Iowa nursing facility oral hygiene (INFOH) intervention: A clinical and microbiological pilot randomized trial

Effect of oral health interventions for dependent older people-A systematic review

BACKGROUND

There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health.

OBJECTIVE

The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people.

METHODS

We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta-analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system.

RESULTS

We included a total of 30 randomised clinical trials assessing educational and non-educational interventions for community-dwelling older people (n = 2) and those residing in long-term care facilities (n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long-term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system.

CONCLUSION

Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long-term effect of interventions, and further research is needed, especially targeting community-dwelling older people.

PROSPERO ID

CRD42021231721.

Oral hygiene prior to cardiac surgery to prevent infections: Randomized clinical trial

CONTEXT

It is not clear if an oral hygiene protocol to control biofilm applied before cardiac surgery can reduce infection rates.

OBJECTIVE

We aim to verify the effectiveness of an oral hygiene protocol in reducing postoperative infections when compared to usual practices, in patients admitted to a cardiology unit, prior to cardiac surgery.

DESIGN, SETTING AND PARTICIPANTS

Randomized, blind, controlled clinical trial, with 107 participants who expected to undergo cardiac surgery, randomized into two groups: Experimental Group (EG) standardized oral hygiene protocol (54) and Control Group (CG), usual practices performed in patients admitted (53).

INTERVENTION

a standardized oral hygiene protocol, 1 day before surgery: professional prophylaxis with a portable ultrasound device, tooth brushing and flossing plus a 0.12% chlorhexidine gluconate solution (0.12% CHX) mouth rinsing. When applicable, removable prostheses cleaning.

PRIMARY OUTCOME

the presence of infection.

RESULTS

The occurrence of postoperative infection was higher in CG = 7 (13.2%) than in EG = 5 (9.3%); but no statistical difference was found between protocols (p = 0.518). The length of stayed from surgery to discharge presented a statistical difference (p = 0.047; RR = 4.9; CI = 1.01-24.33); the percentage of postoperative infection was almost five times higher in those participants who stayed 11 or more days.

CONCLUSION

The standardized oral hygiene protocol with mechanical and chemical cleaning, 1 day before cardiac surgery, was not more effective than the usual practices performed regarding the reduction of postoperative infections. Other interventions regarding oral hygiene procedures before cardiac surgery must be studied to contribute to the reduction of adverse post-surgical events.

CLINICAL TRIAL REGISTRATION

Site Ensaclinicos.gov.br number U1111-1214-2862.

DESCRIPTORS

Healthcare Associated Infections, Cardiovascular Diseases, Periodontal Diseases, Dental Biofilm, Cardiovascular Surgery.

An app to support oral hygiene care: Increasing attitudes, knowledge, and confidence in identifying oral health problems among caregivers of persons living with dementia

PURPOSE

To develop and pilot test an App to help family and paid caregivers perform high quality oral hygiene care.

METHODS

A prototype of the App was refined based on stakeholder feedback (e.g., dental care professionals, direct care providers, nursing home administrator, family caregivers). The refined App was pilot tested with 16 family caregivers and 15 paid care providers of persons living with dementia (PLWD). Participants completed a pre-test, watched an App demonstration, used it for 2 weeks, and completed a post-test. Surveys included both structured and open-ended questions.

RESULTS

Phase 1 data informed the refinement of the App that led to high acceptability and usability by the Phase 2 participants. Both family and paid caregivers reported a significant increase in attitudes toward providing oral hygiene care to frail older adults (p = .05 and p = .02 for family and paid providers, respectively), knowledge about oral health and care (p = .01 and p = .02), and ability to identify oral health problems (p = .005 and p = .01). Additionally, paid caregivers reported increase in perceived support available in providing oral hygiene care (p < .001).

CONCLUSION

Stakeholder engaged approach helped increase the acceptability and usability of the App that successfully increase caregivers' attitude, knowledge, and abilities in oral hygiene care provision.

