Oral health in the elderly patient and its impact on general well-being: a nonsystematic review

Impact of Elderly Masticatory Performance on Nutritional Status: An Observational Study

Background and Objectives: Masticatory limitations on the dietary habits of edentulous subjects restrict their access to adequate nutrition, exposing them to a greater risk of protein energy malnutrition. The aim of this study is to verify the existence of an association between Masticatory Performance (MP) and nutritional changes in the elderly. Materials and Methods: 76 participants were enrolled. MP testing was performed using the two-color chewing gum mixing test. The system used reveals the extent to which the two differently colored chewing gums mix, and allows discrimination between different MPs. The assessment of the participants' nutritional statuses was carried out through a food interview. Anthropometric parameters were collected, and bioimpedance analysis was performed. Results: Mean MP was 0.448 ± 0.188. No statistically significant differences were detected between male and female subjects (p > 0.05). According to the Body Mass Index (BMI), obese patients had a lower MP than overweight and normal weight subjects (0.408 ± 0.225, 0.453 ± 0.169 and 0.486 ± 0.181, respectively). MP values were lower both in male and female subjects with a waist circumference above the threshold than those below it (0.455 ± 0.205 vs. 0.476 ± 0.110, respectively, in males and 0.447 ± 0.171 vs. 0.501 ± 0.138, respectively, in females). No relationship was noticed between MP and bioimpedance parameters (p > 0.05). Conclusions: A statistically significant relation was observed between MP and the number of missing teeth. A reduced MP could worsen nutritional parameters. A reduced MP did not seem to negatively affect bioimpedance parameters.

Inclusive Oral Healthcare for a better Future Together

Oral health is a critical component to overall quality of life. Recommendations and guidelines for oral health continue to evolve while remaining underutilized worldwide. Still, oral healthcare parity and equity are achievable. This public health priority must be supported with stronger research, service delivery must be equitable and transparent, and the impact of oral healthcare must be fully understood. Data, surveillance, evidence and translation must be improved for oral health specialties as well as for greater global governance. Further, interdisciplinary coordination between orthodontic, dentistry, medical, biotechnology and research organizations must be prioritized. With dedication and consistent approach, oral healthcare can achieve the best outcomes for quality of life and cost effective public health.

Thickened Drinks and Oral Nutritional Supplements as Potential Reservoirs of Oral Microorganisms: Microbial Assays In Vitro

Oral hygiene is difficult to achieve for frail older adults. Aging, chronic diseases, polypharmacy, mouth-washes, and crushed drugs can contribute to uncontrolled proliferation and microbial deposits in the mouth. Looking for avoidable risk factors, in vitro microbial survival or proliferation in thickened drinks and oral nutritional supplements (ONS) was investigated. The safest thickened drinks were ready-to-use products containing preservatives. Escherichia coli, Staphylococcus aureus, and Candida albicans proliferated in dairy ONS at room temperature. C. albicans also proliferated in juices. Oral anerobic bacteria were recovered from part eaten ONS. Thickened drinks and ONS could contribute to microbial proliferation, especially with patients who have swallowing alterations or cognitive troubles, who may keep these solutions longer than necessary in their mouth. These products can also constitute microbial reservoirs in the environment of frail older adults. It is important for health care workers and family members to respect hand hygiene and refrigeration procedures. [Research in Gerontological Nursing, xx(x), xx-xx.].

Dental, Vision, And Hearing Services: Access, Spending, And Coverage For Medicare Beneficiaries

Among Medicare beneficiaries, dental, vision, and hearing services could be characterized as high need, high cost, and low use. While Medicare does not cover most of these services, coverage has increased recently as a result of changes in state Medicaid programs and increased enrollment in Medicare Advantage (MA) plans, many of which offer these services as supplemental benefits. Using data from the 2016 Medicare Current Beneficiary Survey, this analysis shows that MA plans are filling an important gap in dental, vision, and hearing coverage, particularly among low- and middle-income beneficiaries. In 2016 only 21 percent of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas 62 percent of MA enrollees were in plans with a dental benefit. Among Medicare beneficiaries with coverage overall, out-of-pocket expenses still made up 70 percent of dental spending, 62 percent of vision spending, and 79 percent of hearing spending. While Medicare beneficiaries are enrolling in private coverage options, they are not getting adequate financial protection. This article examines these findings in the context of recent proposals in Congress to expand Medicare coverage of dental, vision, and hearing services.

Are oral health education for carers effective in the oral hygiene management of elderly with dementia? A systematic review

Elderly with dementia or cognitive impairment are at increased risk of poor oral health. Oral health education programs targeting carers may be an effective strategy to improve oral hygiene. The aim of this review was to assess the effectiveness of oral health education programs for carers on the oral hygiene of elderly with dementia. A literature search was performed to identify studies published in five electronic databases (PubMed, MEDLINE, EMBASE, CINAHL, and PsycINFO), without time and language restrictions. Two independent coders extracted data and assessed the risk of bias for each included study. Of the 243 studies, only four studies met the inclusion criteria. All four studies reported a significant improvement for some oral health measures in dementia elderly following a carer oral health education program. The included studies did not report any other relevant outcomes of interest for this review. This review identifies limited evidence for a carer oral health education as an efficient means to improve oral health in dementia elderly. The review also clearly highlights the need for well-designed, high-quality studies with more relevant outcome measures to better address this knowledge gap.

