A Systematic Review of Oral Health Assessment by Nurses and Carers for Residents with Dementia in Residential Care Facilities

This paper presents systematic review findings to best summarize the assessment of oral health and the use of oral assessment tools by nurses and carers for adults with dementia living in residential aged care facilities. The systematic review searched electronic databases for articles in English (1980 to 2002) and supplemented these with a secondary search of references cited in articles meeting the review inclusion criteria. Delineation is needed between a comprehensive dental examination conducted by a qualified dentist and a dental assessment screening by a carer, nurse, allied health professional or medical practitioner. Dental examinations should be supplemented with oral health assessments and screenings by trained nurses and carers to monitor residents' oral health, evaluate oral hygiene care interventions, act as a trigger to call in a dentist when required, assist with residents' individualized oral hygiene care planning and assist with triaging and prioritization of residents' dental needs. To date, the most comprehensive, validated and reliable assessment screening tool for use by nurses and carers with cognitively impaired institutionalized residents is the Brief Oral Health Status Examination. Other less comprehensive oral assessment tools that are useful for nurses and carers of institutionalized dementia populations include the Index of Activities of Daily Oral Hygiene and the Mucosal Plaque Score. These review findings presented evidence to support the use of oral assessment screening tools by nurses and carers for cognitively impaired residents living in residential aged care facilities. Few validated and reliable tools have been published for use by carers in the cognitively impaired residential care population, and continued evolution of oral assessment screening tools needs to embrace the complete spectrum of residents' levels of cognitive impairment.

[Direct access to the dental hygienist 1. Opinions of relevant national organizations]

The opinions of professional dental organisations, the government (Ministry of Health), patient organizations and the medical assurance companies are collected on the question whether patients could visit the dental hygienist without being seen by a dentist first. The general opinion is that this could be possible for those treatments for which the dental hygienist are fully qualified. However, the professional organizations of the dentists claim that the dentist should always be responsible for the patient register and thereby the first responsible for the dental health of the patients. Pilot projects are advised to study how the various dental workers can most efficiently work together.

[Obesity and oral health]

Obesity has a prevalence of approximately 10% among Dutch adults. It is a chronic, incurable disease with a high mortality and co-morbidity. The co-morbidity can be reduced significantly by a sustained moderate weight loss (5-15%). The main cause of obesity is an imbalance between energy intake and energy expenditure. The primary treatment combines dietary education, behaviour modification and increased physical activity, followed by pharmacotherapy or surgery when necessary. Obesity is related to several aspects of oral health, such as caries, periodontitis and xerostomia. In addition, obesity may have implications for dental treatment.

[Assessment of oral cavity mucosa and teeth state in patients with chronic obstructive pulmonary disease--part I]

The aim of the study was to assess the state of oral cavity mucosa and teeth in patients with chronic obturative pulmonary disease (COPD).

MATERIAL AND METHODS

The study comprised 100 patients with COPD (68 men and 32 women), aged 30-83 years (mean 63.1 +/- 10.17 years). All patients demonstrated II grade COPD (moderate COPD). FEV1/FVC<70% and FEV1 was within 79% and 50% of the predicted value. Beta2-adrenomimetic inhalants or in nebulization, theophylline were applied in the therapy. The control group consisted of 101 subjects (38 men and 63 women), aged 42-88 years (mean 65.3-10.36 years), with no respiratory tract ailments. The rate of smoking was similar in both groups. The examination of oral cavity mucosa and teeth state was performed in artificial lightening with the use of probe and mouth mirror. The number of lacking teeth and the advancement of caries were determined.

RESULTS

Thrush appeared to be the most frequent oral cavity mucosa ailment in COPD patients. Toothlessness and reduced teeth number were observed significantly more often in COPD patients than in the control group (p<0.05). The frequency and the type of caries did not differ significantly between the two groups (p>0.05).

[Assessment of periodontal state in patients with chronic obstructive pulmonary disease--part II]

The aim of the study was to estimate the periodontal state in chronic obstructive pulmonary disease (COPD).

MATERIAL AND METHODS

The study comprised 100 patients with COPD (68 men and 32 women), aged 30-83 years (mean 63.1 +/- 10.17 years). All patients were in the II grade COPD (moderate COPD). FEV1/FVC<70% and FEV1 was within 79% and 50% of the predicted value. Beta2-adrenomimetic inhalants or in nebulization, theophylline were applied in the therapy. The control group consisted of 101 subjects (38 men and 63 women), aged 42-88 years (mean 65.3-10.36 years), with no respiratory tract diseases. The rate of smoking was similar in both groups. To examine periodontal state, periodontal pocket depth was measured (with periodontal sound), Periodontal Index (PI) and dental plaque index were assessed.

