Mortality rate and oral health - a cohort study over 44 years in the county of Stockholm

Frailty index and ten oral conditions in the Coyoacan cohort study: A cross-sectional analysis

OBJECTIVES

To analyse the relationship between the Frailty Index and 10 oral conditions controlling for nutritional status among Mexican community-dwelling older people.

BACKGROUND

Studies suggest that the association between frailty and oral conditions are mediated by nutrition.

MATERIALS AND METHODS

This cross-sectional analysis includes 487 community-dwelling men and women aged ≥70 years old. Interview and clinical examinations were performed at participants' homes. Objective (number of natural teeth, root remnants, dental condition, utilisation and functionality of removable dental prostheses and periodontitis) and subjective (utilisation of dental services, self-rated oral health, chewing difficulties and xerostomia) oral variables were collected by trained personnel. The Frailty Index was calculated considering 35 deficits. Nutritional status measured with the Mini-Nutritional assessment (MNA), age, sex, education, and marital status were included as covariates. We fitted 11 multivariate generalised linear models (one for each oral condition), assuming gamma distribution for Frailty Index as the outcome.

RESULTS

Participants average age was 78.1 years, 52.1% were women. We observed a higher Frailty Index among those rating their oral health as worse than others their age (5.1%), reporting chewing difficulties often (4.9%) and fairly and very often (7.0%), and xerostomia (4.8%). Age, gender and MNA were consistently associated with the Frailty Index.

CONCLUSION

Subjective oral conditions are compatible with the Frailty Index after controlling for older people's nutritional status and covariates.

Barriers to oral care: a cross-sectional analysis of the Canadian longitudinal study on aging (CLSA)

BACKGROUND

Oral health plays a role in overall health, indicating the need to identify barriers to accessing oral care. The objective of this study was to identify barriers to accessing oral health care and examine the association between socioeconomic, psychosocial, and physical measures with access to oral health care among older Canadians.

METHODS

A cross-sectional study was conducted using data from the Canadian Longitudinal Study on Aging (CLSA) follow-up 1 survey to analyze dental insurance and last oral health care visit. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between socioeconomic, psychosocial, and physical measures with access to oral care, measured by dental insurance and last oral health visit.

RESULTS

Among the 44,011 adults included in the study, 40% reported not having dental insurance while 15% had not visited an oral health professional in the previous 12 months. Several factors were identified as barriers to accessing oral health care including, no dental insurance, low household income, rural residence, and having no natural teeth. People with an annual income of <$50,000 were four times more likely to not have dental insurance (adjusted OR: 4.09; 95% CI: 3.80-4.39) and three times more likely to report not visiting an oral health professional in the previous 12 months (adjusted OR: 3.07; 95% CI: 2.74-3.44) compared to those with annual income greater than $100,000.

CONCLUSIONS

Identifying barriers to oral health care is important when developing public health strategies to improve access, however, further research is needed to identify the mechanisms as to why these barriers exist.

Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review

A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.

Oral Health among Elderly, Impact on Life Quality, Access of Elderly Patients to Oral Health Services and Methods to Improve Oral Health: A Narrative Review

Dental health is often neglected among the elderly because of the numerous comorbidities in this population, such as cardiovascular diseases. However, dental health influences general health and quality of life by impacting both the general health and the psychological state of the individual. The present review highlights the main dental comorbidities in the elderly population, their impact on the quality of life, the barriers towards access to dental care in the elderly and methods to improve their dental health. Information related to dental care and its importance must be provided both to older individuals and their caregivers in order to detect dental pathology and treat it adequately. Ensuring dental health involves the whole society of elders, caregivers, dental care providers, the public sector, health policymakers, and the private sector.

Association between Oral Pathology, Carotid Stenosis, and Oral Bacterial DNA in Cerebral Thrombi of Patients with Stroke

Methods

Thrombus aspirates and control arterial blood were taken from 71 patients (70.4% male; mean age, 67.4 years) with acute ischemic stroke. Tooth pathology was registered using CT scans. Carotid stenosis was estimated with CTA and ultrasonography. The presence of bacterial DNA from aspirated thrombi was determined using quantitative PCR. We also analyzed the presence of these bacterial DNAs in carotid endarterectomies from patients with peripheral arterial disease.

