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Klotz AL, Zajac M, Ehret J, Kilian S, Rammelsberg P, Zenthöfer A. Short-Term Effects of a Deterioration of General Health on the Oral Health of Nursing-Home Residents. Clin Interv Aging 2020; 15:29-38. [PMID: 32021130 PMCID: PMC6957004 DOI: 10.2147/cia.s234938] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/07/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose The purpose of this study was to identify how changes to general health might affect the oral health of nursing-home residents over a six-month period. Materials and Methods The study was conducted in nine nursing homes in Germany. Sociodemographic and general data were collected at baseline and after six months. Complete baseline and follow-up data were available for 114 participants. The Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS) were used to identify the presence and, if applicable, severity of dementia among participants. The Apraxia Screen of TULIA (AST) was used to identify motor impairment. A comprehensive dental examination of each participant was also performed. The examination included the documentation of dental and denture status and the number of decayed, missing and filled teeth (DMF-T). In addition, dental and denture hygiene were quantitatively assessed using the Plaque Index (PI) and the Denture Hygiene Index (DHI), respectively. Global dental treatment needs were evaluated by use of the Oral Health Assessment Tool (OHAT). Univariate and multivariate linear regression models were compiled to analyse possible factors affecting the dependent target variables. Results During the study period, denture hygiene among the study population worsened by an average of 15%. The regression models detected that a more advanced age (in years) was associated with a less pronounced deterioration of denture hygiene as measured by use of the DHI (−0.806 per additional year of age; p = 0.030). Furthermore, an increase in the level of care needed (coefficient (C): −1.948; p = 0.002) and a more poorly graded assessment of general health compared with the value at baseline (C: 1.054; p = 0.026) were both associated with a deterioration of oral health as evaluated by use of the OHAT. In addition to these results, an increase in care needs was also associated with a deterioration of dental health as evaluated by use of the DMF-T (C: 0.966; p = 0.013). Conclusion In the short term, a deterioration of general health, including an increase in care needs, seems to be the predominant factor associated with a more pronounced deterioration of oral health among nursing-home residents.
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Affiliation(s)
- Anna-Luisa Klotz
- University of Heidelberg, Dental School, Department of Prosthetic Dentistry, Heidelberg 69120, Germany
| | - Melania Zajac
- University of Heidelberg, Dental School, Department of Prosthetic Dentistry, Heidelberg 69120, Germany
| | - Judith Ehret
- University of Heidelberg, Dental School, Department of Prosthetic Dentistry, Heidelberg 69120, Germany
| | - Samuel Kilian
- University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg 69120, Germany
| | - Peter Rammelsberg
- University of Heidelberg, Dental School, Department of Prosthetic Dentistry, Heidelberg 69120, Germany
| | - Andreas Zenthöfer
- University of Heidelberg, Dental School, Department of Prosthetic Dentistry, Heidelberg 69120, Germany
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52
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Orr ME, Reveles KR, Yeh CK, Young EH, Han X. Can oral health and oral-derived biospecimens predict progression of dementia? Oral Dis 2020; 26:249-258. [PMID: 31541581 PMCID: PMC7031023 DOI: 10.1111/odi.13201] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/09/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022]
Abstract
Growing evidence indicates that oral health and brain health are interconnected. Declining cognition and dementia coincide with lack of self‐preservation, including oral hygiene. The oral microbiota plays an important role in maintaining oral health. Emerging evidence suggests a link between oral dysbiosis and cognitive decline in patients with Alzheimer's disease. This review showcases the recent advances connecting oral health and cognitive function during aging and the potential utility of oral‐derived biospecimens to inform on brain health. Collectively, experimental findings indicate that the connection between oral health and cognition cannot be underestimated; moreover, oral biospecimens are abundant and readily obtainable without invasive procedures, which may help inform on cognitive health.
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Affiliation(s)
- Miranda E Orr
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas.,Geriatric Research, Education & Clinical Center and Research Service, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Medicine, UT Health San Antonio, San Antonio, Texas.,Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas.,Gerontology and Geriatric Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, Texas.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas
| | - Chih-Ko Yeh
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas.,Geriatric Research, Education & Clinical Center and Research Service, South Texas Veterans Health Care System, San Antonio, Texas.,Comprehensive Dentistry, School of Dentistry, UT Health San Antonio, San Antonio, Texas
| | - Eric H Young
- College of Pharmacy, The University of Texas at Austin, Austin, Texas.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas
| | - Xianlin Han
- Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas.,Department of Medicine, UT Health San Antonio, San Antonio, Texas
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53
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Eisenmann Y, Golla H, Schmidt H, Voltz R, Perrar KM. Palliative Care in Advanced Dementia. Front Psychiatry 2020; 11:699. [PMID: 32792997 PMCID: PMC7394698 DOI: 10.3389/fpsyt.2020.00699] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Dementia syndrome is common and expected to increase significantly among older people and characterized by the loss of cognitive, psychological and physical functions. Palliative care is applicable for people with dementia, however they are less likely to have access to palliative care. This narrative review summarizes specifics of palliative care in advanced dementia. Most people with advanced dementia live and die in institutional care and they suffer a range of burdensome symptoms and complications. Shortly before dying people with advanced dementia suffer symptoms as pain, eating problems, breathlessness, neuropsychiatric symptoms, and complications as respiratory or urinary infections and frequently experience burdensome transitions. Pharmacological and nonpharmacological interventions may reduce symptom burden. Sensitive observation and appropriate assessment tools enable health professionals to assess symptoms and needs and to evaluate interventions. Due to lack of decisional capacity, proxy decision making is often necessary. Advanced care planning is an opportunity establishing values and preferences and is associated with comfort and decrease of burdensome interventions. Family carers are important for people with advanced dementia they also experience distress and are in need for support. Recommendations refer to early integration of palliative care, recognizing signs of approaching death, symptom assessment and management, advanced care planning, person-centered care, continuity of care, and collaboration of health care providers.