Oral health and healthy ageing: a scoping review

BACKGROUND

Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.

METHODS

A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework.

RESULTS

The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.

CONCLUSION

There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

The Prevention, Diagnosis, and Treatment of Rapid Oral Health Deterioration (ROHD) among Older Adults

The world’s population is aging. Older adults are at risk for multiple chronic medical problems as they age. The management of these diseases requires these people to take a variety of medications, which may have undesired side effects. These medical issues can impact oral healthcare and result in a precipitous decline in oral health. A standardized teaching model has been developed to help novice dental practitioners learn how to access and treat oral health problems in older adults. This model is called rapid oral health deterioration (ROHD) risk assessment. The model has four steps for assessment and four categories of risk. This paper describes the components of the ROHD risk assessment, and how it can be used to prevent, diagnose and treat ROHD among older adults.

What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world

OBJECTIVE

The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing.

DESIGN

Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community.

INCLUSION CRITERIA

Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French.

RESULTS

305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13).

CONCLUSION

The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.

Dose-dependent association between xerostomia and number of medications among older adults

PURPOSE/AIM

To investigate factors associated with self-reported dry mouth (xerostomia) among older adults seeking dental care at a University clinic.

MATERIALS AND METHODS

A query was performed in the electronic records database and de-identified data were collected from patients aged 65 + recorded on the date that the initial health history was entered. Among these patients, data about patients' medications, gender, age, BMI, tobacco use, alcohol addiction, diabetes, heart disease, joint replacement, allergies to medications, hypertension, and mental disorders were obtained. Evaluation of potential risk factors for dry mouth was performed using univariate and multivariable logistic regression analyzes (alpha = 0.05).

RESULTS

A total of 11,061 subjects were included in the analysis, 51.5% of whom were women. The mean age in years was 74.2 ± 7.0, the median number of medications was 7 (IQR = 4-11), and 38.5% of the participants reported dry mouth. The multivariable logistic regression analysis revealed that the odds of xerostomia for subjects who took 11 +, 7-10, or 4-6 medications were 3.34, 2.07, or 1.38 times those of subjects who had took 0-3 medications, respectively.

CONCLUSION

Number of medications showed a strong and dose-dependent association with xerostomia.

Models of provider care in long-term care: A rapid scoping review

INTRODUCTION

One of the current challenges in long-term care homes (LTCH) is to identify the optimal model of care, which may include specialty physicians, nursing staff, person support workers, among others. There is currently no consensus on the complement or scope of care delivered by these providers, nor is there a repository of studies that evaluate the various models of care. We conducted a rapid scoping review to identify and map what care provider models and interventions in LTCH have been evaluated to improve quality of life, quality of care, and health outcomes of residents.

METHODS

We conducted this review over 10-weeks of English language, peer-reviewed studies published from 2010 onward. Search strategies for databases (e.g., MEDLINE) were run on July 9, 2020. Studies that evaluated models of provider care (e.g., direct patient care), or interventions delivered to facility, staff, and residents of LTCH were included. Study selection was performed independently, in duplicate. Mapping was performed by two reviewers, and data were extracted by one reviewer, with partial verification by a second reviewer.

RESULTS

A total of 7,574 citations were screened based on the title/abstract, 836 were reviewed at full text, and 366 studies were included. Studies were classified according to two main categories: healthcare service delivery (n = 92) and implementation strategies (n = 274). The condition/ focus of the intervention was used to further classify the interventions into subcategories. The complex nature of the interventions may have led to a study being classified in more than one category/subcategory.

CONCLUSION

Many healthcare service interventions have been evaluated in the literature in the last decade. Well represented interventions (e.g., dementia care, exercise/mobility, optimal/appropriate medication) may present opportunities for future systematic reviews. Areas with less research (e.g., hearing care, vision care, foot care) have the potential to have an impact on balance, falls, subsequent acute care hospitalization.

