Clinical and behavioural risk indicators for root caries in older people

Effect of Silver Diamine Fluoride on Bacterial Biofilms-A Review including In Vitro and In Vivo Studies

Caries/carious lesions are a growing concern among the general population across the world, and different strategies are evolving to combat the bacterial invasion that resultantly leads to caries. In this systematic review, we are looking to analyse the role of silver diamine fluoride (SDF) on the growth of bacterial biofilms. The search strategy for the studies to be selected for the review was initiated by a search across multiple databases, which ultimately yielded 15 studies that were in accordance with our objectives. The reviewed articles indicate a very clear correlation between the usage of SDF and the decrease in bacterial biofilms, which are limited not just to one or two but multiple bacterial species. As shown by the events favoring SDF's odds ratio of 3.59 (with a 95% confidence interval of 2.13 to 6.05), a risk ratio of 1.63 (1.32 to 2.00), and a risk difference of 0.28 (0.16 to 0.40), there was strong evidence that SDF is a successful treatment for reducing bacterial biofilms in dental practice. This study offers substantial proof that SDF works well to reduce bacterial biofilms in dentistry practices. We advise further investigation to examine the potential of SDF as a standard therapy choice for dental caries and related conditions given the obvious relationship between the use of SDF and the reduction in bacterial biofilms.

An extensive description of the microbiological effects of silver diamine fluoride on dental biofilms using an oral in situ model

Silver diamine fluoride (SDF) has been long studied in laboratories, and its clinical effectiveness in the treatment and prevention of root caries has been reported. In the present study, we assessed the microbiological effects of SDF on dental biofilms grown on demineralized dentin in situ. Specifically, demineralized bovine root dentin slabs used as biofilm substrates were treated with 38% SDF, and the biofilms formed after this treatment were analyzed via real-time PCR, DEAD/LIVE cell staining, and SEM. Next, the viable cell count was determined, and microbial profiles were compared using 16S rRNA gene sequencing. Untreated slabs were used as controls. We observed significant decreases in viable cell counts (p < 0.05), number of biofilm-forming cells (p < 0.01), biofilm thickness (p < 0.01), and high proportion of dead cells with SDF treatment (p < 0.01). The microcolonies in the SDF-treated biofilms showed less complexity, and only a limited number of genera were differentially abundant between the groups. Microbial diversity index comparisons showed no significant differences between the groups with respect to treatments days (p = 0.362). Thus, SDF negatively influenced dental biofilm growth on demineralized root dentin in situ; however, its antimicrobial action did not target a specific oral taxon.

Oral care, loss of personal identity and dignity in residential care homes

OBJECTIVE

The UK National Institute of Clinical Excellence (NICE) guidelines recommend that care staff who provide daily personal care to residents: "Understand the importance of residents' oral health and the potential effect on their general health, well-being and dignity." The aim of this study was to explore residents' views and perspectives of dental care in care homes in order to understand how to deliver this care.

METHOD

Care homes were identified using care home inspection reports for Wales, the UK. Care homes for older people with residents having mental capacity to consent were invited to participate. Data were collected using semi-structured one-to-one interviews with care home residents, care home managers and oral healthcare leads. Interviews were audio recorded, transcribed and analysed using a thematic approach to data. Analysis was assisted by NVivo 10 software. Data collection was completed when no new themes emerged.

RESULTS

This analysis presents findings from 26 interviews with residents, across five care homes. Going into care was associated with a loss of identity. Having teeth and looking after teeth (natural teeth or dentures) was part of keeping that identity. All prioritised privacy, pride and independence above effective oral hygiene. Oral hygiene was viewed as a very private event. Carers adapted oral care, to balance time constraints, care, privacy and dignity. Teeth were a part of personal pride to the extent that two residents said they did not want to die without dentures in their mouths.

CONCLUSION

Whilst oral care is important to residents, dignity and privacy are often more important; care routines and practices are adapted around this. Carers need to adopt an individualised, pragmatic and sensitive approach to oral care to account for personal dignity when looking after residents to be able to provide appropriate oral care in accordance with guidance. Members of the dental team need to support carers to provide effective oral care, which allows dignified and effective care.

Caries Management in Special Care Dentistry

The objective of this article is to provide a summary of the current evidence-based recommendations for caries management in patients with special health care needs (SHCNs). Considerations regarding caries risk assessment and preventive measures are also discussed with the goal of helping clinicians to manage the caries disease process using a person-centered approach and risk-based interventions. Importantly, most of the evidence is still based on the general population, because the evidence for those with SHCNs is still limited.

Risk factors for root caries annual incidence and progression among older people requiring nursing care: A one-year prospective cohort study

PURPOSE

We aimed to determine root caries annual incidence (RCAI) and root caries annual progression (RCAP) and risk factors for them among older people requiring nursing care.

METHODS

The target population comprised 186 dentate individuals aged ≥ 65 years who required nursing care while living in nursing homes (NHs) or their own homes (OHs) in Okayama, Japan. Survey items included presence/absence and severity of root caries, age, sex, living environment (NH or OH), the Clinical Dementia Rating, and the Barthel Index (BI). Baseline surveys were conducted from 2015 to 2017; subjects were followed up for one year. RCAI and RCAP per tooth and per person were calculated, and risk factors for them were identified using generalized estimating equations.

RESULTS

In total, 104 individuals (mean age: 82.0 ± 12.4 years) completed the follow-up survey. RCAIs per tooth and per person were 14.6% (173/1188) and 59.6% (62/104), respectively. RCAP per tooth was 22.5% (51/227 teeth with root caries at baseline). Significant risk factors for RCAI were living environment (OH, odds ratio [OR]: 2.14), sex (male, OR: 1.84), clasped tooth (OR: 1.82), and older age (OR: 1.05) at baseline. Significant risk factors for RCAP were sex (male, OR: 5.20), regular dental checkup (OR: 2.74), and high BI score (OR: 1.02) at baseline.

CONCLUSIONS

At one-year follow-up, 59.6% of the subjects developed at least one root caries. Risk factors for RCAI were living environment (OH), male, clasped tooth, and older age, whereas those for RCAP were male, regular dental checkup, and high BI score.

Protocol for A randomised feasibility trial comparing fluoride interventions to prevent dental decay in older people in care homes (FInCH trial)

BACKGROUND

The number and proportion of older people globally is growing faster than that of any other age group. At the same time the number of people retaining some of their own teeth is rising. There significant differences between those living in care and their community dwelling peers, with evidence showing those in care having fewer teeth and significantly higher levels of dental decay. There are numerous Cochrane reviews linking the use of fluoride to a reduction in dental decay, however, the majority of research on effectiveness has been conducted on children and consequently, children and adolescents tend to be the main recipients of fluoride interventions. There are to date no studies comparing the effectiveness of fluoride interventions in older people in care homes in the UK. However, prior to developing an appropriate protocol for full-scale trial comparing clinical effectiveness of fluoride interventions, there are a number of trial feasibility and statistical parameters that need to be clarified.