Factors Influencing the Onset of Intra- and Post- Operative Complications Following Tooth Exodontia: Retrospective Survey on 1701 Patients

Complications after tooth extraction may occur because of several factors correlated to the patient's medical history, surgical site or type of intervention. The aim of this retrospective cohort study was to evaluate type and frequency of complications after exodontic surgery, its correlation with antibiotic administration and between patient's related systemic factors. From June 2015 until February 2016 1701 exodontic interventions, for a total of 2322 extracted teeth, were carried out at the Unit of Oral Surgery in Trieste. Descriptive statistic, and backward multiple logistic regressions were performed to identify the variables associated with the presence of post-operative alveolitis or any other post-operative complication. The presence of coagulopathy and smoking habit were related to high risk of post-operative alveolitis (OR = 5.51, p = 0.035 and OR = 2.5, p = 0.029, respectively). Tooth fracture was found to be correlated with higher probability of post-operative alveolitis (p = 0.001) and concomitant chemotherapy put at a higher risk post-operative complications, including alveolitis (OR = 29.5, p = 0.018). According to the present results, antibiotic consumption did not seem to reduce the incidence of post-operative infective complications (alveolitis). A careful analysis of medical history, the adequate surgical technique, and the correct instructions in post-surgical behavior, prevent the insurgence of intra and post-operative complications.

Oral Health-Related Quality of Life Among Publicly Insured Mental Health Service Outpatients With Serious Mental Illness

OBJECTIVE

The study investigated factors associated with unmet need for dental care and oral health-related quality of life (OHQoL) among individuals with serious mental illness receiving outpatient care in a public mental health program serving a largely low-income population, mostly from racial-ethnic minority groups.

METHODS

Cross-sectional interview data were collected from a convenience sample (N=150) of outpatients. Adjusted risk ratios (ARRs) and adjusted risk differences (ARDs) were estimated by logistic regression models to examine the independent contribution of sociodemographic and clinical factors to low OHQoL and past-year unmet dental need, defined as inability to obtain all needed dental care.

RESULTS

More than half of participants reported low OHQoL (54%) and a past-year dental visit (61%). Over one-third (39%) had past-year unmet dental need. Financial barriers (ARR=3.16) and nonfinancial barriers (ARR=2.18) were associated with greater risk for past-year unmet dental need after control for age, gender, high dental anxiety, and limited English proficiency. ARDs for financial and nonfinancial barriers indicated absolute differences of 40 and 27 percentage points, respectively. Unmet dental need (ARR=1.31), xerostomia severity (ARR=1.20), and a schizophrenia spectrum diagnosis (ARR=1.33) were associated with low OHQoL, after control for age and current smoking, with ARDs ranging from 11 to 15 percentage points.

CONCLUSIONS

Improving oral health promotion, oral health service access, and the integration of the mental and oral health systems may help reduce the high prevalence of low OHQoL in this population, given that low OHQoL is partly driven by unmet dental need.

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.

Oral health of adults with intellectual disabilities: a systematic review

BACKGROUND

There have been several past reports that adults with intellectual disabilities experience poor oral health (tooth loss, periodontal health and untreated dental caries). Loss of a functional dentition has serious consequences, including problems with chewing, swallowing, nutrition, speech, temporomandibular joint osteoarthritis and pain and systemic health conditions. Poor oral health is largely preventable through proactive oral care support. In recent years, social care provision for adults has changed, with deinstitutionalisation and home-based personalised care now being the typical provision in high income countries. Hence, oral health inequalities might be reducing. However, there is limited recent evidence-synthesis on the topic. We aimed to address this.

METHOD

PROSPERO registration number: CRD42018089880. We conducted a preferred reporting items for systematic reviews and meta-analyses systematic review of publications since 2008. Four databases were searched with a clear search strategy, strict inclusion criteria for selection of papers, double scoring (two raters), systematic data extraction and quality appraisal of included papers.

RESULTS

A total of 33/3958 retrieved articles were included, of which 14 were drawn from dental service users and 10 from Special Olympic athletes, therefore not necessarily being representative of the wider population with intellectual disabilities. Despite this limitation, adults with intellectual disabilities were still shown to experience poor oral health. High levels of poor oral hygiene and gingivitis were found, with many also affected by periodontitis and untreated dental decay. There is clear unmet need relating to both periodontal (gum) and tooth health, leading to tooth loss.

CONCLUSIONS

Despite reports in the past of poor oral health amongst adults with intellectual disabilities, and despite it being preventable, there remains a high burden of poor oral health. This highlights the need to raise awareness, and for polices on effective daily oral care, and appropriate service provision. The importance of oral health and its possible negative sequelae needs to be elevated amongst carers and professionals.

The Geriatric Syndrome and Oral Health: Navigating Oral Disease Treatment Strategies in the Elderly

Poor oral health in the geriatric population is being framed as a potentially new geriatric syndrome; an oral and maxillofacial geriatric syndrome. As such, the treatment of oral diseases will require a comprehensive approach that considers the multimorbidity of disease, and polypharmacy that is precipitated/exacerbated by oral and maxillofacial dysfunction. This is challenging because oral diseases are not 1 discrete systemic illness but a combination of many with common causes. This article presents a roadmap approach to evaluate symptoms and apply therapeutic strategies for 5 common oral and maxillofacial dysfunctions seen in the elderly.

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

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

Salivary and plasma native and non-urate total antioxidant capacity versus oral health status in older non-smoking adults

OBJECTIVE

The aim of this study was to evaluate the salivary C-reactive protein and native and non-urate total antioxidant capacity (TAC) of saliva and plasma in relation to various oral health status indexes in older non-smoking adults.

