Outreach dental care programme for older adults using long-term care services in Hong Kong: A qualitative study

OBJECTIVES

To explore the effects and improvement needs of an outreach dental care programme (ODCP) for older adults using residential care or daycare services from the perspectives of the caregivers, the dentists and administrative staff involved in the implementation of the ODCP.

METHODS

A qualitative study was conducted through semi-structured interviews with three stakeholders, long-term care (LTC) facility caregivers, administrative staff and dentists working for the ODCP. Combined maximum variation and snowball sampling strategies were adopted, and 22, 9 and 7 participants were interviewed from each stakeholder, respectively. The interviews were conducted via telephone, which were audio-recorded and transcribed verbatim for analysis. NVivo software was used for storing and analysing the data. Data analysis was conducted continuously during the study.

RESULTS

Most participants opined that the ODCP benefited older adults by raising their oral health conditions and awareness. However, they complained of the complicated administrative procedures, unmet dental treatment needs, inefficient coordination, unclear work guidelines and shortage of dental manpower. More advanced dental treatment options, better coordination among different parties, simpler administrative processes and better incentives for dentists were proposed to further improve the programme.

CONCLUSIONS

According to the stakeholders, ODCP seems beneficial to older adults using LTC services. Further improvements in the scope of dental treatments, cooperation between the outreach dental teams and caregivers, and streamlining of the administrative process are needed for the provision of effective outreach dental care to satisfy the unmet treatment needs of older adults who use LTC services. Better incentives are needed to attract and retain dentists.

Outreach dental care program for older adults using residential care or day care services in Hong Kong: A cohort study

AIM

To evaluate the effects of an outreach dental care program (ODCP) on the oral health status and oral health-related quality of life (OHRQoL) of older adults who used residential or day care services in Hong Kong.

METHODS

Older adults who had received dental treatments provided in the ODCP were recruited. Clinical examinations were performed by one calibrated examiner (SXY) at baseline and 1-year follow-up in the residential homes or day care centres. Face-to-face interviews were conducted using the transition scale of the Oral Health Impacts on Daily Living (OHIDL) questionnaire to investigate the perceived change in OHRQoL at baseline, 2-month and 1-year follow-ups. The Wilcoxon matched-pair signed-rank test or McNemar/McNemar-Bowker test was used to explore the change in oral health status after dental treatments. Factors associated with the perceived change in OHRQoL were explored with binary logistic regression.

RESULTS

Four hundred and thirteen older adults (mean age = 83.8 years) participated in the study at baseline, and 377 (91.3%) and 359 (86.9%) were successfully followed 2 months and 1 year after receiving the outreach dental service, respectively. At the 1-year follow-up, the number of decayed teeth and functional tooth units, and the prevalence of poor denture hygiene decreased while there was more dental plaque deposition and a higher proportion of participants with gingival bleeding upon probing. More than 50% of the participants perceived no change or an improvement in OHRQoL in all domains at both follow-ups. Older adults who perceived their oral health status as 'healthy or fair' and those who suffered from toothache at baseline had a higher chance to perceive having a better or at least the same OHRQoL at the 2-month and 1-year follow-ups, respectively.

CONCLUSIONS

The ODCP in Hong Kong can solve some of the dental problems of older adults using long-term care services and keep most of them from deterioration in OHRQoL, especially those suffering from toothache.