METHODS

This trial is a single centre, multi-site randomised controlled assessor blind parallel group (three groups) trial, with the primary objective of establishing the feasibility, practicability and compliance of fluoride interventions to prevent dental decay in care homes. Secondary and tertiary objectives will aim to explore the acceptability of the interventions from resident, care home and dental services perspectives, and estimate the efficacy of the three different fluoride treatments.

DISCUSSION

This feasibility trial will produce new knowledge and add value to a landscape that is under researched. Although the efficacy of fluoride interventions is proven, the feasibility of dental research and prevention in this vulnerable group and in the complex care home setting is novel. This work will not only add to our understanding of the interface of dental care and social care but will also contribute to our broader understanding on undertaking research in care home settings. Dental care for older people has been a longstanding issue, and the events of this past year has shone a light on the vulnerabilities of those residing in care homes and so this research is landing at a pivotal time. Trial registration EudraCT Registration 2017-002248-34. Registered 20th February 2018 https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-002248-34 .

Crisis in care homes: the dentists don't come

Aim/Objectives

To present the findings of the challenges relating to access to dental care for older people in care homes from the Fluoride Interventions in Care Homes (FInCH) Trial.

Methods

Thematic analysis of 11 interviews / focus groups with care home managers and care staff were carried out against a framework informed by the literature drawing on lived experiences.

Results

The challenges identified mapped to Penchanksy and Thomas’s (1981) five dimensions of access but also highlighted themes specifically relevant to the care home population. These include a lack of suitable services for routine and urgent domiciliary and clinic care, complex referral processes, operational challenges in the need for appropriate care chaperones, expectations of information for dental charge exemption and capacity / consent processes within the home.

Discussion

There is a malalignment of dental services offered to meet the needs of care home residents which has resulted in a reactive dental care system that is not fit for purpose and an entire generation of older people living in care with dental neglect.

Conclusion

Urgent action is needed to commission not only the appropriate quantities of both routine and urgent dental care, but ensure it is delivered by clinicians who are appropriately skilled to meet the high levels of dental needs in an increasingly medically and behaviourally complex care home population. In line with eye tests and prescribing at the very least, free routine dental examinations should be offered to all care home residents, creating the opportunity for advice and prevention, and enabling care home residents to function and be free of pain.

Trial Registration

The FinCH Trial registration EudraCT number 2017-002248-34.

Association between root/coronal caries and individual factors in institutionalised elderly using ICDAS severity and activity

Background

Caries in the elderly has been associated with dependence, oral-health status and -care practices. This cross-sectional study aimed to investigate the association between root/coronal caries and individual factors among institutionalised elderly people in Bogotá, Colombia, using the International Caries Detection and Assessment System severity and activity criteria (ICDAS).

Methods

A total of 226 institutionalised elderly were clinically examined for root and coronal caries in 40 institutions. Caries risk was assessed with Cariogram, and demographics, oral health knowledge and practices, oral health-related quality of life and denture-use habits using a questionnaire.

Results

Participants (mean age: 80.1 ± 9.3 years; 63.7% female) presented a mean number of 10.8 ± 7.3 teeth and 19.4 ± 18.8 exposed root surfaces. Prevalence of Coronal-ICDAS caries experience (C-ICDAS DF) was of 100% and of 54.4% for C-ICDAS D; mean number of C-ICDAS DFS was 16.76 ± 27.36, with 50.9% of subjects having ≥ one active C-ICDAS DS. Prevalence of Root Caries Index was of 49.1% and of R-ICDAS DF of 46%; mean number of R-ICDAS DFS was 2.03 ± 2.78, with 40.3% of subjects having ≥ one active R-ICDAS DS. Most individuals had a systemic condition (94.2%) and required oral-hygiene assistance (58%). Logistic regression analyses showed significant associations (p < 0.05): for coronal active caries when having over six teeth (OR: 2.7), and for root caries, when having coronal caries (OR: 2.41), being a man (OR: 1.95), and having over 14 teeth (OR: 0.30). Those presenting with > eight exposed root surfaces were 4.04 more likely to have root caries and 2.4 times more likely to have active root caries.

Conclusion

In the institutionalised elderly population in Bogotá significant associations were found, both for the presence as for the activity status of root and coronal caries, with individual clinical factors including coronal caries, exposed root surfaces and number of teeth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01520-4.

Dental Restorative Materials for Elderly Populations

The incidence of dental caries, especially root caries, has risen in elderly populations in recent years. Specialized restorative materials are needed due to the specific site of root caries and the age-related changes in general and oral health in the elderly. Unfortunately, the restorative materials commonly used clinically cannot fully meet the requirements in this population. Specifically, the antibacterial, adhesive, remineralization, mechanical, and anti-aging properties of the materials need to be significantly improved for dental caries in the elderly. This review mainly discusses the strengths and weaknesses of currently available materials, including amalgam, glass ionomer cement, and light-cured composite resin, for root caries. It also reviews the studies on novel anti-caries materials divided into three groups, antimicrobial, remineralization, and self-healing materials, and explores their potential in the clinical use for caries in the elderly. Therefore, specific restorative materials for caries in the elderly, especially for root caries, need to be further developed and applied in clinical practice.

Perspective and practice of root caries management: A multicountry study - Part II: A deeper dive into risk factors

BACKGROUND

The potential of an improved understanding to prevent and treat a complex oral condition such as root caries is important, given its correlation with multiple factors and the uncertainty surrounding the approach/material of choice. Deeper insights into risk factors may improve the quality of treatment and reduce the formation of root surface caries.

AIM

The present work aims to gain knowledge about dentists' opinions and experiences on assessing the risk factor related to the development of root caries and to help identify any overlooked factors that may contribute to less efficacious clinical outcomes.

METHODOLOGY

A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among the groups.

RESULTS

Dentists around the world ranked the oral hygiene status of patients as the most important factor in the development of root surface caries. Patients with poor oral hygiene, active periodontal disease, reduced salivary flow, and gingival recession are perceived to have a higher risk of developing new root surface caries. There is a greater focus on prevention in the UK and greater levels of untreated dental disease in other countries, especially those recovering from civil wars.

