Burden of poor oral health in older age: findings from a population-based study of older British men

Neighborhood Deprivation and Changes in Oral Health in Older Age: A Longitudinal Population-Based Study

The aim of this study was to examine the extent to which neighborhood-level socioeconomic factors (objective and perceived) are associated with poor oral health in older adults over time, independent of individual socioeconomic position. Data for this cross-sectional and longitudinal observation study came from a socially and geographically representative cohort of men aged 71 to 92 y in 2010-12 (n = 1,622), drawn from British general practices, which was followed up in 2018-19 (aged 78-98 y; N = 667). Dental measures at both times included number of teeth, periodontal pocket depth, self-rated oral health, and dry mouth. Neighborhood deprivation was based on Index of Multiple Deprivation (IMD) and a cumulative index measuring perceptions about local environment. Individual-level socioeconomic position was based on longest-held occupation. Multilevel and multivariate logistic regressions, adjusted for relevant sociodemographic, behavioral, and health-related factors, were performed to examine the relationships of dental measures with IMD and perceived neighborhood quality index, respectively. Cross-sectionally, risks of tooth loss, periodontal pockets, and dry mouth increased from IMD quintiles 1 to 5 (least to most deprived); odds ratios (ORs) for quintile 5 were 2.22 (95% confidence interval [CI], 1.41-3.51), 2.82 (95% CI, 1.72-4.64), and 1.51 (95% CI, 1.08-2.09), respectively, after adjusting for sociodemographic, behavioral, and health-related factors. Risks of increased pocket depth and dry mouth were significantly greater in quintile 5 (highest problems) of perceived neighborhood quality index compared to quintile 1. Over the 8-y follow-up, deterioration of dentition (tooth loss) was significantly higher in the most deprived IMD quintiles after full adjustment (OR for quintile 5 = 2.32; 95% CI, 1.09-4.89). Deterioration of dentition and dry mouth were significantly greater in quintile 5 of perceived neighborhood quality index. Neighborhood-level factors were associated with poor oral health in older age, both cross-sectionally and longitudinally, particularly with tooth loss, and dry mouth, independent of individual-level socioeconomic position.

Learning in conversation-A feasibility pilot study involving dental students and older people

INTRODUCTION

Older people represent a growing proportion of the population in most high-income countries. The impact of oral diseases on health and well-being is far-reaching, and future graduates should be able to meet their needs in this phase of life. This research tested the feasibility of involving dental students in direct community engagement to explore older peoples' oral health concerns and information needs.

MATERIALS AND METHODS

Seventeen older people were recruited locally to attend workshops with eight dental students in a health and well-being centre. First, older people selected oral health-related topics important to them, raising relevant questions and concerns. Students provided evidence-informed feedback on these selected topics at a subsequent workshop. Participants (students and older people) reflected on their involvement (via questionnaires, discussions and personal reflections). Qualitative data were analysed using thematic analysis. The structure, process and outcome of the study were explored.

RESULTS

Structure: Both students and older people were willing to participate in workshops. Workshops in the community facilitated active engagement between both groups without the constraints of clinics.

PROCESS

Students considered pre-workshop preparations adequate but raised issues about their ability to manage 'strong characters' within discussion groups.

OUTCOME

Older people welcomed the initiative. Important topics raised by them were addressed by students giving them advice on maintaining their oral health. Students reported an improved understanding of how older people can be supported and expected a significant impact on future practice.

CONCLUSION

Student involvement in direct community engagement was welcomed by all, demonstrating the feasibility and positive impact of the design whilst highlighting issues of importance for older people's oral health.

Allostatic load and oral health later in life among middle-aged and older adults: An analysis of population-based panel data in China

BACKGROUND

Oral health is a major global public health problem, but its risk factors have not been fully identified. The limited evidence suggests that AL may affect oral health conditions, but most of these studies focus only on middle-aged western populations.

OBJECTIVES

To examine whether allostatic load is associated with oral health conditions later in life among middle-aged and older adults in China and there there is a correlation in both middle-aged and older people.

MATERIALS AND METHODS

Data were collected from the China Health and Retirement Longitudinal Study 2011-2018 (N = 10 890) and were analysed using logistic regressions for the overall sample and subsamples by age.

RESULTS

Results showed that higher inflammation load significantly increased the odds of edentulism (OR = 1.358, 95% CI = 1.020-1.809, p < .05). Higher metabolic load significantly increased the odds of denture use (OR = 1.375, 95% CI = 1.154-1.640, p < 0.001) and difficulty in chewing solid foods (OR = 1.100, 95% CI = 1.035-1.169, p < .01). These associations were manifested in older adults over 60 years of age, while in the middle-aged subsample, the associations were not significant.

CONCLUSION

The findings suggested that higher allostatic load was associated with poorer oral health conditions later in life. It is critical to lower allostatic load and improve oral health conditions, especially for older adults over 60 years of age. Prospective studies and intervention trials help to better understand whether allostatic load is causally linked to oral health.

Description of Poly(aryl-ether-ketone) Materials (PAEKs), Polyetheretherketone (PEEK) and Polyetherketoneketone (PEKK) for Application as a Dental Material: A Materials Science Review

Poly(aryl-ether-ketone) materials (PAEKs), a class of high-performance polymers comprised of polyetheretherketone (PEEK) and polyetherketoneketone (PEKK), have attracted interest in standard dental procedures due to their inherent characteristics in terms of mechanical and biological properties. Polyetheretherketone (PEEK) is a restorative dental material widely used for prosthetic frameworks due to its superior physical, mechanical, aesthetic, and handling features. Meanwhile, polyetherketoneketone (PEKK) is a semi-crystalline thermoplastic embraced in the additive manufacturing market. In the present review study, a new way to fabricate high-performance polymers, particularly PEEK and PEKK, is demonstrated using additive manufacturing digital dental technology, or 3-dimensional (3D) printing. The focus in this literature review will encompass an investigation of the chemical, mechanical, and biological properties of HPPs, particularly PEEK and PEKK, along with their application particularly in dentistry. High-performance polymers have gained popularity in denture prosthesis in advance dentistry due to their flexibility in terms of manufacturing and the growing interest in utilizing additive manufacturing in denture fabrication. Further, this review also explores the literature regarding the properties of high-performance polymers (HPP) compared to previous reported polymers in terms of the dental material along with the current advancement of the digital designing and manufacturing.

The Relationship of Oral Health with Progression of Physical Frailty among Older Adults: A Longitudinal Study Composed of Two Cohorts of Older Adults from the United Kingdom and United States

OBJECTIVE

To investigate the prospective associations between oral health and progression of physical frailty in older adults.