DESIGN

Oral health status indices involved the Decayed, Missing, Filled Teeth index, the number of decayed teeth, Approximal Plaque Index, Plaque Index and Community Periodontal Index with Treatment Needs. Sixty older patients (67.0 ± 4.5 years) with different levels of oral health were examined. Salivary C-reactive protein was assessed. The Ferric Reducing Ability of Saliva/Plasma (FRAS/FRAP) and 2.2-diphenyl-1-picryl-hydrazyl test of saliva/plasma (DPPHS/DPPH) were used to assess the native and non-urate salivary (FRAS, non-urate FRAS, DPPHS, non-urate DPPHS, and plasma TAC (FRAP, non-urate FRAP, DPPH, non-urate DPPH).

RESULTS

Salivary C-reactive protein, native TAC and non-urate TAC did not correspond to any oral health status index. No relation was found for plasma native and non-urate TAC either. In multivariate analyses, age was the only independent predictor of DPPHS and salivary uric acid (p < 0.05) while non-urate DPPH was only negatively predicted by Body Mass Index (p < 0.001). None of oral health status indices was selected as an independent predictor of salivary and plasma TAC or C-reactive protein of saliva.

CONCLUSION

Oral health status indexes did not appear to influence the native or the non-urate local antioxidant status of saliva, or the systemic antioxidant status of plasma; they had no local effect related to salivary C-reactive protein. However, lower plasma non-urate antioxidant potential was related to overweight/obesity.

Hand motor functions on the presence of red fluorescent dental biofilm in older community-dwelling Koreans

BACKGROUND

The Quantitative Light-induced Fluorescence-Digital (QLF-D) system visualizes old and mature dental biofilm as red fluorescence. Risk factors for poor oral hygiene have been identified, however, few studies have evaluated the relationship between mature dental biofilm and hand motor functions. This study aimed to investigate the effects of two important manual motor functions for object manipulation -handgrip strength and manual dexterity- on the presence of red fluorescent dental biofilm in older community-dwelling Koreans using QLF-D, an optical device that reveals dental biofilm.

METHODS

This cross-sectional study included 70 Korean participants aged ≥65 years, all of whom completed questionnaires and were tested for handgrip strength and manual dexterity. In total, 840 dental surfaces were photographed using QLF-D, and ΔR₂₀ values, which reflect mature dental biofilm accumulation, were calculated. The t-test was performed to analyze the differences in the ∆R₂₀ values according to sociodemographic characteristics, health-related characteristics and hand motor functions, while multiple linear regression analysis was used to investigate the effects of hand motor functions on the ∆R₂₀ values.

RESULTS

Multivariate regression analysis revealed that handgrip strength (β = -0.294) was the factor most strongly affecting mature dental biofilm accumulation (ΔR₂₀), followed by tooth-brushing time (β = -0.262) and manual dexterity (β = -0.241).

CONCLUSIONS

Reductions in handgrip strength and manual dexterity were independent risk factors for pathogenic dental biofilm accumulation. The results of this investigation suggest that programs designed to prevent the decline, as well as improve, handgrip strength and manual dexterity might improve the oral hygiene of older adults.

Clinical dental technicians in the United Kingdom: A qualitative understanding of the experiences, of practices and challenges of communication for dental professionals

AIM

To investigate the roles and relationships of registered Clinical Dental Technicians (CDTs) in the dental team and healthcare systems, and their perspective as a professional group in the United Kingdom (UK).

METHODS

This qualitative study was conducted following a national questionnaire survey of CDTs, 18 of whom participated in semi-structured interviews; they were purposively sampled to represent the diversity and demography of CDTs. A topic guide, informed by the literature and survey findings, guided discussions which were recorded and transcribed verbatim. Drawing upon phenomenological and cultural relativistic theories, thematic analysis was conducted, thus enabling an "analytic story" of the lived experience to emerge.

RESULTS

Clinical dental technicians expressed pride, passion and satisfaction in their work yet feel misunderstood in their role. Experiences of being accepted and incorporated into the wider dental profession are strained. Ultimately, there is a complex web of inter-dependence between all actors-a triadic relationship-bounded by policymakers and regulators which directly impacts on best practice and the balance between collaboration and autonomy. Looking to the future, Ideal practice may involve different models of care, with examples of good practice emerging.

CONCLUSION

This paper provides a unique examination of the lived experience, feelings and relationships of CDTs. The perceptions of their role, their inter-professional relations and the progression as a professional group must be addressed, and their potential to work collaboratively actively engaged to serve our ageing population.

Factors affecting oral examinations and dental treatments among older adults in Israel

Background

Routine dental examinations are important for early diagnosis and treatment of dental problems among older adults in order to improve their quality of life and avoid costly future treatments. In Israel, a significant percentage of adults do not seek dental care.

Methods

The study is based on a 2017 telephone survey conducted among people aged 50–75 from different population groups in Israel to examine their health beliefs and attitudes toward dental treatments.

Results

The results show that among older adults the decision to undergo routine dental checkups is affected by socio-demographic status and health beliefs regarding dental health. Lower age, higher income levels, and Jewish religion predicted higher chances of frequent checkups. In addition, those who saw the benefits of routine checkups, believed that dentists were readily available, and had higher levels of health motivation were more likely to seek out routine dental care.

Conclusions

According to the recent dental reform in Israel, people aged 75 and over are eligible for subsidized dental treatments. To enhance the frequency of dental checkups among older adults, it is recommended to provide this subsidized coverage for adults under age 75. In addition, planning dental health services for individuals in this age group should be based upon their accepted beliefs and values. Moreover, systematic health education through the media and health maintenance organizations should specifically target this population group to encourage them to undergo dental checkups more frequently.