CONCLUSION

This work identified some overlooked factors that may have contributed to the less efficacious clinical outcomes reported in the literature. It is hoped that this deep dive into risk factors coupled with the findings presented in Part I of this study will be used as a basis for a more comprehensive investigation into the management of patients with root surface caries.

Refocusing dental care: A risk-based preventative oral health programme for dentate older people in UK care homes

BACKGROUND

There is strong evidence for managing the risk of dental caries, notably dose-dependent use of fluoride based on risk. Specific guidance is lacking on higher fluoride use in older people in care homes and prevention is often omitted from dental care plans.

OBJECTIVES

To introduce a risk-based preventative approach to existing routine dental care for older people in care homes.

METHODS

Three mixed residential and nursing care homes for the frail and elder (>65 years) were selected to participate. All residents were risk assessed based on dependency, dentition status and self-care abilities and consequently placed on the appropriate evidence-based intervention (2800 ppm high dose fluoride toothpaste and/or quarterly fluoride varnish placement). Full mouth ICDAS dental examinations were completed at baseline, 6 months and 12 months.

RESULTS

At baseline, 127 risk assessments were completed in which most dentate residents (58.2%, n = 74) were assessed as Risk Level 2/3 (mod/high) whilst edentulous residents were all Risk Level 1 (low) (41.7%, n = 53). Only 13 (26.5%) of the 49 eligible residents completed the 12-month preventative programme. There was a significant difference in root caries (P < .0001), with 17 (51.5%) root lesions changing from active at baseline to arrested at 12 months.

CONCLUSIONS

The findings provide early indication of fluoride efficacy, especially on root caries in this vulnerable group, and highlight the challenges of delivering programme's in these complex, changing environments.

Factors associated with development of root caries in dentition without root caries experience in a 2-year cohort study in Japan

OBJECTIVES

To investigate factors associated with the development of root caries in dentition without root caries experience and interactive relationships between risk factors.

METHODS

We conducted surveys, consisting of an oral examination (oral hygiene, assessment of the number of teeth, coronal and root caries) and a self-reported questionnaire, among employees of a company in Tokyo, Japan in 2016 and 2018. Questionnaires collected data on smoking status, oral hygiene habits, sugar intake, and frequency of dental visits. Multiple logistic regression and decision tree analyses were used to determine factors associated with the development of root caries.

RESULTS

A total of 299 participants aged 25-63 years were included in the analysis. Males, older adults, smokers/past smokers had a significantly greater risk of developing root caries. The risk of developing root caries was significantly associated with the number of teeth with gingival recession at baseline (6-9 teeth, odds ratio [OR]: 7.69, 95 % confidence interval [CI]: 2.31-25.56; 10+ teeth, OR: 9.19, 95 % CI: 2.73-30.95, relative to ≤5 teeth); and with the number of coronal decayed and filled (DF) teeth (11-13 teeth, OR: 3.21, 95 % CI: 1.12-9.24; and ≥14 teeth, OR: 3.60, 95 % CI: 1.27-10.20, relative to ≤10 teeth). Other factors associated with root caries development differed according to the number of teeth with gingival recession and included drinking sugar-sweetened beverages, and the amount of toothpaste used.

CONCLUSIONS

Gingival recession and number of coronal DF teeth were associated with the development of root caries.

CLINICAL SIGNIFICANCE

Multiple factors are associated with root caries development. The effect of risk factors such as drinking sweetened beverages and less toothpaste use is greater in individuals with greater gingival recession and more coronal decayed and filled teeth. Dental practitioners should focus on modifiable risk factors to prevent root caries.

Cachexia and Cognitive Function in the Community-Dwelling Older Adults: Mediation Effects of Oral Health

BACKGROUND

Cognitive impairment and poor oral health are common problems in older adults and are associated with malnutrition. However, it is unclear how they are related to cachexia in community-dwelling older adults. The aim of this study was to examine the relationships among cachexia, cognitive function, and oral health in community-dwelling older adults.

METHODS

This study is a secondary analysis of a data-set. Data were collected in the community setting on older adults who applied for government-funded long-term care services in Hong Kong in 2017. Subjects were community-dwelling and aged ≥60 years. The outcome variable was cachexia. The predictors were cognitive function and oral health. The covariates included demographics and comorbidities associated with cachexia or malnutrition. Path analysis was employed to examine the associations among cachexia, cognitive function, and oral health using the software SAS/STAT and Mplus.

RESULTS

This analysis included 12,940 subjects. The prevalence of cachexia was 1.3%. Cognitive function was also found to have a direct effect on the oral health indicators of chewing problems (OR=1.073, p<0.001), brushing teeth problems (OR=1.349, p<0.001), and swallowing problems (coeff.=0.177, p<0.001). Oral health indicators with a direct effect on cachexia included dry mouth (OR=1.250, p<0.001), brushing teeth problems (OR = 1.185, p<0.01), and swallowing problems (OR=1.231, p<0.001). Cognitive function had no significant direct effect, but had a significant indirect effect on cachexia (OR=1.100, p<0.001) which is mediated by brushing teeth problems (OR=1.052, p<0.001) and swallowing problems (OR=1.038, p<0.001).

CONCLUSION

Cognitive impairment causes cachexia indirectly through poor oral health. This study recommends adding cognitive function when screening community-dwelling older adults for cachexia. Health policymakers should stress regular oral health screening and interventions, and encourage increased utilization of oral health services by community-dwelling older adults with cognitive problems.

Factors Associated with Dental Root Caries: A Systematic Review

Objectives:

The objectives of this review were to identify the factors associated with root caries and to describe their relationship with the presence and extent of root caries.

Methods:

A search was carried out on the PubMed, Medline, Embase, and Scopus databases for articles published between January 1990 and October 2018. Information was extracted on the factors associated with the presence or extent of decayed or filled root surfaces and/or decayed root surfaces. Factors were sorted into 6 categories: social-demographic background, general health, health behaviors, fluoride exposure, oral health habits, and oral health condition.

Results:

The quality of the 127 identified relevant papers was assessed, and those of low methodological quality were excluded. Finally, 44 articles reporting on 40 cross-sectional studies were included. The total sample size comprised 78,183 participants from different countries around the world. Positive correlations were detected between root caries and age, gingival recession, and use of tobacco, while negative correlations were found for social position, use of fluoride toothpaste, and oral hygiene status. Mixed findings were reported for association with the number of teeth and dental visit behaviors.

Conclusion:

This systematic review found a number of factors in different categories to be associated with root caries. People who are older, of lower socioeconomic status, or tobacco users and those with more gingival recession and poorer oral hygiene have higher risk of root caries.

