial pain in older people with dementia.

Clinical relevance

The current state of oral health in older people with dementia could be improved with oral care education of caretakers and regular professional dental care.

Poor dental hygiene and periodontal health in nursing home residents with dementia: an observational study

Poor oral health conditions are well documented in the institutionalized elderly, but the literature is lacking research on relationships between dementia and periodontal health in nursing home residents. The purpose of this cohort study, therefore, was to assess whether dementia is associated with poor oral health/denture hygiene and an increased risk of periodontal disease in the institutionalized elderly. A total of 219 participants were assessed using the Mini Mental State Examination (MMSE) to determine cognitive state. According to the MMSE outcome, participants scoring ≤20 were assigned to dementia group (D) and those scoring >20 to the non-dementia group (ND), respectively. For each of the groups D and ND, Gingival Bleeding Index (GBI) and Denture Hygiene Index (DHI) linear regression models were used with the confounders age, gender, dementia, number of comorbidities and number of permanent medications. To assess the risk factors for severe periodontitis as measured by the Community Index of Periodontal Treatment Needs, a logistic regression analysis was performed. Statistical analysis revealed no significant differences of GBI as well of DHI for demented and healthy subjects (p > 0.05). Severe periodontitis was detected in 66 % of participants with dementia. The logistic regression showed a 2.9 times increased risk among demented participants (p = 0.006). Oral hygiene, denture hygiene and periodontal health are poor in nursing home residents. The severity of oral problems, primarily periodontitis, seems to be enhanced in subjects suffering from dementia. Longitudinal observations are needed to clarify the cause-reaction relationship.

Dental demographics and metrics of oral diseases in the ageing Australian population

One of the biggest challenges currently facing the dental profession in Australia is the provision of quality and timely dental care to the elderly. Adults aged 65+ years are an exponentially growing section of the community with rapidly changing dental needs, thanks in part to improvements in oral health over the past 60 years that have resulted in a dramatically decreased rate of edentulism and subsequently an increased number of teeth present. This is a challenge not only for the public dental services, but also public health policy makers, private dental practitioners, professional organizations and dental education providers. It is an issue that crosses a range of dental care providers, not only dentists but also dental prosthetists and dental hygienists, whose role in the provision of dental services has been slowly growing in Australia. Furthermore, with evidence of links between oral and systemic health, this issue has significant impacts for the broader health system.

Promoting good dental health in older people: role of the community nurse

Good dental health enables a person to eat, speak, and socialise. It contributes to nutrition, general health, and quality of life. The dental health of people living in the UK has improved in the last 40 years, and older people are retaining their natural teeth throughout their life; nontheless, a significant proportion of people over 75 years still rely on partial and full dentures. Dental disease in all age groups is readily prevented by daily oral hygiene and adherence to a healthy diet, avoidance of smoking, and sensible alcohol intake. Some older people may simply need reminding and encouragement to carry out oral hygiene, while more dependent adults may need support and active help to do so. Nursing teams and health professionals play a key role in promoting oral health by supporting oral hygiene and adequate nutrition, preventing discomfort, and detecting dental diseases early. This article gives a brief overview of how nursing teams and health professionals can promote oral health and provides details of resources from which further detailed information may be obtained.

The impact of oral health on the quality of life of nursing home residents

BACKGROUND

Good oral health in older residents of nursing homes is important for general health and quality of life. Very few studies have assessed how oral symptoms affect residents' quality of life.

OBJECTIVE

To assess the clinical and subjective oral health, including oral health related quality of life (OHRQoL), and the association of oral symptoms with OHRQoL in older people residing in nursing homes in Islington, London.

METHOD

Overall, 325 residents from nine nursing homes were clinically examined and 180 residents were interviewed to assess their oral symptoms and their OHRQoL using the OIDP measure. Managers and carers working in the homes were also interviewed.