Delivery and financing of oral health care in long-term services and supports: A scoping review

BACKGROUND

The oral health of older adults requiring long-term services and supports is reported to be poor as there is no national standard of care for the provision of oral health care. The purpose of this scoping review was to understand the breadth of models of delivery and financing of oral health care in the full spectrum of long-term services and supports.

TYPES OF STUDIES REVIEWED

A literature search was performed in 4 electronic databases: MEDLINE via PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Included articles were those that were regarding a nursing home population or dependent older adults living in the community, included a delivery or financing model for oral health care, and included an outcome measurement.

RESULTS

Sixteen articles were included in the review. Delivery mechanisms included onsite mobile oral health care at nursing homes and adult day health care centers for those living in the community or home visits for those who were homebound. Other mechanisms included teledentistry or using alternative workforce models such as certified public health dental hygienists. Numerous studies reported positive oral health outcomes when comprehensive care was provided in a variety of settings. Other reported outcomes included oral health stability, caries indexes, cost, and oral health-related quality of life.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

If providing onsite oral health care is not possible at facilities, programs can consider home visits, teledentistry, and alternative workforce models.

Cluster randomized control trial of nursing home residents' oral hygiene following the Mouth Care Matters education program for certified nursing assistants

Aims

The purpose of this study was to determine if the number of certified nursing assistants (CNAs) trained with the Mouth Care Matters (MCM) oral health educational program had an impact on nursing facility (NF) resident oral health.

Materials and methods

Three NFs participated in a cluster randomized control trial. In NF‐A: all CNAs were offered the MCM program, NF‐B: 3 CNAs were offered the MCM program, and NF‐C: Control (no CNAs were offered the MCM program). Demographic information, systemic health data, and oral health data at baseline, 3‐month, and 6‐month intervals were collected and analyzed using Kruskal‐Wallis, Wilcoxon signed‐rank and Wilcoxon rank‐sum tests. A total of 24 dentate residents participated in this study. Plaque control record scores for NF‐A were significantly reduced compared to NF‐B and NF‐C (P < .001 and P = .002 respectively) and gingival bleeding index for NF‐A were significantly reduced compared to NF‐B and NF‐C (P = .002 and P < .001 respectively).

Conclusion

Increasing the number of CNA's trained in the Mouth Care Matters educational program positively impacted NF residents’ oral hygiene.

Implementation and evaluation of an oral health education programme for caregivers in nursing homes

AIM

The aim was the design, implementation, and evaluation of an oral health education program for nursing home caregivers.

METHODS AND RESULTS

Fifty-five formal caregivers working in the three units of a nursing home were allocated to either a control (n = 27) or an intervention group (n = 28). A knowledge and attitudes questionnaire about oral health was developed and completed by the caregivers. Then, an education program about oral heath in older people was applied to the intervention group, and the completion of the questionnaire was repeated by both the intervention and control groups. Two months after the intervention, the questionnaire was completed again by the intervention group. Within groups analyses revealed a statistically significant increase in knowledge and attitudes only in the intervention group after the implementation of the education program (P < .001). Between-group analyses showed that the total knowledge and attitudes score in the intervention group were statistically significantly higher than in the control group (P < .001 and P = .02, respectively). In the intervention group, knowledge and attitudes were maintained in the measurement recorded 2 months later (P = .11 and P = .21, respectively).

CONCLUSION

The education program was effective in improving the caregivers' knowledge and attitudes toward nursing home residents' oral health and maintaining them 2 months after implementation.

Interventions for improving oral health in people after stroke

BACKGROUND

For people with physical, sensory and cognitive limitations due to stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group.

OBJECTIVES

To compare the effectiveness of OHC interventions with usual care or other treatment options for ensuring oral health in people after a stroke.