RESULTS

The frequency and severity of periodontal diseases in COPD patients were demonstrated to be significantly increased as compared to the control group (p<0.05). Adult chronic periodontitis (ACP) was observed significantly more frequently in COPD patients (84.21%) than in the control group (59.74%, p<0.05). A positive correlation was found between periodontal pocket depth and dental plaque index in patients with COPD.

CONCLUSION

The frequency and intensification of periodontal diseases speak for their cause-and-effect relationship with COPD. The prophylaxis and treatment of periodontal diseases should be of great importance in the COPD therapy, which may increase its effectiveness.

Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults

INTRODUCTION

The aim of this study was to investigate whether young adults with varying dental esthetics and histories of orthodontic treatment also differ in oral-health attitudes, preventive behaviors, and self-perceived oral health.

METHODS

The sample comprised 298 young adults, 18 to 30 years old, with at least 13 years of primary and secondary school education. The subjects were asked to complete questionnaires dealing with various measures related to oral-health attitudes, preventive behaviors, and perceptions of oral health. Dental esthetics were assessed by means of the aesthetic component of the index of orthodontic treatment need. Dental plaque accumulation was assessed in a subsample of respondents.

RESULTS

Subjects with high dental-esthetics scores reported more favorable oral-health attitudes, such as internal control, dental awareness, value of occlusion, and preventive behavior expectations than subjects with lower scores. Subjects with previous orthodontic treatment showed greater internal control and dental awareness than those who had not previously been treated. Subjects ranking high in dental esthetics and those with previous orthodontic treatment reported stricter oral-hygiene adherence than others. Self-perceived oral health was better in high scorers on dental esthetics. Less plaque accumulation was found in subjects with higher dental esthetic scores and in those with previous orthodontic treatment.

CONCLUSIONS

These findings suggest that favorable dental esthetics and previous orthodontic treatment might be important variables in explaining individual differences in oral-health attitudes and behaviors.

Mundgesundheitsbezogene Lebensqualität älterer Menschen

PURPOSE

The aim of this study was to describe the oral health related quality of life (OHRQoL) of institutionalized elderly.

MATERIAL

159 elderly were randomly selected for this, study ranging in age from 61 to 98 (mean age 82.8; 19.1% male, 80.9% female). For measuring the OHRQoL the Oral Health Impact Profile (OHIP) was used. Additionally, a dental status was evaluated.

RESULTS

15% of the subjects had only natural teeth or fixed dentures, 80% removable dentures and 15% no dentures at all. OHIP-mean reached 33+/-25 points, between 0 and 112. The subcategory "functional limitation" showed the highest impairment (6.3%). The items with the highest impairment on OHRQoL in the different subcategories were: dentures not fitting properly, uncomfortable dentures, self-conscious due to teeth, avoid eating some foods, felt depressed, avoid going out and general health worsened.

CONCLUSIONS

The OHIP summary score represents an overview of OHRQoL and answers detailed questions with the help of the single items. In institutionalized elderly many items showed impairment, especially in items concerning the prosthetic restorations. This demonstrates the need for dental aftercare and not only dental interventions for acute pain. Establishing aftercare and prophylaxis could increase the OHRQoL and subsequently the overall well-being.

Childhood circumstances, psychosocial factors and the social impact of adult oral health

OBJECTIVES

The aim of this study was to determine whether childhood familial conditions are associated with the social impact of adult oral health and to investigate the role of psychosocial attributes as potential mechanisms by which risk might be conveyed from childhood to adulthood.

METHODS

Using a cross-sectional design, self-report data were obtained from a representative sample of adults in Australia with a telephonic interview and a self-completed questionnaire. The dependent variable was the sum of impacts on the short-form Oral Health Impact Profile (OHIP-14). Childhood familial conditions included socioeconomic position assessed by paternal occupation group, family structure and quality of rearing. Current adult sense of control, perceived stress and satisfaction with life were assessed with standard scales and social support was evaluated with four items.