RESULTS

Almost two thirds of the sample were dentate (64.5%). 61.3% of dentate and 50.9% of edentate residents reported problems such as dry mouth, sore cracked lips, broken teeth and toothache and ill-fitting dentures. Oral health impacted considerably upon resident's OHRQoL; 20.2% of dentate and 30.9% of edentate reported at least one oral impact in the past 6 months. Sensitive teeth, toothache, bleeding gums, dry mouth and loose natural teeth among the dentate and loose or ill-fitting dentures among the edentate were strongly associated with higher prevalence of oral impacts even after adjusting for demographic and socio-economic factors, and for the number of teeth (dentate only).

CONCLUSION

The burden of oral conditions was considerable. Oral symptoms were very common and were strongly associated with residents' worse OHRQoL. Health promotion programmes are important to help residents maintain an acceptable level of oral health and function.

Associations between oral health and risk of dementia in a 37-year follow-up study: the prospective population study of women in Gothenburg

OBJECTIVES

To investigate the association between incident dementia and previous number of teeth measured over a long interval.

DESIGN

Retrospective analysis of a 37-year cohort study.

SETTING

Prospective Population Study of Women in Gothenburg.

PARTICIPANTS

Women with (n = 158) and without (n = 539) dementia in 2000 to 2005.

MEASUREMENTS

Tooth counts in 1968-69, 1980-81, and 1992-93. Covariates included age, education, stroke, myocardial infarction, diabetes mellitus, smoking status, blood pressure, body mass index, and cholesterol level.

RESULTS

After adjustment for age, odds ratios (ORs) for dementia in 2000-05, comparing first with fourth tooth count quartiles, were 1.81 (95% confidence interval (CI) = 1.03-3.19) for tooth counts measured in 1968, 2.25 (95% CI = 1.18-4.32) for those in 1980, and 1.99 (0.92-4.30) for those in 1992. After further adjustment for education, ORs were 1.40 (95% CI = 1.03-3.19) for 1968, 1.96 (95% CI = 0.98-3.95) for 1980, and 1.59 (95% CI = 0.71-3.53) for 1992, and after additional adjustment for vascular risk factors, ORs were 1.38 (95% CI = 0.74-2.58) for 1968, 2.09 (95% CI = 1.01-4.32) for 1980, and 1.61 (95% CI = 0.70-3.68) for 1992.

CONCLUSION

In most of the analyses, lower tooth count was not associated with dementia, although a significant association was found for one of the three examinations. Further research may benefit from more-direct measures of dental and periodontal disease.

Oral health and dental care in aged care facilities in New South Wales, Australia. Part 3 concordance between residents' perceptions and a professional dental examination

OBJECTIVES

To determine the perceptions of dental care held by the residents in aged care facilities (ACFs) in New South Wales (NSW) and to compare these perceptions with clinical observations.

BACKGROUND

No specific data exist relating to NSW residents' perceptions of dental care compared with a clinical examination. Planning for appropriate oral health programs in ACFs necessitate such data.

MATERIALS AND METHODS

Four Area Health Services of Sydney and 25 low care ACFs were selected from which representative residents were sampled who completed a survey and underwent a basic dental examination.

RESULTS

Of the subjects (25 males, 96 females), 76.9% had never received a dental visit as entering the ACF; 14.1% suffered from dental pain; 69.4% wore dentures and of these 18.3% required assistance in cleaning. Dentures were cleaned twice/day in 54.9% of cases. Natural teeth were reported present in 71.9% of residents, and 85.1% did not require assistance in cleaning. Appropriate dental care facilities and dry mouth were most frequent problems highlighted. Clinical examinations showed that 69% were denture wearers; oral hygiene and denture hygiene were considered good in 15.7% of cases. A high level of concordance existed between self-reports and examination.

CONCLUSIONS

Increased awareness about oral health across leadership, caregivers and residents with appropriate dental health education and dedicated space within facilities would provide a much needed improvement for addressing oral health issues of the ACF residents. This might be the right time to plan for the future challenges that will need to be met by the NSW care system.

Dental caries in Victorian nursing homes

BACKGROUND

The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics.

METHODS

Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria.

RESULTS

Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken.

CONCLUSIONS

Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services.