Knowledge Transfer Statement:

This systematic review found a number of factors associated with root caries, including age, social position, exposure to fluoride, and oral hygiene status. This information helps dental public health workers and clinicians identify the groups at high risk of caries and the factors to act on for more effective prevention and management of root caries (e.g., use fluoride toothpaste and improve oral hygiene).

Collaborating for oral health in support of vulnerable older people: co-production of oral health training in care homes

BACKGROUND

In recent years, the value of co-production has become embedded in the social care agenda. Care home residents are at significantly higher risk of dental diseases and often rely on the care team for support. It is therefore vital that staff are trained and confident in delivering evidence based oral care to their clients.

METHODS

Three London care homes co-produced a pilot oral health training programme, informed by in-depth interviews and group discussions. The initiative was evaluated using pre/post-questionnaires of carers and semi-structured interviews of managers and the dental teams.

RESULTS

Two care homes were available for delivery of the programme, which resulted in training of 64% (n = 87) of care staff. The training programme involved videos and resources and was delivered flexibly with the support of an oral health educator and a dental therapist. There was an improvement in knowledge and self-reported confidence post-training; however, only 54% (n = 45) completed the post-training questionnaire.

CONCLUSIONS

This study suggests that co-production of an oral care training package for care home staff, is possible and welcome, but challenging in this complex and changing environment. Further work is needed to explore the feasibility, sustainability and impact of doing so.

Relationship between Er,Cr:YSGG laser power and surface roughness of lased radicular dentin

Background: This study sought to assess the effect of Er,Cr:YSGG laser power on the surface roughness of lased radicular dentin using atomic force microscopy (AFM).

Methods: Fifteen human radicular dentin samples were randomly divided into five groups: one control (G1, intact) and four experimental groups treated with 0.25W (G2), 0.5W (G3), 0.75W (G4) and 1W (G5) powers of Er,Cr:YSGG laser (2.78µm) at a repetition rate of 20 Hz, with a 600-µm-diameter sapphire tip. After irradiation, surface topography was analyzed by AFM using a Si probe in tapping mode. Quantitative information concerning the arithmetic average roughness (Ra) and quadratic mean roughness (Rq) was obtained from three 5×5µm areas of each sample. The data were analyzed using one-way ANOVA (P<0.05).

Results: The Ra and Rq values increased in G2 and G5 and decreased in G3 and G4 groups compared to the control group. The maximum Ra and Rq values were noted in G5, which were significantly higher than the corresponding values in G3 (P<0.05).

Conclusion: No direct correlation was found between Er,Cr:YSGG laser power and surface roughness of lased radicular dentin. Laser therapy with a mean power of 0.5W and 1W caused the lowest and highest surface roughness, respectively.

Time to Survival for the Restoration of the Shortened Lower Dental Arch

Removable partial dentures may adversely affect remaining tissues and have a low prevalence of use. This randomized controlled trial was designed to compare the time to survival of cantilever resin-bonded fixed partial dentures and conventional removable partial dentures to restore shortened lower dental arches. We randomly allocated 25 male and 35 female patients (median age, 67 years) to fixed or removable partial denture groups of 30 persons, matched for age and sex. Survival of the prostheses was assessed, based on listed criteria, at each review or when problems arose. Although the removable partial denture group required rather more maintenance visits, the difference in survival rates was not statistically significant (hazard ratio = 0.59, with 95% CI 0.27, 1.29). In the absence of significant differences in five-year survival, the reported advantages of fixed partial dentures, including reduced maintenance frequency, offer positive support for the use of resin-bonded fixed partial dentures.

Randomized Clinical Trial on Preventing Root Caries among Community-Dwelling Elders

Dental root caries is a common disease among elders. More efforts on preventing this disease are needed. Silver diammine fluoride (SDF) is known to prevent dental caries in primary teeth. However, clinical evidence of its efficacy in preventing root surface caries is limited. This clinical trial aimed to compare the effectiveness of SDF in preventing root caries among elders in a water fluoridated area. A total of 323 elders who had at least 5 teeth with exposed root surfaces and who had self-care ability were randomly allocated into 3 intervention groups: group 1 (placebo control), annual application of tonic water; group 2, annual application of SDF solution; group 3, annual application of SDF solution, immediately followed by potassium iodide (KI) solution. Oral hygiene instructions and fluoride toothpaste were provided to all subjects. Status of dental root surface was assessed every 6 mo by the same independent examiner. After 30 mo, 257 (79.6%) elders were reviewed. The mean numbers of root surface with new caries experience in the control, SDF, and SDF/KI groups were 1.1, 0.4, and 0.5, respectively (analysis of variance, P < 0.001). Scheffe’s multiple comparison showed that elders who received placebo developed more new root caries lesions ( P < 0.05), while the difference between the SDF and SDF/KI groups was not statistically significant ( P > 0.05). Moreover, elders who had higher visible plaque index scores at 30-mo examination (analysis of covariance, P < 0.001) and those who had higher baseline DMFT scores (analysis of covariance, P = 0.005) developed more new root caries. It is concluded that annual application of SDF or SDF/KI solution is effective in preventing root caries among community-dwelling elders in a fluoridated area ( ClinicalTrials.gov NCT02360124).

Knowledge Transfer Statement: Annual topical application of silver diammine fluoride or silver diammine fluoride / potassium iodide solution is effective in preventing dental root surface caries among community-dwelling elders in a fluoridated area.

Prevalence of root caries among elders living in residential homes of Bengaluru city, India

Background

Among the various oral ailments which have been observed in elderly, root caries is a significant one. Tooth loss is chief oral health-related negative variable to the quality of life in elderly and root caries is the major cause of tooth loss in them. It has been reported about a third of older population bears most of the root caries burden, so the present study aimed to assess the prevalence of root caries among older individuals residing in residential homes of Bengaluru city India.

Material and Methods

Elderly individuals aged 60 and above, residing in residential homes of Bangalore city, were included in the study. The study participants filled a questionnaire regarding their demographic details and oral health habits. Root surface caries was recorded according to criteria described by Banting et al. and root caries was expressed in terms of the root caries index (RCI). The statistical analysis was performed using descriptive statistics and chi-square test. P < 0.05 was considered as statistically significant.

Results

The prevalence of root caries was 46.4%. The root caries index was 15%. Statistically significant differences (P < 0.05) observed across gender, marital status, diet, socio-economic status, medication, method of cleaning and frequency of cleaning and were identified as significant predictors of root caries.

Conclusions

The prevalence of root caries among institutionalized older people was high. Oral health policies and preventive measures are needed focusing on the special needs of this neglected and socioeconomically deprived population to improve their quality of life.

Key words:Elders, residential home, root caries.