A Systematic Review and Meta-analysis of the Effect of Oral Exercises on Masticatory Function

The aim of the current systematic review was to summarize and to evaluate the available information on the effectiveness of oral exercise in improving the masticatory function of people ≥18 y. Electronic databases (Medline, Embase, CENTRAL) and gray literatures were searched (up to December 2020) for relevant randomized and nonrandomized controlled clinical trials. Two reviewers independently conducted the study selection, data extraction, and quality assessments. Meta-analysis was conducted for the comparison of bite force and masticatory performance using mean difference (MD) and standardized mean difference (SMD), respectively. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment was adopted for collective grading of the overall body of evidence. Of the 1,576 records identified, 18 studies (21 articles) were included in the analysis. Results of meta-analysis indicated that oral exercise could significantly improve the mean bite force of the participants (parallel comparison: MD, 41.2; 95% CI, 11.6-70.7, P = 0.006; longitudinal comparison: MD, 126.5; 95% CI, 105.2-144.9, P < 0.001). However, the improvement in masticatory performance was not significant (parallel comparison: SMD, 0.11; 95% CI, -0.20 to 0.42, P = 0.48; longitudinal comparison: SMD, 0.4; 95% CI, -0.11 to 0.91, P = 0.13). Results of meta-regression showed that greater improvements in bite force can be achieved among younger adults and with more intensive exercise. Chewing exercise is the most effective oral exercise, followed by clenching exercise, while simple oral exercise may not have a significant effect. Based on the results of the meta-analysis and GRADE assessment, a weak recommendation for people with declined masticatory function to practice oral exercise is made.

Willingness to pay for implant therapy: a study of patient preference

AIMS

This study determined the amount of willingness to pay (WTP) for implant treatment and identified the factors affecting WTP.

METHODS

Subjects attending a university dental hospital were recruited (n=59). They were presented with two hypothetical clinical scenarios: missing one anterior/posterior tooth. The clinical procedures, outcome and plausible complications of various replacement options (fixed and removable partial dentures, implants) and sequelae of no treatment were presented. They were then asked how much they were willing to pay for tooth replacement under the two situations using a bidding method, with a starting bid of Hong Kong (HK)$20,000 in HK$1000 increment/decrement if they were willing/unwilling to pay that amount (1 USD=7.8 HKD). The amount was recorded at which the subject chose the opposite option or it reached HK$0. Demographic data were also collected. WTP values were compared between anterior and posterior replacements, and among various demographic subgroups. Spearman's correlations and linear regression analysis were also conducted.

RESULTS

Ninety-four percent and 84% of the subjects chose implant treatment to replace missing anterior and posterior teeth, respectively. The mean WTP amounts for anterior/posterior tooth replacement were HK$11,000/HK$10,000 (P>0.05). Higher WTP amounts were obtained from females, subjects without missing teeth or restorative need, and had attained higher level of education (P<0.05). Gender (P<0.05), level of education (P=0.042), and the presence of missing teeth (P=0.001) were independent predictors of WTP.

CONCLUSIONS

The estimated WTP value for a single tooth replacement using dental implants was HK$10,000. Gender, level of education and presence of missing teeth were independent predictors that influenced WTP.

Sjögren's syndrome sufferers have increased oral yeast levels despite regular dental care

AIM

To investigate the prevalence and quantity of oral yeasts and their association with oral candidiasis in Sjögren's syndrome (SS) patients receiving regular dental care.

MATERIALS AND METHODS

Yeasts in oral rinse and full-mouth supra-gingival plaque samples from 25 primary SS, 27 secondary SS and 29 control subjects were selectively cultured. All yeasts except single-species isolates were genotyped using pulsed field gel electrophoresis (PFGE).

RESULTS

Ten (19%) SS sufferers had symptomless candidiasis. SS subjects had a higher prevalence (73%vs 7%) and quantity of yeasts than controls in both oral rinse and plaque samples (P < 0.05). The prevalence of yeasts in plaque was associated with candidiasis regardless of denture wearing (P < or = 0.04). Candida albicans was the predominant yeast isolated. PFGE showed 20 (66% of total) C. albicans isolate pairs, i.e. C. albicans species isolated from plaque and oral rinse samples of the same individual, were of closely related genetic clonal types (P < 0.01).

CONCLUSIONS

Despite effective oral hygiene, more SS subjects than controls had detectable levels of oral yeasts and their presence in supra-gingival plaque was associated with candidiasis. Candida albicans colonized supra-gingival biofilm even in well-maintained SS individuals, posing a challenge to the control of oral candidiasis.