Tooth loss, chewing efficiency and cognitive impairment in geriatric patients

BACKGROUND

Patients with dementia have poorer oral health and fewer teeth than their peers without cognitive impairment.

OBJECTIVE

The hypothesis of this study is that the number of natural teeth and the chewing efficiency are associated with cognitive functioning.

METHODS

This cross-sectional study included 29 patients diagnosed with dementia aged 75 years or older and 22 controls who were either cognitively normal (n = 19) or with mild cognitive impairment (n = 3). Neuropsychological, nutritional and dental assessments were performed. The chewing efficiency was evaluated with a two-colour mixing test.

RESULTS

Demented patients and controls presented with a mean of 4.9 and 6.5 teeth, respectively (n.s.). The number of natural teeth was not associated with dementia (p = 0.553). Same results were found for age (p = 0.746) and sex (p = 0.901). The chewing efficiency by visual inspection proved worse in participants with dementia than in the controls (p < 0.011) and explained 9.3% of the variance in the diagnosis of dementia. Neither dental state nor chewing efficiency was related to the nutritional state.

CONCLUSION

Chewing efficiency seems stronger associated with cognitive impairment than the number of teeth. Hence, in a more holistic approach for the geriatric assessment, the dental examination may be complemented by a chewing efficiency test.

Atraumatic restorative treatment and Carisolv use for root caries in the elderly: 2-year follow-up randomized clinical trial

OBJECTIVES

New preventive and treatment strategies are required to address the high prevalence of caries among the elderly. The main objective of this study was to analyze the effectiveness of Carisolv® gel to improve the clinical behavior of restorations obtained by atraumatic restorative treatment (ART) in root caries of elderly patients. A secondary objective was to determine the factors associated with the failure of ART restorations after a 2-year follow up.

MATERIAL AND METHODS

A randomized controlled trial with 2-year follow-up was designed for this purpose. Candidate caries lesions were randomly assigned to an ART group for root caries treatment with the conventional ART technique, filling with glass ionomer, or an ART + Carisolv® gel for the same ART plus the application of a caries solvent (Carisolv®). Evaluations were conducted at 6, 12, and 24 months.

RESULTS

A total of 81 restorations were performed, 37 in the ART group and 44 in the ART + Carisolv® gel group, with 22 and 26 restorations, respectively, surviving at the end of the 24-month follow-up. Survival rates at 24 months did not significantly differ between ART (63 %) and ART + Carisolv® gel (62 %) restorations. The best model for predicting the failure of the restorations included the number of tooth-brushings/day, the presence or not of prosthesis, the anterior or posterior location of the tooth, and the baseline plaque level.

CONCLUSION

The application of Carisolv does not modify the survival rate of ART restorations in elderly patients.

CLINICAL RELEVANCE

The use of Carisolv gel does not improve the outcomes of atraumatic restorative treatment.

Oral health status and physical, mental and cognitive disabilities among nursing home residents in Jordan

OBJECTIVE

The purpose of this study is to describe physical, mental and cognitive disabilities and periodontal status as indicated by periodontal health, edentulism and use of dentures among nursing home residents in Jordan.

METHODS

A sample of 221 subjects with a mean age of 62.4 years (121 males and 100 females) from nursing home residents in Jordan were recruited to participate in this study. Oral health status, mini mental state examination (MMSE), Geriatric Depression Scale (GDS), Tinetti Assessment Battery for gait and balance (TAB) and disability of arm, shoulder and hand test (DASH) were assessed for all subjects.

RESULTS

The response rate was about 88%. The multivariate analysis showed that the degree of upper limb disabilities, as measured by DASH, and reporting not brushing of teeth were the main risk indicators for severity of periodontal disease. Residents with dentures were found to have significantly higher cognitive abilities scores (MMSE), better upper arm abilities (DASH) and gait and balance score (TAB) in comparison with edentulous adults without dentures. Edentulous residents were found to suffer more from cognitive impairment (MMSE) than dentate residents. There was no predilection of upper limb (DASH) and lower limb (TAB) disabilities or depressive symptoms (GDS) for edentulous over dentate subjects.