SEARCH METHODS

We searched the Cochrane Stroke Group and Cochrane Oral Health Group trials registers, CENTRAL, MEDLINE, Embase, and six other databases in February 2019. We scanned reference lists from relevant papers and contacted authors and researchers in the field. We handsearched the reference lists of relevant articles and contacted other researchers. There were no language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that evaluated one or more interventions designed to improve the cleanliness and health of the mouth, tongue and teeth in people with a stroke who received assisted OHC led by healthcare staff. We included trials with a mixed population provided we could extract the stroke-specific data. The primary outcomes were dental plaque or denture plaque. Secondary outcomes included presence of oral disease, presence of related infection and oral opportunistic pathogens related to OHC and pneumonia, stroke survivor and providers' knowledge and attitudes to OHC, and patient satisfaction and quality of life.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened abstracts and full-text articles according to prespecified selection criteria, extracted data and assessed the methodological quality using the Cochrane 'Risk of bias' tool. We sought clarification from investigators when required. Where suitable statistical data were available, we combined the selected outcome data in pooled meta-analyses. We used GRADE to assess the quality of evidence for each outcome.

MAIN RESULTS

Fifteen RCTs (22 randomised comparisons) involving 3631 participants with data for 1546 people with stroke met the selection criteria. OHC interventions compared with usual care Seven trials (2865 participants, with data for 903 participants with stroke, 1028 healthcare providers, 94 informal carers) investigated OHC interventions compared with usual care. Multi-component OHC interventions showed no evidence of a difference in the mean score (DMS) of dental plaque one month after the intervention was delivered (DMS -0.66, 95% CI -1.40 to 0.09; 2 trials, 83 participants; I² = 83%; P = 0.08; very low-quality evidence). Stroke survivors had less plaque on their dentures when staff had access to the multi-component OHC intervention (DMS -1.31, 95% CI -1.96 to -0.66; 1 trial, 38 participants; P < 0.0001; low-quality evidence). There was no evidence of a difference in gingivitis (DMS -0.60, 95% CI -1.66 to 0.45; 2 trials, 83 participants; I² = 93%; P = 0.26: very low-quality evidence) or denture-induced stomatitis (DMS -0.33, 95% CI -0.92 to 0.26; 1 trial, 38 participants; P = 0.69; low-quality evidence) among participants receiving the multi-component OHC protocol compared with usual care one month after the intervention. There was no difference in the incidence of pneumonia in participants receiving a multi-component OHC intervention (99 participants; 5 incidents of pneumonia) compared with those receiving usual care (105 participants; 1 incident of pneumonia) (OR 4.17, CI 95% 0.82 to 21.11; 1 trial, 204 participants; P = 0.08; low-quality evidence). OHC training for stroke survivors and healthcare providers significantly improved their OHC knowledge at one month after training (SMD 0.70, 95% CI 0.06 to 1.35; 3 trials, 728 participants; I² = 94%; P = 0.03; very low-quality evidence). Pooled data one month after training also showed evidence of a difference between stroke survivor and providers' oral health attitudes (SMD 0.28, 95% CI 0.01 to 0.54; 3 trials, 728 participants; I² = 65%; P = 0.06; very low-quality evidence). OHC interventions compared with placebo Three trials (394 participants, with data for 271 participants with stroke) compared an OHC intervention with placebo. There were no data for primary outcomes. There was no evidence of a difference in the incidence of pneumonia in participants receiving an OHC intervention compared with placebo (OR 0.39, CI 95% 0.14 to 1.09; 2 trials, 242 participants; I² = 42%; P = 0.07; low-quality evidence). However, decontamination gel reduced the incidence of pneumonia among the intervention group compared with placebo gel group (OR 0.20, 95% CI 0.05 to 0.84; 1 trial, 203 participants; P = 0.028). There was no difference in the incidence of pneumonia in participants treated with povidone-iodine compared with a placebo (OR 0.81, 95% CI 0.18 to 3.51; 1 trial, 39 participants; P = 0.77). One OHC intervention compared with another OHC intervention Twelve trials (372 participants with stroke) compared one OHC intervention with another OHC intervention. There was no difference in dental plaque scores between those participants that received an enhanced multi-component OHC intervention compared with conventional OHC interventions at three months (MD -0.04, 95% CI -0.33 to 0.25; 1 trial, 61 participants; P = 0.78; low-quality evidence). There were no data for denture plaque.

