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Santervas LR, Wyller TB, Skovlund E, Jensen JL, Fjeld KG, Hove LH, Ringstad IB, Nordberg LB, Mellingen KM, Kristoffersen ES, Romskaug R. Cooperation across healthcare service levels for medication reviews in older people with polypharmacy admitted to a municipal in-patient acute care unit (The COOP II Study): study protocol for a randomized controlled trial. Trials 2024; 25:612. [PMID: 39272164 PMCID: PMC11396309 DOI: 10.1186/s13063-024-08442-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Polypharmacy and inappropriate drug use are associated with adverse health outcomes in older people. Collaborative interventions between geriatricians and general practitioners have demonstrated effectiveness in improving clinical outcomes for complex medication regimens in home-dwelling patients. Since 2012, Norwegian municipalities have established municipal in-patient acute care (MipAC) units, designed to contribute towards reducing the number of hospital admissions. These units predominantly serve older people who typically benefit from multidisciplinary approaches. The primary objective of this study is to evaluate the effect of cooperative medication reviews conducted by MipAC physicians, supervised by geriatricians, and in collaboration with general practitioners, on health-related quality of life and clinical outcomes in MipAC patients ≥ 70 years with polypharmacy. Additionally, the study aims to assess the carbon footprint of the intervention. METHODS This is a randomized, single-blind, controlled superiority trial with 16 weeks follow-up. Participants will be randomly assigned to either the control group, receiving usual care at the MipAC unit, or to the intervention group which in addition receive clinical medication reviews that go beyond what is considered usual care. The medication reviews will evaluate medication appropriateness using a structured but individualized framework, and the physicians will receive supervision from geriatricians. Following the clinical medication reviews, the MipAC physicians will arrange telephone meetings with the participants' general practitioners to combine their assessments in a joint medication review. The primary outcome is health-related quality of life as measured by the 15D instrument. Secondary outcomes include physical and cognitive functioning, oral health, falls, admissions to healthcare facilities, and mortality. DISCUSSION This study aims to identify potential clinical benefits of collaborative, clinical medication reviews within community-level MipAC units for older patients with polypharmacy. The results may offer valuable insights into optimizing patient care in comparable municipal healthcare settings. TRIAL REGISTRATION The study was registered prospectively on ClinicalTrials.gov 30.08.2023 with identifier NCT06020391.
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Affiliation(s)
- Leonor Roa Santervas
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
- City of Oslo Health Agency, Municipality of Oslo, Oslo, Norway.
- Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Katrine Gahre Fjeld
- Department of Cariology and Gerodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Ingrid Beate Ringstad
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Lena Bugge Nordberg
- REMEDY Centre for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akerhus University Hospital, Lørenskog, Norway
| | - Rita Romskaug
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Westad YAS, Flemmen GL, Solem S, Monsen T, Hollingen H, Feuerherm A, Havnen A, Hagen K. Interdisciplinary CBT treatment for patients with odontophobia and dental anxiety related to psychological trauma experiences: a case series. BMC Psychiatry 2024; 24:606. [PMID: 39256740 PMCID: PMC11389481 DOI: 10.1186/s12888-024-06055-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/30/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND While cognitive-behavioural therapy (CBT) is a well-established treatment for odontophobia, research is sparse regarding its effect on patients with dental anxiety related to psychological trauma experiences. This study aimed to evaluate changes in symptoms and acceptability of interdisciplinary Torture, Abuse, and Dental Anxiety (TADA) team treatment for patients with odontophobia or dental anxiety. We also wanted to describe the sample's oral health status. The TADA teams offer targeted anxiety treatment and adapted dental treatment using a CBT approach. METHODS The study used a naturalistic, case series design and included 20 consecutively referred outpatients at a public TADA dental clinic. Pre- and post-treatment assessments included questionnaires related to the degree of dental anxiety, post-traumatic stress, generalized anxiety, and depression. Patients underwent a panoramic X-ray before treatment. Before dental restoration, patients underwent an oral health examination to determine the mucosal and plaque score (MPS) and the total number of decayed, missing, and filled teeth (DMFT). Patients were referred to dentist teams for further dental treatment and rehabilitation (phase 2) after completing CBT in the TADA team (Phase 1). Results from the dental treatment in phase 2 is not included in this study. RESULTS All patients completed the CBT treatment. There were significant improvements in symptoms of dental anxiety, post-traumatic stress, and depression and moderate changes in symptoms of generalized anxiety. Dental statuses were heterogeneous in terms of the severity and accumulated dental treatment needs. The TADA population represented the lower socioeconomic range; 15% of patients had higher education levels, and half received social security benefits. All patients were referred to and started adapted dental treatment (phase 2). CONCLUSIONS TADA treatment approach appears acceptable and potentially beneficial for patients with odontophobia and dental anxiety related to psychological trauma experiences. The findings suggest that further research, including larger controlled studies, is warranted to validate these preliminary outcomes. TRIAL REGISTRATION The study was approved by the regional ethical committee in Norway (REK-Midt: 488462) and by the Data Protection Board at Møre and Romsdal County Authority.
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Affiliation(s)
- Yngvill Ane Stokke Westad
- Molde Competence Clinic for Public Dental Health Service, Møre and Romsdal County Authority, Molde, Norway
| | - Gina Løge Flemmen
- Molde Competence Clinic for Public Dental Health Service, Møre and Romsdal County Authority, Molde, Norway
| | - Stian Solem
- Molde Competence Clinic for Public Dental Health Service, Møre and Romsdal County Authority, Molde, Norway
| | - Trine Monsen
- Molde Competence Clinic for Public Dental Health Service, Møre and Romsdal County Authority, Molde, Norway
| | - Henriette Hollingen
- Molde Competence Clinic for Public Dental Health Service, Møre and Romsdal County Authority, Molde, Norway
| | - Astrid Feuerherm
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Nidaros Division of Psychiatry, Community Mental Health Centre, St. Olav's University Hospital, Trondheim, Norway
| | - Kristen Hagen
- Molde Hospital, Møre og Romsdal Hospital Trust, Molde, Norway.
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
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Yang H, Xiao J, Cui S, Zhang L, Chen L. Oral Health Assessment Tools for Elderly Adults: A Scoping Review. J Multidiscip Healthc 2023; 16:4181-4192. [PMID: 38148947 PMCID: PMC10750773 DOI: 10.2147/jmdh.s442439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose The aim of this study was to synthesize the Oral Health Assessment Tool for elderly adults and determine its psychosocial properties. Methods We conducted a scoping review. The Arkey and O'Malley methodology was employed to conduct scoping reviews involving the exploration of both national and international databases, as well as a manual search of the reference lists of the selected studies. We focused on oral health assessment tools for elderly adults (>60 years). The review report adhered to the standards outlined in the PRISMA-ScR guidelines. The study protocol was officially filed with the Open Science Framework. Results A total of 19 documents were included. The literature search included a time frame ranging from 1995 to 2023 and covered a diverse range of 13 countries. Of the 19 assessment tools examined, it was found that only the Oral Assessment Sheet had multidimensional characteristics, while the remaining tools were unidimensional in nature. The evaluation of oral health assessment tools was conducted across several contexts, including nursing homes, geriatric facilities, communities, and hospitals. A total of eleven studies underwent reliability testing, whereas two studies were alone validated for validity and did not undergo reliability testing. Additionally, seven studies were exclusively validated for reliability and did not undergo validity testing. Conclusion Multidimensional oral health assessment tools for elderly adults that integrate social and psychological aspects need to be developed and validated. It is necessary to develop oral health assessment tools based on hospitalized elderly patients to meet the oral and dental health needs of elderly patients.
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Affiliation(s)
- Heng Yang
- Department of Nursing, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Jiechenming Xiao
- Department of Nursing, Huangyan Hospital, Wenzhou Medical University, Taizhou, Zhejiang, People’s Republic of China
| | - Shaomei Cui
- Department of Nursing, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Liyan Zhang
- Department of Nursing, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Lixia Chen
- Department of Nursing, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
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Quinn B. Best Practices in Oral Care. Crit Care Nurse 2023; 43:64-67. [PMID: 37257868 PMCID: PMC10443897 DOI: 10.4037/ccn2023507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Topic Assessing functional cognition is a critical need for intensive care unit survivors transitioning to another level of care. Clinical Relevance Up to 62% of patients discharged from an intensive care unit have significant cognitive impairment that is not associated with severity of illness, number of comorbidities, or length of hospital stay. For more than 20 years, researchers have published an array of potentially effective interventions, including case management, patient and informal caregiver education, and home health care services. Purpose To describe the impact of and potential interventions for cognitive decline at intensive care unit discharge and discharge readiness on 30-day readmission rates. Content Covered Assessing the patient’s functional cognition assessment and advocating for appropriate resources are needed to improve patient and clinical outcomes.
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Affiliation(s)
- Barbara Quinn
- Barbara Quinn is a nurse consultant with 30 years of experience, most recently the Director of Professional Practice and Nursing Excellence at Sutter Health in the Office of the Chief Nurse Officer
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Monsen RE, Kristoffersen AK, Gay CL, Herlofson BB, Fjeld KG, Hove LH, Nordgarden H, Tollisen A, Lerdal A, Enersen M. Identification and susceptibility testing of oral candidiasis in advanced cancer patients. BMC Oral Health 2023; 23:223. [PMID: 37072843 PMCID: PMC10111683 DOI: 10.1186/s12903-023-02950-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Patients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity. METHODS An observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014-2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied. RESULTS Fifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2-3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin. CONCLUSION C. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer. TRAIL REGISTRATION The study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014.