Developing pathways for oral care in elders: evidence-based interventions for dental caries prevention in dentate elders

BACKGROUND

Dental caries is becoming an ever-growing challenge as the number of elders maintaining their teeth increases. There is a need for low-cost, effective preventive interventions to retain natural teeth for elders.

OBJECTIVE

The purpose of this article is to evaluate evidence based interventions for dentate elders, specifically the adjunct therapies of fluoride, chlorhexidine, xylitol, casein phosphopeptide-amorphous calcium phosphate, ozone, and herbal liquorice.

RESULTS

Fluoride interventions have demonstrated prevention and remineralization of dental caries in elders. Systematic reviews of the literature are unable to establish definitive conclusions regarding the effectiveness of other adjunct therapies in dental caries prevention.

CONCLUSIONS

Further research with elders requires improved study design with well designed multi-center trials. Considerations for new strategies for research of the effectiveness of therapies to reduce dental caries include the development and evaluation of combinations of therapeutic interventions and dental caries management by risk assessment.

Root caries, root surface restorations and lifestyle factors in adult Danes

AIM

To investigate selected lifestyle factors in relation to active caries and restored root surface lesions in adults.

MATERIALS AND METHODS

Based on clinical examinations and questionnaires, data on root caries, socioeconomic status, body mass index, dietary habits, alcohol consumption, tobacco use and oral hygiene routines were collected from 4369 adults aged 21-89 who took part in a survey covering 13 municipalities across Denmark. Uni- and multivariate logistic regression analyses were applied to analyse the relationship between the independent lifestyle variables and active caries and restored root surface lesions, respectively.

RESULTS

The prevalence of active root caries was 4%, while 26% displayed restored root surfaces. The sugar intake was not related to root caries. A multivariate logistic regression analysis revealed that, in subjects aged 45 or over, smoking and wearing dentures were significantly associated with presence of active root caries (p<0.01). The intake of 15 drinks or more per week was associated with higher odds of root surface restorations compared with no alcohol intake (OR=1.7; p<0.001).

CONCLUSIONS

Lifestyle factors such as tobacco use and alcohol consumption, as well as wearing dentures, were significantly associated with the occurrence of untreated caries and restored root surface lesions, especially in persons over 45. Thus, such lifestyle factors should be taken into consideration, identifying persons with a need of preventive dental services. In addition, oral health education should focus on the possible risks of smoking and a high alcohol intake.

The Impact of the Crown-Root Ratio on Survival of Abutment Teeth for Dentures

Crown-root ratio (CRR) is commonly recorded when planning prosthodontic procedures. However, there is a lack of longitudinal clinical data evaluating the association between CRR and tooth survival. The aim of this longitudinal practice-based study was to assess the impact of CRR on the survival of abutment teeth for removable partial dentures (RPDs). Data were collected from 147 patients provided with RPDs at a dental hospital in Japan. In total, 236 clasp-retained RPDs and 856 abutment teeth were analyzed. Survival of abutment teeth was assessed using Kaplan-Meier methods and Cox's proportional hazard (PH) regression. The Cox PH regression was used to assess the prognostic significance of initial CRR value with adjustments for clinically relevant factors, including age, sex, frequency of periodontal maintenance programs, occlusal support area, type of abutment tooth, status of endodontic treatment, and probing pocket depth. Abutment teeth were divided into 1 of 5 risk groups according to CRR: A (≤0.75), B (0.76-1.00), C (1.01-1.25), D (1.26-1.50) and E (≥1.51). The 7-year survival rate was 89.1% for group A, 85.9% for group B, 86.5% for group C, 76.9% for group D, and 46.7% for group E. The survival curves of groups A, B, and C were illustrated to be quite similar and favorable. The multivariable analysis treating CRR as a continuous variable allowed estimation of the hazard ratio at any specific CRR value. When CRR = 0.80 was set as a reference, the estimated hazard ratio was 0.58 for CRR = 0.50 (95% confidence interval [CI], 0.36-0.91), 1.13 for CRR = 1.00 (95% CI, 0.93-1.37), 1.35 for CRR = 1.25 (95% CI, 1.02-1.80), 1.53 for CRR = 1.50 (95% CI, 1.15-2.08), or 1.95 for CRR = 2.00 (95% CI, 1.44-2.65). These practice-based longitudinal data provide information to improve the evidence-based prognosis of teeth in providing prosthodontic procedures.

[Root caries prevalence and severity in Brazilian adults and older people]

OBJECTIVE

To estimate the prevalence of root caries in Brazilian adults and elderly.

METHODS

We assessed data from the Brazilian Oral Health Survey (SBBrasil 2010). Dental examinations were performed on 9,564 adults and 7,509 elderly individuals in households in the 26 state capitals, the Federal District and 150 provincial towns. Diagnostic criteria and data assessment tools were those standardized by the World Health Organization. The outcome was measured by using root caries index and the index of decayed and filled dental roots.

RESULTS

The prevalence of root caries was 16.7% in adults and 13.6% in the elderly. The index of decayed and filled dental roots was 0.42 and 0.32 for adults and the elderly respectively, with most of the index represented by untreated caries. The prevalence of root caries differed significantly among states capitals and provincial towns, with higher values being reported in the state capitals in the North and Northeastern Brazilian regions. In adults, the root caries index ranged from 1.4% in Aracaju to 15.1% in Salvador (both in the Northeast). Among the elderly, this index ranged from 3.5% in Porto Velho to 29.9% in Palmas (both North). Root caries was more prevalent in men than in women in both age groups.

CONCLUSIONS

There is a wide variation in root caries indices in adults and in the elderly, and between and within Brazilian regions. Most root caries is untreated. We recommend the incorporation of this disease into the oral health surveillance system.

High-fluoride toothpaste: a multicenter randomized controlled trial in adults

Objective

The aim of this single – blind, multicenter, parallel, randomized controlled trial was to evaluate the effectiveness of the application of a high-fluoride toothpaste on root caries in adults.

Methods

Adult patients (n = 130, ♂ = 74, ♀ = 56; mean age ± SD: 56.9 ± 12.9) from three participating centers, diagnosed with root caries, were randomly allocated into two groups: Test (n = 64, ♂ = 37, ♀ = 27; lesions = 144; mean age: 59.0 ± 12.1; intervention: high-fluoride toothpaste with 5000 ppm F), and Control (n = 66, ♂ = 37, ♀ = 29; lesions = 160; mean age: 54.8 ± 13.5; intervention: regular-fluoride toothpaste with 1350 ppm F) groups. Clinical examinations and surface hardness scoring of the carious lesions were performed for each subject at specified time intervals (T₀ – at baseline before intervention, T₁ – at 3 months and T₂ – at 6 months after intervention). Mean surface hardness scores (HS) were calculated for each patient. Statistical analyses comprised of two-way analysis of variance and post hoc comparisons using the Bonferroni–Dunn correction.