Domiciliary dental care among homebound older adults: A nested case-control study in Japan

AIM

Improving the availability of dental care is essential to maintain older adults' general health and wellbeing. Domiciliary dental care is a feasible alternative. The present study aimed to investigate factors affecting the use of domiciliary dental care among home-dwelling dependent older adults.

METHODS

A retrospective nested case-control study was carried out. We identified long-term care recipients who used home care services between April 2012 and March 2014 using Japan's nationwide long-term care service claim database. One-to-one case-control matching was carried out between those with and without domiciliary dental care, based on sex, age and the time home care service use was started. We carried out multivariable conditional logistic regression analyses to assess various factors associated with using domiciliary dental care.

RESULTS

We identified 3 377 998 eligible homebound long-term care beneficiaries aged ≥65 years. Of these, 278 302 (8.2%) received domiciliary dental care. Factors associated with a higher probability of receiving domiciliary dental care were: higher level of care need (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.93-2.06), exemption from out-of-pocket payment (OR 1.35, 95% CI 1.32-1.39]), living in a group home (OR 7.93, 95% CI 7.71-8.16), using other domiciliary services such as physician visits (OR 3.15, 95% CI 3.08-3.22) and a large number of dental clinics providing domiciliary dental care in their municipality (OR 1.74, 95% CI 1.70-1.77). Significant barriers to receiving domiciliary dental care were living alone (OR 0.64, 95% CI 0.62-0.66) and dementia (OR 0.89, 95% CI 0.88-0.91).

CONCLUSIONS

Our findings might help to improve the availability of dental care in this population. Geriatr Gerontol Int 2019; 19: 679-683.

Effect of gummy candy containing ubiquinol on secretion of saliva: A randomized, double-blind, placebo-controlled parallel-group comparative study and an in vitro study

A randomized, double-blind, placebo-controlled, parallel-group comparative clinical study was conducted to examine the effects of ubiquinol (the reduced form of Coenzyme Q10) on secretion of saliva. This interventional study enrolled 40 subjects aged 65 years or younger who were healthy, but noted slight dryness of the mouth. Subjects were randomized with stratification according to gender and age to ingestion of gummy candy containing 50 mg of ubiquinol or placebo twice daily for 8 weeks. At the end of study, along with a significant increase of the CoQ10 level in saliva (p = 0.025*, d = 0.65), there was a significant increase of the saliva flow rate (p = 0.048*, d = 0.66) in the ubiquinol candy group (n = 18; 47.4±6.2 years; 6 men and 12 women) compared to the placebo group (n = 20; 52.2±7.7 years; 4 men and 16 women). The strength of the stomatognathic muscles was not significantly enhanced by ingestion of ubiquinol candy. Compared with baseline, significant improvement of the following four questionnaire items was observed in the ubiquinol group at the end of the study: feeling tired (p = 0.00506, d = -0.726), dryness of the mouth (p = 0.04799, d = -0.648), prone to catching a cold (p = 0.00577, d = -0.963), and diarrhea (p = 0.0166, d = -0.855). There were no serious adverse events. An in vitro study revealed that ubiquinol stimulated a significant and concentration-dependent increase of ATP production by a cell line derived from human salivary gland epithelial cells (p<0.05), while 1 nM ubiquinol significantly suppressed (p = 0.028) generation of malondialdehyde by cells exposed to FeSO4-induced oxidative stress. These findings suggest that ubiquinol increases secretion of saliva by suppressing oxidative stress in the salivary glands and by promoting ATP production. Trial Registration: UMIN-CTR UMIN000024406.

Is the oral health reform in Israel optimally distributed? - A commentary

A traditional and ethical principle recognizes a country’s primary general welfare responsibility to the young and the old. However, the middle, adult, age group cannot and should not be disregarded. The current dental component of the National Health Insurance Law (NHIL), in Israel, only includes children and the elderly. The present commentary focuses on the large group of adults, age 19–74, which are currently excluded.

The cumulative incidence of disease increases over the lifetime of a person. We believe that a NHIL commitment with a major age gap in coverage is unacceptable. The recent manuscript, published by Natapov et al., in this journal, has documented the overall dental health of the older Israeli population, with emphasis on nutritional aspects. This contribution to the literature is commendable. However, we aim to follow in the steps of the Alma Ata Declaration and Ottawa Charter of the World Health Organization (WHO) and to clarify that the government’s responsibility should cover all residents regardless of their age. In addition, a dental health epidemiological data base, currently nonexistent for adults, is called for.

A built-in adjuvant-engineered mucosal vaccine against dysbiotic periodontal diseases

Periodontitis is associated with a dysbiotic shift in the oral microbiome. Vaccine approaches to prevent microbial shifts from healthy to diseased state in oral biofilms would provide a fundamental therapeutic strategy against periodontitis. Since dental plaque formation is a polymicrobial and multilayered process, vaccines targeting single bacterial species would have limited efficacy in clinical applications. In this study, we developed a divalent mucosal vaccine consisting of a mixture of FlaB-tFomA and Hgp44-FlaB fusion proteins targeting virulence factors of inflammophilic bacteria Fusobacterium nucleatum and Porphyromonas gingivalis, respectively. Introduction of peptide linkers between FlaB and antigen improved the stability and immunogenicity of engineered vaccine antigens. The intranasal immunization of divalent vaccine induced protective immune responses inhibiting alveolar bone loss elicited by F. nucleatum and P. gingivalis infection. The built-in flagellin adjuvant fused to protective antigens enhanced antigen-specific antibody responses and class switch recombination. The divalent vaccine antisera recognized natural forms of surface antigens and reacted with diverse clinical isolates of Fusobacterium subspecies and P. gingivalis. The antisera inhibited F. nucleatum-mediated biofilm formation, co-aggregation of P. gingivalis and Treponema denticola, and P. gingivalis-host cell interactions. Taken together, the built-in adjuvant-engineered mucosal vaccine provides a technological platform for multivalent periodontitis vaccines targeting dysbiotic microbiome.