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Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
| | | | - Caryl L Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Family Health Care Nursing, University of California, San Francisco, USA
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Katrine Gahre Fjeld
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Hilde Nordgarden
- National Resource Centre for Oral Health in Rare Disorders, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anita Tollisen
- Unger-Vetlesens Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Morten Enersen
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Critén S, Andersson P, Renvert S, Götrick B, Berglund JS, Bengtsson VW. Oral health status among 60-year-old individuals born in 1941-1943 and 1954-1955 and 81-year-old individuals born in 1922-1924 and 1933-1934, respectively: a cross-sectional study. Clin Oral Investig 2022; 26:6733-6742. [PMID: 35906339 DOI: 10.1007/s00784-022-04632-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to analyze the oral health status of four different birth cohorts: two cohorts of 60-year-olds born in 1941-1943 and 1954-1955 and 2 cohorts of 81-year-olds born in 1920-1922 and 1933-1934. MATERIAL AND METHODS The study was based on data from an ongoing longitudinal population project, The Swedish National Study on Aging and Care (SNAC). Oral health status was repeatedly examined clinically and radiographically in 2001-2003 and 2014-2015, including 60- and 81-year-olds, in total 412 individuals. Statistical analyses were performed using independent-samples t test and Pearson's χ2 test. RESULTS More individuals were dentate in 2014-2015 compared to 2001-2003 in the two age groups: 60 and 81 years (p < 0.001 for both). The mean number of teeth increased in the 60-year-olds from 24.2 to 27.0 and in the 81-year-olds from 14.3 to 20.2. The numbers of at least one intact tooth increased for both age groups (p < 0.001 and p < 0.004, respectively). In the age groups 81 years, there was an increase in having at least one PPD ≥ 6 mm (p < 0.016) and bone loss ≥ 5 mm (p < 0.029) between the two examinations. No such differences were found in the age groups of 60 years. CONCLUSION Over 13 years, oral health improved for both 60- and 81-year-old age groups. The most significant changes were in the 81-year-olds where oral health had improved except for periodontal status. CLINICAL RELEVANCE More natural teeth and impaired periodontal status potentially impact oral health and should increase focus on preventive and supportive dental care in older individuals.
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Affiliation(s)
- Sladjana Critén
- Faculty of Health Sciences, Kristianstad University, 291 88, Kristianstad, Sweden.
| | - Pia Andersson
- Faculty of Health Sciences, Kristianstad University, 291 88, Kristianstad, Sweden
| | - Stefan Renvert
- Faculty of Health Sciences, Kristianstad University, 291 88, Kristianstad, Sweden.,Department of Health, Blekinge Institute of Technology, 371 79, Karlskrona, Sweden
| | - Bengt Götrick
- Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden
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BaHammam FA, McCracken GI, Wassall R, Durham J, Abdulmohsen B. Measurement properties, interpretability and feasibility of instruments measuring oral health and orofacial pain in dependent adults: a systematic review. BMC Oral Health 2022; 22:208. [PMID: 35614421 PMCID: PMC9131695 DOI: 10.1186/s12903-022-02235-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dependent adults have been shown to have a greater experience of oral health deterioration and orofacial pain. This is partly because their non-dental caregivers may not easily identify oral health problems and orofacial pain experienced by them. Thus, this systematic review aimed to investigate measurement properties, interpretability and feasibility of instruments assessing oral health and orofacial pain in dependent adults, which can be used by the non-dental caregivers to establish oral care plans for those who are dependent upon them.
Methods Seven bibliographic databases were searched: MEDLINE, Embase, CINAHL, CENTRAL, HTA, OATD and OpenGrey. Citations and reference lists of the included studies were also manually searched. Two authors independently screened titles and abstracts, and then full texts. A quality assessment of included studies was conducted independently by two authors using the COSMIN Risk of Bias checklist. The best evidence synthesis method was used to synthesise results from different studies for each measurement property per measurement instrument by integrating the overall rating for each measurement property per measurement instrument with its quality level of evidence. Results Nineteen eligible studies were included, which reported the development, measurement properties’ evaluation, interpretability and feasibility of nine oral health and three orofacial pain measurement instruments. Methodological quality of the included studies ranged from very good to inadequate. None of the identified measurement instruments has been adequately and comprehensively tested. Conclusions While several measurement instruments were identified in this systematic review, more evidence is needed to be able to more comprehensively evaluate these instruments. Among those identified, the OPS-NVI demonstrated sufficient construct validity, while the OHAT and the THROAT demonstrated sufficient reliability. These instruments therefore have potential for future use with more confidence once other measurement properties, interpretability and feasibility have been sufficiently tested and evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02235-w.
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Affiliation(s)
- Fahad A BaHammam
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. .,College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Giles I McCracken
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Wassall
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Justin Durham
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Bana Abdulmohsen
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Evensen KB, Bull VH, Ness L. A health promotion intervention to improve oral health of prisoners: results from a pilot study. Int J Prison Health 2021; 17:546-559. [PMID: 38902900 PMCID: PMC8753622 DOI: 10.1108/ijph-11-2020-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Prisoners have poorer oral health than the general population. Good oral health is essential for both social and physical well-being. For prisoners, poor oral health is also related to drug use after release, whereas good oral health is related to successful reintegration into society. The purpose of this study was twofold: to examine the effect of an intervention based on motivational interviewing (MI) on prisoners' oral health-related behavior and to assess if the intervention is a good fit for this population. DESIGN/METHODOLOGY/APPROACH In total, 16 prisoners in a Norwegian prison were offered a brief MI-based intervention focusing on changing their oral health-related behavior. An oral examination was also performed and the prisoners received a small package containing oral hygiene aids. Two weeks later, a second oral examination and a semi-structured interview were conducted to explore the effect of the intervention and examine the prisoners' responses to the intervention. Qualitative data analyzes were guided by thematic analysis. FINDINGS The findings indicate that the intervention had positive effects on both the prisoners' motivation to use oral health-related behavior and their performance of oral health-related behavior. The findings also indicate that the intervention was well adapted to the target population. ORIGINALITY/VALUE This is one of the first studies that explore the effect of an intervention in improving prisoners' oral health and bridges a knowledge gap in the literature. The findings may increase the understanding of how dental services should be organized and offered to provide dental health care to this vulnerable group.
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Affiliation(s)
| | | | - Linda Ness
- Oral Health Centre of Expertise-Rogaland, Stavanger, Norway
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Winning L, Lundy FT, Blackwood B, McAuley DF, El Karim I. Oral health care for the critically ill: a narrative review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:353. [PMID: 34598718 PMCID: PMC8485109 DOI: 10.1186/s13054-021-03765-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/11/2021] [Indexed: 12/13/2022]
Abstract
Background The link between oral bacteria and respiratory infections is well documented. Dental plaque has the potential to be colonized by respiratory pathogens and this, together with microaspiration of oral bacteria, can lead to pneumonia particularly in the elderly and critically ill. The provision of adequate oral care is therefore essential for the maintenance of good oral health and the prevention of respiratory complications. Main body Numerous oral
care practices are utilised for intubated patients, with a clear lack of consensus on the best approach for oral care. This narrative review aims to explore the oral-lung connection and discuss in detail current oral care practices to identify shortcomings and offer suggestions for future research. The importance of adequate oral care has been recognised in guideline interventions for the prevention of pneumonia, but practices differ and controversy exists particularly regarding the use of chlorhexidine. The oral health assessment is also an important but often overlooked element of oral care that needs to be considered. Oral care plans should ideally be implemented on the basis of an individual oral health assessment. An oral health assessment prior to provision of oral care should identify patient needs and facilitate targeted oral care interventions. Conclusion Oral health is an important consideration in the management of the critically ill. Studies have suggested benefit in the reduction of respiratory complication such as Ventilator Associated Pneumonia associated with effective oral health care practices. However, at present there is no consensus as to the best way of providing optimal oral health care in the critically ill. Further research is needed to standardise oral health assessment and care practices to enable development of evidenced based personalised oral care for the critically ill.
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Affiliation(s)
- Lewis Winning
- Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Fionnuala T Lundy
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK
| | - Bronagh Blackwood
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK
| | - Daniel F McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK
| | - Ikhlas El Karim
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
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Overgaard C, Bøggild H, Hede B, Bagger M, Hartmann LG, Aagaard K. Improving oral health in nursing home residents: A cluster randomized trial of a shared oral care intervention. Community Dent Oral Epidemiol 2021; 50:115-123. [PMID: 33899261 DOI: 10.1111/cdoe.12638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare a designated shared oral care intervention in a group of public nursing home residents with a standard oral care programme, focusing on levels of oral plaque and oral inflammation. METHODS A cluster randomized field trial was undertaken in 14 Danish public nursing homes. There were 145 participants included in the intervention group and 98 in the control group. We undertook a six-month intervention based on the principle of situated interprofessional learning. The primary outcomes were plaque and inflammation levels measured with the mucosal plaque index (MPS); this was assessed at baseline, after three and six months (end of intervention), and at follow-up (six months postintervention). The odds ratios (OR) and 95% confidence intervals (CI) were estimated with ordinal regression. RESULTS Socio-demographic characteristics and oral health status at baseline were comparable between the two groups, with the exception of age: the intervention group were significantly younger than controls (median 82 vs 87 years). After three and six months, those receiving the shared oral care intervention had significantly lower plaque and inflammation than the control group. The adjusted ORs for a reduction in MPS were 11.8 (CI: 6.5-21.3) and 11.0 (CI: 5.8-20.9), respectively. At follow-up, plaque levels and oral inflammation had approached the pre-intervention level, with no remaining statistically significant group differences. CONCLUSIONS The shared oral care intervention based on a situated learning perspective was effective in improving oral health among care home residents. However, after termination of the intervention, the effect quickly decreased. This confirms the challenges of achieving long-term improvement in oral health in nursing home residents. An implementation strategy focusing on achieving changes at both organizational and individual levels with persistent attention to oral health care seem required for long-term improvement.