The efficacy of cevimeline hydrochloride in the treatment of xerostomia in Sjögren's syndrome in southern Chinese patients: a randomised double-blind, placebo-controlled crossover study

Cevimeline hydrochloride, a specific agonist of the M3 muscarinic receptor, is beneficial in the treatment of symptoms of xerostomia and xerophthalmia associated with Sjögren's syndrome (SS). Cevimeline has not been evaluated in southern Chinese patients. Furthermore, the effects of cevimeline on health-related quality of life and oral health status are not known. In this randomised, double-blind, placebo-controlled crossover study, patients received cevimeline 30 mg or matched placebo three times per day over 10 weeks followed by a 4-week washout period before treatment crossover. Participants self-completed the following questionnaires: Xerostomia Inventory (XI), the General Oral Health Assessment Index (GOHAI), the Ocular Surface Disease Index (OSDI) and the Medical Outcomes Short Form (SF-36). Clinical assessments included sialometry, examination of the oral cavity for the degree of xerostomia and dental complications of xerostomia. Fifty patients (22 primary SS and 28 secondary SS) were enrolled in the trial. Forty-four patients completed the study. There was a significant improvement in the XI and GOHAI scores as well as the objective rating of xerostomic signs of the oral cavity after treatment with cevimeline. However, there was no improvement in salivary flow rates and dry eye symptoms. SS patients had lower SF-36 scores, but these did not improve after treatment with cevimeline.

Supra-gingival microbiota in Sjögren’s syndrome

The aim of this study was to investigate the microbiota of noncaries associated supra-gingival plaque (SGP) microbiology in Sjögren's syndrome (SS). Stimulated whole saliva (SWS) and full-mouth SGP on intact tooth surfaces were collected from 26 primary (p) SS, 27 secondary (s) SS, and 29 control subjects for selective culture of lactobacilli, mutans streptococci, and aerobic and facultatively anaerobic gram-negative rods (AGNR). Predominant cultivable anaerobes from SGP of 11 randomly selected subjects from each group were investigated. Clinical and sialometric data were also collected. SS sufferers had significantly lower SWS flow rate and higher mean DMFT (decayed, missing, filled teeth), while pSS subjects also had lower SWS pH and fewer standing teeth. Lactobacillus acidophilus levels in SWS (P = 0.012) and SGP (P < 0.0001) were significantly elevated in pSS sufferers compared with sSS individuals and controls. AGNR isolation was uncommon. SS sufferers had significantly lower proportion of gram-negative species (P = 0.047). Non-oral species were isolated in greater proportions from pSS SGP (P = 0.007). Subjects with pSS harbored increased levels of L. acidophilus and non-oral species, while SS sufferers generally had lower proportions of gram-negative species. The microbial composition of noncaries associated SGP indicates a potential source of increased caries risk in SS.

A retrospective clinical evaluation of two-unit cantilevered resin-bonded fixed partial dentures

BACKGROUND

The authors conducted a study to examine the clinical performance of two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) that were inserted at The Prince Philip Dental Hospital, University of Hong Kong.

METHODS

The authors recalled patients who had received two-unit cantilevered RBFPDs at least 24 months before the recall examination. The authors recorded the following data: patient's sex and age, operator's experience, prosthesis cementation date, endodontic treatment if performed, bone support, tooth mobility, the presence of shim-stock contacts on the abutment or pontic in intercuspal position, and the presence of aproximal axial contacts adjacent to the prosthesis. They also recorded the date of any debonding with subsequent treatment. They asked the patients qualitative questions about their prostheses.

RESULTS

A total of 269 prostheses were placed in 214 patients and had a mean service life of 51.7 months +/- 19.5 months standard deviation, with a range of 13.2 to 141.6 months. Of 14 failed prostheses, 12 debonded, resulting in a success rate of 94.8 percent and clinical retention rate of 95.5 percent. No discernable rotation or drifting of the abutments was apparent in any of the prostheses. Overall patient satisfaction with RBFPDs was good, with an average assessment score of 8.5.