Teaching undergraduate geriatric dentistry in five South America countries

OBJECTIVE

This study aimed to qualitatively analyse undergraduate geriatric dentistry (GD) teaching characteristics identified by geriatric dentistry teachers and senior students in five South American countries.

BACKGROUND

GD involves the knowledge and skills required to provide oral health care for older people.

METHODS

Exploratory-descriptive research with a qualitative approach developed in the undergraduate context of public universities in Chile, Argentina, Brazil, Colombia and Peru. Nine dental schools were intentionally selected. The participants were GD module teachers (20) and their senior students (30). Data were collected through open interviews via Skype^® conducted between May and August 2015 and were analysed using a content analysis technique with ATLAS.ti^® software, resulting in four categories.

RESULTS

GD modules are theoretical or a theoretical-practical mix. Most teachers are prosthodontists without specific training in GD. Their motivations to teach GD are related to personal, family, professional and social reasons. Humanity, sensitivity and knowledge of older people are considered fundamental characteristics of a GD teacher.

CONCLUSIONS

Students' first contact with an older person usually occurs during clinical activities. The participants mentioned insufficient hours for GD modules in the curricula and exclusively theoretical modules that do not allow students to learn typical specificities of older people. In the context of this study, the undergraduate GD teaching-learning process presented some weaknesses regarding educational methods, professor training and the interaction between older people and students. Diversification of learning scenarios and GD professor training are highly recommended.

Number of remaining teeth and health-related quality of life: the Korean National Health and Nutrition Examination Survey 2010-2012

Objectives/aims

With the Euro-Qol-5 dimension (EQ-5D) system, we investigated the relationship between the number of remaining teeth and QoL using data from the Korean National Health and Nutrition Examination Survey (KNHANES), 2010–2012. A total of 17,417 participants, more than 19 years old, were finally included in this study (men = 7394 and women = 10,023). Through this study, we have discovered that the remaining teeth affect overall health and that the fewer number of them may indicate a lower quality of life, as well.

The quality of life according to the number of remaining teeth was assessed among Koreans using the Euro-Qol-5 dimension (EQ-5D) system.

Method

The Euro-Qol-5 dimension (EQ-5D) system was used to measure the health-related QoL. Its five dimensions included mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The respondents were asked to choose one of the followings: G 1, no problems; G 2, some problems; and G 3, problematic, to best describe their health status for the five dimensions. Then, we assigned low QoL to G2 + G3 and high QoL to G1.

We used age, gender, economic income, educational level, residence, and marital status for the demographic variables and, drinking, smoking, exercise, BMI, and metabolic syndrome for health behaviors. Multiple logistic regression analysis was performed to examine the odds ratios (ORs) and confidence intervals (CIs) for the high QoL (G1) on the five categories of EQ-5D according to the number of remaining teeth. On the basis of the 0–15 remaining teeth group, we drew a comparison of the QoL between the 16–20 and 21–28 remaining teeth groups.

Results

Subjects with 21–28 remaining teeth had higher QoL scores and had higher ORs of high QoL, especially for mobility (OR = 1.256, 95% CI = 1.056–1.495), self-care (OR = 1.441, 95% CI = 1.096–1.894), and usual activities (OR = 1.241, 95% CI = 1.022–1.508, respectively), than those with 0–15 remaining teeth after adjusting for age, sex, body mass index, smoking, drinking, exercise, income, education, and metabolic syndrome.

ORs from the high QoL had the tendency to increase as the number of remaining teeth increased (all p for trend < 0.05). However, there was no relationship between the number of remaining teeth and QoL in the pain/discomfort and anxiety/depression dimensions.

Conclusion

The number of remaining teeth was associated with QoL, and subjects who had more teeth obtained higher QoL scores. The subjects in the high QoL group were especially associated with the components of EQ-5D such as mobility, self-care, and daily living.

Relationship between dentition, anthropometric measurements, and metabolic syndrome in the elderly

Abstract Introduction Tooth loss is a health disorder of the elderly population that may lead to masticatory deficiency and nutritional risks, inducing the biochemical changes of metabolic syndrome (MS). Objective To verify the relationship among number of teeth, anthropometric measurements, and MS in a group of elderly people. Material and method The study was developed in Porto Alegre, RS, Brazil, and it was divided into three phases. The first phase collected information from the database of all project participants and the second one collected sociodemographic, anthropometric, and biochemical data. The third phase was divided into two other phases: first, oral health interviews were applied to the elderly (281 patients evaluated by telephone and 23 visited at home) and second, 45 patients were randomly selected and invited to validate the data obtained by telephone with oral clinical examinations performed by a trained dental surgeon. The sample consisted of 304 individuals. The data collected were tabulated and analyzed using statistical tests. Result Elderly women with severe tooth loss present a significantly higher risk of developing MS. Thus, the maintenance of natural teeth in the elderly is a protective factor for the syndrome. Conclusion The findings support the hypothesis that the oral health of individuals, expressed by the number of teeth, may compromise and increase the risk of MS in the elderly.