RESULTS

Data were obtained for 3678 dentate adults aged 18-91 years. In bivariate analysis controlling for sex, age and household income in adulthood, parenting style was significantly associated with OHIP-14 scores (anova, P < 0.001). Adults who were reared supportively had more favourable scores on all four current psychosocial attributes (anova, P < 0.001). All four psychosocial attributes were associated with summed OHIP scores in the expected directions (anova, P < 0.001). In the multiple regression, parental rearing style was significantly associated with social impact after adjusting for sex, age and household income in adulthood, but was no longer significant in the presence of the psychosocial factors.

CONCLUSION

The importance of parental rearing to adult oral health may be mediated through the quality and nature of psychosocial attributes.

Oro-dental health in children with chronic renal failure and after renal transplantation: a clinical review

As a consequence of chronic renal failure (CRF) and its treatment, a number of oro-dental changes occur that persist after the end-stage is reached. An early effect is enamel hypoplasia due to a defect of enamel development and mineralisation. This is usually reparable to a high aesthetic standard using dental composite filling material. Children with CRF have significantly less dental caries than healthy children due to the inhibitory effect of increased salivary urea levels. Grafted patients frequently develop gingival enlargement as a result of immunosuppression with cyclosporine A, which is further exacerbated by the additional use of antihypertensive calcium-blocking agents. Surgical reduction of gingival hyperplasia is effective and is required in approximately one third of adolescents. A very high standard of home care should be encouraged for all children with CRF in the form of thorough mechanical tooth cleaning and plaque inhibition through the use of an antibacterial mouthwash. In transplanted children presenting an increased risk of infection, antibiotic prophylaxis may be indicated for dental treatment procedures. The drug dosage should be adapted to the reduced renal function. Pediatric nephrologists should be aware that dental surgeons can make a considerable contribution to the general health and well-being of children with CRF. Thus, only oro-dental problems that are mainly encountered and treated by dental surgeons are reviewed.

Oral health findings for HIV-infected adult medical patients from the HIV Cost and Services Utilization Study

BACKGROUND

The HIV Cost and Services Utilization Study (HCSUS) was conducted by a consortium of private and government institutions centered at the RAND Corp. to provide national estimates of adult medical patients who are HIV-positive. This article presents descriptive oral health findings from that study.

METHODS

The National Opinion Research Center (NORC) conducted four interviews of a nationally representative sample of adults with HIV who made a medical visit for regular care in early 1996. This article uses data from the second interview conducted between December 1996 and July 1997. The authors constructed analytical weights for each respondent so the 2,466 interviewees represented a population of 219,700.

RESULTS

Most adult medical patients with HIV rated their oral health as at least "good," but 12 percent (representing a population of 25,300) rated it as "poor." Xerostomia was the most commonly reported symptom (37 percent) to arise in the time since the previous interview. Twenty-nine percent had a dental benefit under Medicaid and 23 percent had private insurance. Eighteen percent had not revealed their HIV status to the dentist they usually saw.

CONCLUSIONS

National data on adult medical patients with HIV provide a context for local or convenience sample studies and can help give direction to public health and public policy programs directed to the oral health needs of this population.

CLINICAL IMPLICATIONS

The attitudes and beliefs of adult HIV patients should be taken into account in the creation of community health education programs and continuing education for dentists. Medicaid programs should include adult dental benefits.

Developing the First Dental Care Pathway: The Oral Health Assessment

In this paper the authors define the concept of care pathways and explain what they are and how they have been applied in various areas of healthcare. The authors discuss the benefits of the care pathway approach and outline the first national dental NHS (clinical) care pathway and its link to National Institute for Clinical Excellence (NICE) guidance on dental recall intervals.

The authors go on to explain that as a result of one of the key recommendations of Options for Change, the concept of care pathways will be extended to the primary dental services of the NHS. The first care pathway will be the Oral Health Assessment (OHA). The authors describe the development of, and rationale for, the OHA and provide details of its planned introduction.

The authors conclude that the OHA should act as the initial interface between the primary care team and the dental patient. In so doing it should enable a change in the focus of care, from treatment-based to more prevention-led, personalised care appropriate to the specific needs of individual patients.