Results

Bacterial DNA was found in 59 (83.1%) of the thrombus aspirates (median, 8.6-fold). Oral streptococcal DNA was found in 56 (78.9%) of the thrombus aspirates (median, 5.1-fold). DNA from A. actinomycetemcomitans and P. gingivalis was not found. Most patients suffered from poor oral health and had in median 19.0 teeth left. Paradoxically, patients with better oral health had more oral streptococcal DNA in their thrombus than the group with the worst pathology (p = 0.028). There was a trend (OR 7.122; p = 0.083) in the association of ≥50% carotid artery stenosis with more severe dental pathology. Oral streptococcal DNA was detected in 2/6 of carotid endarterectomies.

Conclusions

Stroke patients had poor oral health which tended to associate with their carotid artery stenosis. Although oral streptococcal DNA was found in thrombus aspirates and carotid endarterectomy samples, the amount of oral streptococcal DNA in thrombus aspirates was the lowest among those with the most severe oral pathology. These results suggest that the association between poor oral health and acute ischemic stroke is linked to carotid artery atherosclerosis.

Analysis of Healthy Lifestyle Habits and Oral Health in a Patient Sample at the Dental Hospital of the University of Barcelona

The association between general health and oral health has been studied over recent years. In order to evaluate the lifestyle and the presence of healthy habits, a descriptive observational study was conducted from December 2018 to April 2019 with 230 patients, aged from 18 to 65 years old, that attended the Dental Hospital of the University of Barcelona for the first time. A total of 230 participants were considered, 98 (43%) were men and 132 (57%) were women, with a mean age of 37 years old. Our hypothesis was that patients with healthy habits had a better oral status in comparison with patients with bad lifestyle habits. No statistically significant results were found regarding oral hygiene between gender, smokers and patients with systemic pathology. Regarding a healthy lifestyle (High adherence to dietary intake), no statistically significant results were found. No significant differences were found regarding physical activity between male and female patients. Our hypothesis wasn't confirmed; therefore, we cannot conclude that patients with healthy habits have better oral status in comparison with patients with bad lifestyle habits. Consequently, more prospective longitudinal studies should be carried out.

The Impact of Dental Care in Head and Neck Cancer Outcomes: A Systematic Review and Meta-Analysis

OBJECTIVE/HYPOTHESIS

The objective of this study was to perform a systematic review and meta-analysis to determine the impact of dental care on head and neck (H&N) cancer survival.

METHODS

A comprehensive literature search was performed using PubMed, MEDLINE, and CINAHL to find all relevant studies from the date of inception to March 2020. Systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and meta-analysis was performed using the random effects logistic regression model. Primary outcomes of interest were 5-year survival and hazard ratios comparing survival between dental care subgroups.

RESULTS

H&N cancer survival rates strongly correlate with dental care adherence. Patients with good dental care had significantly better survival than patients with poor dental care (HR = 0.67, 95% CI: 0.55-0.83), with similar improved survival among patients with moderate versus poor dental care (HR = 0.67, 95% CI: 0.57-0.80). In addition, patients with good dental care had significantly decreased mortality than those with moderate dental care (HR = 0.81, 95% CI: 0.69-0.96), indicating an exposure-response gradient.

CONCLUSIONS

For patients with H&N cancer, survival is significantly higher in those who receive recommended dental care compared with those who do not.

LEVEL OF EVIDENCE

N/A Laryngoscope, 2021.