Burden of Oral Symptoms and Health-Related Quality of Life in Long-Term Care Settings in Helsinki, Finland

OBJECTIVES

Poor oral health may complicate eating and deteriorate nutritional status. However, little is known about how the burden of oral symptoms (OS) is associated with the health-related quality of life (HRQoL) of vulnerable older people in institutional settings. This study explores how the burden of certain OS (chewing problems, swallowing difficulties, dry mouth) is associated with functioning, morbidity, nutritional status and eating habits. It also examines the association between the OS burden and HRQoL.

DESIGN

A cross-sectional study in 2017.

SETTING

All long-term care wards in Helsinki, Finland.

PARTICIPANTS

2401 older residents (74% females, mean age 83.9).

MEASUREMENTS

Nurses assessed the residents and completed questionnaires on the participants' demographics, functional status, diagnoses, OS and eating habits. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and HRQoL with a 15-dimensional instrument (15D).

RESULTS

Of the residents, 25.4% had one OS and 16.6% two or three OS. OS burden was associated linearly with poorer cognitive and physical functioning and a higher number of comorbidities, edentulousness without dentures, and less frequent teeth brushing/denture cleaning. OS burden was also associated with malnutrition, lower BMI and eating less during main meals. In the multivariate analyses adjusted for various confounding factors, a higher number of OS was associated with lower HRQoL. OS burden correlated with nearly all dimensions of HRQoL.

CONCLUSION

Oral symptoms are associated with generic HRQoL. Therefore, OS should be regularly assessed and managed in daily care.

Social inequalities in oral health in a group of older people in a Middle Eastern country: a cross-sectional survey

BACKGROUND AND OBJECTIVE

The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon. Data were collected from an administered questionnaire that included sociodemographic variables, perception of oral health, and regular dental visits. Oral examination included the number of missing and decayed teeth, the prosthetic status, and the number of functional dental units (FUs). The SES of the participants was determined by educational level, previous or actual work, and neighborhood level.

RESULTS

264 participants aged 71.4 ± 6.27 years (64.7% female) were included in the study. Regular dental visit, dental status, FU, and oral health perception were significantly related to the participants' place of residence, educational level, and work. Moreover, the mean number of missing teeth (p = 0.048) and decayed teeth (p = 0.018) was significantly elevated in the low SES.

CONCLUSION

There is a clear socioeconomic inequality in oral health among the Lebanese older people. Further researches should explore the potential contribution of psychosocial and behavioral factors in explaining these disparities.

Oral Health-Related Outcomes in Edentulous Patients Treated With Mandibular Implant-Retained Dentures Versus Complete Dentures: Systematic Review With Meta-Analyses

The objective of this systematic review was to determine the effect on oral health-related outcomes from mandibular implant-retained dentures opposing maxillary complete dentures in edentulous middle-age and older adults, compared with complete removable dentures in both arches. Randomized controlled trials included participants with an average age of 65 years or older. The Cochrane Library, MEDLINE, and Web of Science were searched. A total of 228 abstracts were reviewed for inclusion criteria, with 14 trials included and analyzed for risk of bias. Eleven of these studies were assessed as being at an unclear risk of bias, and 3 were at high risk. Mandibular implant-retained overdenture therapy showed statistically significant improvements in the patients' general satisfaction (P = .003), oral health-related quality of life (P &lt; .001), and chewing ability (P &lt; .001), over the patients with complete dentures. There were no significant differences in the percentage of patients who were satisfied with their overdentures vs complete dentures for comfort, retention, esthetics, or chewing ability; however, only 2 studies reported these outcomes. In terms of nutritional status 1 year after treatment, vitamin B12 blood levels increased significantly in the implant-retained group (P = .003), but not the other nutritional values. Implant-retained mandibular overdentures are an option for middle-aged and elderly edentulous patients as they significantly improve some of the outcomes; however, the quality of the evidence was moderate/low, due to the small number of studies included and the risk of bias. Future research should include objective outcomes such as masticatory performance, chewing efficacy, and muscular coordination.

Oral declines and mastication deficiencies cause alteration of food bolus properties

In the elderly, masticatory function often presents failure in certain oral tasks due to impairment such as decline in muscular force, jaw or tongue motility, neuro-muscular coordination, tooth damage, malocclusion and saliva production. Great disparity is observed in the various and potentially cumulative oral declines that occur with ageing. Such difficulties may have an impact on food consumption and nutritional status. To obtain better understanding of the consequences of several oral deficiencies, a series of swallowable boluses were prepared in vitro with the AM² masticator apparatus with normal and deficient programming. Physiological normal mastication (NM) was simulated using in vivo data from healthy subjects. Chewing deficiencies were reproduced by alteration of NM programming to perform different levels and combinations of force loss, lack of saliva and decrease in the motility of oral elements. Poultry meatballs were used as test-food. Particle size distribution in the food bolus was measured by sieving and rheological features (hardness, cohesiveness and elasticity) were assessed with a TPA test. Compared to the NM outcome, significant and gradual deterioration of the food bolus was observed and associated with alteration in force, saliva and motility. Combinations of several failures led to greater or cumulative deficiencies in swallowable bolus properties. For the elderly presenting a high prevalence of various oral injuries, tailoring textured food cannot be ignored as a solution for remedying deficiencies and favoring the formation of a safe-swallowable bolus, which is an essential vector of nutrients. Knowing the impacts of oral injuries on the food bolus is obviously a requisite for developing diet strategies, including nutritional items for specific populations.