Dynamics of nutritional health in a community sample of american elders: a multidimensional approach using roy adaptation model

Nutritional health of community-dwelling elders has been shown to be one of the prime indices of health, influencing the elders' ability to live independently. However, little research has been directed toward understanding the dynamics of nutritional health in community-dwelling elders using a multidimensional theory approach. The purpose of this study was to evaluate the dynamics of nutritional health within the context of Roy Adaptation Model. Factors associated with nutritional health of community-dwelling elders were cross-examined. Depressive symptoms, functional status, oral health, and income emerged as independent predictors of nutritional health adjusting for confounders. This finding lends support to the notion that multidimensional biopsychosocial factors contribute to the dynamics of nutritional health.

Chewing Ability of the Long-Term Hospitalized Elderly

We investigated the chewing ability of 260 (25 percent men) long-term hospitalized elderly patients 60 years of age and older in Laakso hospital, Helsinki, Finland, in relation to their mastication capacity, sore mouth and degree of dependence. The subjects' (mean age 83.3 years, SD = 8.1 years) mastication capacity was determined by a specialist dentist by means of: (a) number of functioning teeth and dentures; (b) modified Eichner Index; and (c) the Eichner Score, based on the index. Based on the information given by the nursing staff, an indicator of chewing ability was created. The chewing ability was poor for 55 percent, limited for 17 percent, moderate for 14 percent and excellent for 14 percent. Excellent or moderate ability to chew was related to a subject's lesser degree of dependence (OR = 1.5; p = 0.02) and higher Eichner Score (OR = 1.3; p = 0.000). More attention should be focused on mastication capacity of the hospitalized elderly.

The use of Traditional Chinese Medicine in managing oral health — Hong Kong: one country, two systems

OBJECTIVES

To determine knowledge, use, and interest in traditional methods to manage oral health among Hong Kong adults.

DESIGN

A cross sectional epidemiological survey.

PARTICIPANTS

A random sample of 500 Hong Kong adults.

METHODS

Telephone interviews about Traditional Chinese Medicine (TCM) approaches to mange oral health, employing a battery of 50 questions over a one month period in 2002.

RESULTS

Most completed the interview (96%, 481/500). Over half (52%, 250/481) had some knowledge about using TCM to manage oral health. Approximately a third (32%, 155/481) reported using TCM to manage their oral health in the past, most frequently for oral mucosal lesions (65%, 101/155) or for periodontal reasons (62%, 96/155). TCM was used predominately in combination with western dentistry or as a last resort (55%, 86/155). Most (89%, 428/481) expressed an interest in TCM approaches to managing oral health, particularly if administered by their dentist (54%, 259/481), and expressed many reasons for such interest. Socio-demographic variations in knowledge, use and interest in the use of TCM to manage oral health were apparent (p<0.05).

CONCLUSION

Knowledge, use and interest in traditional based approaches to managing oral health is widespread in Hong Kong, and is associated with age and educational attainment.

[Caries prevalence and oral health among schoolchildren]

Last decennia much attention has been paid to improve the oral health of schoolchildren. The purpose of this study was to examine the present caries prevalence and the state of oral health of schoolchildren. Therefore 1.147 children from group 2 and group 8 of the primary school (6 and 12 years of age) in the province Drenthe were examined. Of the children 33% had caries and 13% had gingivitis. The highest percentages of caries were found in the low SES-group and among children that have education at schools for children with special needs. The study showed that these children brushed their teeth less often, they visited the dentist for the first time at an older age and they were eating many snacks. Children who had received an instruction in how to brush one's teeth, did not score better in the caries prevalence compared to children without previous instruction. Also the children whose parents had information about oral health, did not score better than the other children.

Medical health care professionals' assessments of oral health needs in children with disabilities: a qualitative study

Good collaboration between medical and dental care is essential to provide not only good oral health care, but also more holistic care for children with disabilities. The aim was to explore and describe medical health care professionals' assessments and considerations of orofacial problems and treatment needs in children with disabilities and in their families. In-depth interviews focusing on orofacial function were carried out with 17 medical health care employees. Interviews were transcribed verbatim and analysed in open and focused (selective) coding processes according to grounded theory. A core category was identified and named focusing on basic needs, showing that oral health care assessment was not on the agenda of medical health care professionals, but was instead viewed as a responsibility of parents or dentists. This study shows that oral health issues are not fully integrated in the medical care of children with disabilities. The omission of oral health issues from the medical agenda implies a risk of oral health problems in children with disabilities. To put the oral cavity and oral health on the medical agenda, dentists need to influence the undergraduate training of medical professionals and to initiate co-operation with the medical care system.