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Affiliation(s)
- Yvonne Eisenmann
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Holger Schmidt
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Klaus Maria Perrar
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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54
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Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol 2019; 277:863-872. [PMID: 31797041 PMCID: PMC7031181 DOI: 10.1007/s00405-019-05742-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/24/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE This study reviews our experience with deep neck space infections (DNIs) requiring surgical intervention, including cervical necrotizing fasciitis. The aim of the study was to identify predisposing and aggravating factors of the disease and recognize the possible factors that can lead to life-threatening complications and slow down the healing process. METHODS We compare the results to previous data from 1985 to 2005 to find possible alterations and changing trends. The characteristics of four lethal cases are described. This retrospective analysis includes patient data from 2004 to 2015 in tertiary referral hospital and in total, 277 patients were found. RESULTS Surgical drainage through a neck opening ± intraoral incision was made in 215 (77.6%) patients, an intraoral incision was only made in 62 patients (22.4%). ICU care was needed in 66 (23.8%) cases. Odontogenic etiology (44.8%) was the most common origin. The most common comorbidity was a psychiatric disorder and/or dementia and occurred in 55 (19.9%) patients. Patients with underlying illnesses were more likely to be admitted to the ICU (p = 0.020), required a longer ICU stay (p = 0.004) and repeated surgery (p = 0.009). Gas formation seemed to be predictive of a more severe course of infection. Early extraction of the odontogenic foci was related to a lower length of stay (LOS) (p = 0.039). CONCLUSION The annual numbers have risen from 14 to 24 cases per year when compared to previous data. DNIs remain a cause of lethal complications; the mortality was 1.4% and overall complications occurred in 61 (22.0%) patients.
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55
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Oral Health Status and Need for Oral Care in an Aging Population: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224558. [PMID: 31752149 PMCID: PMC6888624 DOI: 10.3390/ijerph16224558] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/05/2019] [Accepted: 11/10/2019] [Indexed: 12/15/2022]
Abstract
Background. The world population is aging. This phenomenon is accompanied by an increase in the number of elderly with dementia, whose oral hygiene care is a challenge. Objective. This paper presents a literature review of oral health status and the need for oral care in people with dementia, as compared to people without dementia and also of the relationship between periodontal disease and cognitive impairment. Methods. A systematic review was conducted in PubMed, CINAHL, and the Cochrane Library. Fifty-six articles met the inclusion criteria and were consequently included for quality assessment and data extraction. Results. No significant differences were found between both groups with regard to the number of present teeth, DMFT Index, edentulousness/use of denture, and orofacial pain. Coronal/root caries and retained roots were more common in people with dementia than in those without dementia. Most of the participants with dementia presented gingival bleeding or inflammation and they suffered from the periodontal disease more than people without dementia. Conclusions. Poor oral health is a common condition among the elderly with dementia. The education process of caregivers might improve the oral health status of people with dementia. Finally, periodontal disease might contribute to the onset or progression of dementia.
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56
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Aging and Oral Care: An Observational Study of Characteristics and Prevalence of Oral Diseases in an Italian Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193763. [PMID: 31591317 PMCID: PMC6801690 DOI: 10.3390/ijerph16193763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/17/2022]
Abstract
Background: Poor oral health is a common condition in patients suffering from dementia. Several aspects of this systemic pathology contribute to causing oral problems: cognitive impairment, behavior disorders, communication and, motor skills deterioration, low levels of cooperation and medical-nursing staff incompetency in the dental field. Objectives: The objectives of this study were to evaluate the prevalence and the characteristics of oral pathology in a demented elderly population, as well as to check the association between the different degree of dementia and the oral health condition of each patient. Materials and Methods: In this observational study (with cross-sectional design) two groups of elderly patients suffering from dementia, living in two different residential care institutions were recruited. The diagnosis of dementia of each included patient was performed using the Clinical Dementia Rating Scale. In order to evaluate the oral health condition of the included subjects, each patient underwent a physical examination of the oral cavity, during which different clinical parameters were analyzed (number of remaining teeth, oral mucosa, periodontal tissues, bone crests). To each parameter, a score was assigned. Spearman’s Rho test was used. Results: Regarding the prevalence of oral pathology in elderly suffering from dementia, it emerged that 20.58% of the included patients had mucosal lesions and/or new mucosal formations (in most cases undiagnosed and therefore untreated). The prevalence of periodontal disease was equal to 82.35% and a marked clinically detectable reabsorption of bone crests was found in almost all patients (88.23%). 24.13% of patients, who underwent the oral examination, had totally edentulous maxillae and/or with retained roots, without prosthetic rehabilitations. The correlation index r showed the presence of a linear correlation (inverse relationship) between the degree of dementia and the state of health of the oral cavity of each patient. Conclusions: Several factors contribute to poor oral health in the elderly suffering from dementia: cognitive functions deterioration, behavioral disorders and inadequate medical-staff nursing training on oral hygiene. This study also demonstrated that the lower the dementia degree is, the lower tends to be the oral health status. In order to guarantee a complete assistance to these patients, residential care institutions should include in their healthcare program specific dental protocols.