CONCLUSIONS

The authors observed a 95.5 percent clinical retention rate of 269 two-unit RBFPDs, with no apparent drifting of the abutments. Longer-term follow-up studies are required.

CLINICAL IMPLICATIONS

Two-unit RBFPDs are conservative and clinically retentive prostheses in the short to medium term.

A longitudinal study of the oral health condition of elderly stroke survivors on hospital discharge into the community

AIM

To investigate the oral health of elderly stroke survivors on discharge from hospital into the community after rehabilitation and six months later compared with community dwelling elderly people without stroke.

METHOD

The study took place in the rehabilitation unit of a general medical hospital in Hong Kong. It was a longitudinal study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. Verified clinical examination techniques and measures were used to assess dental caries, periodontal disease, oral hygiene, oral candidiasis, prosthetic status/need and functional disability (Barthel Index [BI]). Socio-demographic information was also collected.

RESULTS

Stroke survivors had significantly higher plaque and bleeding scores on hospital discharge and after six months compared with the control group (p<0.01). On hospital discharge, the stroke group also had a poorer periodontal condition with more 4-5mm pockets. The mean BI on hospital admission was 71 and 91 on discharge. Stroke survivors with a higher BI on discharge had lower plaque scores after six months. The tooth condition, number of functional tooth pairs, prosthetic status, presence of oral candidiasis and oral yeast carriage were similar between stroke and comparison groups.

CONCLUSIONS

Despite significant objective improvement in functional ability after stroke, elderly survivors returning to the community had significantly poorer periodontal health compared with community dwelling elderly without stroke, and the situation did not improve dramatically over six months. The protracted recovery of hand, arm and oral sensori-motor function is the most likely cause.

Oral health-related quality of life of stroke survivors on discharge from hospital after rehabilitation

The study aimed to investigate oral health-related quality of life (OHR-QoL) of stroke survivors on hospital discharge after rehabilitation. It was a cross-sectional study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. The Medical Outcomes Short Form 36 (SF-36) measure, the General Oral Health Assessment Index (GOHAI) and an oral health transition scale were administered prior to a dental examination. Median SF-36 subscale scores were significantly different between groups (P < 0.05). In physical function, role-physical, role-emotional and mental health domains, stroke survivors had significantly lower scores indicating poorer health. The median GOHAI score for the stroke group was 52 and 54 for the comparison group with no significant difference between groups although more stroke survivors had difficulty speaking compared with the comparison group. About 75% of stroke survivors considered their appearance to be worse, half of them felt that speech was worse and about a third had difficulty chewing hard food compared with the pre-stroke condition (P < 0.05). Most participants were partially dentate with no significant difference in DMFT scores or prosthetic status between groups (P > 0.05). Health-related quality of life in general was significantly poorer after stroke although patients were considered physically well enough to be discharged from hospital. There was some impairment of OHR-QoL. The nature of the stroke, the hospital environment including diet, coping strategies and elderly Chinese peoples' perception of health should be taken into account when interpreting measures of health status in stroke survivors.

A preliminary report on patient acceptance of a novel intra-oral lubricating device for the management of radiotherapy-related xerostomia

Management of radiotherapy-related xerostomia is difficult. Saliva substitutes are helpful but the effects are short-lived. The purpose of the study was to develop a prototype intra-oral lubricating device for the management of radiotherapy-related xerostomia and to evaluate patient acceptance. An intra-oral lubricating device was fabricated that incorporated a reservoir in the palatal vault and permitted slow release of saliva substitute by the patient. Preliminary clinical testing was done in five patients with radiotherapy-related xerostomia. A measure incorporating seven questions was used to explore patient acceptance. The device was simple to fabricate using materials available in a technical laboratory. All patients were able to wear the device for at least 4 h per day throughout the test period. The device was considered easy to use and clean. Some impairment of speech and chewing was noted although this appeared to be related to the bulkiness of the reservoir. General oral comfort was improved due to the lubricating effect. The bulk of the reservoir was reduced as a consequence of patient feedback. The design addressed key problems associated with previous lubricating systems. Patient reports on oral functioning with the device in situ provided pivotal information on the device's utility.