Water-Switchable Interfacial Bonding on Tooth Enamel Surface

Tooth enamel is a distinctive nanocomposite with a highly organized hierarchical structure made of nanometer- and micrometer-scale building blocks. This structure has an excellent mechanical function that can last for decades thanks to an effective but underexploited interfacial chemical bonding between the building blocks. In this study, the nanomechanical system test (NST), scanning electron microscope (SEM), X-ray diffraction (XRD, including powder XRD or PXRD, small angle XRD or SAXRD, and grazing incidence small angle XRD or GISAXRD), and atomic force microscope (AFM) have been employed to analyze the water-mediated bonding on the enamel surface. Via the cycling between hydration, dehydration, and rehydration treatments, a reversible change in the interfacial distance (i.e., d-space in the XRD pattern) between hydroxyapatite (HAP) nanocrystallites have been found switchable between the embrittling and toughening on the enamel surface. From the hydrated to the dehydrated conditions, an energy dissipation to deform a unit volume (1 μm³) of biocomposite on the enamel surface and subsurface has decreased by 20%. This finding can help quantify and predict biomineral-surface properties in all humidity and develop new methods to protect tooth enamel of "dry-mouth" patients.

Low reproducibility between oral radiologists and general dentists with regards to radiographic diagnosis of caries

AIM

Early clinical and radiological diagnosis of dental caries is one of the fundamental objectives of clinical dentistry because of the high frequency of the disease and severe complications if caries remains untreated, especially among the elderly and patients with immunodeficiency. Dental panoramic tomography (DPT) is a common radiographic method for evaluating dentition when indicated, especially in an adult population. The aim of this study was to assess the reproducibility of diagnosis between specialists in oral radiology and general dentists with regards to caries lesions based on DPTs of adults.

MATERIAL AND METHODS

One-hundred DPTs taken from adult patients (average age 35) and then analyzed and reported on by 42 general dentists were then analyzed independently by two specialists in oral radiology with respect to caries lesions in the premolar and molar areas using radiographic criteria established for caries diagnosis. The general dentists versus oral radiologists were not calibrated before. Level of agreement between specialists and general dentists was measured using Cohen's kappa.

RESULTS

Comparison between observations of general dentists and specialists in oral radiology showed that 61% of the caries lesions on proximal surfaces of premolars and molars observed by specialists went unobserved by general dentists. Cohen's kappa value for specialists was 0.85 (p < .001) and for each specialist and general dentists 0.48 (p < .001) and 0.44 (p < .001).

CONCLUSIONS

The reproducibility between specialists in oral radiology and general dentists for detecting caries in DPTs was low.

Influence of the dental prosthetic status on self-perceptions of health and treatment needs: A cross-sectional study of middle-aged adults with chronic disease

Background

Subjective aspects of dental prosthesis need in middle-aged adults are poorly explored, especially when the population presents chronic diseases. Objectives: To investigate if the use and necessity of dental prosthesis influence the self-perceptions of health and dental treatment need in middle-aged adults with chronic diseases.

Material and Methods

A cross-sectional study was performed in 210 middle-aged adults. Socio-demographic aspects, dental services use, oral and general perceptions of health, dental treatment need and OIDP were assessed using a standardized questionnaire. One trained dentist evaluated the use and necessity of dental prosthesis. Data were analyzed using Chi-square and multivariate logistic regression (p<0.05).

Results

The use of dental prosthesis showed a proportion of 2.2:1 for upper to lower arch. Dental prosthesis need was largely prevalent (90 and 95% in upper and lower arch, respectively). The self-perceptions of dental treatment need and oral health were associated with the use and necessity of dental prosthesis (p<0.05), which could not be observed in relation to the general self-perception. The adjusted model demonstrated that the subjective necessity of dental treatment was 16.04 (1.92-133.7) fold higher in individuals with necessity of rehabilitation in the lower arch. Besides, a positive self-perception of oral health (satisfied) was 2.59 (1.38-4.85) more expressive in individuals that used a dental prosthesis in upper arch.

Conclusions

The self-perception of oral health was influenced by the use of maxillary dental prosthesis in individuals with chronic disease. Moreover, individuals were more likely able to perceive treatment need when the lower jaw was affected by tooth loss. Key words:Tooth loss, epidemiology, personal satisfaction, aged, chronic disease.

Dental and periodontal problems of elderly people in Vietnamese nursing homes

OBJECTIVE

To determine the oral health status and treatment needs of elderly residents in Vietnamese nursing homes.

METHODS

This study was conducted among 360 men and 431 women with a mean age of 72.9 ± 9.1 years in three nursing homes in Ho Chi Minh City. Demographic information on education, duration of stay, chronic diseases, tooth brushing and tobacco use were obtained from medical records and a questionnaire. The oral health of participants was clinically assessed by a dental examiner using WHO criteria. Oral health status included estimates of coronal and root caries, periodontal disease, denture status and dental treatment needs.

RESULTS

Nearly all (90.1%) of the participants had natural teeth. The mean numbers of teeth with coronal or root decay were 5.8 ± 4.0 and 6.0 ± 4.2, respectively, and almost everyone required at least one restoration for coronal or root caries. Most of the participants with natural teeth had bleeding gingiva on probing, 26.2% had deep periodontal pockets, 96.5% needed oral hygiene improvement plus scaling and 20.3% required complex periodontal treatment. None of the edentulous participants had dentures, and 86.6% required new or repaired dentures.

CONCLUSION

The prevalence of untreated oral diseases is very high and the need for dental care extensive among the residents of government-administered long-term care facilities in Ho Chi Minh City.