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Affiliation(s)
- Charlotte Overgaard
- Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Aalborg Øst, Denmark
| | - Henrik Bøggild
- Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Aalborg Øst, Denmark
| | - Børge Hede
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maiken Bagger
- Department of Special Care Dentistry, Municipality of Aalborg, Aalborg, Denmark
| | - Line Gøtz Hartmann
- Department of Special Care Dentistry, Municipality of Aalborg, Aalborg, Denmark
| | - Karin Aagaard
- Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Aalborg Øst, Denmark.,Department of Integrated Healthcare and Cross-Sectoral Processes, North Regional Hospital, Hjørring, Denmark
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Monsen RE, Herlofson BB, Gay C, Fjeld KG, Hove LH, Malterud KE, Saghaug E, Slaaen J, Sundal T, Tollisen A, Lerdal A. A mouth rinse based on a tea solution of Salvia officinalis for oral discomfort in palliative cancer care: a randomized controlled trial. Support Care Cancer 2021; 29:4997-5007. [PMID: 33586003 PMCID: PMC8295113 DOI: 10.1007/s00520-021-06021-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few clinical studies evaluate interventions to reduce oral discomfort among patients in palliative care. AIM This study examines the efficacy of a Salvia officinalis (SO) based herbal mouth rinse compared to conventional normal saline (NS) in order to improve oral health. DESIGN A block-randomized controlled trial. Data were collected before and after a 4-day intervention with either SO (n=44) or NS (n=44). Numerical rating scales (NRS, 0-10) and 12 items from the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Oral Health 17 (EORTC QLQ-OH17) measured patient-reported oral symptoms. An oral examination was performed before and after the intervention. SETTING/PARTICIPANTS This study included adult patients with late-stage cancer in an inpatient hospice unit. RESULTS Of the 88 patients included (mean age=63.9 years, SD=10.6), 73 (83%) completed the study. At baseline, 78% reported dry mouth on the EORTC QLQ-OH17, and 80% rated dry mouth ≥4 on the NRS. Total oral health scores based on the 12 EORTC QLQ-OH17 items improved similarly in both groups (p<0.001). However, dry mouth ratings on both the EORTC QLQ-OH17 (p=0.036) and NRS (p=0.045) improved more in the SO group than in the NS group. Plaque on the teeth improved in both the SO (p=0.008) and NS (p=0.018) groups, but plaque on the tongue and erythema only improved with NS. CONCLUSIONS This study did not detect an overall significant difference between SO and NS. Both mouth rinses improved oral health parameters, indicating that systematic assessment and oral care may reduce oral discomfort. TRIAL REGISTRATION NCT02067572.
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Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway. .,Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Caryl Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Katrine Gahre Fjeld
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Karl Egil Malterud
- Department of Pharmacy, Section Pharmaceutical Chemistry, University of Oslo, Oslo, Norway
| | | | - Joran Slaaen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Tone Sundal
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anita Tollisen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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12
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Sun J, Han W, Cui N, Li Q, Wang H, Li Z, Luo H, Liu J. Effect of Nurse-Led Goal-Directed Lung Physical Therapy on the Prognosis of Pneumonia in Sepsis Patients in the ICU: A Prospective Cohort Study. J Intensive Care Med 2021; 37:258-266. [PMID: 33511893 DOI: 10.1177/0885066620987200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pneumonia poses a significant burden on healthcare systems. However, few studies have focused on nurse-led goal-directed lung physical therapy (GDLPT) for pneumonia in sepsis patients in the intensive care unit (ICU). OBJECTIVES This study aimed to investigate the effects of nurse-led GDLPT on the prognosis of pneumonia in sepsis patients in the ICU. METHODS We performed a prospective 2-phase (before-and-after) study over 3 years. After an observational phase (phase 1, n = 188), we designed, implemented, and evaluated a nurse-led GDLPT protocol (phase 2, n = 359) for pneumonia in sepsis patients in the ICU. The primary outcome was 28-day mortality. RESULTS We evaluated 742 critically ill patients with sepsis from January 2017 to January 2020. Among the 742 sepsis patients, 609 were diagnosed with pneumonia and 547 who met the inclusion criteria were enrolled in the study. Compared with patients in phase 1, patients in phase 2 had significantly shorter mechanical ventilation duration (5 [4, 6] days vs. 5 [4, 8] days, p = 0.037), shorter ICU stay (9 [4, 16] days vs. 9 [6, 20] days, p = 0.010), lower ICU mortality (15.0% [54/359] vs. 25.5% [48/188], p = 0.003), and lower 28-day mortality (16.7% [60/359] vs. 27.1% ([51/188], p = 0.004). Multivariate logistic regression analysis revealed that nurse-led GDLPT (odds ratio 0.540, 95% confidence interval 0.345-0.846, p = 0.007), clinical pulmonary infection score (odds ratio 1.111, 95% confidence interval 1.012-1.221, p = 0.028), and ventilation day (OR 1.160, 95% CI, 1.058-1.240, p<0.001)were independent predictors of 28-day mortality for pneumonia in sepsis patients, and that nurse-led GDLPT was a protective factor. CONCLUSIONS Nurse-led GDLPT improved the outcomes of pneumonia in sepsis patients, and was particularly associated with shortened mechanical ventilation duration and ICU stay, and reduced ICU mortality and 28-day mortality.
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Affiliation(s)
- Jianhua Sun
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Wen Han
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Na Cui
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.,Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Qi Li
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.,Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Hao Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Zunzhu Li
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Hongbo Luo
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Jinbang Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
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13
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Thapa R, Chimoriya R, Arora A. The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: a systematic review. BMC Geriatr 2021; 21:35. [PMID: 33422009 PMCID: PMC7797120 DOI: 10.1186/s12877-020-01989-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/25/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties. METHODS This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines. RESULTS Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria. CONCLUSIONS None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps.
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Affiliation(s)
- Rojina Thapa
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Ritesh Chimoriya
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia.
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
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14
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Girestam Croonquist C, Dalum J, Skott P, Sjögren P, Wårdh I, Morén E. Effects of Domiciliary Professional Oral Care for Care-Dependent Elderly in Nursing Homes - Oral Hygiene, Gingival Bleeding, Root Caries and Nursing Staff's Oral Health Knowledge and Attitudes. Clin Interv Aging 2020; 15:1305-1315. [PMID: 32982191 PMCID: PMC7495352 DOI: 10.2147/cia.s236460] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose The primary aim was to describe the effects for nursing home residents of monthly professional cleaning and individual oral hygiene instruction provided by registered dental hygienists (RDHs), in comparison with daily oral care as usual. The secondary aim was to study the knowledge and attitudes among nursing staff regarding oral health care and needs. Patients and Methods In this randomised controlled trial (RCT), 146 residents were recruited from nine nursing homes in Regions of Stockholm and Sörmland and were randomly assigned (on nursing home level) to either intervention group (I; n=72) or control group (C; n=74). Group I received monthly professional cleaning, individual oral hygiene instructions and information given by an RDH. Group C proceeded with daily oral care as usual (self-performed or nursing staff-assisted). Oral health-related data was registered with the mucosal-plaque score index (MPS), the modified sulcus bleeding index (MSB), and root caries. The nursing staff’s attitudes and knowledge were analysed at baseline and at six-month follow-up. Statistical analysis was performed by Fisher’s exact test and two-way variance analysis (ANOVA). Results Improvements were seen in both Group I and Group C concerning MPS, MSB and active root caries. The nursing staff working with participants in Group I showed significant improvements regarding the Nursing Dental Coping Beliefs Scale (DCBS) in two of four dimensions, oral health care beliefs (p=0.0331) and external locus of control (p=0.0017) compared with those working with Group C. The knowledge-based questionnaire showed improvement (p=0.05) in Group I compared with Group C. Conclusion Monthly professional oral care, combined with individual oral health care instructions, seems to improve oral hygiene and may reduce root caries among nursing home residents. This may also contribute to a more positive attitude regarding oral hygiene measures among nursing home staff, as compared with daily oral care as usual.
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Affiliation(s)
| | - Jesper Dalum
- Department Of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Pia Skott
- Folktandvården Stockholm AB, Stockholm, Sweden.,Academic Centre Of Geriatric Dentistry, Stockholm, Sweden
| | | | - Inger Wårdh
- Academic Centre Of Geriatric Dentistry, Stockholm, Sweden.,Department Of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Elisabeth Morén
- Department Of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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15
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Everaars B, Weening-Verbree LF, Jerković-Ćosić K, Schoonmade L, Bleijenberg N, de Wit NJ, van der Heijden GJMG. Measurement properties of oral health assessments for non-dental healthcare professionals in older people: a systematic review. BMC Geriatr 2020; 20:4. [PMID: 31900125 PMCID: PMC6942417 DOI: 10.1186/s12877-019-1349-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/06/2019] [Indexed: 11/28/2022] Open
Abstract
Background Regular inspection of the oral cavity is required for prevention, early diagnosis and risk reduction of oral- and general health-related problems. Assessments to inspect the oral cavity have been designed for non-dental healthcare professionals, like nurses. The purpose of this systematic review was to evaluate the content and the measurement properties of oral health assessments for use by non-dental healthcare professionals in assessing older peoples’ oral health, in order to provide recommendations for practice, policy, and research. Methods A systematic search in PubMed, EMBASE.com, and Cinahl (via Ebsco) has been performed. Search terms referring to ‘oral health assessments’, ‘non-dental healthcare professionals’ and ‘older people (60+)’ were used. Two reviewers individually performed title/abstract, and full-text screening for eligibility. The included studies have investigated at least one measurement property (validity/reliability) and were evaluated on their methodological quality using “The Consensus-based Standards for the selection of health Measurement Instruments” (COSMIN) checklist. The measurement properties were then scored using quality criteria (positive/negative/indeterminate). Results Out of 879 hits, 18 studies were included in this review. Five studies showed good methodological quality on at least one measurement property and 14 studies showed poor methodological quality on some of their measurement properties. None of the studies assessed all measurement properties of the COSMIN. In total eight oral health assessments were found: the Revised Oral Assessment Guide (ROAG); the Minimum Data Set (MDS), with oral health component; the Oral Health Assessment Tool (OHAT); The Holistic Reliable Oral Assessment Tool (THROAT); Dental Hygiene Registration (DHR); Mucosal Plaque Score (MPS); The Brief Oral Health Screening Examination (BOHSE) and the Oral Assessment Sheet (OAS). Most frequently assessed items were: lips, mucosa membrane, tongue, gums, teeth, denture, saliva, and oral hygiene. Conclusion Taken into account the scarce evidence of the proposed assessments, the OHAT and ROAG are most complete in their included oral health items and are of best methodological quality in combination with positive quality criteria on their measurement properties. Non-dental healthcare professionals, policymakers and researchers should be aware of the methodological limitations of the available oral health assessments and realize that the quality of the measurement properties remains uncertain.