DESIGN

Prospective analysis.

SETTING AND PARTICIPANTS

Data are from the British Regional Heart Study (BRHS) comprising 2137 men aged 71 to 92 years from 24 British towns and the Health, Aging, and Body Composition (HABC) Study of 3075 men and women aged 70 to 79 years.

METHODS

Oral health markers included denture use, tooth count, periodontal disease, self-rated oral health, dry mouth, and perceived difficulty eating. Physical frailty progression after ∼8 years follow-up was determined based on 2 scoring tools: the Fried frailty phenotype (for physical frailty) and the Gill index (for severe frailty). Logistic regression models were conducted to examine the associations between oral health markers and progression to frailty and severe frailty, adjusted for sociodemographic, behavioral, and health-related factors.

RESULTS

After full adjustment, progression to frailty was associated with dentition [per each additional tooth, odds ratio (OR) 0.97; 95% CI: 0.95-1.00], <21 teeth with (OR 1.74; 95% CI: 1.02-2.96) or without denture use (OR 2.45; 95% CI 1.15-5.21), and symptoms of dry mouth (OR ≥1.8; 95% CI ≥ 1.06-3.10) in the BRHS cohort. In the HABC Study, progression to frailty was associated with dry mouth (OR 2.62; 95% CI 1.05-6.55), self-reported difficulty eating (OR 2.12; 95% CI 1.28-3.50) and ≥2 cumulative oral health problems (OR 2.29; 95% CI 1.17-4.50). Progression to severe frailty was associated with edentulism (OR 4.44; 95% CI 1.39-14.15) and <21 teeth without dentures after full adjustment.

CONCLUSIONS AND IMPLICATIONS

These findings indicate that oral health problems, particularly tooth loss and dry mouth, in older adults are associated with progression to frailty in later life. Additional research is needed to determine if interventions aimed at maintaining (or improving) oral health can contribute to reducing the risk, and worsening, of physical frailty in older adults.

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.

The Relationships of Dentition, Use of Dental Prothesis and Oral Health Problems with Frailty, Disability and Diet Quality: Results from Population-Based Studies of Older Adults from the UK and USA

OBJECTIVES

This study examined the relationships of dental status, use and types of dental prothesis and oral health problems, individually and combined, with diet quality, frailty and disability in two population-based studies of older adults.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Men form the British Regional Heart Study (BRHS) (aged 85±4 years in 2018; n=1013) and Men and Women from the Health, Aging, and Body Composition (HABC) Study (aged 75±3 years in 1998-99; n=1975).

MEASUREMENTS

Physical and dental examinations and questionnaires were collected with data available for dental status, oral problems related to eating, diet quality, Fried frailty phenotype, disability based on mobility limitations, and activities of daily living (ADL). The associations of dental status and oral health problems, individually and combined, with risk of frailty and disability were quantified. The relationship with diet quality was also assessed.

RESULTS

In the BRHS, but not HABC Study, impaired natural dentition without the use of dentures was associated with frailty independently. This relationship was only established in the same group in those with oral problems (OR=3.24; 95% CI: 1.30-8.03). In the HABC Study, functional dentition with oral health problems was associated with greater risk of frailty (OR=2.21; 95% CI: 1.18-4.15). In both studies those who wore a full or partial denture in one or more jaw who reported oral problems were more likely to have disability. There was no association with diet quality in these groups.

CONCLUSION

Older adults with impaired dentition even who use dentures who experience self-report oral problems related to eating may be at increased risk of frailty and disability. Further research is needed to establish whether improving oral problems could potentially reduce the occurrence of frailty and disability.

Salivary film thickness and MUC5B levels at various intra-oral surfaces

OBJECTIVES

In this study, we investigated the salivary film thickness and the MUC5B levels at various intra-oral locations in healthy volunteers, with a focus on the palate. Besides, measurements of the palatal surface area were included to explore the possible relationships between the palatal surface area and the palatal salivary film and MUC5B levels.

MATERIALS AND METHODS

The salivary film thickness was determined using filter strips, which were pressed to the mucosal surfaces of five different intra-oral locations; conductance was then analysed using a Periotron. After elution of the strips, the MUC5B levels at various intra-oral locations were determined using ELISA. The palatal surface area was measured using an intra-oral scanner. The surface area was subsequently calculated using the software.

RESULTS

The anterior tongue had the thickest salivary film and also the highest levels of MUC5B, while the anterior palate had the thinnest salivary film and lowest MUC5B levels. There was no association between the palatal surface area and the salivary film thickness of the palate.

CONCLUSION

The salivary film and MUC5B levels are unequally distributed over the intra-oral regions of the soft tissues. The lack of association between the palatal surface area and the salivary film thickness indicates that a larger surface area is not associated with a relative thinner palatal salivary film.

CLINICAL RELEVANCE

The results of the current study increase our understanding of saliva distribution in the oral cavity and could be used as reference values for future studies.

Association between oral health markers and decline in muscle strength and physical performance in later life: longitudinal analyses of two prospective cohorts from the UK and the USA

BACKGROUND

Poor oral health could be associated with changes in musculoskeletal health over time. This aim of this study was to investigate the longitudinal relationship between oral health and decline in physical function in later life.

METHODS

We did a prospective analysis of two cohorts of older adults (aged 70 years or older) including men from the British Regional Heart Study (BRHS; n=612), and men and women from the Health, Aging and Body Composition (Health ABC) Study (n=1572), followed up for about 8 years. Data were available for clinical or self-reported oral health measures, muscle (grip) strength, and physical performance (chair stand and gait speed). ANCOVA models were used to assess the association between oral health and follow-up physical function scores. Multivariate logistic regression models were used to examine the associations between oral health and decline in physical function over the follow-up period. In the BRHS, changes in oral health and physical function were also assessed. All models were adjusted for relevant sociodemographic, behavioural, and health-related factors.

FINDINGS

In the BRHS, complete tooth loss and difficulty eating were associated with weaker grip strength at follow-up, and periodontal status was associated with decline in gait speed. In the Health ABC Study, complete tooth loss, poor self-rated oral health, and the presence of one oral health problem were associated with slower gait speed at follow-up. In both studies, dry mouth was associated with declines in physical function. In the BRHS, deterioration of dentition (tooth loss) over the follow-up period was associated with decline in chair stand speed (adjusted odds ratio 2·34 [95% CI 1·20-4·46]), as was deterioration in difficulty eating (2·41 [1·04-5·60]).

INTERPRETATION

Oral health problems are associated with poorer physical function and greater decline in physical function in older adults, and could be an indicator of individuals at risk of reduced physical capacity and subsequent frailty and disability in later life.