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57
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Marchini L, Ettinger R, Hartshorn J. Personalized Dental Caries Management for Frail Older Adults and Persons with Special Needs. Dent Clin North Am 2019; 63:631-651. [PMID: 31470918 DOI: 10.1016/j.cden.2019.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Leonardo Marchini
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, N337-1 Dental Science, Iowa City, IA 52242, USA.
| | - Ronald Ettinger
- Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, N-409 Dental Science, Iowa City, IA 52242, USA
| | - Jennifer Hartshorn
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, W327 Dental Science, Iowa City, IA 52242, USA
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58
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Dioguardi M, Gioia GD, Caloro GA, Capocasale G, Zhurakivska K, Troiano G, Russo LL, Muzio LL. The Association between Tooth Loss and Alzheimer's Disease: a Systematic Review with Meta-Analysis of Case Control Studies. Dent J (Basel) 2019; 7:dj7020049. [PMID: 31052367 PMCID: PMC6630622 DOI: 10.3390/dj7020049] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022] Open
Abstract
Alzheimer's disease is classified as a neurodegenerative condition, a heterogeneous group of illnesses characterized by the slow and progressive loss of one or more functions of the nervous system. Its incidence tends to increase gradually from 65 years of age, up to a prevalence of 4% at age 75. The loss of dental elements is more prevalent in this population and might negatively affect the masticatory capacity, quality of life, and pathogenesis of Alzheimer's disease. This study investigated problems related to oral health and the loss of dental elements in elderly patients suffering from Alzheimer's and considered whether local inflammatory processes could affect the etiopathogenesis of Alzheimer's disease. The purpose of this systematic review is to identify a link between the causes leading to tooth loss and the onset/progression of Alzheimer's disease. We also studied whether there is a higher incidence of tooth loss (primary outcome) and edentulism (secondary outcome) among Alzheimer's patients. We searched records in electronic databases such as PubMed, EBSCO, and Web of Science using the following keywords: Alzheimer's Disease AND periodontal, Alzheimer's Disease AND periodontitis, dementia AND (periodontitis OR periodontal) "Alzheimer's Disease" AND "tooth" OR "dental loss," "dementia" AND "edentulous," "Alzheimer's Disease" AND "edentulous," "dementia" AND "tooth" OR "dental loss." The records were screened, and after applying the eligibility and inclusion criteria, nine articles were left, six of which were analyzed for the primary outcome (loss of dental elements) and six for the secondary outcome (tooth loss). Results from this meta-analysis revealed that Alzheimer's disease patients have an increased risk of dental loss (hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.00-2.30, p = 0.05) and edentulous condition (HR 2.26, 95% CI 1.70-3.01, p < 0.001). A quantitative analysis of the included studies indicated that patients suffering from Alzheimer's disease are characterized by a greater number of lost dental elements and general edentulism compared to the control groups.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy.
| | - Giovanni Di Gioia
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy.
| | - Giorgia Apollonia Caloro
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Via Piazza Giulio Cesare, 70124 Bari, Italy.
| | - Giorgia Capocasale
- Department of Surgical, Oncological and Surgery, University of Palermo, 90121 Palermo, Italy.
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy.
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy.
| | - Lucio Lo Russo
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy.
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy.
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59
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Marchini L, Ettinger R, Caprio T, Jucan A. Oral health care for patients with Alzheimer's disease: An update. SPECIAL CARE IN DENTISTRY 2019; 39:262-273. [PMID: 30964560 DOI: 10.1111/scd.12375] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/14/2019] [Accepted: 03/24/2019] [Indexed: 12/11/2022]
Abstract
Alzheimer's disease and related disorders (ADRD) are among the age-associated chronic conditions that are most challenging to health care systems around the globe, as patients with dementia require full-time, intensive care for multiple years. Oral health care is negatively impacted by cognitive decline, and consequently poor oral health is common among people with ADRD. Poor oral health status is linked with many undesirable consequences for the well-being of people with ADRD, from excruciating local pain to life-threatening conditions, as aspiration pneumonia. In this paper, the authors provide an update on the most current concepts about Alzheimer's disease epidemiology, etiology, and management, current oral health care for patients with Alzheimer's disease, oral health promotion strategies for this population, as well as current research and future direction for improving oral health care for patients with Alzheimer's disease. It concludes that oral health care should be included in the patient's routine health care as early as possible in the progression of Alzheimer's disease for preventing rapid oral health deterioration. Establishing oral hygiene routines and providing dental treatment that is customized to the patients' individual needs and disease stage are important to achieve good oral health outcomes and prevent quality of life decline.