Results

At T₀, there was no statistical difference between the two groups with regard to gender (P = 0.0682, unpaired t-test), or age (P = 0.9786, chi-squared test), and for the overall HS (Test group: HS = 3.4 ± 0.61; Control group: HS = 3.4 ± 0.66; P = 0.8757, unpaired t-test). The anova revealed significantly better HS for the test group than for the control groups (T₁: Test group: HS = 2.9 ± 0.67; Control group: HS = 3.1 ± 0.75; T₂: Test group: HS = 2.4 ± 0.81; Control group: HS = 2.8 ± 0.79; P < 0.0001). However, the interaction term time-point*group was not significant.

Conclusions

The application of a high-fluoride containing dentifrice (5000 ppm F) in adults, twice daily, significantly improves the surface hardness of otherwise untreated root caries lesions when compared with the use of regular fluoride containing (1350 ppm F) toothpastes.

Cost-effectiveness of tooth replacement strategies for partially dentate elderly: a randomized controlled clinical trial

OBJECTIVE

To conduct a cost-effectiveness analysis comparing two different tooth replacement strategies for partially dentate older patients, namely partial removable dental prostheses (RDP) and functionally orientated treatment based on the shortened dental arch concept (SDA).

METHODS

Ninety-two partially dentate older patients completed a randomized controlled clinical trial. Patients were randomly allocated to two treatment groups: the RDP group and the SDA group. Treatment effect was measured using impact on oral health-related quality of life (OHrQOL), and the costs involved in providing and maintaining care were recorded for all patients. Patients were followed for 12 months after treatment intervention. All treatment was provided by a single operator.

RESULTS

The total cost of achieving the minimally important clinical difference (MID) in OHrQOL for an average patient in the RDP group was €464.64. For the SDA group, the cost of achieving the MID for an average patient was €252.00. The cost-effectiveness ratio was therefore 1:1.84 in favour of SDA treatment.

CONCLUSION

With an increasingly ageing population, many patients will continue to benefit from removable prostheses to replace their missing natural teeth. From a purely economic standpoint, the results from this analysis suggest that the treatment of partially dentate older adults should be focused on functionally orientated treatment because it is simply more cost-effective.

Root caries: a periodontal perspective

BACKGROUND AND OBJECTIVE

A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs.

MATERIAL AND METHODS

The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders.

RESULTS

Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking.

CONCLUSION

Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

Approaches to caries prevention and therapy in the elderly

The population of the world is aging. A greater proportion of older people are retaining increasing numbers of natural teeth. Aging is associated with changes in oral architecture and muscle weakness, making personal oral hygiene more difficult, particularly for the oldest and most frail individuals. Furthermore, there is exposure of root dentin with its higher pH for demineralization in addition to enamel as a substrate for caries. Aging is also associated, for many in the developed world, with taking multiple medications, with the associated risk of dry mouth. These variables combine to increase caries risk in older vulnerable populations. Caries occurs on both the crowns of teeth (predominantly around existing restorations) and the exposed roots. Prevention needs to be aggressive to control disease in this combination of circumstances, with multiple strategies for limiting the damage associated with caries in this population. This paper explores the evidence that is available supporting preventive strategies, including fluorides in various forms, chlorhexidine, and calcium phosphate supplementation.

Root caries: a survey of Queensland dentists

BACKGROUND

Root caries stands to be a significant burden for Australia's ageing population. The objective of this study was to describe Queensland dental practitioners' perceptions of root caries prevalence, presentation and predisposing factors as well as diagnosis and recording practices.

METHODS

Using the Queensland Dental Board register, all 2,515 dentists and dental specialists practising in Queensland were invited to participate in a questionnaire-based postal survey.

RESULTS

Of the 660 responses received, 638 were included for final analysis. Use of diagnostic measures such as surface elasticity and contour were reported frequently. A majority of respondents (77%) reported not recording root caries in a way that could be distinguished from coronal caries. Dietary analysis was the most commonly reported adjunctive aid for risk assessment. Recommendations for use of remineralizing agents were frequently reported (home use 90%; in office use 71%). Salivary impairment was reported to be an important risk factor for root caries by 93% of respondents, but only 18% reported performing salivary analysis. A large proportion of respondents (32%) considered patients with diabetes to be of low or no risk of root caries.

CONCLUSIONS

While the Queensland dental practitioners who participated in this survey demonstrated an awareness of root caries and its predisposing factors, clinical risk assessment particularly for patients with diabetes should be further examined.

Root caries and diabetes: risk assessing to improve oral and systemic health outcomes

This report reviews the current understanding of the relationship between diabetes and root caries, and investigates the evidence for dental chairside testing of gingival crevicular blood (GCB) glucose levels to assess risk for type 2 diabetes mellitus. Diabetes is linked with the progression of periodontal disease and a greater number of exposed root surfaces at risk for root caries. The rapidly increasing prevalence of type 2 diabetes coupled with a general trend towards retention of teeth means that the number of patients with increased risk for root caries is expanding significantly. Many patients with diabetes or abnormal blood glucose levels are unaware of their condition or that they are at increased risk for oral disease. Systemic blood glucose concentrations are comparable to those found in GCB and therefore may be a useful adjunctive clinical aid in determining appropriate care for patients and providing timely referrals to general medical practitioners. Use of GCB testing within the dental clinic is described. It is proposed that future studies be undertaken to provide clinicians with improved risk assessment strategies and to evaluate GCB glucose screening models.

Prevalence and incidence of dental caries and related risk factors in 70- to 76-year-olds

OBJECTIVE

The prevalence of caries and various risk factors was studied cross-sectionally in two cohorts of 72-year-olds over the course of 20 years. Incidence was also studied over a period of 6 years.

MATERIAL AND METHODS

Samples of two dentate subjects from cohorts of 70 to 72-year-olds were included; cohort III (n=135), born 1911-12, and cohort VI (n=139), born 1930. Cohort III was also examined at 70 years of age and re-examined after 6 years. An interview and clinical examination, including DMFS, plaque and gingival bleeding indices, pocket depth, and secretion rate for stimulated whole saliva, were carried out.

RESULTS

The mean numbers of teeth in cohorts III and VI were 14 and 21, respectively. On average, 2.1 tooth surfaces were decayed (DS) in cohort III compared with 1.3 in cohort VI (p<0.05). 49% of the individuals in cohort III did not develop any new DS, while 19% developed ≥3 DS during the 6-year follow-up period. The prevalence of caries was related to plaque and gingival bleeding indices, as well as a pocket depth of ≥4 mm, at ages 70 and 72. Moreover, the incidence of caries was related to the same factors.