FUNDING

The Dunhill Medical Trust and the US National Institutes of Health-National Institute of Dental and Craniofacial Research.

Protein Intake and Oral Health in Older Adults-A Narrative Review

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein-energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults.

Modification of Polymer Based Dentures on Biological Properties: Current Update, Status, and Findings

Polymers remain an integral part of denture fabrication materials, specifically polymethylmetacrylate (PMMA). PMMA has been extensively used, particularly in construction as a denture base material. Nonetheless, various challenges, including microbial threats in the form of candidiasis occurrence, still remain a biological challenge to denture wearers. The present article comprehensively reviews the biomodifications introduced to denture components, in particular denture base material, to improve the overall biological properties, together with physical, mechanical, structural integrity, and optical properties. In addition, fundamental information specifically to PMMA as a conventional denture base material and the causative aetiological microbial agents for biological threat to dentures are explored.

Gender modified association of oral health indicators with oral health-related quality of life among Korean elders

OBJECTIVE

To evaluate the association between oral health-related quality of life (OHRQoL) and oral health indicators including dental status, total occlusion force (TOF), number of natural and rehabilitated teeth (NRT), number of natural teeth (NT), and to explore the effect modification on the association by gender among Korean elders.

METHODS

A total of 675 participants aged 65 or above recruited by a cluster-based stratified random sampling were included in this cross-sectional study. The 14-items Korean version of the Oral Health Impact Profile (OHIP) was used to measure OHRQoL. The responses about OHIP were dichotomized by the cut-off point of 'fairly often' to determine the 'poor' versus 'fair' OHRQoL. Age, gender, education level, alcohol drinking, smoking, metabolic syndrome, frailty, and periodontitis were considered as confounders. Multiple multivariable logistic regression analyses were applied to assess the adjusted association between oral health indicators and OHRQoL. Gender stratified analysis was also applied to explore the effect modification of the association.

RESULTS

The prevalence of poor OHRQoL was 43.0%, which was higher in women, less-educated elders, alcohol non-drinkers and frailty elders (p < 0.05). Elders with poor OHRQoL also showed lower values of oral health indicators than elders with fair OHRQoL (p < 0.05). Those with NRT ≤ 24, NT ≤ 14, and TOF < 330 N increased the risk of poor OHRQoL by 2.3 times (OR = 2.26, confidence interval [CI] 1.54-3.31), 1.5 times (OR = 1.45, CI 1.02-2.07), and 1.5 times (OR = 1.47, CI 1.06-2.04), respectively. In women, the association of NRT ≤ 24 with poor OHRQoL increased from OR of 2.3 to OR of 2.4, while, in men, the association of TOF < 330 N with poor OHRQoL increased from OR of 1.5 to OR of 3.2.

CONCLUSION

Oral health indicators consisting of TOF, NRT, and NT were independently associated with poor OHRQoL among Korean elders. Gender modified the association of TOF and NRT. Preventive and/or curative management for keeping natural teeth and the rehabilitation of missing teeth to recover the occlusal force may be essential for reducing poor OHRQoL.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA

Preventing deterioration of oral health in older age can be crucial for survival. We aimed to examine associations of oral health problems with all-cause, cardiovascular disease (CVD), and respiratory mortality in older people. We used cohort data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) Study (USA) (N = 3075, 71-80 years). Follow-up was 9 years (BRHS) and 15 years (HABC Study). Oral health comprised tooth loss, periodontal disease, dry mouth, and self-rated oral health. Cox regression was performed for all-cause mortality, competing risks for CVD mortality, and accelerated failure time models for respiratory mortality. In the BRHS, tooth loss was associated with all-cause mortality (hazard ratio (HR) = 1.59, 95% CI 1.09, 2.31). In the HABC Study, tooth loss, dry mouth, and having ≥ 3 oral problems were associated with all-cause mortality; periodontal disease was associated with increased CVD mortality (subdistribution hazard ratio (SHR) = 1.49, 95% CI 1.01, 2.20); tooth loss, and accumulation of oral problems were associated with high respiratory mortality (tooth loss, time ratio (TR) = 0.73, 95% CI 0.54, 0.98). Findings suggest that poor oral health is associated with mortality. Results highlight the importance of improving oral health to lengthen survival in older age.

Poor oral health and the association with diet quality and intake in older people in two studies in the UK and USA

We aimed to investigate the associations of poor oral health cross-sectionally with diet quality and intake in older people. We also examined whether change in diet quality is associated with oral health problems. Data from the British Regional Heart Study (BRHS) comprising British males aged 71-92 years and the Health, Aging and Body Composition (HABC) Study comprising American males and females aged 71-80 years were used. Dental data included tooth loss, periodontal disease, dry mouth and self-rated oral health. Dietary data included diet quality (based on Elderly Dietary Index (BRHS) and Healthy Eating Score (HABC Study)) and several nutrients. In the BRHS, change in diet quality over 10 years (1998-2000 to 2010-2012) was also assessed. In the BRHS, tooth loss, fair/poor self-rated oral health and accumulation of oral health problems were associated with poor diet quality, after adjustment. Similar associations were reported for high intake of processed meat. Poor oral health was associated with the top quartile of percentage of energy content from saturated fat (self-rated oral health, OR 1·34, 95 % CI 1·02, 1·77). In the HABC Study, no significant associations were observed for diet quality after adjustment. Periodontal disease was associated with the top quartile of percentage of energy content from saturated fat (OR 1·48, 95 % CI 1·09, 2·01). In the BRHS, persistent low diet quality was associated with higher risk of tooth loss and accumulation of oral health problems. Older individuals with oral health problems had poorer diets and consumed fewer nutrient-rich foods. Persistent poor diet quality was associated with oral health problems later in life.

Type 2 diabetes and its characteristics are associated with poor oral health: findings from 60,590 senior women from the E3N study

BACKGROUND

Type 2 diabetes (T2D) has been identified as a risk factor for poor oral health, however, a limited number of oral health and T2D characteristics have been studied so far. We sought to assess T2D status, age at diagnosis, duration since diagnosis and treatment in relation to a variety of oral diseases.

METHODS

Cross-sectional data were analyzed from the E3N (Etude Epidémiologique auprès de femmes de l'Education Nationale) cohort study which enrolled 60,590 women. Participants self-reported oral health status, and T2D cases were identified using diabetes-specific questionnaires and drug reimbursement insurance databases. Multivariable-adjusted ORs and 95% CIs were estimated using logistic regression models.