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Affiliation(s)
- Babette Everaars
- University of Applied Sciences Utrecht, Research Group Innovations in Preventive Care, Heidelberglaan 7, 3512, CS, Utrecht, The Netherlands. .,Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081LA, Amsterdam, The Netherlands.
| | - Linet F Weening-Verbree
- Hanze University of Applied Sciences Groningen, Center of Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen (RUG), A. Deusinglaan 1, 9713, AV, Groningen, The Netherlands
| | - Katarina Jerković-Ćosić
- University of Applied Sciences Utrecht, Research group innovations in Preventive Care, Heidelberglaan 7, 3512, CS, Utrecht, The Netherlands
| | - Linda Schoonmade
- Medical Library, VU University Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Nienke Bleijenberg
- University of Applied Sciences Utrecht, Research Group Innovations in Preventive Care, Heidelberglaan 7, 3512, CS, Utrecht, The Netherlands.,Utrecht University, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Huispost Str.6.131, 3508, GA, Utrecht, The Netherlands
| | - Niek J de Wit
- Utrecht University, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Huispost Str.6.131, 3508, GA, Utrecht, The Netherlands
| | - Geert J M G van der Heijden
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081LA, Amsterdam, The Netherlands
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16
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Johansson I, Torgé CJ, Lindmark U. Is an oral health coaching programme a way to sustain oral health for elderly people in nursing homes? A feasibility study. Int J Dent Hyg 2019; 18:107-115. [PMID: 31618518 DOI: 10.1111/idh.12421] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/30/2019] [Accepted: 10/12/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study examines the feasibility of an oral health coaching programme involving practical support on individual level to staff in a nursing home in Sweden, aiming to improve oral health care-related beliefs of nursing staff and the oral health of residents. METHODS This intervention study consisted of three wards from one nursing home, and both staff (n = 48) and residents (n = 58) were invited. In the control ward, 9 staff and 16 residents participated; in test ward 1, 10 staff and 13 residents participated; and at test ward 2, 14 staff and 17 residents participated. An oral health coaching programme was performed 4 h/wk for 3 months. The staff completed the nursing Dental Coping Beliefs Scale at baseline and after 9 months. Oral health of the residents was assessed using the Revised Oral Assessment Guide and mucosal-plaque score at baseline and after 3, 6 and 9 months. RESULTS At baseline, 33 staff participated and 22 at 9 months follow-up. For the residents, the figures were 48 and 32, respectively. After the intervention, the nursing DCBS revealed changes related to usage of fluoride, oral health support, gum disease and approximal cleaning. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents' relatively high level of oral health was stable during the study period. CONCLUSIONS Despite limitations in the programme, an oral health coaching programme can support nursing staff in maintaining a high level of oral health in residents. The programme was shown feasible, although design improvements are needed.
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Affiliation(s)
- Isabelle Johansson
- The Research School of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Aging Research Network, Jönköping, Sweden
| | - Cristina Joy Torgé
- Aging Research Network, Jönköping, Sweden.,Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Ulrika Lindmark
- Aging Research Network, Jönköping, Sweden.,Department of Natural Science and Biomedicine, Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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17
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Ames NJ, Barb JJ, Ranucci A, Kim H, Mudra SE, Cashion AK, Townsley DM, Childs R, Paster BJ, Faller LL, Wallen GR. The oral microbiome of patients undergoing treatment for severe aplastic anemia: a pilot study. Ann Hematol 2019; 98:1351-1365. [PMID: 30919073 DOI: 10.1007/s00277-019-03599-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/07/2019] [Indexed: 12/11/2022]
Abstract
The microbiome, an intriguing component of the human body, composed of trillions of microorganisms, has prompted scientific exploration to identify and understand its function and role in health and disease. As associations between microbiome composition, disease, and symptoms accumulate, the future of medicine hinges upon a comprehensive knowledge of these microorganisms for patient care. The oral microbiome may provide valuable and efficient insight for predicting future changes in disease status, infection, or treatment course. The main aim of this pilot study was to characterize the oral microbiome in patients with severe aplastic anemia (SAA) during their therapeutic course. SAA is a hematologic disease characterized by bone marrow failure which if untreated is fatal. Treatment includes either hematopoietic stem cell transplantation (HSCT) or immunosuppressive therapy (IST). In this study, we examined the oral microbiome composition of 24 patients admitted to the National Institutes of Health (NIH) Clinical Center for experimental SAA treatment. Tongue brushings were collected to assess the effects of treatment on the oral microbiome. Twenty patients received standard IST (equine antithymocyte globulin and cyclosporine) plus eltrombopag. Four patients underwent HSCT. Oral specimens were obtained at three time points during treatment and clinical follow-up. Using a novel approach to 16S rRNA gene sequence analysis encompassing seven hypervariable regions, results demonstrated a predictable decrease in microbial diversity over time among the transplant patients. Linear discriminant analysis or LefSe reported a total of 14 statistically significant taxa (p < 0.05) across time points in the HSCT patients. One-way plots of relative abundance for two bacterial species (Haemophilus parainfluenzae and Rothia mucilaginosa) in the HSCT group, show the differences in abundance between time points. Only one bacterial species (Prevotella histicola) was noted in the IST group with a p value of 0.065. The patients receiving immunosuppressive therapy did not exhibit a clear change in diversity over time; however, patient-specific changes were noted. In addition, we compared our findings to tongue dorsum samples from healthy participants in the Human Microbiome Project (HMP) database and found among HSCT patients, approximately 35% of bacterial identifiers (N = 229) were unique to this study population and were not present in tongue dorsum specimens obtained from the HMP. Among IST-treated patients, 45% (N = 351) were unique to these patients and not identified by the HMP. Although antibiotic use may have likely influenced bacterial composition and diversity, some literature suggests a decreased impact of antimicrobials on the oral microbiome as compared to their effect on the gut microbiome. Future studies with larger sample sizes that focus on the oral microbiome and the effects of antibiotics in an immunosuppressed patient population may help establish these potential associations.
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Affiliation(s)
- N J Ames
- Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA.
| | - J J Barb
- Mathematical and Statistical Computing Lab, Center for Information Technology, National Institutes of Health, Bethesda, MD, USA
| | - A Ranucci
- Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA.,Tulane University School of Medicine, New Orleans, LA, USA
| | - H Kim
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - S E Mudra
- Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA.,University of Louisville School of Medicine, Louisville, KY, USA
| | - A K Cashion
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - D M Townsley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - R Childs
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - B J Paster
- Forsyth Institute, Cambridge, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - L L Faller
- Forsyth Institute, Cambridge, MA, USA.,Ginkgo Bioworks, Boston, MA, USA
| | - G R Wallen
- Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA
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18
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Oliveira MB, Lopes FF, Rodrigues VP, Alves CMC, Hugo FN. Association between socioeconomic factors, behavioral, general health and oral mucosa status in elderly. CIENCIA & SAUDE COLETIVA 2018; 23:3663-3674. [PMID: 30427439 DOI: 10.1590/1413-812320182311.26182016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 11/15/2016] [Indexed: 12/22/2022] Open
Abstract
This study aimed to investigate the association between socioeconomic and behavioral factors, general health, oral health, and plaque accumulation and oral mucosa condition outcomes in the elderly. This is a cross-sectional study conducted from 2004 to 2005 with 785 elderly dwellers of the city of Carlos Barbosa (RS), Brasil. We used questionnaires to collect socioeconomic, behavior and health status data. The physical examination of the oral structures comprised the Mucosal-Plaque Index proposed by Henriksen (MPS). A higher prevalence of moderate/severe plaque accumulation was observed in the elderly group, in less educated male elderly. The use of full upper dentures and income under one minimum wage were protective factors for moderate/severe plaque accumulation. Only the variables of the first block of the conceptual structure, male gender (OR = 2.13; 95% CI 1.26-3.61) and lower education (OR = 1.37; 95% CI 1.06-1.78) remained associated with an unacceptable MPS score. The findings suggest that, as per MPS, less educated male elderly are more likely to have poor oral health.