CONCLUSIONS

Results suggest that nursing home residents with a variety of physical, cognitive and psychological disabilities are at increased risk of deterioration of their oral health. All those associated with the health of residents need to be aware of this issue and take preventive and therapeutic measures as needed.

Adverse oral health and cognitive decline: the health, aging and body composition study

OBJECTIVES

To investigate the relationship between periodontal disease and cognitive decline.

DESIGN

Analysis of a prospective cohort study.

SETTING

The Health, Aging and Body Composition (Health ABC) Study.

PARTICIPANTS

One thousand fifty-three participants who were administered the Modified Mini-Mental State Examination (3MS) at Year 1 (baseline) and Year 3 and had participated in a comprehensive periodontal examination at Year 2.

MEASUREMENTS

The prospective association between a range of oral health parameters and cognitive function was examined. Decline in 3MS score from Year 3 to 5 was investigated in 947 (89.9%) participants. Covariates included age, sex, education, race, cardiovascular disease and risk, and depressive symptoms.

RESULTS

Most indicators of adverse oral health at Year 2 were associated with cognitive impairment based on averaged 3MS scores less than 80 for Years 1 and 3, but education and race substantially confounded these associations. Higher gingival index, a measure of gingival inflammation, at Year 2 remained independently associated with this definition of cognitive impairment and, in fully adjusted analyses, was also an independent predictor of a more-than-5-point cognitive decline from Year 3 to 5.

CONCLUSION

Periodontitis may be a risk factor for cognitive decline. Gingivitis is reversible, and periodontitis to some degree is preventable and controllable when manifest. Therefore, further research is needed to clarify potential underlying mechanisms and oral health interventions that might ameliorate cognitive decline.

Self-reported oral health and oral health behaviors in older adults in the last year of life

BACKGROUND

The complex physiological, psychological, and functional changes at the end of life may dramatically affect oral health. However, evidence regarding oral health changes at the end of life is scarce. This study's objective was to examine self-rated oral health and oral health behaviors among community-dwelling elders in the last year of life.

METHODS

This study was a retrospective longitudinal study including 810 dentate community-dwelling older adults aged 65 and older. Based on death certificate data, the participants were retrospectively classified into two groups: died within 1 year after the last interview (end-of-life group) and survived more than 1 year after the last interview (comparison group). Participants were interviewed at baseline, 18, 36, 60, and 84 months regarding their sociodemographics, self-reported oral health, oral conditions, use of oral health services, and preventive behaviors. Generalized estimating equations were used to compare self-reported oral health and oral health behaviors between two groups.

RESULTS

After adjusting for sociodemographics, the end-of-life group was more likely to rate their oral health (odds ratio [OR] = 2.94, 95% confidence interval [CI]: 1.32, 6.54) and overall health (OR = 2.35, 95% CI: 1.12, 4.91) as bad than the comparison group. End-of-life participants were also more likely to dislike their mouth appearance (OR = 2.27, 95% CI: 1.07, 4.83) and rate their ability to taste (OR = 7.24, 95% CI: 2.64, 19.77) and smell (OR = 2.98, 95% CI: 1.09, 8.15) as bad. There was no difference in self-reported oral conditions, use of oral health services, and preventive behaviors.

CONCLUSIONS

Self-rated oral health significantly declines in the last year of life.

Oral health status and needs of homebound elderly in an urban home-based primary care service

OBJECTIVES

This study assessed the oral health status, dental utilization and dental needs of the homebound elderly (HBE) care patients within the Mount Sinai Visiting Doctor program.

METHODS

Of the 334 eligible patients, 57% agreed to participate and 95.4% completed the clinical examinations, the Dental Utilization and Needs survey and Geriatric Oral Health Assessment Index conducted in each subject's home by a trained research team.

RESULTS

Among 75% who were dentate subjects, 40% needed restorative dental care, 45.6% needed dental extractions, and 33% complained of current oral pain. Overall, 92.0% needed some type of dental care and 96% stated that they had not seen a dentist since they became homebound (mean number of years in program = 3.2 ± 2.58).