Mortality-and Health-Related Factors in a Community-Dwelling of Oldest-Older Adults at the Age of 90: A 10-Year Follow-Up Study

Mortality is obviously intended for epidemiological studies of community-dwelling older adults. There are several health-related factors associated with nutritional status and mortality. The aim of this study was to elucidate the risk factor for mortality in community-dwelling oldest-older adults at the age of 90 and clarify the structure of health-related factors associated with mortality. A 10-year follow-up study was performed for 93 subjects at the age of 90. The mean and median of their survival days were 2373 and 2581 days for women, and 1694 and 1793 days for men. By Cox's proportional hazards model, health-related factors associated with mortality were self-assessed for chewing ability, activities of daily living (ADLs), serum albumin, total cholesterol, serum creatinine, and gripping power for women but not for men. These factors interacted with each other, and the association of these factors was different in women and men. Self-assessed chewing ability was a powerful risk factor for mortality in women at the age of 90. It acted independently from nutritional status. For older adults, addressing healthy food choices together with improved oral functions is useful. However, risk factors for mortality may depend on the life stage of subjects. To investigate the risk factor for the mortality, the life course approach is necessary.

U.S. state correlations between oral health metrics and Alzheimer's disease mortality, prevalence and subjective cognitive decline prevalence

Given the association between periodontal disease (PdD) and Alzheimer’s disease (AD), we examined correlations between states’ age-adjusted AD mortality rates, AD prevalence, subjective cognitive decline (SCD) prevalence, and oral health data. Data sources include the Centers for Disease Control and Prevention, scientific literature, and oral health rankings formulated by WalletHub.com and Toothbrush.org. Pearson (r) or Spearman (r_s) correlation coefficients were generated and evaluated. AD mortality rates correlate with dental visits (r = − 0.50, p = 0.0003), partial (r = 0.39, p = 0.005) or total (r = 0.44, p = 0.001) edentulism, WalletHub.com (r_s = 0.30, p = 0.03) and Toothbrush.org (r_s = 0.35, p = 0.01) rankings. AD prevalence correlates with dental visits (r = − 0.30, p = 0.03), partial (r = 0.55, p = 0.00003) or total (r = 0.46, p = 0.0009) edentulism, prevalence of any (r = 0.38, p = 0.006) or severe-stage (r = 0.46, p = 0.0009) PdD, and WalletHub.com (r_s = 0.38, p = 0.006) rankings. SCD prevalence in adults aged ≥ 45 years correlates with dental visits (r = − 0.69, p < 0.00001), partial (r = 0.33, p = 0.02) or total (r = 0.37, p = 0.008) edentulism, prevalence of any (r = 0.53, p = 0.0001) or severe-stage (r = 0.57, p = 0.00002) PdD, WalletHub.com (r_s = 0.53, p = 0.00008) and Toothbrush.org (r_s = 0.60, p < 0.00001) rankings. State metrics indicative of compromised oral health correlate with AD mortality rates, AD prevalence and SCD prevalence.

Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study

Background

Poor oral health at hospital admission is a potential higher mortality risk predictor. We aimed to determine in-hospital mortality by assessing poor oral health using a validated tool.

Methods

A retrospective observational study was conducted in an acute care hospital, and 624 consecutive geriatric patients were included. Patients were divided into three groups according to oral health, stratified by the Oral Health Assessment Tool (OHAT) scores. Nutritional status, daily living activities, cognitive impairment, and comorbidities were collected as covariates. Univariate and multivariate analyses were performed to identify the relationship between oral health and survival.

Results

The mean age was 83.8 ± 7.9 years, and 41% were males. Groups with an OHAT score equivalent to 0, 1–2, and ≥ 3 comprised 213, 206, and 205 patients, and 11 (5.2%), 13 (6.3%), and 37 (18.0%) of those patients died in the hospital, respectively. Patients in the OHAT score ≥ 3 group had higher mortality than those in the other groups (log-rank test: p = 0.012 for the OHAT = 0 group; p = 0.010 for the OHAT = 1–2 group after Bonferroni corrections). Patients in the OHAT score ≥ 3 group continued to have poor survival even after adjusting for confounders in the Cox’s regression analysis (hazard ratio: 2.514, 95% confidence interval: 1.220–5.183, p = 0.012).

Conclusion

In geriatric patients, poor oral health at hospital admission was an independent in-hospital mortality predictor. Future studies on oral care intervention stratified by oral health conditions are warranted.