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Affiliation(s)
- Marisa Borges Oliveira
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Maranhão. Avenida dos Portugueses s/n, Bacanga. 65080-805 São Luís MA Brasil.
| | - Fernanda Ferreira Lopes
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Maranhão. Avenida dos Portugueses s/n, Bacanga. 65080-805 São Luís MA Brasil.
| | - Vandilson Pinheiro Rodrigues
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Maranhão. Avenida dos Portugueses s/n, Bacanga. 65080-805 São Luís MA Brasil.
| | - Claudia Maria Coelho Alves
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Maranhão. Avenida dos Portugueses s/n, Bacanga. 65080-805 São Luís MA Brasil.
| | - Fernando Neves Hugo
- Centro de Pesquisas em Odontologia Social, Universidade Federal do Rio Grande do Sul. Porto Alegre RS Brasil
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19
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Hayes M, Da Mata C, McKenna G, Burke FM, Allen PF. Evaluation of the Cariogram for root caries prediction. J Dent 2017; 62:25-30. [PMID: 28456556 DOI: 10.1016/j.jdent.2017.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/30/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate complete and reduced Cariogram models in predicting root caries risk in independently living older adults by comparing the caries risk assessment of the programme to observed root caries increment over a two-year period. METHODS A prospective study recording root caries incidence was conducted on 334 dentate older adults. Data were collected on participant's medical history, fluoride exposure, and diet. Saliva samples were collected to measure salivary flow rate, buffer capacity and bacterial counts. Clinical examination was completed to record decayed, missing and filled teeth (DMFT) and also exposed, filled and decayed root surfaces (RDFS). This was repeated after 12 and 24 months. Scores were entered into the Cariogram and baseline risk category was recorded. Reduced Cariogram models were generated by omitting individual salivary variables and all salivary variables. The performance of the complete and reduced Cariogram models in predicting root caries incidence were evaluated by receiver operating characteristic (ROC) analysis. RESULTS 280 participants were examined at two year follow up. 55.6% of those in the highest risk group developed new caries compared to 3.8% in the lowest risk group. The mean root caries increment in the highest risk group was 2.00 (SD 3.20) compared to 0.04 (SD 0.20) in the lowest risk group. The area under the ROC curve for the complete Cariogram model was 0.77 (95% CI 0.70-0.83) indicating a fair performance in predicting root caries. Omitting individual or all salivary variables did not significantly alter the predictive ability of the Cariogram. CONCLUSION Within the limitations of this study, the Cariogram was clinically useful in identifying individuals with a high risk of developing root caries. CLINICAL SIGNIFICANCE Identification of a caries risk assessment tool which could reliably select high-risk individuals for root caries prevention strategies would maximise the cost effectiveness of professionally delivered prevention measures.
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Affiliation(s)
- M Hayes
- Restorative Dentistry, University College Cork, Ireland.
| | - C Da Mata
- Restorative Dentistry, University College Cork, Ireland
| | - G McKenna
- Centre for Public Health, Queen's University Belfast, UK
| | - F M Burke
- Restorative Dentistry, University College Cork, Ireland
| | - P F Allen
- Restorative Dentistry, National University of Singapore, Singapore
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Albrecht M, Kupfer R, Reissmann DR, Mühlhauser I, Köpke S. Oral health educational interventions for nursing home staff and residents. Cochrane Database Syst Rev 2016; 9:CD010535. [PMID: 27689868 PMCID: PMC6457754 DOI: 10.1002/14651858.cd010535.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Associations between nursing home residents' oral health status and quality of life, respiratory tract infections, and nutritional status have been reported. Educational interventions for nurses or residents, or both, focusing on knowledge and skills related to oral health management may have the potential to improve residents' oral health. OBJECTIVES To assess the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health of nursing home residents. SEARCH METHODS We searched the Cochrane Oral Health Trials Register (to 18 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 12), MEDLINE Ovid (1946 to 18 January 2016), Embase Ovid (1980 to 18 January 2016), CINAHL EBSCO (1937 to 18 January 2016), and Web of Science Conference Proceedings (1990 to 18 January 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 18 January 2016. In addition, we searched reference lists of identified articles and contacted experts in the field. We placed no restrictions on language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs comparing oral health educational programmes for nursing staff or residents, or both with usual care or any other oral healthcare intervention. DATA COLLECTION AND ANALYSIS Two review authors independently screened articles retrieved from the searches for relevance, extracted data from included studies, assessed risk of bias for each included study, and evaluated the overall quality of the evidence. We retrieved data about the development and evaluation processes of complex interventions on the basis of the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). We contacted authors of relevant studies for additional information. MAIN RESULTS We included nine RCTs involving 3253 nursing home residents in this review; seven of these trials used cluster randomisation. The mean resident age ranged from 78 to 86 years across studies, and most participants were women (more than 66% in all studies). The proportion of residents with dental protheses ranged from 62% to 87%, and the proportion of edentulous residents ranged from 32% to 90% across studies.Eight studies compared educational interventions with information and practical components versus (optimised) usual care, while the ninth study compared educational interventions with information only versus usual care. All interventions included educational sessions on oral health for nursing staff (five trials) or for both staff and residents (four trials), and used more than one active component. Follow-up of included studies ranged from three months to five years.No study showed overall low risk of bias. Four studies had a high risk of bias, and the other five studies were at unclear risk of bias.None of the trials assessed our predefined primary outcomes 'oral health' and 'oral health-related quality of life'. All trials assessed our third primary outcome, 'dental or denture plaque'. Meta-analyses showed no evidence of a difference between interventions and usual care for dental plaque (mean difference -0.04, 95% confidence interval (CI) -0.26 to 0.17; six trials; 437 participants; low quality evidence) or denture plaque (standardised mean difference -0.60, 95% CI -1.25 to 0.05; five trials; 816 participants; low quality evidence). None of the studies assessed adverse events of the intervention. AUTHORS' CONCLUSIONS We found insufficient evidence to draw robust conclusions about the effects of oral health educational interventions for nursing home staff and residents. We did not find evidence of meaningful effects of educational interventions on any measure of residents' oral health; however, the quality of the available evidence is low. More adequately powered and high-quality studies using relevant outcome measures are needed.
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Affiliation(s)
- Martina Albrecht
- University of HamburgMIN Faculty, Unit of Health Sciences and EducationMartin‐Luther‐King PlatzHamburgGermany20146
| | - Ramona Kupfer
- University of HamburgMIN Faculty, Unit of Health Sciences and EducationMartin‐Luther‐King PlatzHamburgGermany20146
- Institute of Social Medicine, University of LübeckNursing Research Group, Institute of Social Medicine and EpidemiologyLübeckGermany
| | - Daniel R Reissmann
- University Medical Center Hamburg‐EppendorfDepartment of Prosthetic DentistryMartinistr. 52HamburgGermany20246
| | - Ingrid Mühlhauser
- University of HamburgMIN Faculty, Unit of Health Sciences and EducationMartin‐Luther‐King PlatzHamburgGermany20146
| | - Sascha Köpke
- University of LübeckNursing Research Group, Institute of Social Medicine and EpidemiologyRatzeburger Allee 160LübeckGermanyD‐23538
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Olerud E, Hagman-Gustavsson ML, Gabre P. Oral health status in older immigrants in a medium-sized Swedish city. SPECIAL CARE IN DENTISTRY 2016; 36:328-334. [PMID: 27458173 DOI: 10.1111/scd.12195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to investigate oral health and oral care habits among older immigrants to Sweden from countries outside the Nordic region. METHOD Participants ≥60 years of age from senior social centers for immigrants were invited to attend oral examinations. Data was collected on the number of teeth, dentures, caries, periodontal status, saliva secretion, and plaque scores. Participants also described their general health and oral care habits. RESULTS Fourteen men and 28 women, median age 71.5 years, participated. Seventeen percent were edentulous, women often than men. Three out of four had caries and 63% had gingival bleeding. Two-thirds brushed their teeth twice per day and 60% had visited dental services in the last 2 years. CONCLUSION The group had a high prevalence of oral diseases and discomfort. They used dental services and brushed their teeth less frequently than Swedish populations of the same age.
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Affiliation(s)
- Eva Olerud
- Public Dental Health, Uppsala County Council, Sweden
| | | | - Pia Gabre
- Public Dental Health, Uppsala County Council, Sweden. .,Department of Cariology, Institute of Odontology, The Sahlgrens, ka Academy, University of Gothenburg, Gothenburg, Sweden.
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Gupta A, Gupta A, Singh TK, Saxsena A. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients. Saudi J Anaesth 2016; 10:95-7. [PMID: 26955317 PMCID: PMC4760051 DOI: 10.4103/1658-354x.169484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.
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Affiliation(s)
- A Gupta
- Department of Prosthodontics, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - A Gupta
- Department of Anaesthesiology and Critical Care, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
| | - T K Singh
- Department of Anaesthesiology and Critical Care, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
| | - A Saxsena
- Department of Surgery, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
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Sjögren P, Girestam CC, Skott P, Marsson N, Nova R, Zimmerman M, Wårdh I. Professional Domiciliary Oral Care for Elderly in Nursing Homes—A Randomized Controlled Pilot Trial. Health (London) 2016. [DOI: 10.4236/health.2016.811116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang TF, Huang CM, Chou C, Yu S. Effect of oral health education programs for caregivers on oral hygiene of the elderly: A systemic review and meta-analysis. Int J Nurs Stud 2015; 52:1090-6. [DOI: 10.1016/j.ijnurstu.2015.01.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 11/15/2022]
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Wilberg P, Hjermstad MJ, Ottesen S, Herlofson BB. Chemotherapy-associated oral sequelae in patients with cancers outside the head and neck region. J Pain Symptom Manage 2014; 48:1060-9. [PMID: 24751438 DOI: 10.1016/j.jpainsymman.2014.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/11/2014] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
Abstract
CONTEXT Chemotherapy induces a wide array of acute and late oral adverse effects that makes symptom alleviation and information important parts of patient care. OBJECTIVES To assess the prevalence and intensity of acute oral problems in outpatients receiving chemotherapy for cancers outside the head and neck region and to investigate if information about possible oral adverse effects was received by the patients. METHODS In this cross-sectional study, outpatients aged 18 years or older were invited to participate and included if they fulfilled the inclusion criteria. All patients completed the Edmonton Symptom Assessment System, participated in a semistructured interview, and underwent an oral examination by a dentist. RESULTS Of 226 eligible patients, 155 (69%) participated. Mean age was 57 years, and 34% were males. The most prevalent diagnoses were breast (45%) and gastrointestinal cancers (37%). Xerostomia was reported by 59%, taste changes by 62%, oral discomfort by 41%, and 27% had problems eating. Fatigue (3.4) and xerostomia (3.1) received the highest intensity scores on the Edmonton Symptom Assessment System. Oral candidiasis confirmed by positive cultures was seen in 10%. Twenty-seven percent confirmed that they had received information on oral adverse effects of cancer treatment. CONCLUSION Oral sequelae were frequently reported, and health care providers should be attentive to the presence and severity of these problems. Less than one-third of the patients remembered having received information about oral sequelae associated with chemotherapy. A continuous focus on how to diagnose, manage, and inform about oral cancer-related complications is advisable.