Oral and salivary parameters in patients with rheumatic diseases

We studied the presence of secondary Sjögren's syndrome (SS) and the composition of saliva, prevalence of oral pathogens, periodontitis, mouth mucosa, and teeth in patients with various rheumatic diseases and in healthy controls. The hypothesis was that different rheumatic diseases might cause differences in oral health characteristics because of the liability of secondary SS in the patients. The study involved 77 patients and 77 age-matched and sex-matched controls. Twenty patients were suffering from spondylarthropathy (SPA), 18 from ankylosing spondylitis (AS), 24 from rheumatoid arthritis (RA), and 15 from mixed connective tissue disease (MCTD). Clinical and radiographic oral health status was recorded and salivary flow rates were measured. Selected salivary proteins and immunoglobulins were analysed by routine methods. Minor salivary gland biopsy samples were taken from the patients for assessment of inflammatory focus scores. Differences between patients and controls and in between the different rheumatic diseases were analysed statistically. Secondary SS was diagnosed in 39% (30/77) of the patients. A severe periodontal condition (community periodontal index of treatment needs score 3 or 4) occurred in 58% (45/77) of the rheumatic patients compared with only 26% (20/77) of the controls (p < 0.0001). The severity of focal sialadenitis (focus score) correlated significant with salivary IgA, IgG, and IgM concentrations. Salivary albumin, total protein, IgG, and IgM concentrations were higher in all patient groups than in the controls. The number of patients with low salivary flow rates was higher in all patient groups compared to controls. Oral yeast counts were significantly higher in the patients than in the controls (p < 0.001). In a subgroup analysis, patients with SS had higher values for salivary IgA and IgM than patients without SS. Dental caries and oral lactobacilli were more frequent in patients with SS, but SS was not associated with periodontitis. No major differences were noted in other salivary biochemical parameters between these two groups. Patients with rheumatic diseases, irrespective of specific diagnosis, thus had various alterations in salivary flow and composition and oral health. The findings may reflect the autoimmune inflammation of the salivary glands frequently observed in these patients.

Oral health-related quality of life for 8-10-year-old children: an assessment of a new measure

OBJECTIVES

The aim of the study was to assess the reliability and construct validity of the Child Oral Health-Related Quality of Life for 8-10-year-olds (COHRQoL [8-10]) using confirmatory factor analysis (CFA) and to test the measurement properties of latent variables believed to define the multidimensional construct of OHRQoL.

METHODS

A convenience sample of 270, year 4 children from six schools was obtained. The administered questionnaire included the 25-item COHRQoL [8-10] and the Coopersmith Self-Esteem Inventory-School Form. The analytical method was based upon CFA using maximum likelihood estimation. A second-order factoring approach was applied to determine the extent that the latent variables tapped a single over-arching domain of quality of life.

RESULTS

Seven items were withdrawn for low endorsement and poor association with resultant factors. The COHRQoL [8-10] was confirmed to measure a single construct of three latent variables invariant to gender. Internal consistency of the three scales derived comprising a total of 18 retained items was acceptable. Associations with self-esteem and with a single question on the extent that the mouth was a problem were confirmed and strengthened the construct validity of the COHRQoL [8-10] measure.

CONCLUSIONS

Reliability and construct validity were demonstrated for COHRQoL [8-10] and supported the scale for adoption as an epidemiological and scientific tool for group comparisons. CFA showed that the three constructs or latent variables underlying the overall COHRQoL ratings were discrete measures that can be reliably assessed in children. Further model testing with additional data will increase generalization of these findings.

Mundgesundheit, Zahnstatus und Ernährung im Alter

The loss of natural teeth impairs essentially the chewing function and can only partly be restored by the insertion of dental prostheses. Equally, xerostomia and dysphagia may aggravate the nutritional intake in older adults. Often denture wearers do subjectively not notice the adjustment of their food choice and the employment of special preparation techniques. Finally the dental state influences the nutritional intake. A reduced number of teeth correlates with the intake of less calories, proteins, fat, non-starch polysaccharides and vitamins. Often missing calories are compensated by an increased consumption of sugar and fat. Especially edentulous persons with a low level of education choose a diet which is rich in fat and sugar. Further the daily intake of fruit and vegetables diminishes along with fewer occlusal contacts in posterior teeth. The restoration of the chewing function by dental intervention does not lead to an improvement of the nutritional intake by itself and should therefore always be complemented by nutritional advice.