Masticatory efficiency contributing to the improved dynamic postural balance: A cross-sectional study

OBJECTIVE

To evaluate whether masticatory efficiency is associated with dynamic postural balance.

BACKGROUND

Masticatory dysfunction can cause deterioration of general health due to nutritional imbalances, thereby negatively affecting postural balance. However, few studies have investigated the association between masticatory efficiency and postural balance.

MATERIALS AND METHODS

The masticatory efficiency of 74 participants was evaluated by calculating mixing ability index (MAI) using a wax cube. The timed up and go test (TUGT) was used to measure dynamic balance. Participants with an MAI above or below the median value of 1.05 were defined as having high or low masticatory efficiency, respectively. An independent samples t-test was used to identify significant differences in TUGT, according to masticatory efficiency. Analysis of covariance was performed to adjust for confounding factors. Logistic regression analysis was used to assess the correlation between masticatory efficiency and postural balance.

RESULTS

The high masticatory efficiency group could complete the TUGT exercise approximately 1.67 seconds faster while maintaining the postural balance, compared to the low masticatory efficiency group (P = .005). Furthermore, the postural imbalance odds of the group with high mastication efficiency decreased by 0.14-fold, relative to the group with low mastication efficiency (95% confidence interval: 0.04-0.46).

CONCLUSION

With some reservations about statistical power, the association found between masticatory efficiency and postural balance justifies further investigations to confirm the strength of the associations, and possibly to identify causal relationships between mastication and posture in old age.

A practice based longevity study on single-unit crowns

OBJECTIVES

This retrospective longitudinal study aimed to assess the longevity of single unit crowns placed by several dentists and to investigate risk factors associated with crown failures.

METHODS

From patient files, longevity of 3404 full crown restorations placed in 1557 patients by 8 Dutch dentists between 1996 and 2011 were analyzed. Annual failure rates (AFRs) were calculated and variables associated with failure (success and survival of crowns) were assessed by multivariate Cox-regressions analysis with shared frailty for patients.

RESULTS

Most of crowns were PFM (63.8%) placed in molars (58.1%) and non endodontically treated teeth (65.4%). The observation time of restorations varied from 3 weeks to 11 years with a mean of 7 years, resulting in a mean AFR at 11 years of 2.1% and 0.7% for success and survival of crowns, respectively. Among dentists a relevant variation for type of interventions was observed with AFR varying between 1.2% and 3.5%. The most significant risk factor for failure of crowns was the presence of an endodontic treatment, resulting in Hazard ratios of 1.31 for success [95%CI 1.07-1.61] and 1.89 [95%CI 1.35-2.65] for survival of crowns. Tooth type, tooth position (jaw) and gender showed also a significant influence on success of crowns. For survival, increase in patients' age results in a higher risk for failure.

CONCLUSIONS

Overall, crowns placed by a selected group of dentist showed a good to acceptable success and survival rates, mainly dependent from the practice. The presence of an endodontically treated tooth was a significant risk factor leading to more failures.

Mechanical adaptation of trabecular bone morphology in the mammalian mandible

Alveolar bone, together with the underlying trabecular bone, fulfils an important role in providing structural support against masticatory forces. Diseases such as osteoporosis or periodontitis cause alveolar bone resorption which weakens this structural support and is a major cause of tooth loss. However, the functional relationship between alveolar bone remodelling within the molar region and masticatory forces is not well understood. This study investigated this relationship by comparing mammalian species with different diets and functional loading (Felis catus, Cercocebus atys, Homo sapiens, Sus scrofa, Oryctolagus cuniculus, Ovis aries). We performed histomorphometric analyses of trabecular bone morphology (bone volume fraction, trabecular thickness and trabecular spacing) and quantified the variation of bone and tooth root volumes along the tooth row. A principal component analysis and non-parametric MANOVA showed statistically significant differences in trabecular bone morphology between species with contrasting functional loading, but these differences were not seen in sub-adult specimens. Our results support a strong, but complex link between masticatory function and trabecular bone morphology. Further understanding of a potential functional relationship could aid the diagnosis and treatment of mandibular diseases causing alveolar bone resorption, and guide the design and evaluation of dental implants.

Charlson comorbidity index as a predictor of periodontal disease in elderly participants

Purpose

This study investigated the validity of the Charlson comorbidity index (CCI) as a predictor of periodontal disease (PD) over a 12-year period.

Methods

Nationwide representative samples of 149,785 adults aged ≥60 years with PD (International Classification of Disease, 10th revision [ICD-10], K052-K056) were derived from the National Health Insurance Service-Elderly Cohort during 2002-2013. The degree of comorbidity was measured using the CCI (grade 0-6), including 17 diseases weighted on the basis of their association with mortality, and data were analyzed using multivariate Cox proportional-hazards regression in order to investigate the associations of comorbid diseases (CDs) with PD.

Results

The multivariate Cox regression analysis with adjustment for sociodemographic factors (sex, age, household income, insurance status, residence area, and health status) and CDs (acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebral vascular accident, dementia, pulmonary disease, connective tissue disorders, peptic ulcer, liver disease, diabetes, diabetes complications, paraplegia, renal disease, cancer, metastatic cancer, severe liver disease, and human immunodeficiency virus [HIV]) showed that the CCI in elderly comorbid participants was significantly and positively correlated with the presence of PD (grade 1: hazard ratio [HR], 1.11; P<0.001; grade ≥2: HR, 1.12, P<0.001).

Conclusions

We demonstrated that a higher CCI was a significant predictor of greater risk for PD in the South Korean elderly population.