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Affiliation(s)
- Petter Wilberg
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Marianne J Hjermstad
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stig Ottesen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway; Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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Gaszynska E, Szatko F, Godala M, Gaszynski T. Oral health status, dental treatment needs, and barriers to dental care of elderly care home residents in Lodz, Poland. Clin Interv Aging 2014; 9:1637-44. [PMID: 25284997 PMCID: PMC4181440 DOI: 10.2147/cia.s69790] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives To determine oral health status, dental treatment needs, and to identify barriers that prevent easy access to dental care by elderly care home residents in Lodz. Background Studies in many countries show that oral health status of elderly care home residents is poor and there is an urgent need to improve it. Methods The study included 259 care home residents, aged 65 years and older. The oral examination was performed. In face-to-face interviews, subjects were asked about frequency of cleaning teeth and/or dentures, whether they needed assistance, and whether the assistance was available; they were also asked about the perceived dental needs, and about the time since their last visit to a dentist and the purpose of the visit. If they had not visited the dentist in the past 12 months, they were asked about reasons for failing to visit the dentist. Results Forty-six percent of the subjects were edentulous. Only 5.8% of all participants had a sufficient number of functional natural teeth. Dental treatment was found to be necessary in 59.8% of the respondents. One in four subjects reported reduced ability of correctly cleaning teeth and dentures themselves, of whom only one-third were helped by others. An insufficient level of hygiene was found in every other subject. About 42% of residents had not visited a dentist for over 5 years, mainly due to organizational reasons. Conclusion Expanding the current scope of medical care for the elderly care home residents to include dental care would improve their currently poor oral health status.
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Affiliation(s)
- Ewelina Gaszynska
- Department of Hygiene and Health Promotion, Medical University of Lodz, Lodz, Poland
| | - Franciszek Szatko
- Department of Hygiene and Health Promotion, Medical University of Lodz, Lodz, Poland
| | - Malgorzata Godala
- Department of Nutrition and Epidemiology, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gaszynski
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland
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Fjeld KG, Mowe M, Eide H, Willumsen T. Effect of electric toothbrush on residents' oral hygiene: a randomized clinical trial in nursing homes. Eur J Oral Sci 2014; 122:142-8. [DOI: 10.1111/eos.12113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | - Morten Mowe
- Medical Clinic; Institution of Clinical Medicine; Oslo University Hospital; University of Oslo; Oslo Norway
| | - Hilde Eide
- Faculty of Health Sciences; Buskerud University College; Drammen Norway
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de Lugt-Lustig KH, Vanobbergen JN, van der Putten GJ, De Visschere LM, Schols JM, de Baat C. Effect of oral healthcare education on knowledge, attitude and skills of care home nurses: a systematic literature review. Community Dent Oral Epidemiol 2013; 42:88-96. [DOI: 10.1111/cdoe.12063] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Kersti H.M.E. de Lugt-Lustig
- BENECOMO Flemish-Netherlands Geriatric Oral Research Group Ghent; Belgium/Nijmegen The Netherlands
- Department of Oral Function and Prosthetic Dentistry; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
- Naarderheem; Vivium Zorggroep; Huizen The Netherlands
| | - Jacques N.O. Vanobbergen
- BENECOMO Flemish-Netherlands Geriatric Oral Research Group Ghent; Belgium/Nijmegen The Netherlands
- Department of Community Dentistry and Oral Public Health; Ghent University; Ghent Belgium
| | - Gert-Jan van der Putten
- BENECOMO Flemish-Netherlands Geriatric Oral Research Group Ghent; Belgium/Nijmegen The Netherlands
- Birkhoven Zorggoed Amersfoort; Amersfoort The Netherlands
| | - Luc M.J. De Visschere
- BENECOMO Flemish-Netherlands Geriatric Oral Research Group Ghent; Belgium/Nijmegen The Netherlands
- Department of Community Dentistry and Oral Public Health; Ghent University; Ghent Belgium
| | - Jos M.G.A. Schols
- BENECOMO Flemish-Netherlands Geriatric Oral Research Group Ghent; Belgium/Nijmegen The Netherlands
- CAPHRI/Department of General Practice and Department of Health Services Research; Maastricht University; Maastricht The Netherlands
| | - Cees de Baat
- BENECOMO Flemish-Netherlands Geriatric Oral Research Group Ghent; Belgium/Nijmegen The Netherlands
- Department of Oral Function and Prosthetic Dentistry; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
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Portella FF, Rocha AW, Haddad DC, Fortes CB, Hugo FN, Padilha DM, Samuel SM. Oral hygiene caregivers’ educational programme improves oral health conditions in institutionalised independent and functional elderly. Gerodontology 2013; 32:28-34. [DOI: 10.1111/ger.12049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Fernando F. Portella
- Tutorial Education Program; School of Dentistry, Federal University of Rio Grande do Sul; Porto Alegre Brazil
- Dental Materials Laboratory; School of Dentistry, Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Aline W. Rocha
- Tutorial Education Program; School of Dentistry, Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Daniel C. Haddad
- Tutorial Education Program; School of Dentistry, Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Carmem B.B. Fortes
- Dental Materials Laboratory; School of Dentistry, Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Fernando N. Hugo
- Research Center in Social Dentistry, School of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Dalva M.P. Padilha
- Research Center in Social Dentistry, School of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Susana M.W. Samuel
- Tutorial Education Program; School of Dentistry, Federal University of Rio Grande do Sul; Porto Alegre Brazil
- Dental Materials Laboratory; School of Dentistry, Federal University of Rio Grande do Sul; Porto Alegre Brazil
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Weening-Verbree L, Huisman-de Waal G, van Dusseldorp L, van Achterberg T, Schoonhoven L. Oral health care in older people in long term care facilities: a systematic review of implementation strategies. Int J Nurs Stud 2013; 50:569-82. [PMID: 23290098 DOI: 10.1016/j.ijnurstu.2012.12.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the importance of a clear evidence-based implementation strategy to improve oral health care. The aim of this study is to review implementation strategies used to promote or improve oral health care for older people in long term care facilities from the perspective of behaviour change, to code strategy content at the level of determinants, and to explore their effectiveness. DESIGN Systematic review of literature. DATA SOURCES The digital databases of the Cochrane Library, PubMed and Cinahl have been searched up to September 2011 for relevant articles. REVIEW METHODS After a systematic selection process, included studies were quality assessed by three researchers. We extracted the study characteristics using the EPOC Data Collection Checklist and Data Abstraction Form. Strategy content was extracted and coded by using the Coding Manual for Behavioural Change Techniques. This manual groups the behaviour change techniques under relevant behavioural determinants. RESULTS Twenty studies were included in this review. Implementation strategies were delivered by dental hygienists or dentists. Oral health care was performed by nurses and nurse assistants in all studies. All studies addressed knowledge, mostly operationalized as one educational session. Knowledge was most often combined with interventions addressing self efficacy. Implementation strategies aimed at knowledge (providing general information), self-efficacy (modelling) or facilitation of behaviour (providing materials to facilitate behaviour) were most often identified as successful in improving oral health. CONCLUSIONS Knowledge, self-efficacy and facilitation of behaviour are determinants that are often addressed in implementation strategies for successful improvement of oral health care in older patients. Strategies addressing increasing memory, feedback of clinical outcomes, and mobilizing social norm are promising and should be studied in the future. However, as the quality and heterogeneity of studies is a reason for concern, it is not possible to unequivocally recommend strategies or combinations of strategies for improving oral health care in the older population. When choosing strategies to improve oral health care, care professionals should thoroughly examine the setting and target group, identify barriers to change and tailor their implementation strategies to these barriers for oral health care.
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Affiliation(s)
- L Weening-Verbree
- University Medical Center Groningen, Centre for Dentistry and Oral Hygiene Groningen (CTM), Groningen, The Netherlands
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The impact of oral health on taste ability in acutely hospitalized elderly. PLoS One 2012; 7:e36557. [PMID: 22570725 PMCID: PMC3343000 DOI: 10.1371/journal.pone.0036557] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/06/2012] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate to what extent various oral health variables are associated with taste ability in acutely hospitalized elderly. Background Impaired taste may contribute to weight loss in elderly. Many frail elderly have poor oral health characterized by caries, poor oral hygiene, and dry mouth. However, the possible influence of such factors on taste ability in acutely hospitalized elderly has not been investigated. Materials and Methods The study was cross-sectional. A total of 174 (55 men) acutely hospitalized elderly, coming from their own homes and with adequate cognitive function, were included. Dental status, decayed teeth, oral bacteria, oral hygiene, dry mouth and tongue changes were recorded. Growth of oral bacteria was assessed with CRT® Bacteria Kit. Taste ability was evaluated with 16 taste strips impregnated with sweet, sour, salty and bitter taste solutions in 4 concentrations each. Correct identification was given score 1, and maximum total taste score was 16. Results Mean age was 84 yrs. (range 70–103 yrs.). Total taste score was significantly and markedly reduced in patients with decayed teeth, poor oral hygiene, high growth of oral bacteria and dry mouth. Sweet and salty taste were particularly impaired in patients with dry mouth. Sour taste was impaired in patients with high growth of oral bacteria. Conclusion This study shows that taste ability was reduced in acutely hospitalized elderly with caries activity, high growth of oral bacteria, poor oral hygiene, and dry mouth. Our findings indicate that good oral health is important for adequate gustatory function. Maintaining proper oral hygiene in hospitalized elderly should therefore get high priority among hospital staff.