AUTHORS' CONCLUSIONS

We found low- to very low-quality evidence suggesting that OHC interventions can improve the cleanliness of patient's dentures and stroke survivor and providers' knowledge and attitudes. There is limited low-quality evidence that selective decontamination gel may be more beneficial than placebo at reducing the incidence of pneumonia. Improvements in the cleanliness of a patient's own teeth was limited. We judged the quality of the evidence included within meta-analyses to be low or very low quality, and this limits our confidence in the results. We still lack high-quality evidence of the optimal approach to providing OHC to people after stroke.

Factors associated with the counts of selected oral microorganisms in nursing home residents

PURPOSE/AIM

To analyze potential factors associated with levels of selected oral pathogens, as well as total aerobic bacterial species, among nursing home residents.

MATERIALS AND METHODS

Nursing home residents were divided into three groups (G1 included people with teeth but no dentures, G2 included people with teeth and dentures, and G3 included people with no teeth and with dentures). All participants had microbiological samples collected from their oral cavity and dentures. Counts of total aerobic bacterial species, Porphyromonas gingivalis, Fusobacterium nucleatum, Actinomyces viscosus, Aggregatibacter actinomycetemcomitans, and Candida albicans were compared among groups using the Wilcoxon rank sum test. A multivariate analysis was also performed to control other available covariates.

RESULTS

Bivariate analysis revealed significant differences among the groups, and multivariate analysis showed that sex, the presence of natural teeth, denture wearing, oral hygiene indices, and systemic health conditions were associated with bacterial and Candida albicans log counts.

CONCLUSIONS

Presence of natural teeth and denture wearing, as well as oral hygiene, sex and systemic health conditions were associated with bacterial and Candida albicans log counts among nursing home residents.

Interventions to improve oral health of older people: A scoping review

OBJECTIVES

A range of interventions have been tested to improve oral health of older people. We performed a scoping review to map interventions' aims, outcome measures and findings, and to locate them on different levels of care.

DATA

We systematically screened for (1) controlled studies on (2) people over 65 years of age, (3) comparing at least two interventions to improve oral health. Interventions were summarized according to their aims and the employed intervention type, mapped on their level of action, and classified as primary/secondary/tertiary prevention.

SOURCES

Studies retrieved via MEDLINE, EMBASE, CINAHL.

STUDY SELECTION

Eighty-one studies (published 1997-2019, conducted mainly in high-income countries) were included. Sample sizes varied (n = 24-1987). Follow-up was 0.25-60 months. Most studies (64/81) found a statistically significant benefit of the intervention. A total of 13 different aims were identified, and a range of intervention types employed (e.g. educational interventions, professional oral healthcare, restorative treatment, fluoride application and, generally, dentifrices, mouthwashes, chewing gums/food supplements). Most studies were located on the carer/patient level (56/81 studies) or the system/policy-maker level (44/81). The majority of studies aimed for primary prevention (64/81).

CONCLUSIONS

Oral health improvement interventions are widely studied. However, study aims, methods and outcome measures are highly heterogeneous, which limits the ability for robust conclusions. Current research focusses on primary prevention on the level of patients/carers or system/policy-maker level. Future studies may want to consider interventions on dentists' level focussing on secondary prevention. These studies should rely on a core set of comprehensive, standardized set of outcome measures.

CLINICAL SIGNIFICANCE

While specific interventions seem efficacious to improve older people's oral health, the current body of evidence is neither comprehensive (significant gaps exists in relevant levels of the care process) nor comparable enough to draw robust conclusions.

Teaching rapid oral health deterioration risk assessment: A 5-year report

PURPOSE/OBJECTIVES

The purpose of this study was to present a 5-year report about the outcomes of using a teaching tool that guides dental students through the thought process of the expert about how to assess the risk of rapid oral health deterioration (ROHD) among older adults and provide viable treatment alternatives.