RESULTS

The mean age (SD) of the women was 70 years (7.2), and 4.7% (n = 2857) had T2D. Compared to women without T2D, women with T2D were more likely to report a poor perceived oral health (OR 1.37 [95% CI 1.18, 1.60]), wearing dental prostheses (1.26 [1.14, 1.39]) and having problems of biting and chewing food (1.19 [1.07, 1.33]). In addition, for women with T2D the age at diagnosis (inversely) and the duration (positively) were associated with the likelihood to report poor oral health.

CONCLUSIONS

For women with T2D, duration and age at diagnosis are associated with wearing prostheses, problems of biting and chewing, periodontitis and gingivitis.

COVID-19 in Dental Settings: Novel Risk Assessment Approach

The novel coronavirus (COVID-19) outbreak is a public health emergency of international concern, and this emergency led to postponing elective dental care procedures. The postponing aimed to protect the public from an unknown risk caused by COVID-19. At the beginning of the outbreak, for public health authorities, the aerosol-generating procedures and the close proximity between dental care workers and patients in dentistry represented sufficient justification for the delay of dental visits. Dental care is a priority, and for many years, studies have proven that the lack and delay of dental care can cause severe consequences for the oral health of the general population, which can cause a high global burden of oral diseases. Safety is necessary while resuming dental activities, and risk assessment is an efficient method for understanding and preventing the COVID-19 infectious threats facing the dental industry and affecting dental care workers and patients. In this study, for safe dental care delivery, we adapted risk assessment criteria and an approach and an occupational classification system. Based on those tools, we also recommend measures that can help to minimize infectious risk in dental settings.

Changes in gingivitis and protective factors among adults: A 4-year prospective population-based study

OBJECTIVES

There are limited longitudinal data regarding gingival inflammation in adults. This study aimed to assess changes in gingivitis over 4 years and to determine protective factors.

METHODS

A representative sample of 1023 adults living in Porto Alegre, Brazil, was obtained in the Caries-Perio Collaboration Study. At follow-up, 402 individuals were re-examined. Gingivitis was assessed by the gingival bleeding index (GB) at both time points. Individuals were dichotomized into those showing reductions ≥ 15% and those showing reductions < 15% or increase in bleeding sites. Multivariable Poisson regression models were fitted with 11 possible risk factors, estimating relative risks (RR) and 95% confidence intervals (95% CI).

RESULTS

Percentage of individuals with GB ≥ 10% reduced from 72.4% to 53.8%. Bleeding sites significantly reduced (25.9%-20.1%), and in a higher magnitude in buccal/palatal sites (34.1%-24.0%). 31.0% of individuals presented GB reduction ≥ 15% in all sites. Toothbrushing ≥ 3 times/d increased 72% the probability of ≥15% GB reduction compared with ≤1/d (RR = 1.72; 95% CI 1.01-3.16). For each 10 pack-years smoked, the probability of ≥15% GB reduction was 3% higher (RR = 1.03; 95% CI: 1.01-1.04). At buccal/palatal sites, normal weight individuals had 26% higher probability of reducing GB than overweight-obese individuals (RR = 1.26; 95% CI: 1.01-1.62). A 5% higher decrease in GB sites was observed in the absence than the presence of periodontitis. Younger individuals had higher reduction in GB sites.

CONCLUSIONS

In the studied population, gingivitis reduced over time, with younger age, better oral hygiene, absence of periodontitis and normal weight being found to be protective factors. Smoking was associated with lower levels of gingivitis over time, probably due to its vasoconstrictive effect.

Influences of behaviour and attitude on education related inequality in tooth loss: findings from Norway and Sweden over 5 years of follow- up

OBJECTIVES

Following community dwelling cohorts in Norway and Sweden from 65 to 70 years, this study aimed to answer the following questions; Is there cross country variation in educational inequality in tooth loss between the Norwegian and Swedish cohorts? Does oral health behaviours and attitudinal beliefs play a role in explaining educational inequality in tooth loss across time and cohorts?

MATERIAL AND METHODS

In 2007 and 2012 Statistics Norway administered mailed questionnaires to all individuals born in 1942 in three counties. The response rate was 58% (n = 4211) in 2007 and 54.5% (n = 3733) in 2012. In Sweden the same questionnaires were sent to the 1942 cohort in two counties. The final response rate in 2007 and 2012 were respectively, 73.1% (n = 6078) and 72.2% (n = 5697).

RESULTS

In Norway, tooth loss prevalence was 21.8% in 2007 and 23.2% in 2012. Corresponding figures in Sweden were 25.9% and 27.3%. The prevalence of tooth loss was higher among lower than higher educated participants and the gradient was significantly weaker in Sweden than in Norway. Multiple variable analyses adjusting for oral behavioural and attitudinal variables attenuated education related gradients in both cohorts.

CONCLUSION

Education related inequality in tooth loss was stronger in the Norwegian than in the Swedish cohort across the survey years. Oral behaviours and attitudinal beliefs played a role in explaining the gradients across time. This illustrates a necessity to promote oral health enhancing behaviours and attitudinal beliefs, particularly so in lower educational groups.

Correlation between microbial host factors and caries among older adults

Background

There is little knowledge about factors which may affect oral health among older adults. The objective of this study was to determine the relationship between Streptococcus mutans (MS) and Lactobacilli (LB) counts and caries among older adults.

Methods

In this community-based observation study, 141 participants aged 60 years and above were recruited from the west district of Singapore. Alongside the clinical examination, saliva samples were collected to determine Streptococcus mutans (MS) and Lactobacilli (LB) counts, as well as to record salivary flow rate and buffering capacity of saliva.

Results

Of the 141 participants, 63.8% were female and 94.3% were of Chinese ethnicity. The mean DMFT was 11.08 (s.d. 8.27). 9.9% of participants had at least one decayed tooth, 52.5% had minimum one missing tooth and 86.5% had at least one filled tooth. 67.4% had MS counts of ≥ 10⁵ while LB counts were ≥ 10⁵ for 48.2%. 83.7% had normal salivary flow or hypersalivation (> = 1 mL/min), the buffering capacity of the saliva was alkaline in 61% of the participants. Multivariate analysis showed that participants who had high MS counts were less likely to have a DMFT < 12 [OR (95% CI), 0.29 (0.11–0.77)] whereas participants who had high LB counts were less likely to have a DMFT ≤ 14 [OR (95% CI), 0.45 (0.20–1.002)].

Conclusion

Our study showed a positive correlation between MS and LB counts and caries experience in older adults. The mean DMFT was on the low side in our sample despite having a relatively high MS count. This suggests that there are many other factors which vary according to host environment, physiological and biological conditions that may affect MS and LB counts in the oral cavity.

Clinical relevance

Our study supports the knowledge that the aetiology of dental caries among older adults is a complex process and it would be wrong to consider caries as a same problem with the same solution for all age groups.