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Oral health is an important issue in end-of-life cancer care. Support Care Cancer 2012; 20:3115-22. [PMID: 22434497 DOI: 10.1007/s00520-012-1441-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 03/12/2012] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aims to assess the prevalence of oral morbidity in patients receiving palliative care for cancers outside the head and neck region and to investigate if information concerning oral problems was given. METHODS Patients were recruited from two Norwegian palliative care inpatient units. All patients went through a face-to-face interview, completed the Edmonton Symptom Assessment System (ESAS) covering 10 frequent cancer-related symptoms, and went through an oral examination including a mouth swab to test for Candida carriage. RESULTS Ninety-nine of 126 patients (79 %) agreed to participate. The examined patients had a mean age of 64 years (range, 36-90 years) and 47 % were male. Median Karnofsky score was 40 (range, 20-80) and 87 % had metastatic disease. Estimated life expectancy was <3 months in 73 %. Dry mouth was reported by 78 %. The highest mean scores on the modified 0-10 ESAS scale were 4.9 (fatigue), 4.7 (dry mouth), and 4.4 (poor appetite). Clinical oral candidiasis was seen in 34 % (86 % positive cultures). Mouth pain was reported by 67 % and problems with food intake were reported by 56 %. Moderate or rich amounts of dental plaque were seen in 24 %, and mean number of teeth with visible carious lesions was 1.9. One patient was diagnosed with bisphosphonate-related osteonecrosis of the jaw. Overall, 78 % said they had received no information about oral adverse effects of cancer treatment. CONCLUSION Patients in palliative care units need better mouth care. Increased awareness among staff about the presence and severity of oral problems is necessary. Systematic information about oral problems is important in all stages of cancer treatment.
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Olerud E, Hagman-Gustafsson ML, Gabre P. Oral status, oral hygiene, and patient satisfaction in the elderly with dental implants dependent on substantial needs of care for daily living. SPECIAL CARE IN DENTISTRY 2012; 32:49-54. [DOI: 10.1111/j.1754-4505.2012.00236.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Solemdal K, Sandvik L, Møinichen-Berstad C, Skog K, Willumsen T, Mowe M. Association between oral health and body cell mass in hospitalised elderly. Gerodontology 2011; 29:e1038-44. [PMID: 22187971 DOI: 10.1111/j.1741-2358.2011.00607.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine whether oral health in hospitalised elderly was associated with body cell mass (BCM) measured with Bioimpedance spectroscopy. BACKGROUND Body cell mass is the tissue producing the metabolic work necessary for all body functions. BCM is mainly muscle tissue. Low BCM is associated with diseases, ageing and poor nutritional status. Reduced oral health is also associated with these parameters; thus, BCM and oral health may be related. METHODS Body cell mass was measured using Bioimpedance spectroscopy in 138 acutely hospitalised elderly ≥70 years. The number of own teeth, posterior occluding tooth pairs and decayed teeth were registered. Oral hygiene was registered with Mucosal-Plaque Score, an index based on assessment of plaque accumulation and mucosal/gingival inflammation. Mini Nutritional Assessment-Short Form, body mass index and handgrip strength were used as nutritional indicators. Comorbidity was assessed with Cumulative Index Rating Scale. RESULTS Mean age was 83.2 ± 5.9 years, ranging from 70 to 101 years. Dentition status was significantly and positively associated with BCM. Reduced oral hygiene was significantly associated with low BCM. These findings remained significant after adjusting for confounders. CONCLUSION These results show that compromised oral health was significantly associated with reduced BCM in hospitalised elderly.
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Strömberg E, Hagman-Gustafsson ML, Holmén A, Wårdh I, Gabre P. Oral status, oral hygiene habits and caries risk factors in home-dwelling elderly dependent on moderate or substantial supportive care for daily living. Community Dent Oral Epidemiol 2011; 40:221-9. [DOI: 10.1111/j.1600-0528.2011.00653.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Willumsen T, Karlsen L, Naess R, Bjørntvedt S. Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Gerodontology 2011; 29:e748-55. [PMID: 22023222 DOI: 10.1111/j.1741-2358.2011.00554.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To explore nursing home patients' oral hygiene and their nurses' assessments of barriers to improvement. BACKGROUND In nursing homes, nurses are responsible for patients' oral hygiene. MATERIALS AND METHODS This study assessed the oral hygiene of 358 patients in 11 Norwegian nursing homes. 494 nurses in the same nursing homes participated in a questionnaire study. RESULTS More than 40% of patients had unacceptable oral hygiene. 'More than 10 teeth' gave OR = 2, 1 (p = 0.013) and 'resist being helped' OR = 2.5 (p = 0.018) for unacceptable oral hygiene. Eighty percent of the nurses believed knowledge of oral health was important, and 9.1% often considered taking care of patients' teeth unpleasant. Half of the nurses reported lack of time to give regular oral care, and 97% experienced resistant behaviour in patients. Resistant behaviour often left oral care undone. Twenty-one percent of the nurses had considered making legal decisions about use of force or restraints to overcome resistance to teeth cleaning. CONCLUSION Oral hygiene in the nursing homes needed to be improved. Resistant behaviour is a major barrier. To overcome this barrier nurses' education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients are important factors.
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Ames NJ, Sulima P, Yates JM, McCullagh L, Gollins SL, Soeken K, Wallen GR. Effects of systematic oral care in critically ill patients: a multicenter study. Am J Crit Care 2011; 20:e103-14. [PMID: 21885453 DOI: 10.4037/ajcc2011359] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND No standard oral assessment tools are available for determining frequency of oral care in critical care patients, and the method of providing oral care is controversial. OBJECTIVES To examine the effects of a systematic program of oral care on oral assessment scores in critically ill intubated and nonintubated, patients. METHODS Clinical data were collected 3 times during critical care admissions before and after institution of a systematic program of oral care in 3 different medical centers. The oral care education program consisted of instruction from a dentist or dental hygienist and a clear procedure outlining systematic oral care. The Beck Oral Assessment Scale and the mucosal-plaque score were used to assess the oral cavity. Data were analyzed by using linear mixed modeling with controls for severity of illness. RESULTS Scores on the Beck Scale differed significantly (F = 4.79, P = .01) in the pattern of scores across the 3 days and between the control group (before oral education) and the systematic oral care group. Unlike the control group, the treatment group had decreasing scores on the Beck Scale from day 1 to day 5. The mucosal-plaque score and the Beck Scale scores had strong correlations throughout the study; the highest correlation was on day 5 (r = 0.798, P < .001, n = 43). CONCLUSIONS Oral assessment scores improved after nurses implemented a protocol for systematic oral care. Use of the Beck Scale and the mucosal-plaque score could standardize oral assessment and guide nurses in providing oral interventions.
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Samson H, Berven L, Strand GV. Long-term effect of an oral healthcare programme on oral hygiene in a nursing home. Eur J Oral Sci 2009; 117:575-9. [PMID: 19758255 DOI: 10.1111/j.1600-0722.2009.00673.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article reports on the long-term effect of an oral healthcare programme aimed at improving and maintaining the oral hygiene of elderly residents in a nursing home. The method was based on (i) motivation and oral-care training of the nursing staff, (ii) production of picture-based oral-care procedure cards, (iii) distribution of adequate oral-care equipment, (iv) practical implementation of new routines, and (v) assessment of results attained. The level of oral hygiene in the nursing home was assessed using the mucosal-plaque score (MPS) index. Overall evaluation was made before the start of the study, after 3 months, and eventually after 6 yr. Before implementation of the oral healthcare programme, 36% of the residents had an acceptable score. Six years later, the proportion was 70%. The evaluation showed that the introduction of such an oral healthcare programme significantly improved the oral hygiene of the residents on a long-term basis. However, 30% of the residents did not achieve an acceptable score because they were very ill or dying, aggressive or wanted to brush their teeth themselves.
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Affiliation(s)
- Heidi Samson
- Department of Clinical Dentistry - Gerodontology, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
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Isaksson R, Becktor JP, Brown A, Laurizohn C, Isaksson S. Oral health and oral implant status in edentulous patients with implant-supported dental prostheses who are receiving long-term nursing care. Gerodontology 2009; 26:245-9. [DOI: 10.1111/j.1741-2358.2009.00275.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Persson K, Axtelius B, Söderfeldt B, Ostman M. Monitoring oral health and dental attendance in an outpatient psychiatric population. J Psychiatr Ment Health Nurs 2009; 16:263-71. [PMID: 19291155 DOI: 10.1111/j.1365-2850.2008.01364.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Impaired mental health has been associated with an increased need for dental care. Population surveys have indicated that people with enduring mental health problems make less frequent planned visits to the dentist and report a greater number of missing teeth than the general population. The study aims to examine oral health status, attendance to dental care, and medication in an outpatient psychiatric sample. A descriptive study combining a structured interview with a visual oral examination carried out in 113 outpatients under psychiatric care. Dental health was described in terms of sound, missing and/or filled teeth, and showed a relation between these categories and types of psychiatric diagnosis, age and numbers of antidepressant and neuroleptic drugs. Oral hygiene was found to be more neglected among men and in patients with the diagnosis of schizophrenia. The need of dental treatment was widespread, although regular dental visits were commonly reported. In order to maintain good oral health, regular dental check-ups should be encouraged for patients under psychiatric care. Further studies are required to reveal contributory causes for/to decreased oral health. The difficulty such individuals have in maintaining additional self-efficacy raises questions about the necessity for oral health interventions in outpatient psychiatric services.