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Affiliation(s)
- Leonardo Marchini
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
| | - Ronald Ettinger
- Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
| | - Thomas Caprio
- Departments of Medicine, Public Health Science and Nursing, University of Rochester Medical Center, Rochester, New York
| | - Adina Jucan
- Departments of Dentistry and Medicine, University of Rochester Medical Center, Rochester, New York
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60
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Barriers and facilitators for provision of oral health care in dependent older people: a systematic review. Clin Oral Investig 2019; 23:979-993. [PMID: 30707299 DOI: 10.1007/s00784-019-02812-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Provision of oral health care (OHC), including oral hygiene (OH) or oral/dental treatment, to dependent older people (DOP) is frequently insufficient. We aimed to assess barriers and facilitators perceived by different healthcare professionals towards providing OHC to DOP. MATERIALS AND METHODS A systematic review was performed. Studies reporting on knowledge, attitudes, and beliefs acting as barriers and facilitators for provision of OHC were included. One database (PubMed) was searched and data extraction independently performed by two reviewers. Thematic analysis was used and identified themes translated to the domains and constructs of the theoretical domains framework (TDF) and aligned with the domains of the behavior change wheel (BCW). Analyses were stratified for the two target behaviors (providing oral hygiene and providing oral/dental treatment) and according to different stakeholders' perspective. For quantitative analysis, frequency effect sizes (FES) were calculated. RESULTS In total, 1621 articles were identified and 41 (32 quantitative, 7 qualitative, 2 mixed method) studies included. Within these 41 studies, there were 7333 participants (4367 formal caregivers, 67 informal caregivers, 1100 managers of care, 1322 dentists, 340 DOP). Main barriers for providing OH were "lack of knowledge" (FES 65%, COM-B domain: capability, TDF domain: knowledge) and "patients refusing care" (62%, opportunity, environmental context and resources). Main facilitators were "OHC training/education" (41%, capability, skills) and "presence of a dental professional" (21%, opportunity, environmental context and resources). Main barriers for provision of dental treatment were "lack of suitable facilities for treatment/transportation of patients" (76%) and "patients refusing care" (53%) (both: opportunity, environmental context and resources). Main facilitators were "regular visiting dentist" (35%) and "routine assessment/increased awareness by staff" (35%) (both: opportunity, environmental context and resources). CONCLUSIONS A number of barriers and facilitators for providing different aspects of OHC were identified for different stakeholders. CLINICAL RELEVANCE Our findings help provide the evidence to develop implementation strategies for providing high-quality systematic OHC to DOP. REGISTRATION This review was registered at Prospero (CRD42017056078).
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61
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Weijenberg RAF, Delwel S, Ho BV, van der Maarel-Wierink CD, Lobbezoo F. Mind your teeth-The relationship between mastication and cognition. Gerodontology 2018; 36:2-7. [PMID: 30480331 PMCID: PMC7380285 DOI: 10.1111/ger.12380] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/08/2018] [Accepted: 10/20/2018] [Indexed: 12/22/2022]
Abstract
This article explores the multifactorial relationship between mastication and cognition, with a focus on dementia. Older persons, especially those with dementia, are at great risk of suffering from oral health problems such as orofacial pain and loss of natural teeth. A possible explanation could be that the cognitive and motor impairments resulting from dementia cause a decrease in self‐care and as such, a worsening of oral health. An alternative explanation is that cognition and oral health influence each other. Animal studies show that a decrease in masticatory activity, for example, due to a soft diet or loss of teeth, causes memory loss and neuronal degeneration. The relationship between mastication and cognition has also been researched in human studies, but a cause‐effect relationship has not been proven. It is likely that multiple factors play a role in this relationship, such as self‐care, nutrition, stress and pain.
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Affiliation(s)
- Roxane A F Weijenberg
- Oral Kinesiology, Academisch Centrum Tandheelkunde Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Delwel
- Oral Kinesiology, Academisch Centrum Tandheelkunde Amsterdam, Amsterdam, The Netherlands.,Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bach Van Ho
- Oral Kinesiology, Academisch Centrum Tandheelkunde Amsterdam, Amsterdam, The Netherlands
| | | | - Frank Lobbezoo
- Oral Kinesiology, Academisch Centrum Tandheelkunde Amsterdam, Amsterdam, The Netherlands
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62
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Zimmerman S, Sloane PD. The Epidemic of Poor Oral Hygiene. J Am Med Dir Assoc 2018; 19:1031-1032. [PMID: 30471796 DOI: 10.1016/j.jamda.2018.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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63
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Delwel S, Scherder EJA, de Baat C, Binnekade TT, van der Wouden JC, Hertogh CMPM, Maier AB, Perez RSGM, Lobbezoo F. Orofacial pain and its potential oral causes in older people with mild cognitive impairment or dementia. J Oral Rehabil 2018; 46:23-32. [PMID: 30281826 PMCID: PMC7380060 DOI: 10.1111/joor.12724] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 12/24/2022]
Abstract
Background The number of people with dementia and natural dentition is growing. As dementia progresses, the degree of self‐care decreases and the risk of oral health problems and orofacial pain increases. Objectives To examine and compare the presence of orofacial pain and its potential causes in older people with Mild Cognitive Impairment (MCI) or dementia. Methods In this cross‐sectional observational study, the presence of orofacial pain and its potential causes was studied in 348 participants with MCI or dementia with all levels of cognitive impairment in two outpatient memory clinics and ten nursing homes. Results Orofacial pain was reported by 25.7% of the 179 participants who were considered to present a reliable pain self‐report (Mini‐Mental State Examination score ≥14 points), while it could not be determined in people with more severe cognitive impairment. The oral health examination of the 348 participants indicated that potential painful conditions, such as coronal caries, root caries, tooth root remnants or ulcers were present in 50.3%. There was a significant correlation between the level of cognitive impairment and the number of teeth, r = 0.185, P = 0.003, teeth with coronal caries, r = −0.238, P < 0.001, and the number of tooth root remnants, r = −0.229, P = 0.004, after adjusting for age. Conclusions This study indicated that orofacial pain and its potential causes were frequently present in participants with MCI or dementia. Therefore, a regular oral examination by (oral) healthcare providers in people with MCI or dementia remains imperative, even if no pain is reported.