Impact of Sjogren's syndrome on oral health-related quality of life in southern Chinese

The effect of oral symptoms of Sjögren's syndrome (SS) on health-related quality of life is presently uncertain. This study aimed to investigate oral health-related quality of life (OHRQOL) among southern Chinese people with SS. Twenty-six primary SS cases, 25 secondary cases and 29 matched controls took part in this cross-sectional study. Each participant completed a SF-36 questionnaire, the Oral Health Impact Profile and a dry mouth measure, assisted by a trained interviewer. Data on socio-demographic variables were also collected. The dry mouth measure revealed that people with primary and secondary SS had significant problems associated with subjective symptoms of dry mouth generally, and dry mouth when eating and speaking (P < 0.01). Sticky saliva and coughing were also problems in some primary SS cases. OHIP summary and sub-scale scores did not reveal differences in negative impacts between groups. Mean SF-36 sub-scale scores were significantly different between groups (P < 0.05). In physical function, role-physical and general health domains, primary and secondary SS sufferers had lower scores indicating poorer health. Oral symptoms of SS, notably xerostomia, had a negative effect on OHRQOL. Health-related quality of life in general was also impaired in SS sufferers. The OHIP did not appear to discriminate oral problems of concern to SS sufferers.

Oral health condition and saliva flow in southern Chinese with Sjögren’s syndrome

OBJECTIVE

To investigate the oral health condition and saliva flow of southern Chinese patients with Sjögren's syndrome (SS).

METHOD

51 SS patients (26 primary and 25 secondary cases) and 29 controls took part in this cross-sectional study. Stimulated whole and parotid saliva flow rates, pH, and buffer capacity, and xerostomia, oral mucosal lesions, oral hygiene status, dental and periodontal conditions, prosthetic status were assessed and compared between groups.

RESULTS

Stimulated whole saliva (SWS) flow was reduced in primary and secondary SS cases (p<0.001), pH and buffer capacity were also reduced in the primary SS group (p<0.05). SS patients had a greater prevalence of xerostomia than controls (p<0.001). Primary SS patients had a higher mean DMFT, more missing teeth, and more prostheses than secondary SS cases and controls (p<0.05). SWS flow correlated negatively with the number of filled teeth in both SS groups (p<0.05) and the number of decayed teeth in the primary SS group (p<0.05).

CONCLUSION

Despite good oral hygiene and regular dental check-ups, the oral health of southern Chinese with primary SS was significantly compromised compared with secondary SS cases and controls, most probably due to the combined effect of impaired salivary gland function and poorer saliva buffer capacity.

Oral perception and oral motor ability in edentulous patients with stroke and Parkinson's disease

Oral perception and oral motor ability were assessed in edentulous patients with stroke, Parkinson's disease, and an age and gender matched control group. Standard stereognosis and oral motor ability tests were performed, with and without complete dentures in situ. Statistical comparisons were made using ANOVA, Levene's test and paired t-tests. Stroke patients had significantly poorer stereognostic measures than Parkinson's disease patients and controls (P < 0.02). Stereognostic measures were better in all groups when dentures were worn. There were no differences in oral motor ability between groups. Oral stereognosis was significantly impaired in stroke patients. Oral stereognostic ability was better in all groups when dentures were worn. The oral motor ability test lacked the sensitivity to detect differences in motor ability between experimental groups. Edentulous patients with stroke should be encouraged to wear dentures during the rehabilitation phase as oral stereognosis is then less impaired.