Poor Oral Health and Inflammatory, Hemostatic, and Cardiac Biomarkers in Older Age: Results From Two Studies in the UK and USA

BACKGROUND

We examined the association of objective and subjective oral health markers with inflammatory, hemostatic, and cardiac biomarkers in older age.

METHODS

Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising British men aged 71-92 years (n = 2,147), and the Health, Aging and Body Composition (HABC) Study comprising American men and women aged 71-80 years (n = 3,075). Oral health markers included periodontal disease, tooth count, dry mouth. Inflammatory biomarkers included C-reactive protein (CRP), interleukin-6 (IL-6) in both studies, and tissue plasminogen activator (t-PA), von Willebrand Factor (vWF), fibrin D-dimer, high-sensitivity Troponin T (hsTnT), and N-terminal pro-brain natriuretic peptide (NTproBNP) only in the BRHS.

RESULTS

In both studies, tooth loss, was associated with the top tertile of CRP-odds ratios (ORs) (95% confidence interval [CI]) are 1.31 (1.02-1.68) in BRHS; and 1.40 (1.13-1.75) in the HABC Study, after adjusting for confounders. In the HABC Study, cumulative (≥3) oral health problems were associated with higher levels of CRP (OR [95% CI] =1.42 [1.01-1.99]). In the BRHS, complete and partial tooth loss was associated with hemostatic factors, in particular with the top tertile of fibrin D-dimer (OR [95% CI] = 1.64 [1.16-2.30] and 1.37 [1.05-1.77], respectively). Tooth loss and periodontal disease were associated with increased levels of hsTnT.

CONCLUSIONS

Poor oral health in older age, particularly tooth loss, was consistently associated with some inflammatory, hemostatic, and cardiac biomarkers. Prospective studies and intervention trials could help understand better if poor oral health is causally linked to inflammatory, hemostatic, and cardiac biomarkers.

The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: a systematic review

BACKGROUND

Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties.

METHODS

This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines.

RESULTS

Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria.

CONCLUSIONS

None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps.

Trueness of removable partial denture frameworks additively manufactured with selective laser melting

STATEMENT OF PROBLEM

Although studies have reported on selective laser melting (SLM)-fabricated removable partial dentures (RPDs), research addressing the trueness of SLM-fabricated RPD metal frameworks is sparse.

PURPOSE

The purpose of this in vitro study was to evaluate the trueness of powdered cobalt-chromium (Co-Cr) or titanium-6 aluminum-4 vanadium (Ti-6Al-4V) alloy frameworks for RPDs fabricated by SLM.

MATERIAL AND METHODS

A digital scan of a Kennedy class II mandible typodont was obtained to design an RPD framework by using a computer-aided design (CAD) software program (denoted as CRF). Two experimental groups of frameworks were fabricated from the CRF by using SLM in alloys of Co-Cr (SLM-Co-Cr, n=6) and in Ti-6Al-4V (SLM-Ti-6Al-4V, n=6) while a control group was fabricated by using traditional lost-wax casting following stereolithography (CA-Co-Cr, n=6). In total, 18 RPD frameworks were digitally scanned (denoted as CRF), with each scan then superimposed on the CRF and evaluated for discrepancies by using a 3D analysis software program. A nonparametric Kruskal-Wallis test was performed to determine differences in trueness among groups (α=.05).

RESULTS

The CA-Co-Cr group showed the highest discrepancy between CEF and CRF. Statistically significant differences were found between the CA-Co-Cr and SLM-fabricated groups (P=.03 for Co-Cr, and P=.016 for Ti-6Al-4V). However, no significant difference was found between the SLM-Co-Cr and SLM-Ti-6Al-4V groups (P=.787).

CONCLUSIONS

SLM-fabricated RPD frameworks exhibited higher trueness than CA-Co-Cr fabricated ones, indicating the potential of selective laser melting to produce the geometric shapes required for accurate dental restorations.

Association between disability status and dental attendance in Australia-A population-based study

AIMS

Disability is a key social determinant of health. The objective of this study was to test the association between disability status and irregular dental attendance among the Australian population, and to examine whether the observed association varied among adolescents.

METHODS

Data on 17 501 participants from The Household, Income and Labour Dynamics in Australia (HILDA) were analysed. The main outcome examined was irregular dental attendance (two or more years since last dental visit) with disability as the primary exposure. Multivariable logistic regression models were fitted to test the associations between disability and dental attendance pattern. Models were adjusted for age, gender, country of birth, region of residence, education and income. Analysis was repeated among adolescents (15- to 24-year-old) to examine for variations in observed association.

RESULTS

One in four participants reported having a disability. Unadjusted model showed that the odds for irregular dental attendance were 1.40 times greater (95%; CI, 1.30-1.51) in those with disability than those without disability. After adjusting for all covariates, participants with disability had 1.20 times higher odds (95%; CI 1.10-1.30) of irregular dental attendance than those without disability. Irregular dental attendance was 1.41 times greater (95%; CI 1.10-1.80) in those with disability aged 15-24 years than those without disability.

CONCLUSIONS

Australian individuals with disability are more likely to have irregular dental attendance than those without.

Does non-institutionalized elders have a better oral health status compared to institutionalized ones? A systematic review and meta-analysis

Abstract This systematic review compared the oral health status between institutionalized and non-institutionalized elders. The following electronic databases were searched: PubMed (Medline), Scopus, Web of Science, Lilacs and Cochrane Library, in a comprehensive and unrestricted manner. Electronic searches retrieved 1687 articles, which were analyzed with regards to respective eligibility criteria. After reading titles and abstracts, five studies were included and analyzed with respect their methodological quality. Oral status of institutionalized and non-institutionalized elderly was compared through meta-analysis. Included articles involved a cross-sectional design, which investigated 1936 individuals aged 60 years and over, being 999 Institutionalized and 937 non-institutionalized elders. Studies have investigated the prevalence of edentulous individuals, the dental caries experience and the periodontal status. Meta-analysis revealed that institutionalized elderly have greater prevalence of edentulous (OR = 2.28, 95%CI = 1.68-3.07) and higher number of decayed teeth (MD = 0.88, 95%CI = 0.71-1.05) and missed teeth (MD = 4.58, 95%CI = 1.89-7.27). Poor periodontal status did not differ significantly between groups. Compared to non-institutionalized, institutionalized elders have worse dental caries experience.