METHODS

A teaching tool was previously developed using ROHD risk factors identified in the literature and the steps that experts apply in their treatment decision making, summarized in 10 questions. During 5 years, 188 senior dental students were introduced to the teaching tool and asked to use the 10-question set to present a case they have treated during their Geriatric and Special Needs Program. Two evaluators were asked to grade the students on each question. Students were graded "G" if they answered the question and grasped the principles behind it, "A" if they only answered the question, or "M" if they missed the question. Additionally, the students were given a form to grade the importance of and comment on the exercise.

RESULTS

More than 75% of the students had an A or G for most questions, agreement between the 2 evaluators was above 85%, and students' performances improved during the 5-year period. Additionally, 94.4% of the students considered the teaching tool as important or very important for the general dentist.

CONCLUSION

The vast majority of the students had an A or G grade, examiner agreement was high, and the students appreciated the importance of this teaching tool for the general dentist.

Self-perceived oral health among institutionalized older adults in Taubate, Brazil

PURPOSE/AIM

To assess self-perception of oral health among institutionalized older adults in Taubate, Brazil.

METHOD AND MATERIALS

Demographics, oral, and systemic health data were collected from a sample of 89 institutionalized older adults. The Geriatric Oral Health Assessment Index (GOHAI) was applied to assess their self-perception of oral health. A linear regression model using GOHAI scores and considering age, BMI, gender, race, dry mouth, denture status, number of teeth, number of comorbid conditions, and number of medications as independent variables was generated.

RESULTS

Fifty-five percent were male, with an average age of 75.9 years (±9.1), 43.8% identified as mixed race, and 42.7% as white. The average BMI was 23.9 (±3.8), the average number of comorbid condition was 1.8 (±1.4), and the average number of daily medications was 6.2 (±3.6). The average number of teeth was 3.9 (±7.4), and 57.3% of the participants reported dry mouth sensation; 8.9% presented oral lesions, with denture stomatitis as the most common oral lesion (5.6%). The average GOHAI score was 31.1 (±3.7). Regression analysis showed a negative correlation between BMI and GOHAI scores (P = .032, R²  = 7.2%).

CONCLUSIONS

Self-perception of oral health was good and negatively correlated with BMI.

Personalized Dental Caries Management for Frail Older Adults and Persons with Special Needs

Frail older adults and persons with special needs are at higher risk of oral diseases including dental caries. Considering the diverse background of the population, a personalized approach for each patient is mandatory to successfully manage their oral health needs. This article describes a succinct way to assess and categorize the risk of rapid oral health deterioration (ROHD) among this group. The procedures for assessing ROHD risk examine the ROHD risk categories, how risk factors impact treatment strategies, what techniques and materials exist for caries prevention and treatment, and how one effectively communicates caries management plans for this population.

Oral health care for patients with Alzheimer's disease: An update

Alzheimer's disease and related disorders (ADRD) are among the age-associated chronic conditions that are most challenging to health care systems around the globe, as patients with dementia require full-time, intensive care for multiple years. Oral health care is negatively impacted by cognitive decline, and consequently poor oral health is common among people with ADRD. Poor oral health status is linked with many undesirable consequences for the well-being of people with ADRD, from excruciating local pain to life-threatening conditions, as aspiration pneumonia. In this paper, the authors provide an update on the most current concepts about Alzheimer's disease epidemiology, etiology, and management, current oral health care for patients with Alzheimer's disease, oral health promotion strategies for this population, as well as current research and future direction for improving oral health care for patients with Alzheimer's disease. It concludes that oral health care should be included in the patient's routine health care as early as possible in the progression of Alzheimer's disease for preventing rapid oral health deterioration. Establishing oral hygiene routines and providing dental treatment that is customized to the patients' individual needs and disease stage are important to achieve good oral health outcomes and prevent quality of life decline.