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Affiliation(s)
- Suzanne Delwel
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees de Baat
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tarik T Binnekade
- Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Delwel S, Scherder EJA, Perez RSGM, Hertogh CMPM, Maier AB, Lobbezoo F. Oral function of older people with mild cognitive impairment or dementia. J Oral Rehabil 2018; 45:990-997. [DOI: 10.1111/joor.12708] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/31/2018] [Accepted: 08/15/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Suzanne Delwel
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
- Department of Clinical Neuropsychology; Faculty of Behavioral and Movement Sciences; Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - Erik J. A. Scherder
- Department of Clinical Neuropsychology; Faculty of Behavioral and Movement Sciences; Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - Roberto S. G. M. Perez
- Department of Anesthesiology; Amsterdam Public Health Research Institute; VU University Medical Center; Amsterdam The Netherlands
| | - Cees M. P. M. Hertogh
- Department of Elderly Care Medicine; Faculty of Medicine; VU University Medical Center Amsterdam; Amsterdam The Netherlands
| | - Andrea B. Maier
- Department of Medicine and Aged Care @AgeMelbourne; The Royal Melbourne Hospital; University of Melbourne; Melbourne Australia
- Department of Human Movement Sciences @AgeAmsterdam; Faculty of Behavioural and Movement Sciences; Amsterdam Movement Sciences; Vrije Universiteit; Amsterdam The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
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Chen X, Xie XJ, Yu L. The pathway from cognitive impairment to caries in older adults: A conceptual model. J Am Dent Assoc 2018; 149:967-975. [PMID: 30205901 DOI: 10.1016/j.adaj.2018.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/08/2018] [Accepted: 07/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Caries significantly increases in people with cognitive impairment (PWCI). However, the interrelationships among cognitive impairment, dentally related function (DRF), oral hygiene, and caries remain unclear, increasing difficulties to care appropriately for PWCI. In this study, the researchers tested a conceptual model in which impaired DRF acts as a mediator between cognitive impairment and poor oral hygiene, which then leads to caries. METHODS The researchers recruited 68 older adult dentate participants with normal to severely impaired cognition from 3 assisted-living communities in North Carolina. Within 1 week of a calibrated oral examination performed by a geriatric dentist, a trained examiner blinded to the oral examination results conducted cognitive and functional assessments. The researchers conducted statistical analyses to examine the mediating effect of DRF on the relationship between cognitive impairment and oral hygiene or caries. RESULTS Cognitive impairment (β = 0.05; standard error [SE], 0.02; P = .017) and DRF (β = -0.07; SE, 0.02; P = .005) were significantly associated with oral hygiene. However, the association between cognitive impairment and oral hygiene was greatly reduced and became nonsignificant after controlling for DRF (β = 0.01; SE, 0.03; P = .430), suggesting that the effect of cognitive impairment on oral hygiene was mediated by DRF. DRF accounted for 80% of the total effect of cognitive impairment on oral hygiene. The ratio of the indirect effect to the total effect was .8. Associations between either cognitive impairment or DRF and caries were not significant, but oral hygiene was significantly associated with caries (β = 0.87; SE, 0.28; P < .001). CONCLUSIONS DRF mediated the association between cognitive impairment and oral hygiene. It accounted for 80% of the total impact of cognitive impairment on oral hygiene, which was associated with increased caries in PWCI. PRACTICAL IMPLICATIONS As a result of cognitive impairment, impaired DRF plays a critical role in the pathway from cognitive impairment to oral health decline. Therefore, DRF assessment should be a standard component of geriatric dental assessment. A functionally-tailored oral hygiene intervention is essential to improve oral health for persons with cognitive impairment.
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Tonetti MS, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, López R, Madianos P, Müller F, Needleman I, Nyvad B, Preshaw PM, Pretty I, Renvert S, Schwendicke F, Trombelli L, van der Putten GJ, Vanobbergen J, West N, Young A, Paris S. Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2018; 44 Suppl 18:S135-S144. [PMID: 28266112 DOI: 10.1111/jcpe.12681] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health-related quality of life in older age pose formidable challenges to clinical care and healthcare systems. AIMS The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing. METHODS Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion. RESULTS Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders. CONCLUSIONS Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders.