Oral health status and associated lifestyle behaviors in a sample of Iranian adults: an exploratory household survey

BACKGROUND

Poor oral hygiene can lead to serious diseases, such as periodontitis, tooth decay, pain and discomfort in teeth or gums, infections, and loss of teeth. In Iran, adults aged 50 y and older are a high-risk group for oral health problems, and this age group will grow in the coming decades. Despite increasing attention on healthy aging, there is relatively less emphasis on oral hygiene and health-related problems. The present study investigated the oral health status of Iranian adults using the oral health self-assessment questionnaire (OHQ) developed by the World Health Organization (WHO).

METHODS

A population-based household survey of a sample of adults aged 18-65 y was conducted. In this study, the participants were recruited between May and October 2016 in Tabriz, Iran, and the study population was sampled using a multi-stage cluster sampling design. The WHO's OHQ for adults was used for measuring oral health status and oral hygiene behavior.

RESULTS

In total, 2310 respondents completed the survey. The mean age (SD) of the participants was 41.6(23.4) y. Males accounted for 48.8% of the participants. Of the 2310 respondents,187 (8.1%) individuals were edentulous, 152(20.7%) of whom were aged 51-65 y. Furthermore, 72.3% of those aged 51-65 y were dentate, and 50% of adults aged 51-65 y said they had 20 or more teeth. About one-third of the participants reported that they did not brush their teeth daily (23% of those aged 18-35 y,35.9% of those aged 36-50 y, and 44.6% for those aged 51-65 y). In the sample, 39.4% of individuals aged 18-35 y,34.1% of individuals aged 36-50 y, and 26.6% of individuals aged 51-65 y had visited a dentist less than 6 month ago. One-third of the participants consumed sweets and sugary drinks daily.

CONCLUSIONS

Although the majority of Iranian adults considered their oral health status good, only a small percentage of the sample visited their dentist regularly. Furthermore, visits to the dentist declined in accordance with increasing age, a time when the incidence of oral health problems may increase. Poor oral health may increase the risk of adverse health outcomes, particularly among the aging population.

Socioeconomic disadvantage across the life-course and oral health in older age: findings from a longitudinal study of older British men

Background

The influence of life-course socioeconomic disadvantage on oral health at older ages is not well-established. We examined the influence of socioeconomic factors in childhood, middle-age and older age on oral health at older ages, and tested conceptual life-course models (sensitive period, accumulation of risk, social mobility) to determine which best described observed associations.

Methods

A representative cohort of British men aged 71-92 in 2010-12 included socioeconomic factors in childhood, middle-age and older age. Oral health assessment at 71-92 years (n = 1622) included tooth count, periodontal disease and self-rated oral health (excellent/good, fair/poor) (n = 2147). Life-course models (adjusted for age and town of residence) were compared with a saturated model using Likelihood-ratio tests.

Results

Socioeconomic disadvantage in childhood, middle-age and older age was associated with complete tooth loss at 71-92 years-age and town adjusted odds ratios (95% CI) were 1.39 (1.02-1.90), 2.26 (1.70-3.01), 1.83 (1.35-2.49), respectively. Socioeconomic disadvantage in childhood and middle-age was associated with poor self-rated oral health; adjusted odds ratios (95% CI) were 1.48 (1.19-1.85) and 1.45 (1.18-1.78), respectively. A sensitive period for socioeconomic disadvantage in middle-age provided the best model fit for tooth loss, while accumulation of risk model was the strongest for poor self-rated oral health. None of the life-course models were significant for periodontal disease measures.

Conclusion

Socioeconomic disadvantage in middle-age has a particularly strong influence on tooth loss in older age. Poor self-rated oral health in older age is influenced by socioeconomic disadvantage across the life-course. Addressing socioeconomic factors in middle and older ages are likely to be important for better oral health in later life.

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, Disability and Physical Function: Results From Studies of Older People in the United Kingdom and United States of America

OBJECTIVES

Studies examining the associations between oral health and disability have limited oral health measures. We investigated the association of a range of objectively and subjectively assessed oral health markers with disability and physical function in older age.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising men aged 71 to 92 years (n = 2147) from 24 British towns, and the Health, Aging, and Body Composition (HABC) Study comprising men and women aged 71 to 80 years (n = 3075) from the United States. Assessments included oral health (periodontal disease, tooth count, dry mouth, and self-rated oral health), disability, and physical function (grip strength, gait speed, and chair stand test).

RESULTS

In the BRHS, dry mouth, tooth loss, and cumulative oral health problems (≥3 problems) were associated with mobility limitations and problems with activities of daily living and instrumental activities of daily living; these remained significant after adjustment for confounding variables (for ≥3 dry mouth symptoms, odds ratio (OR) 2.68, 95% confidence interval (CI) 1.94-3.69; OR 1.76, 95% CI 1.15-2.69; OR 2.90, 95% CI 2.01, 4.18, respectively). Similar results were observed in the HABC Study. Dry mouth was associated with the slowest gait speed in the BRHS, and the weakest grip strength in the HABC Study (OR 1.75, 95% CI 1.22, 2.50; OR 2.43, 95% CI 1.47-4.01, respectively).

CONCLUSIONS AND IMPLICATIONS

Markers of poor oral health, particularly dry mouth, poor self-rated oral health, and the presence of more than 1 oral health problem, were associated with disability and poor physical function in older populations. Prospective investigations of these associations and underlying pathways are needed.

Posição socioeconômica e autoavaliação da saúde bucal no Brasil: resultados da Pesquisa Nacional de Saúde

Resumo: Analisou-se a autoavaliação da saúde bucal da população adulta brasileira segundo a posição socioeconômica (região de residência, escolaridade, renda e classe social), explorando as variáveis com maior sensibilidade para medir tal associação. Estudaram-se 59.758 indivíduos com 18 anos ou mais de idade, que participaram da Pesquisa Nacional de Saúde 2013, um inquérito domiciliar de base populacional. A autoavaliação da saúde bucal (dentes e gengivas) foi analisada como positiva, regular e negativa. Com base na regressão logística multinomial, estimaram-se odds ratio (OR) brutos e ajustados e os respectivos intervalos de 95% de confiança (IC95%). Foram calculados os percentuais de concordância e o valor de kappa para comparar os valores obtidos pelos modelos de regressão e os valores esperados. A prevalência da autoavaliação da saúde bucal positiva foi 67,4%, 26,7% para regular e 5,9% para negativa. Após ajuste, a chance de autoavaliar a saúde bucal como negativa foi significativamente mais elevada entre os indivíduos com renda domiciliar per capita de até um salário mínimo (OR = 4,71; IC95%: 2,84-7,83), sem nível de escolaridade completo (OR = 3,28; IC95%: 2,34-4,61), da classe social destituídos de ativos (OR = 3,03; IC95%: 2,12-4,32) e residentes na Região Nordeste (OR = 1,50; IC95%: 1,19-1,89). Diversos indicadores de posição socioeconômica influenciam a percepção sobre a saúde bucal, mas a renda domiciliar per capita, a escolaridade e a classe social foram as responsáveis pelo maior gradiente na autoavaliação da saúde bucal de adultos no Brasil em 2013.