CONCLUSIONS

The numbers of remaining teeth increased and the prevalence of caries decreased over the 20-year period. The incidence of caries over the follow-up period of 6 years was moderate. The results indicate that the prevalence of plaque, gingival bleeding, and a pocket depth of ≥4 mm are predictive factors for both prevalence and incidence of caries.

Dental care utilization among dentate adults with asthma: findings from the 2008 Behavioral Risk Factor Surveillance System

OBJECTIVES

This study investigated dental care service utilization among dentate adults with asthma and identified factors affecting dental care use among this population.

METHODS

Data from 414,509 adults in the United States who participated in the 2008 Behavioral and Risk Factor Surveillance System were used to estimate the percentage of dentate adults with asthma who had at least one dental visit within the past year.

RESULTS

The proportion of respondents with asthma who had at least one dental visit within the past year compared with the general population was significantly lower (67.4 percent versus 71.2 percent, P < 0.001 for dental visit for any reason; 64.3 percent versus 69.6 percent, P < 0.001 for dental cleaning). The adjusted odds of a dental visit for any reason within the past year for those with asthma were 0.86 [95% confidence interval (CI), 0.81-0.91], and for dental cleaning 0.82 (95% CI, 0.78-0.87) times that of those without asthma, respectively. Multivariable modeling showed dentate adults with asthma who are male, high school or less educated, unemployed, lower income, current smokers, and have lost more than six teeth were less likely to have a dental visit within the past year.

CONCLUSIONS

Compared with nonasthmatic individuals, dentate adults with asthma had a lower frequency of dental visits in the past year. Given a higher risk of oral disease among this population, healthcare providers should focus more effort on educating certain subgroups of patients with asthma on the importance of regular dental care.

Risk indicators of coronal and root caries in Greek middle aged adults and senior citizens

Background

Dental caries is the result of a complex interplay of multiple determinants which may change overtime. Therefore, periodic surveys of caries experience and redetermination of the risk indicators of the disease are needed. The aim of this study was to assess the prevalence and severity of coronal and root caries in Greeks aged 35-44 and 65-74-year-old in relation to socio-demographic parameters. Furthermore, trends in coronal caries experience of the 35-44-year-olds were investigated.

Methods

A sample of 1188 35-44-year-old and 1093 65-74-year-old individuals was selected in 2005 according to WHO guidelines for national pathfinder surveys. Caries was assessed in dentate subjects using the DMFT, DMFS, RDFS and RCI indices. Socio-demographic data were also collected. Univariate and multivariate regression analyses were performed to identify the effect of socio-demographic parameters.

Results

The mean DMFT and DMFS scores of the adults were 14.06 and 45.78 respectively, while those of the senior citizens were 20.63 and 89.82. Among the 35-44-year-ods, men and those having a higher educational attainment had significantly lower DMFS values (women OR = 1.679, CI: 1.243-2.267 and >12 years of education OR = 0.321, CI: 0.193-0.535 respectively), while educational level was the only predictor of DMFS in senior citizens (OR = 0.279, CI: 0.079-0.992). The mean DMFT score of the 35-44-year-olds has not improved since 1985, but there was a remarkable reduction in the number of DT related to a simultaneous increase in the number of FT. The mean RDFS rose from 0.39 in adults to 2.66 in senior citizens. The mean RDFS score of the middle aged adults was significantly correlated with education (OR = 0.346, CI: 0.180-0.664). The RCI was almost four times greater in seniors (9.73) than in adults (2.53). There were significant differences in caries experience between the surveyed regions. MS and RDS were the major components of the DMFS and RDFS indices respectively, in both age groups.

Conclusions

Caries experience in Greek adults is similar to what is observed in most industrialized countries. The mean DMFT score of the 35-44-year-olds has not improved since 1985, but a great improvement in restorative care has been observed. Senior citizens had a high percentage of untreated coronal and root surfaces. Region and education were the strongest predictors of caries experience. An increase in oral care utilization and effective prevention over the whole lifespan are needed to improve the dental health of the Greek adult population.

Alveolar ridge augmentation for implant fixation: status review

This literature review was performed to illustrate and compare different alveolar ridge augmentation procedures before dental implant placement. The review was based on clinical and research studies listed in Pubmed. There is not enough evidence to support any single method as gold standard for any given condition, and choice seemed to be based on personal preferences. There is a lack of long-term survival data or success rates of grafting materials regarding donor and recipient sites. Although ridge splitting and distraction osteogenesis techniques eliminate donor site morbidity, circumvent the use of grafting materials, and reduce the operation time, some disadvantages and limitations should be considered. More studies are needed to compare the fate and characteristics of new bone obtained by these different procedures, as well as subsequent implant survival rates.

Elderly at greater risk for root caries: a look at the multifactorial risks with emphasis on genetics susceptibility

Root caries is one of the most significant dental problems among older adults today. Many studies have demonstrated that older adults are at greater risk for developing root caries. Here we examine what risk factors older adults are prone to and explain how they contribute to higher rates of oral disease, in particular root caries. The elderly are at risk for root caries due to dentures, lack of dexterity, a shift from complex to simple sugars, and poor oral hygiene. Decreased salivary flow and its manifestations with other social/behavioral and medical factors may provide a more comprehensive explanation to a higher frequency of root caries in older adults.

Dental health of community-living older people attending secondary healthcare: a cross-sectional comparison between those with and without diagnosed mental illness

BACKGROUND

Mental illness and cognitive impairment are risk factors for poor dental health.

METHODS

We conducted a cross-sectional study to compare the dental health of older patients attending out-patient clinics and day hospitals of old age psychiatry services (the psychiatry group, n = 103) with those attending general/geriatric medical services (the medical group; n = 99). Those living in care homes, and those with diagnosed mental illness (in the medical group) were excluded. A registered mental health nurse assessed mental and general health using validated and previously published instruments. A registered dentist made an independent assessment of dental health (examination to assess oral pathology, status of remaining teeth, and dentures) and made an overall judgment about whether the patient needed any dental treatment (a "normative" need).

RESULTS

The normative need for dental treatment was significantly higher among the psychiatry group compared to the medical group (85% vs 52%; p<0.001); even after taking account of the effect of age, gender, teeth status, physical comorbidity, cognition, depressive symptoms, and overall mental and social health [adjusted odds ratio, OR (95% confidence interval): 4.32 (2.09, 8.91)]. The presence of any natural remaining teeth [OR: 4.44 (2.10, 9.42)] and Barthel Index [OR: 0.96 (0.93, 0.99)] were the two other independent predictors of the need for treatment.

