Periodontitis and orofacial health-related systemic impairment in patients with brain injury: a factor analysis approach

Perceptions of patients towards oral health care in a spinal cord injury rehabilitation unit: A qualitative study

BACKGROUND

Individuals with spinal cord injuries (SCIs) are at an increased risk of poor oral health compared to the general population. However, little is known about the related barriers and facilitators experienced by these individuals within the hospital setting.

OBJECTIVES

Understand the oral health knowledge, attitudes and practices of people with SCIs, barriers and facilitators to managing their oral health, and recommendations to improve oral care at acute/rehabilitation hospital settings.

METHODS

Semi-structured interviews were conducted with 11 participants, from a major metropolitan hospital in Sydney, Australia. The interviews were thematically analysed.

RESULTS

Three themes were constructed. Participants believed that the onus was on them to manage their oral health. Individuals also had limited knowledge of its importance to general health, and placed a lower priority on oral health compared to other aspects of health. All participants identified a combination of factors, such as cost, time, resources and prior negative experiences, that contributed to the neglect of their oral care. Participants also discussed the need of support from the multidisciplinary team and family/carers to facilitate oral care and identified various appropriate oral health education formats.

CONCLUSION

This study highlighted some areas where oral health knowledge among people with SCIs could be improved. It also identified the need for oral health training for the multidisciplinary team, as well as carers, to better integrate oral care during rehabilitation in the hospital. The development of oral health interventions would need to utilise a co-design approach to best support clients and their carers to facilitate oral care self-management.

Patterns and predictors of dental hospitalizations in patients with acquired brain injury from pre-injury to acute and post-acute injury

BACKGROUND

Acquired brain injury (ABI) can cause long-term disability and functional impairment.

OBJECTIVE

This study aims to determine the prevalence of dental hospitalizations in an ABI cohort across different phases of injury and identify factors associated with such hospitalizations.

METHODS

The cohort comprises patients with ABI (n = 683), traumatic (n = 282) and non-traumatic (n = 401) who were admitted to a neurorehabilitation service in Western Australia between 1991 and 2016. De-identified patient data were linked to the Hospital Morbidity Data Collection. The incidence of dental hospitalizations was calculated per 1,000 person-years (PY), and associated factors were investigated using multilevel mixed-effects logistic regression.

RESULTS

Dental hospitalizations significantly increased from pre-injury (3.35/1,000PY) to acute injury (302.65, Δ+299.3) and remained elevated in the post-acute phase (23.98, Δ+20.63). Dental caries had the highest incidence rate among all diagnoses in the pre-injury and post-acute phases (0.68 and 8.93, respectively), followed by gingivitis and periodontal diseases (3.60) in the post-acute phase. Tooth extractions were performed more often than restorative and preventive treatment in the pre-and post-injury phase, p < 0.001. Dental hospitalizations were associated with the type of ABI, age at injury, remoteness, and history of pre-injury hospitalization.

CONCLUSION

Implementing comprehensive preventive dental care can reduce potentially preventable dental hospitalization among ABI patients.

Association of periodontitis with tinnitus: A population-based cohort study in Taiwan

AIM

Tinnitus, ringing in the ears, is speculated to be driven by inflammation. This study examined whether periodontitis is a risk factor for tinnitus using Taiwan's National Health Insurance Research Database.

MATERIALS AND METHODS

Among the 79,456 patients who visited for dental concerns, 11,055 patients who were diagnosed with periodontitis and underwent periodontal treatment between 2000 and 2015 were enrolled in Group 1. After matching for sex, age, and index year, 11,055 patients with periodontitis who received no treatment were enrolled in Group 2. Similarly, 11,055 participants without periodontitis were included as controls.

RESULTS

At the end of the follow-up, 412 and 404 participants in the two periodontitis groups and 321 participants in the control group had tinnitus. Cumulative risk for tinnitus in Group 1 or 2 was significantly greater than in the control group. More periodontitis patients than controls developed tinnitus (adjusted hazard ratios were 1.71 (95% confidence interval [CI]: 1.49-1.97, p < .001) and 1.64 (95% CI: 1.37-1.86, p < .001) in Groups 1 and 2, respectively). The risks were not significantly different between Groups 1 and 2. Similar findings were obtained after excluding data for the first 1 or 5 years.

CONCLUSIONS

The study findings indicate that periodontitis is associated with tinnitus.

Effectiveness of Standard Oral Care Plan During Hospital Stay in Individuals With Brain Injury

Objective: To investigate the effectiveness of an existing standard oral care program (SOCP) and factors associated with it during hospitalization in individuals with acquired brain injury (ABI).

Material and Methods: A total of 61 individuals underwent a SOCP for 4 weeks in a longitudinal observational study. Rapidly noticeable changes in oral health were evaluated by performing plaque, calculus, bleeding on probing (BOP) and bedside oral examination (BOE) at weeks 1 and 5. Individuals' brushing habits, eating difficulties, and the onset of pneumonia were retrieved from their medical records. Association between oral-health outcomes to systemic variables were investigated through multilevel regression models.

Results: Dental plaque (P = 0.01) and total BOE score (P &lt; 0.05) decreased over time but not the proportion of dental calculus (P = 0.30), BOP (P = 0.06), and tooth brushing frequency (P = 0.06). Reduction in plaque and BOE over time were negatively associated with higher periodontitis scores at baseline (coef. −6.8; −1.0), respectively, which in turn were associated with an increased proportion of BOP (coef. ≈ 15.0). An increased proportion of calculus was associated with eating difficulties (coef. 2.3) and the onset of pneumonia (coef. 6.2).