Associations Between Acculturation and Oral Health Among Older Chinese Immigrants in the United States

Background: The aim of this study was to understand the associations between acculturation and oral health among older Chinese immigrants in the United States. Method: We used data from the PINE study, which included the foreign-born older Chinese immigrants (N = 3,128). We measured acculturation by measuring participants' length of stay and behavioral acculturation. Participants' tooth and gum symptoms were the outcome variables. Results: Longer stay in the United States was significantly associated with fewer gum symptoms but not with tooth symptoms. Behavioral acculturation was not significantly associated with either tooth or gum symptoms. The middle tertile of behavioral acculturation, compared with its upper and lower tertiles, deemed to be a more significant risk factor of tooth/gum symptoms. In addition, older immigrants with more social interactions with the Americans were more likely to have tooth symptoms. Discussion: In the future, we will conduct a study using longitudinal data to help us better understand the relationship between acculturation and oral health in Chinese American population.

Perceived oral health and its association with symptoms of psychological distress, oral status and socio-demographic characteristics among elderly in Norway

Background

There is poor knowledge about the extent to which psychological distress influences oral health in older people in Norway. The aim of this study was two-fold: i) to describe the oral health of Norwegian elderly and their levels of psychological distress; and ii) to examine the relationship of psychological distress with self-rated oral health, while controlling for oral status and socio-demographic characteristics, in Norwegian elderly.

Methods

Data were retrieved from a national cross-sectional survey conducted by Statistics Norway in 2012 and included information about self-rated oral health, psychological distress (measured using the Hopkins Symptom Checklist 25; HSCL-25), gender, age, civil status, smoking, self-reported number of teeth present and dental attendance for 949 non-institutionalised adults aged 65 years or older. Logistic regression was used to establish whether psychological distress predicts self-rated oral health, controlling for socio-demographic characteristics and oral status.

Results

Around 27% of the elderly reported having poor oral health, and 8 % had a HSCL-25 mean score ≥ 1.75, which indicates higher levels of psychological distress. Among the symptoms listed in the HSCL-25, the most frequently reported problems were lack of energy (1.7 ± 0.8) and difficulties falling and staying asleep (1.6 ± 0.7). The likelihood of reporting poor oral health was independently associated with having a mean HSCL-25 score ≥ 1.75 (OR = 1.89; 95% CI = 1.14–3.15), even when smoking (OR = 1.83; 95% CI = 1.17, 2.87) and having fewer than 20 teeth (OR = 3.49; 95% CI = 2.56, 4.76) were taken into account.

Conclusion

Most of the Norwegian elderly in our sample perceived themselves to have good oral health and reported relatively low levels of psychological distress. Higher levels of psychological distress can influence the oral health of the elderly independently of other factors such as smoking and having reduced number of teeth. Dental care professionals should consider screening their elderly patients for psychological distress and individualise the information about dental care for this specific population.

Developing an integrated resource to promote oral health in nursing homes

Public health is the responsibility of every nurse and nursing practice should adopt a life course approach to the promotion of health and well-being. This approach requires a renewed focus on health promotion interventions aimed at older people, including those resident in nursing homes. The oral health status of older people in nursing homes has been reported as suboptimal, predisposing them to poorer health-related quality of life. Interventions focusing on knowledge and behaviours related to oral health management for nurses, other caregivers and older people have the potential to improve the provision of oral care. This article discusses a project undertaken by a team of preregistration nursing students to plan and develop an integrated oral health promotion resource for older people in nursing homes. Healthy Smile, Healthy Me comprises a poster called five steps for oral hygiene and an oral health box. Initial feedback from a pilot of the resource in a nursing home is encouraging and research is planned to explore the feasibility, acceptability and efficacy of the resource.

Health and quality of life differ between community living older people with and without remaining teeth who recently received formal home care: a cross sectional study

Objective

To assess oral health, health, and quality of life (QoL) of care-dependent community-living older people with and without remaining teeth who recently received formal home care.

Materials and methods

For this cross-sectional observational study, community-living older people (≥ 65 years), who recently (< 6 months) received formal home care, were interviewed with validated questionnaires and underwent an oral examination. Oral health, general health, medicines usage, frailty (Groningen Frailty Indicator), cognition (Minimal Mental State Examination), QoL (RAND 36), and oral health-related QoL (Oral Health Impact Profile-14) were assessed.

Results

One hundred three out of 275 consecutive eligible older people (median age 79 [IQR (Inter Quartile Range) 72–85 years] participated in the study. Thirty-nine patients had remaining teeth and 64 were edentulous. Compared with edentulous older people, older people with remaining teeth scored significantly better on frailty, QoL, physical functioning, and general health. No significant differences were seen in cognition. Dental and periodontal problems were seen in more than half of the patients with remaining teeth. Two third of the edentulous patients did not visit their dentist regularly or at all.

Conclusions

Care-dependent home-dwelling older people with remaining teeth generally were less frail, scored better on physical functioning and general health and had better QoL than edentulous older people. Dental and periodontal problems were seen in approximately 50% of the elderly.

Clinical relevance

Notwithstanding their common dental problems, frailty, health, and QoL are better in home-dwelling older people with remaining teeth. To maintain this status, we advise not only dentists, but also health care workers and governments, to encourage people to maintain good oral health.

Influence of Poor Oral Health on Physical Frailty: A Population-Based Cohort Study of Older British Men

Objectives

To investigate the associations between objective and subjective measures of oral health and incident physical frailty.

Design

Cross‐sectional and longitudinal study with 3 years of follow‐up using data from the British Regional Heart Study.

Setting

General practices in 24 British towns.

Participants

Community‐dwelling men aged 71 to 92 (N = 1,622).

Measurements

Objective assessments of oral health included tooth count and periodontal disease. Self‐reported oral health measures included overall self‐rated oral health; dry mouth symptoms; sensitivity to hot, cold, and sweet; and perceived difficulty eating. Frailty was defined using the Fried phenotype as having 3 or more of weight loss, grip strength, exhaustion, slow walking speed, and low physical activity. Incident frailty was assessed after 3 years of follow‐up in 2014.