CONCLUSION

Dental problems are common in community-living older people, especially those with some natural remaining teeth and those with mental illness. There is a need to develop integrated mental health and dental care services for older people with emphasis on prevention of dental problems.

Root caries patterns and risk factors of middle-aged and elderly people in China

The objectives of this study were to describe root caries patterns of Chinese adults and to analyze the effect of selected demographic and socioeconomic factors on these patterns. A total sample of 1080 residents aged 35-44-years-old and 1080 residents aged 65-74-years-old from three urban and three rural survey sites in Hubei Province participated in both an oral health interview and a clinical oral health examination. Root surface caries prevalence rates were 13.1% in the middle-aged group and 43.9% in the elderly group. The mean number of teeth affected by caries in the middle-aged group was reported at 0.21 and 1.0 in the elderly group. Mean Root Caries Index (RCI) scores of the middle-aged were reported at 6.29 and elderly subjects were reported at 11.95. Elderly people living in rural areas reported a higher RCI score (13.24) than those living in urban areas (10.70). A significantly higher frequency of root surface caries was observed in elderly participants (P < 0.001, OR = 3.80) and ethnic minorities (P < 0.001, OR = 1.93). In addition, smokers, nontea drinkers, and those with an annual household income of 10,000 yuan or less tended to have higher caries prevalence. RCI figures for the different tooth types ranged from 1% to 16%, indicating a wide variation in attack rates. In conclusion, our study suggests that root surface caries occurrence is high among the Chinese adult population, especially older adults. With an increasing number of retained teeth in both middle-aged and elderly people, root caries is a growing disease in the People's Republic of China which deserves more attention in future research.

Associations between oral sugar clearance, dental caries, and related factors among 71-year-olds

OBJECTIVE

To investigate the associations between oral sugar clearance and the prevalence of dental decay.

MATERIAL AND METHODS

A total of 92 (44 F, 48 M) 71-year-old subjects in Goteborg, Sweden were consecutively chosen from a representative cohort study. The subjects were examined for: 1) caries-related status, 2) oral function, 3) salivary conditions, 4) cariogenic micro-organisms, and 5) oral sugar clearance. A factor analysis was used to investigate the possible existence of latent variables within these five areas. The latent variables from the factor analyses were used to study the associations between clearance and caries in multivariate regression models.

RESULTS

Only one latent variable relating to oral sugar clearance was found. In the regression model with the latent variable related to oral sugar clearance as a dependent variable and gender plus the latent variables related to oral function and salivary conditions as an independent variable, there were associations with gender and some latent variables reflecting oral function and one reflecting glucose in saliva (R(2)=0.20/0.17). Three latent variables relating to caries-related status were found and these were associated with the number of teeth, the percentage of filled tooth surfaces, and the percentage of decayed tooth surfaces (DS%). In the regression analysis using the latent variable associated with DS% as a dependent variable, this variable was related to the latent variables of oral sugar clearance and to some reflecting oral function, as well as glucose in saliva (R(2)=0.28).

CONCLUSIONS

Oral sugar clearance appears to be independently associated with the prevalence of dental caries in the elderly.

Sources of total, non-milk extrinsic, and intrinsic and milk sugars in the diets of older adults living in sheltered accommodation

The WHO recommends limiting non-milk extrinsic sugars (NMES) consumption to < or = 10 % energy to reduce the risk of unhealthy weight gain and dental caries, and to restrict frequency of intake to < or = 4 times/d to reduce risk of dental caries. Older adults, especially those from low-income backgrounds, are at increased risk of dental caries, yet there is little information on sugars intake (frequency of intake and food sources) in this age group. The aim of this report is to present baseline data from a community-based dietary intervention study of older adults from socially deprived areas of North East England, on the quantity and sources of total sugars, NMES, and intrinsic and milk sugars, and on frequency of NMES intake. Dietary intake was assessed using two 3-d estimated food diaries, completed by 201 participants (170 female, thirty-one male) aged 65-85 years (mean 76.7 (sd 5.5) years) recruited from sheltered housing schemes. Total sugars represented 19.6 %, NMES 9.3 %, and intrinsic and milk sugars 10.3 % of daily energy intake. Eighty-one (40.3 %) exceeded the NMES intake recommendation. Mean frequency of NMES intake was 3.4 times/d. The fifty-three participants (26.4 %) who exceeded the frequency recommendation ( < or = 4 times/d) obtained a significantly greater percentage of energy from NMES compared with those participants who met the recommendation. The food groups 'biscuits and cakes' (18.9 %), 'soft drinks' (13.1 %) and 'table sugar' (11.1 %) made the greatest contributions to intakes of NMES. Interventions to reduce NMES intake should focus on limiting quantity and frequency of intake of these food groups.

Position of the American Dietetic Association: Oral Health and Nutrition

It is the position of the American Dietetic Association that nutrition is an integral component of oral health. The American Dietetic Association supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health and nutrition have a synergistic bidirectional relationship. Oral infectious diseases, as well as acute, chronic, and terminal systemic diseases with oral manifestations, impact the functional ability to eat as well as diet and nutrition status. Likewise, nutrition and diet may affect the development and integrity of the oral cavity as well as the progression of oral diseases. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. Dietetics practice requires registered dietitians to provide medical nutrition therapy that incorporates a person's total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

Reduction in caries rate among patients with xerostomia using a power toothbrush

The purpose of this study was to evaluate whether the use of a Sonicare toothbrush could be beneficial in reducing coronal and/or root caries among patients with medication-induced xerostomia. Eighty subjects with drug-induced xerostomia using either a Sonicare toothbrush (SC) or a manual toothbrush (MTB) were included in the study. Control subjects using a MTB were frequency-matched to 40 subjects using a SC, based on age, gender, number of teeth at baseline, and salivary flow rates. Subjects were individually matched according to the type of xerostomic medication they were taking. Caries were assessed at baseline, and subjects were instructed to have carious teeth restored. Summary statistics were assessed and computed by treatment group for incipient and frank coronal and root caries after one year. Statistical comparisons of the number of frank and incipient coronal and root caries between treatment groups were conducted using paired t-tests. After one year of use, the numbers of incipient and frank root caries were significantly lower among subjects using SC compared to subjects using MTB. Subjects using SC also exhibited somewhat lower incipient and frank coronal caries than subjects using MTB, although their differences were not statistically significant. The authors concluded that the Sonicare toothbrush may be beneficial in reducing root caries among older adults with medication-induced xerostomia.