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Affiliation(s)
- Maurizio S Tonetti
- Faculty of Dentistry, University of Hong Kong, Hong Kong, China.,European Research Group on Periodontology, Genova, Italy
| | | | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter Eickholz
- Department of Periodontology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Peter Heasman
- Department of Restorative Dentistry, University of Newcastle, Newcastle, UK
| | - Marie-Charlotte Huysmans
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rodrigo López
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Phoebus Madianos
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Ian Needleman
- International Centre for Evidence-Based Oral Health, Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Bente Nyvad
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Philip M Preshaw
- Department of Restorative Dentistry, University of Newcastle, Newcastle, UK
| | - Iain Pretty
- Division of Dentistry, University of Manchester, Manchester, UK
| | - Stefan Renvert
- Department of Periodontology, Kristianstad University, Kristianstad, Sweden
| | - Falk Schwendicke
- Department of Operative Dentistry, Charitè - Universitätsmedizin Berlin, Berlin, Germany
| | - Leonardo Trombelli
- Research Center for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Gert-Jan van der Putten
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacques Vanobbergen
- Community Dentistry and Oral Public Health, Ghent University, Ghent, Belgium
| | - Nicola West
- Department of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Alix Young
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Sebastian Paris
- Department of Operative Dentistry, Charitè - Universitätsmedizin Berlin, Berlin, Germany
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Kooshki R, Abbasnejad M, Esmaeili-Mahani S, Raoof M. The effect of CA1 administration of orexin-A on hippocampal expression of COX-2 and BDNF in a rat model of orofacial pain. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:603-608. [DOI: 10.1590/0004-282x20180099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/12/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT The neuropeptide orexin-A and its receptors are widely distributed in both hippocampal circuitry and pain transmission pathways. Objective: Involvement of the CA1 orexin 1 receptor (OX1R) on the modulation of orofacial pain and pain-induced changes in hippocampal expression of cyclooxygenase-2 (COX-2) and brain-derived neurotrophic factor (BDNF) was investigated. Methods: Orofacial pain was induced by an intra-lip injection of capsaicin (100 μg). Reverse transcription polymerase chain reaction and immunoblot analysis were used to indicate changes in hippocampal BDNF and COX-2 expression, respectively. Results: Capsaicin induces a significant pain response, which is not affected by either orexin-A or SB-334867-A, an OX1R antagonist. However, an increased expression of COX-2 and decreased expression of BDNF was observed in the hippocampus of animals that received capsaicin or SB-334867-A (80 nM) plus capsaicin. Meanwhile, orexin-A (40 pM) attenuated the effects of capsaicin on the expression of COX-2 and BDNF. Conclusions: CA1 OX1R activation moderates capsaicin-induced neuronal inflammation and neurotrophic deficiency.
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Affiliation(s)
| | | | | | - Maryam Raoof
- Kerman University of Medical Sciences, Iran; Kerman University of Medical Sciences, Iran
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68
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Newton P, Curl C, Prasad R, Pass P, Bowden J. A Qualitative Exploratory Study of Informal Carers' Experiences of Identifying and Managing Oral Pain and Discomfort in Community-Dwelling Older People Living with Dementia. Geriatrics (Basel) 2018; 3:geriatrics3030032. [PMID: 31011070 PMCID: PMC6319232 DOI: 10.3390/geriatrics3030032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 11/16/2022] Open
Abstract
Increased prevalence of dementia and poor oral health in older people is associated with more people living with dementia who experience oral pain and discomfort. However, little is known about how informal carers manage oral pain for people living with dementia in the community. This study aimed to explore informal carers' experiences of identifying and managing oral pain and discomfort in people living with dementia, and barriers and enablers they encountered. Focus groups with informal carers of people living with dementia were conducted, transcribed verbatim, and analysed using thematic analysis. Carers' accounts suggested that day-to-day contact was required to identify oral pain and discomfort, and a symptomology of the signs and symptoms was developed. Carers' accounts also highlighted issues in maintaining oral health, difficulties in accessing the mouth, managing dentures, competing demands, and difficulties in accessing treatment due to health service-, behavioural- and treatment- related barriers. Enablers included informal carers' pivotal role in the identifying and managing oral pain and discomfort in people living with dementia. The study concludes that carers want more partnership work with dental professionals, and clearer care pathways are required to meet the oral health needs of people living with dementia who experience oral pain.
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Affiliation(s)
- Paul Newton
- Department of Adult Nursing and Paramedic Science, Faculty of Education and Health, University of Greenwich, Avery Hill Campus, Southwood Site, London SE9 2UG, UK.
| | - Charlotte Curl
- Special Care Dentistry, King's College Hospital NHS Foundation Trust, King's College Dental Hospital, Denmark Hill, London SE5 9RS, UK.
| | - Ria Prasad
- Special Care Dentistry, King's College Hospital NHS Foundation Trust, King's College Dental Hospital, Denmark Hill, London SE5 9RS, UK.
| | - Patricia Pass
- Department of Adult Nursing and Paramedic Science, Faculty of Education and Health, University of Greenwich, Avery Hill Campus, Southwood Site, London SE9 2UG, UK.
| | - Julie Bowden
- Department of Adult Nursing and Paramedic Science, Faculty of Education and Health, University of Greenwich, Avery Hill Campus, Southwood Site, London SE9 2UG, UK.