Results

Three hundred three (19%) men were frail at baseline (aged 71–92). Having fewer than 21 teeth, complete tooth loss, fair to poor self‐rated oral health, difficulty eating, dry mouth, and more oral health problems were associated with greater likelihood of being frail. Of 1,284 men followed for 3 years, 107 (10%) became frail. The risk of incident frailty was higher in participants who were edentulous (odds ratio (OR) = 1.90, 95% confidence interval (CI) = 1.03–3.52); had 3 or more dry mouth symptoms (OR = 2.03, 95% CI = 1.18–3.48); and had 1 (OR = 2.34, 95% CI = 1.18–4.64), 2 (OR = 2.30, 95% CI = 1.09–4.84), or 3 or more (OR = 2.72, 95% CI = 1.11–6.64) oral health problems after adjustment for age, smoking, social class, history of cardiovascular disease or diabetes mellitus, and medications related to dry mouth.

Conclusion

The presence of oral health problems was associated with greater risks of being frail and developing frailty in older age. The identification and management of poor oral health in older people could be important in preventing frailty.

See related editorial by https://doi.org/10.1111/jgs.15253.

A Teaching Tool for Establishing Risk of Oral Health Deterioration in Elderly Patients: Development, Implementation, and Evaluation at a U.S. Dental School

The aim of this study was to develop and evaluate a learning strategy using critical thinking to teach dental students how to assess the risk of rapid oral health deterioration (ROHD) among elderly patients. A learning guide was developed using risk factors identified in the literature and the steps that expert faculty members apply in their clinical decision making, summarized in a set of ten steps. A new system of labeling risk was developed for the elderly population, which correlates the level of risk with the amount of disease. Participants in the study were all 91 fourth-year dental students in two subsequent classes who took part in a five-week Geriatrics and Special Needs Clinic rotation in the spring of 2015 and 2016. The students were introduced to the ROHD concept and asked to use the guide in a presentation during their rotation. The students were graded on an A, G, or M scale (Applied concept, Grasped and applied concept, or Missed application of concept). Students were also asked to assess their learning experience, and their answers were thematically grouped and analyzed. For eight of the ten steps, at least 93% of the students were graded A or G. The exceptions were the steps about developing a communications plan, which was missed by 23.1%, and self-assessment, which was missed by 30.8%. Interexaminer agreement on students' applying (A + G grades) versus missing the step was moderate or high on six of ten items. Nearly all the students (98.7%) considered assessing the risk of ROHD an important or very important skill. In this study, a learning strategy to teach dental students how to assess the risk of ROHD among elderly patients was developed and successfully implemented.

Dental injury associated with anaesthesia: An 8-year database analysis of 592 claims from a major French insurance company

INTRODUCTION

Dental injury is the most common incident associated with anaesthesia. Regarding recent recommendations on informed consent and changes in airway management practices, a large series of claims related to dental injury has not been recently described. The aim of this study was to analyse a recent database in order to describe the characteristics of dental injury in France.

METHODS

A database that prospectively collected claims reported to Le Sou Médical-MACSF between January 2003 and December 2010, was analysed. Five hundred and ninety-two cases were reported. The following characteristics were analysed: number and type of teeth injured, mechanism of injury, anaesthetic procedure, risk factors and dental outcome after injury.

RESULTS

Amongst the 1514 claims related to anaesthesia, 592 (39.2%) were classified as dental damage. Preoperative informed consent concerning possible perioperative dental injury was documented in only 34.8% of patients. Only one tooth was affected in 65.2% of patients, dental bridge injury in 12.8% of cases and damage to two or more teeth in 14% of patients. Incisors were involved in 50% of cases. Fracture was the most common type of injury (64.2%). Poor dentition was the most common risk factor (23.1%) followed by difficult intubation (15.4%). Both risks were combined in only 7.6% of cases. Tracheal intubation was the highest risk procedure (41.6%).

CONCLUSION

Dental injury remains the most common anaesthesia-related claim. Dental examination and documentation in patient medical files requires improvement and better informed consent on dental injury risk needs to be provided to patients.

Evaluation of Periodontal Status and Treatment Needs of Institutionalized Intellectually Disabled Individuals in Lebanon

AIMS AND OBJECTIVES

No reported data is available on the periodontal health and treatment needs of the intellectually disabled in Lebanon. To evaluate the periodontal condition and treatment needs of institutionalized intellectually disabled individuals in Lebanon.

MATERIALS AND METHODS

A total of 272 individuals (141 males and 131 females) aged 15 years and 35-44 years were examined. Periodontal health was recorded following the community periodontal index of treatment needs (CPITN), and treatment need was assigned accordingly. The IBM® SPSS® statistics 20.0 and Stata/SE 11.1 statistical packages were used to carry out all statistical analyses. Statistical analysis was performed using linear regression (P ≤ 0.05).

RESULTS

Healthy periodontium was recorded in 26.1%, bleeding on probing in 27.9%, supra-/sub-gingival calculus in 31.3%, pockets of 4-5 mm in 11% and ≥6 mm in 3.7%. The largest proportion of the sample was in need for oral hygiene instruction and calculus removal (42.3%). Age, geographical location, consumption of carbohydrate-rich meals and sweets between meals were significantly associated with CPITN score severity in multivariate analysis (P < 0.05). Gender, severity of disability, frequency of tooth brushing, and caretaker characteristics were not significant predictors of CPITN (P > 0.05).

CONCLUSION

The predominantly poor periodontal health and social inequalities warrant nationwide preventive oral health programs in addition to planning the provision of treatment services to meet existing treatment needs.

Periodontitis as a Modifiable Risk Factor for Dementia: A Nationwide Population-Based Cohort Study

OBJECTIVES

To determine whether periodontitis is a modifiable risk factor for dementia.

DESIGN

Prospective cohort study.

SETTING

National Health Insurance Research Database in Taiwan.

PARTICIPANTS

Individuals aged 65 and older with periodontitis (n = 3,028) and an age- and sex-matched control group (n = 3,028).

MEASUREMENTS

Individuals with periodontitis were compared age- and sex-matched controls with for incidence density and hazard ratio (HR) of new-onset dementia. Periodontitis was defined according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 diagnosed by dentists. To ensure diagnostic validity, only those who had concurrently received antibiotic therapies, periodontal treatment other than scaling, or scaling more than twice per year performed by certified dentists were included. Dementia was defined according to ICD-9-CM codes 290.0-290.4, 294.1, 331.0-331.2.

RESULTS

After adjustment for confounding factors, the risk of developing dementia was calculated to be higher for participants with periodontitis (HR = 1.16, 95% confidence interval = 1.01-1.32, P = .03) than for those without.

CONCLUSION

Periodontitis is associated with greater risk of developing dementia. Periodontal infection is treatable, so it might be a modifiable risk factor for dementia. Clinicians must devote greater attention to this potential association in an effort to develop new preventive and therapeutic strategies for dementia.