Conclusions: Nursing care has been fundamental in improving oral health, especially reducing dental plaque and BOE scores. However, our findings indicate a need for improving the existing SOCP through academic-clinical partnerships.

Clinical Relevance: Early introduction of oral care program to brain-injured individuals is beneficial in reducing plaque accumulation and improving oral health.

Internal structure and validity of the bedside oral examination tool in patients with brain injury at neurorehabilitation setting

OBJECTIVES

To assess the internal structure and validity of the 'bedside oral examination' (BOE) instrument in individuals with acquired brain injury (ABI).

METHODS

Ninety ABI individuals were examined using BOE in their first week of neurorehabilitation. BOE measures oral health within eight categories including: swallow, tongue, odour, teeth, lips, saliva, mucosa and gingiva. To assess the validity of BOE, full-mouth clinical examination (gold standard) was performed. The internal structure of BOE was assessed using exploratory and confirmatory factor analyses. To measure the validity, the BOE scores were dichotomised into excellent oral health and altered oral health. Sensitivity, specificity and area under the receiver operating characteristic (ROC) curve of the six/eight BOE items were compared with their related clinical oral examination tool.

RESULTS

Overall, the patients had poor oral health irrespective of the oral examination tool used. Factor analyses indicated two factors within BOE: 'oral hygiene' (teeth, gingiva and mucosa) and 'orofacial health' (lips, swallow and saliva). BOE tongue and odour items loaded in neither factor. BOE items showed low validity since the highest area under the ROC curve was 0.60. Findings on the sensitivity value ranged from 35.0 to 74.2, while specificity from 44.4 to 83.3, depending on the item evaluated.

CONCLUSION

Bedside oral examination does not seem to be an ideal 'single' outcome tool in a neurorehabilitation setting as it lacks validity. BOE evaluates oral health as two independent but correlated components and treat them separately indicating precision treatment depending on their oral health dysfunction. It is advisable to use BOE as a screening tool. However, it should be complimented by proper clinical examination before establishing a treatment plan for oral health in patients with ABI.

Tongue cleaning in the elderly and its role in the respiratory and swallowing functions: Benefits and medical perspectives

Oral dysfunction, including oral uncleanness and decline in tongue motor function, tongue pressure and swallowing function, precedes frailty. The tongue's dorsum is a reservoir of oral microbiota, desquamated epithelial mucosa and leukocytes due to the multi-papillate anatomy, and leads to tongue coating. The tongue coating is frequently found in older adults because of hyposalivation, immunity's hypoactivity, diminished motor function and compromised tongue's pressure with age. Anaerobe-driven volatile sulphur compounds in tongue coating are a major cause of intra-oral malodor. Dysbiosis of the tongue-coating microbiome rather than the amount of microorganisms is associated with a risk of aspiration pneumonia. Daily tongue cleaning with a brush or scraper is an easy way to control tongue coating deposits and quality. Using mouth wash or rinse-containing germicides is also a way to control the microbiota of tongue coating. The tongue function is closely related to swallowing. Tongue and suprahyoid muscles are linked with respiratory muscles through the endothoracic fascia. The mechanical stimulation during the cleaning of the tongue may stimulate the respiratory muscles. An intervention trial revealed that tongue cleaning by mucosal brush improves tongue pressure, swallowing and respiratory function in old residents of nursing homes, suggesting a rehabilitative effect of tongue cleaning on the swallowing and respiratory functions, preventing aspiration pneumonia. This narrative review assesses the tongue-cleaning benefits for respiratory and swallowing functions and the possibility of preventing aspiration pneumonia.

Tongue cleaning maintains respiratory function in older individuals: A 1-year randomised controlled trial

OBJECTIVE

The aim of this 1-year longitudinal randomised controlled trial was to evaluate the effectiveness of tongue cleaning on the maintenance of respiratory function in older adults requiring care.

METHODS

The participants included 24 residents of two nursing homes in Kitakyushu, Japan. The participants were randomised to receive tongue cleaning with routine oral care (intervention group, n = 12), or routine oral care alone (control group, n = 12). Among the participants, three in the intervention group and four in the control group had cerebrovascular disease history, four in the intervention group and four in the control group had a history of cardiac disease, and five in the intervention group and four in the control group were without medical history. Respiratory function was assessed on the basis of the peak expiratory flow rate (PEFR). Tongue pressure, swallowing function, oral health status, activities of daily living and nutritional status were also measured at baseline and at the end of the 1-year follow-up period.

RESULTS

The number of analysed participants in each group was 12. In the control group, the PEFR (1.6 [0.4-4.2] L s^-1 vs 1.4 [0.4-3.2] L s^-1 , P = .034) and tongue pressure (16.4 [1.7-35.2] kPa vs 8.0 [1.4-38.6] kPa, P = .032) significantly declined after 1-year. However, the PEFR (1.5 [0.8-2.9] L s^-1 vs 1.6 [0.7-4.2] L s^-1 , P = .366) and tongue pressure (18.1 [4.2-37.1] kPa vs 16.1 [5.2-41] kPa, P = .307) were maintained in the intervention group. The change in the PEFR was significantly greater in the intervention group compared with the control group (0.130 [-0.45-1.70] L s^-1 vs -1.70 [-10.00-10.00] L s^-1 , P = .028).

CONCLUSION

Our findings suggest that tongue cleaning may help maintain tongue and respiratory function in older adults requiring care.