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The impact of a preventive and curative oral healthcare program on the prevalence and incidence of oral health problems in nursing home residents. PLoS One 2018; 13:e0198910. [PMID: 29894494 PMCID: PMC5997339 DOI: 10.1371/journal.pone.0198910] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 05/29/2018] [Indexed: 11/19/2022] Open
Abstract
AIMS To assess the impact of an oral healthcare program in nursing homes on the initial treatment backlog and residents' oral health stability. MATERIALS AND METHODS The study is a longitudinal cohort study in nursing home residents in Flanders, Belgium, to evaluate the oral healthcare programme Gerodent. The program consisted of: (1) the introduction of an oral healthcare team, (2) oral health education, (3) the implementation of oral health guidelines and protocols, and (4) regular visits of a mobile dental team. Data were extracted from the oral health records of 381 residents from 21 nursing homes who received treatments from the mobile dental team between October 2010 and March 2014 (mean follow-up period of 22.5 months). Oral health and treatment need between baseline and follow-up were compared. RESULTS The mean age at baseline was 82.4 years and the mean number of consultations per resident was 3.61 during the follow-up period. The proportion of residents with an oral treatment need was reduced from 65.9% to 31.3%. Among residents with natural teeth, there was significantly lower prevalence of caries (from 70.5% at baseline to 36.5% at follow-up; p<0.001), residual roots (from 54.2% to 25.1%; p<0.001), and need for fillings (from 31.9% to 17.1%; p<0.001) or extractions (from 64.3% to 31.6%; p<0.001). In the group with partial or full dentures (n = 223), 38.1% needed a repair, rebasing or renewal of their existing dentures at baseline and the respective figure at follow-up was 9.0% (p<0.001). In terms of oral health stability, 53% of the residents had no incident restorative and prosthetic treatment need throughout the follow-up period. A lower number of natural teeth at baseline (p<0.001) and a shorter follow-up period (p = 0.002) were associated with higher chances of oral health stability. CONCLUSION The oral healthcare program Gerodent significantly reduced the treatment backlog and contributed to a considerable proportion of residents being stable in terms of oral health without any incident treatment needs.
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70
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van de Rijt LJM, Weijenberg RAF, Feast AR, Vickerstaff V, Lobbezoo F, Sampson EL. Oral health and orofacial pain in people with dementia admitted to acute hospital wards: observational cohort study. BMC Geriatr 2018; 18:121. [PMID: 29792172 PMCID: PMC5966900 DOI: 10.1186/s12877-018-0810-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/07/2018] [Indexed: 11/14/2022] Open
Abstract
Background Orofacial pain in people with dementia is difficult to detect, and often under-treated. Our aim was to investigate the prevalence of orofacial pain in people with dementia in acute hospitals in the UK. Secondary aims were to examine oral health status and explore associations between orofacial pain and oral health factors. Methods This cross-sectional observational study was carried out in two UK hospitals. Using the Orofacial Pain Scale in Non-Verbal Individuals (OPS-NVI) to identify orofacial pain, 101 participants with dementia, admitted to acute medical wards, were observed for at least 3 min during rest and chewing. Verbal participants were then asked about presence of orofacial pain, using self-report pain scales. Finally, a brief oral assessment was performed. Results Orofacial pain, assessed with the OPS-NVI, was present in 11.9% (95% C.I. 5.9, 18.8) of participants at rest and 21.9% (95% C.I. 14.6, 31.3) whilst chewing. Participants who were no longer able to self-report pain were significantly more likely to experience orofacial pain. Oral health in both dentate and edentate participants was poor. Brush frequency, indication of chewing quality, consistency of the food, presence of extra-oral abnormalities, person who performed mouth care, and oral hygiene in dentate participants were significant predictors for the presence of orofacial pain. Conclusion Improving oral care in acute hospital patients with dementia, particularly those who cannot self-report pain, may significantly reduce pain and suffering in this population. Electronic supplementary material The online version of this article (10.1186/s12877-018-0810-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liza J M van de Rijt
- Faculty of Dentistry, Department of Oral Kinesiology, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Roxane A F Weijenberg
- Faculty of Dentistry, Department of Oral Kinesiology, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexandra R Feast
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,The Research Department of Primary Care and Population Health, University College London, London, UK
| | - Frank Lobbezoo
- Faculty of Dentistry, Department of Oral Kinesiology, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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71
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Delwel S, Perez RSGM, Maier AB, Hertogh CMPM, de Vet HCW, Lobbezoo F, Scherder EJA. Psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals as a screening tool for orofacial pain in people with dementia. Gerodontology 2018; 35:200-213. [PMID: 29707824 DOI: 10.1111/ger.12339] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to describe the psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals (OPS-NVI) as a screening tool for orofacial pain in people with dementia. BACKGROUND The OPS-NVI has recently been developed and needs psychometric evaluation for clinical use in people with dementia. The pain self-report is imperative as a reference standard and can be provided by people with mild-to-moderate cognitive impairment. METHODS The presence of orofacial pain during rest, drinking, chewing and oral hygiene care was observed in people with mild cognitive impairment (MCI) and dementia using the OPS-NVI. Participants who were considered to present a reliable self-report were asked about pain presence, and in all participants, the oral health was examined by a dentist for the presence of potential painful conditions. After item-reduction, inter-rater reliability and criterion validity were determined. RESULTS The presence of orofacial pain in this population was low (0%-10%), resulting in an average Positive Agreement of 0%-100%, an average Negative Agreement of 77%-100%, a sensitivity of 0%-100% and a specificity of 66%-100% for the individual items of the OPS-NVI. At the same time, the presence of oral problems, such as ulcers, tooth root remnants and caries was high (64.5%). CONCLUSION The orofacial pain presence in this MCI and dementia population was low, resulting in low scores for average Positive Agreement and sensitivity and high scores for average Negative Agreement and specificity. Therefore, the OPS-NVI in its current form cannot be recommended as a screening tool for orofacial pain in people with MCI and dementia. However, the inter-rater reliability and criterion validity of the individual items in this study provide more insight for the further adjustment of the OPS-NVI for diagnostic use. Notably, oral health problems were frequently present, although no pain was reported or observed, indicating that oral health problems cannot be used as a new reference standard for orofacial pain, and a regular oral examination by care providers and oral hygiene care professionals remains indispensable.