CONCLUSION

Findings show the oral health status of these homebound elderly was poor and their quality of life was significantly affected by the lack of basic dental care.

Dentition, dental health habits, and dementia: the Leisure World Cohort Study

OBJECTIVES

To explore the association between dentition and dental health behaviors and incident dementia.

DESIGN

Longitudinal cohort.

SETTING

Leisure World, Laguna Hills, CA; a retirement community.

PARTICIPANTS

Five thousand four hundred sixty-eight older (median age 81) adults followed from 1992 to 2010.

MEASUREMENTS

Questions regarding dental health focused on number of natural teeth, dentures worn, number of visits to a dentist, and oral health habits. Dementia status was determined from in-person evaluations, follow-up questionnaires, hospital data, and death certificates. Estimates of dementia risk were calculated using Cox regression analysis in men and women separately.

RESULTS

Men with inadequate natural masticatory function who did not wear dentures had a 91% greater risk of dementia than those with adequate natural masticatory function (≥ 10 upper teeth and ≥ 6 lower teeth). This risk was also greater in women but not significantly so. Dentate individuals who reported not brushing their teeth daily had a 22% to 65% greater risk of dementia than those who brushed three times daily.

CONCLUSION

In addition to helping maintain natural, healthy, functional teeth, oral health behaviors are associated with lower risk of dementia in older adults.

Indicators for root caries in Danish persons with recently diagnosed Alzheimer's disease

OBJECTIVE

To identify indicators of root caries among persons with newly diagnosed Alzheimer's disease (AD).

BACKGROUND

Few studies have investigated dental caries in older adults with AD. Previously we found that persons with AD had significantly more root caries compared to persons with dementia other than AD.

METHODS

Participants were recruited from two university hospital clinics in Copenhagen, Denmark. A team of neurologists/geriatricians carried out the diagnostic screening. The study included an interview, oral examination and medical records.

RESULTS

We evaluated potential indicators of root decay across subjects with 3+ decayed surfaces vs. <3 decayed surfaces. Variables associated with increased odds of root caries were age over 80 years, 2+ decayed coronal surfaces and 5+ filled root surfaces. Among the social variables, living with someone was associated with a nearly 70% reduction in the odds of having 3+ surfaces of untreated caries.

DISCUSSION

Root caries is highly prevalent among individuals with new AD and there is still a strong need for active assessment of and attention to oral problems in persons with AD. Our findings document that recently diagnosed AD cases with multiple coronal caries lesions are at elevated risk of having more root caries. Also persons 81+ years and those with multiple root fillings are more likely to have numerous untreated root lesions.

Oral health in nursing home residents with different cognitive statuses

OBJECTIVE

To compare oral health in nursing home (NH) residents with different cognitive statuses.

BACKGROUND

Oral health is a significant issue for NH residents because of its relationships to quality of life, systemic health and well-being. It is known that oral health is poor in NH residents. However, how oral health differs in NH residents with different cognitive statuses remains unclear.

MATERIALS AND METHODS

Nine hundred and two NH residents were retrospectively recruited from a community-based geriatric dental clinic in Minnesota, USA. Comprehensive medical, dental, cognitive and functional assessments were completed for the participants. On the basis of medical history and cognitive status, participants were categorized into three groups: without cognitive impairment (non-impaired group), with cognitive impairment but no dementia (impaired group) and with dementia (demented group). ANOVA, Chi-square and Fisher's exact tests were used to compare medical, dental and functional statuses between groups.

RESULTS

Oral hygiene was poor in NH residents. Forty per cent of participants in the impaired group were edentulous, significantly higher than the edentulism rate in the demented group (29%, p = 0.01). More than 60% of the participants lost 16 or more teeth prior to examination. Depending on their cognitive status, 82-92% of the participants arrived with one or more caries or retained root. Dentate participants in the impaired and demented groups averaged about six caries or retained roots, significantly more than 4.7 caries or retained roots in the non-impaired group (p = 0.01).

CONCLUSION

Oral health was poor but slightly different in NH residents with different cognitive and functional statuses.

Education on physical restraint reduction in dementia care: a review of the literature

Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the individual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.