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Affiliation(s)
- K Persson
- Faculty of Health and Society, Malmö University, Malmö, Sweden.
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Kida IA, Astrøm AN, Strand GV, Masalu JR. Clinical and socio-behavioral correlates of tooth loss: a study of older adults in Tanzania. BMC Oral Health 2006; 6:5. [PMID: 16536880 PMCID: PMC1471779 DOI: 10.1186/1472-6831-6-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 03/15/2006] [Indexed: 11/25/2022] Open
Abstract
Background Focusing 50 year olds and above, this study assessed the frequency, extent and correlates of tooth loss due to various reasons. Frequency and correlates of posterior occluding support was also investigated. Method A cross-sectional household survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. One thousand and thirty-one subjects, mean age 62.9 years participated in a clinical examination and completed interviews. Results The prevalence of tooth loss due to any reason was 83.5 %, due to caries 63.4% and due to other reasons than caries, 32.5%. A total of 74.9% had reduced number of posterior occluding units. Compared to subjects having less than 5 teeth lost due to caries, those with 5 or more lost teeth were more likely to be females, having decayed teeth, confirming dental attendance and to be among the least poor residents. Compared to subjects who had lost less than 5 teeth due to reasons other than caries, those who had lost 5 or more teeth were more likely to be of higher age, having mobile teeth, being males, being very poor and to disconfirm dental attendance when having problems. Predictors of prevalence of tooth loss (1 or more lost tooth) due to various reasons and reduced number of occluding units followed similar patterns of relationships. Conclusion The results are consistent with prevalence and extent of tooth loss due to caries and due to reasons other than caries being differently related to disease- and socio- behavioral risk indicators. Caries was the principle cause of tooth loss and molar teeth were the teeth most commonly lost.
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Affiliation(s)
- Irene A Kida
- Centre for International Health, UoB, Bergen, Norway.
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Abstract
AIM This paper presents a literature review of oral hygiene care for adults with dementia in residential aged care facilities, including evidence for: (1) prevalence, incidence, experiences and increments of oral diseases; (2) use of assessment tools to evaluate residents' oral health; (3) preventive oral hygiene care strategies; and (4) provision of dental treatment. BACKGROUND The impact of dementia on residential care is ever-increasing and regular oral hygiene care provision is challenging for cognitively impaired residents. Although an abundance of oral hygiene care recommendations for older people have been published, the supporting evidence has not been clearly delineated. METHODS A review was conducted of English language publications (1980-2002), using a two-step approach (keyword electronic database search, supplemented with secondary search of cited references). All 306 selected articles were critically reviewed and systematically categorized. RESULTS Evidence confirmed clinicians' observations of poor oral health in older residents with dementia. Possible risk factors identified were: salivary dysfunction, polypharmacy, medical conditions, swallowing and dietary problems, functional dependence, oral hygiene care assistance and poor use of dental care. One comprehensive, reliable and validated oral assessment screening tool for residents with dementia had been published. Expert opinion indicated that oral assessment screening by staff and a dentist would be ideal at admission and regularly thereafter. Clinicians and researchers suggested that oral hygiene care strategies were effective in preventing oral diseases and appropriate for residents with dementia. CONCLUSION These literature review findings supported the use of oral assessment screening tools by staff and efficacious preventive oral hygiene care strategies/products for adults with dementia in residential care facilities. Further research with this population is needed to develop and validate oral assessment tools and staff education programmes, trial preventive oral hygiene care strategies/products and trial dementia-focused behaviour management and communication strategies.
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Affiliation(s)
- Jane Chalmers
- Preventive and Community Dentistry, The University of Iowa College of Dentistry, Iowa city, Iowa 52242-1010, USA.
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Chalmers JM, Pearson A. A Systematic Review of Oral Health Assessment by Nurses and Carers for Residents with Dementia in Residential Care Facilities. SPECIAL CARE IN DENTISTRY 2005; 25:227-33. [PMID: 16454098 DOI: 10.1111/j.1754-4505.2005.tb01654.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper presents systematic review findings to best summarize the assessment of oral health and the use of oral assessment tools by nurses and carers for adults with dementia living in residential aged care facilities. The systematic review searched electronic databases for articles in English (1980 to 2002) and supplemented these with a secondary search of references cited in articles meeting the review inclusion criteria. Delineation is needed between a comprehensive dental examination conducted by a qualified dentist and a dental assessment screening by a carer, nurse, allied health professional or medical practitioner. Dental examinations should be supplemented with oral health assessments and screenings by trained nurses and carers to monitor residents' oral health, evaluate oral hygiene care interventions, act as a trigger to call in a dentist when required, assist with residents' individualized oral hygiene care planning and assist with triaging and prioritization of residents' dental needs. To date, the most comprehensive, validated and reliable assessment screening tool for use by nurses and carers with cognitively impaired institutionalized residents is the Brief Oral Health Status Examination. Other less comprehensive oral assessment tools that are useful for nurses and carers of institutionalized dementia populations include the Index of Activities of Daily Oral Hygiene and the Mucosal Plaque Score. These review findings presented evidence to support the use of oral assessment screening tools by nurses and carers for cognitively impaired residents living in residential aged care facilities. Few validated and reliable tools have been published for use by carers in the cognitively impaired residential care population, and continued evolution of oral assessment screening tools needs to embrace the complete spectrum of residents' levels of cognitive impairment.
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Affiliation(s)
- Jane M Chalmers
- Preventive and Community Dentistry, The University of Iowa, USA.
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Henriksen BM, Ambjørnsen E, Laake K, Axéll TE. Oral hygiene and oral symptoms among the elderly in long-term care. SPECIAL CARE IN DENTISTRY 2004; 24:254-9. [PMID: 15552343 DOI: 10.1111/j.1754-4505.2004.tb01702.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Dental teams examined 1910 elderly adults living in long-term care settings (1358 institutionalized, 552 homebound) from all 19 counties in Norway to document oral hygiene, oral symptoms and ability to receive dental treatment. The Mucosal-Plaque Score (MPS) was used to assess oral status. The MPS was significantly better in women than in men, in individuals with dentures than in those with any remaining teeth, and in people who were homebound rather than those who lived in institutions. The MPS did not differ between age groups or geographic regions. According to the Treatment Ability Index, nearly a quarter of the sample was able to receive comprehensive dental care. Reports of "any oral symptom" and "eating/chewing problems" decreased with age and were most prevalent for individuals who had dentures. The MPS had only slight impact on oral symptoms, chewing ability and dry mouth (p > 0.05). Dry mouth was found in 16.9% and was most prevalent in individuals with dentures.
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Pearson A, Chalmers J. Oral hygiene care for adults with dementia in residential aged care facilities. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1479-6988.2004.00009.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Pearson A, Chalmers J. Oral hygiene care for adults with dementia in residential aged care facilities. ACTA ACUST UNITED AC 2004. [DOI: 10.11124/jbisrir-2004-378] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pearson A, Chalmers J. Oral hygiene care for adults with dementia in residential aged care facilities. ACTA ACUST UNITED AC 2004; 2:1-89. [PMID: 27820001 DOI: 10.11124/01938924-200402030-00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: INCLUSION CRITERIA: This review considered any randomised or non-randomised controlled studies, cohort studies, case-control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community-dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to:1 quantify the oral health status of older adults living in residential aged care facilities;2 quantify the oral health status of adults with dementia living in the community and in residential aged care facilities;3 evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities;4 evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and5 evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities.Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss-of-attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics. SEARCH STRATEGY The aim of the search was to locate relevant English-language studies and publications appearing between 1980 and 2002. The search utilised a two-step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents. METHODOLOGICAL QUALITY All selected studies were critically appraised by two reviewers prior to inclusion in the review. RESULTS In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents' oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions. CONCLUSIONS This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands-on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.
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Affiliation(s)
- Alan Pearson
- 1The Joanna Briggs Institute, Adelaide, South Australia, Professor of Nursing, La Trobe University, Melbourne, Victoria, and Adjunct Professor, The University of Adelaide, Adelaide, South Australia, Australia 2Preventive and Community Dentistry, The University of Iowa, Iowa City, Iowa, USA Associate Professor Jane Chalmers, Preventive and Community Dentistry, College of Dentistry, The University of Iowa, Iowa City, IA 52242-1010, USA
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Wårdh I, Berggren U, Andersson L, Sörensen S. Assessments of oral health care in dependent older persons in nursing facilities. Acta Odontol Scand 2002; 60:330-6. [PMID: 12512881 DOI: 10.1080/000163502762667342] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The number of dependent elderly with natural teeth is increasing dramatically. If these elderly persons do not receive proper oral health care, severe oral problems are likely to result. In conjunction with an oral health care education program for the staff of nursing facilities, oral health status was assessed and semi-structured interviews performed with residents and their relatives about oral health care. The assessments were made at baseline and at an 18-month follow-up. The project was conducted as a longitudinal, controlled study with an intervention and a control group. The aim of the study was to evaluate differences between the intervention and control group after oral health care intervention. At follow-up, it was shown that the intervention group had established more dental contacts. However, the results also indicated that the residents were not concerned about their oral health. Nursing staff therefore have to be responsible for oral health care if improved care for residents is to be realized.
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Affiliation(s)
- Inger Wårdh
- Department of Oral Diagnosis, Faculty of Odontology, Göteborg University, Sweden.
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