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Affiliation(s)
- Suzanne Delwel
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Human Movement Sciences, MOVE Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Elderly Care Medicine, Faculty of Medicine, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Molony SL, Kolanowski A, Van Haitsma K, Rooney KE. Person-Centered Assessment and Care Planning. THE GERONTOLOGIST 2018; 58:S32-S47. [DOI: 10.1093/geront/gnx173] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 11/13/2022] Open
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Lin CS. Revisiting the link between cognitive decline and masticatory dysfunction. BMC Geriatr 2018; 18:5. [PMID: 29304748 PMCID: PMC5756393 DOI: 10.1186/s12877-017-0693-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/18/2017] [Indexed: 12/17/2022] Open
Abstract
Age-related decline in cognitive functions and dementia are major challenges in geriatric healthcare. Accumulating evidence from clinical, epidemiological and animal research suggests that tooth loss may be a risk factor for the decline of cognitive functions. This issue highlights the role of the brain-stomatognathic axis in geriatric medicine. Whether input from the stomatognathic apparatus can affect the brain remains an open debate. By revisiting the evidence published in the past five years, we argue that the hypothesis regarding the association between cognitive decline and masticatory dysfunction should be carefully interpreted. Most of the available clinical and epidemiological studies present only cross-sectional data. With respect to the prospective studies, important confounding factors, such as nutritional and physical conditions, were not fully controlled for. Animal research has revealed that hippocampal deficits may play key roles in the observed cognitive decline. However, experimental intervention and outcome assessments may not capture the condition of human subjects. Brain neuroimaging research may be suitable for bridging the gap between clinical and animal research, potentially contributing to (a) the clarification of the brain network associated with mastication, (b) the identification of brain imaging markers for exploring the mechanisms underlying long-term changes in masticatory functions, and (c) the elucidation of interactions between mastication and other cognitive-affective processing systems. Three potential models of the brain-stomatognathic axis and relevant hypotheses are summarized, focusing on the sensory feedback mechanisms, the compensation of motor control, and cerebellar deficits. Finally, we highlight four critical aspects of study and experimental design that should be considered in future research: (a) the refinement of the considered behavioral assessments, (b) the inclusion of baseline changes in mental and physical conditions,
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Affiliation(s)
- Chia-Shu Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, 11221, Taiwan.
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74
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Delwel S, Binnekade TT, Perez RSGM, Hertogh CMPM, Scherder EJA, Lobbezoo F. Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues. Clin Oral Investig 2018; 22:93-108. [PMID: 29143189 PMCID: PMC5748411 DOI: 10.1007/s00784-017-2264-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/24/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published. OBJECTIVE To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues. METHODS A literature search was conducted in the databases PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. A critical appraisal of the included studies was performed with the Newcastle-Ottawa scale (NOS) and Delphi list. RESULTS The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia. CONCLUSIONS The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow. SCIENTIFIC RATIONALE FOR STUDY With the aging of the population, a higher prevalence of dementia and an increase in oral health problems can be expected. It is of interest to have an overview of the prevalence of oral problems in people with dementia. PRINCIPAL FINDINGS Older people with dementia have multiple oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, mucosal lesions, and reduced salivary flow. PRACTICAL IMPLICATIONS The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.
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Affiliation(s)
- Suzanne Delwel
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands.
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Faculty of Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahler Laan 3004, 1081, LA, Amsterdam, The Netherlands.
| | - Tarik T Binnekade
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Faculty of Medicine, Department of Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Faculty of Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahler Laan 3004, 1081, LA, Amsterdam, The Netherlands
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75
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Fereshtehnejad SM, Garcia-Ptacek S, Religa D, Holmer J, Buhlin K, Eriksdotter M, Sandborgh-Englund G. Dental care utilization in patients with different types of dementia: A longitudinal nationwide study of 58,037 individuals. Alzheimers Dement 2017; 14:10-19. [DOI: 10.1016/j.jalz.2017.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/10/2017] [Accepted: 05/14/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Neurology and Neurosurgery; McGill University; Montreal QC Canada
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Internal Medicine; Section for Neurology; Södersjukhuset Stockholm Sweden
| | - Dorota Religa
- Department of Geriatric Medicine; Karolinska University Hospital; Stockholm Sweden
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
| | - Jacob Holmer
- Division of Periodontology, Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Kåre Buhlin
- Division of Periodontology, Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Geriatric Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Gunilla Sandborgh-Englund
- Department of Dental Medicine; Karolinska Institutet; Stockholm Sweden
- Academic Center for Geriatric Dentistry; Stockholm Sweden
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76
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Rozas NS, Sadowsky JM, Jeter CB. Strategies to improve dental health in elderly patients with cognitive impairment. J Am Dent Assoc 2017; 148:236-245.e3. [DOI: 10.1016/j.adaj.2016.12.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/08/2016] [Accepted: 12/12/2016] [Indexed: 12/18/2022]
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