Dental status and satisfaction with oral function in a sample of community-dwelling elderly people in Japan

Oral Health of Older Patients in Dental Practice: An Exploratory Study

BACKGROUND

Some older people stop visiting the dentist when they get older. This study aims to identify the characteristics and oral health status of older people who do visit community dental practices.

METHODS

In this exploratory cross-sectional study, the oral health of Dutch community-dwelling older people was assessed. A random sample of general dental practitioners and older people who visit the dental practice was drawn. The dentists were asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to complete a questionnaire. Data were described for 3 distinct groups of older people. Statistical measures for distribution and dispersion were used to describe the oral health of community-dwelling older patients in relation to the age.

RESULTS

A total of 373 (40.4%) dentist registration forms and 372 (40.3%) patient questionnaires were returned. Data were available for 364 (39.4%) dentist-patient couples. Amongst the patients, 52.8% were female and most had a high socioeconomic status. About 65.7% had one or more problems related to general health, and 75.2% used medication. Regarding the overall oral health status, the average number of teeth was 20, 3.5% were edentulous. Oral health problems were more common in the older patient group (aged 75+), in whom frailty was also most common.

CONCLUSIONS

Older people who visit community dental practices are still relatively healthy, non-frail, and highly educated.  Even in this group, there is a turning point in both general and oral health from the age of 75.

Taste disorder's management: a systematic review

BACKGROUND

Taste disorder is a frequent drug-induced or disease-related oral trouble. Various pharmacological, surgical, or physical treatments have previously been proposed for taste function recovery.

OBJECTIVES

The aim of the present systematic review was to assess the effects of palliative and curative interventions on taste recovery in light of recent literature.

MATERIALS AND METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a search of the literature published up to June 2019 was conducted using MEDLINE via PubMed, EMBASE, and The US National Institutes of Health Trials Register (PROSPERO registration reference: CRD 42019139315). The methodological quality of the included trials was rated with the "Delphi list For Quality Assessment of Randomized Clinical Trials" and the Newcastle-Ottawa scale.

RESULTS

From the 1842 titles first identified, 28 articles met the inclusion criteria. Interventions included zinc (aspartate, sulfate, gluconate, acetate, picolinate, and Polaprezinc®), esomeprazole, L-thyroxin, bethanechol, oral glutamine, delta-9-tetrahydrocannabinol, alpha-lipoic acid, Ginkgo biloba, artificial saliva, pilocarpine, local anesthesia, and improved oral hygiene. The quality of evidence ranged from poor to high.

CONCLUSION

Improving oral hygiene may promote taste ability. Zinc may prevent and alleviate taste disorder in patients undergoing head and neck radiotherapy.

CLINICAL RELEVANCE

The systematic review provided evidence about the clinical efficacy of oral procedures, zinc supplementation, and palliative cares in dysgeusic patients. Further research is needed to find effective treatments with low adverse effects.

Distribution of dentists in the Greater Tokyo Area, Japan

INTRODUCTION

Japan is considered to have an overabundance of dentists; however, there are scarce data on regional inequalities in the ratio of dentists to patients. We examined these inequalities in Japan's Greater Tokyo Area - otherwise known as the Kanto region, and the world's most populous metropolitan area - by subdividing it into small- and medium-sized medical care zones.

METHODS

We calculated the number of dentists per 100,000 population using the 2012 Survey of Physicians, Dentists, and Pharmacists for the three medical district tiers [primary medical care zones: municipalities (cities, towns, villages and special wards); secondary medical care zones: multiple adjacent municipalities; and tertiary care zones: prefectures]. We also estimated the influence of having a dental school in the district or an adjacent district on the number of dentists.

RESULTS

The number of dentists per 100,000 population was 79.2 across the whole Kanto region; the range for each type of medical care zone was as follows: 65.3-126.4 at the tertiary level; 38.0-929.6 at the secondary level; and 0-3,087.6 at the primary level. The median Gini coefficient among tertiary medical care zones was 0.16 (range 0.11-0.36). The median number of dentists per 100,000 population was 273.8 in primary medical care zones that had a dental school, 79.9 in adjacent zones, and 59.6 in other zones.

CONCLUSIONS

We identified significant inequalities in the number of dentists among the medical care zones, and the presence of a dental school had a major influence on this number.

Does reduced mastication influence cognitive and systemic health during aging?

There is a growing body of literature which suggests that oral health and mastication can influence cognitive and systemic health during aging. However, it is currently unclear whether oral health, masticatory efficiency, cognitive health and systemic health merely deteriorate independently with age, or whether mechanisms exist linking mastication to cognitive and systemic health directly. The aim of this paper is to review the extent to which reduced mastication influences cognitive and systemic health during aging because this knowledge may underpin future interventions that improve quality of life. Current evidence suggests that a deterioration in mastication and oral health during aging can have: 1) direct effects on systemic health through mechanisms such as the migration of the oral microbiota into the systemic environment, and 2) indirect effects on systemic health through changes nutrient intake. A loss of teeth and reduction in masticatory efficiency during aging can have: 1) direct effects on cognitive performance and potentially impact cognitive health through mechanisms such as enhanced adult hippocampal neurogenesis, and 2) indirect effects on cognitive health through changes in nutrient intake. It is concluded that oral health and masticatory efficiency are modifiable factors which influence the risk poor cognitive and systemic health during aging, although it is currently premature to propose chewing-based interventions to slow the rate of cognitive decline and improve cognitive health during aging. Future research should include large-scale longitudinal studies which control for the types of confounding factors which concurrently influence the association between mastication and cognitive and systemic health.

Problems faced by complete denture-wearing elderly people living in jammu district

CONTEXT

Poor oral health is increasing dramatically among old people especially those living in rural and remote areas. Various factors such as low education background, low income, poor living conditions, unhealthy lifestyle, inadequate oral hygiene and tobacco use lead to poor oral health among older people which in turn lead to risks to their general health. The older people especially from rural areas are apprehensive about seeing a dentist and do not visit them regularly. This may lead to various problems which may have a detrimental influence on their quality of life.

AIM

To know the problems faced by complete denture wearers in rural areas in Jammu district.

MATERIALS AND METHODS

Fifty patients from rural area Bishna, initially treated with a complete denture in the maxilla or mandibles were examined. The data were collected with the help of a questionnaire.

RESULTS

The results revealed that majority of respondents were in the age - group of 65-70 y. Majority of respondents complained of "difficulty chewing", "sore spots", "painful and swollen gums". Majority of respondents had difficulty in speech, it was difficult for them to interact and communicate with their dentures on. Most of the respondents had lost confidence and had low self esteem. Clinical observations revealed that the commonest condition associated with denture wearing was Oral Stomatitis/ Burning mouth Syndrome, Superimposed infection and Angular cheilitis.

CONCLUSION

Older people should Communicate and visit dentists, regularly, so that the dentists can adjust the treatment and pace according to their needs. Behavioural therapy techniques can make dental visits relatively anxiety and pain-free.

A randomised trial of a simplified method for complete denture fabrication: patient perception and quality

Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage for the patient. This study compared a simplified method for complete denture fabrication to a conventional protocol in terms of oral health-related quality of life (OHRQoL), patient satisfaction and denture quality. Forty-two edentulous patients requesting treatment with complete dentures were randomly allocated into two study groups. Group S received dentures fabricated by a simplified method and Group C received conventionally fabricated dentures. Before interventions and after three and 6 months following insertion, OHRQoL and patient satisfaction were analysed by specific instruments. A prosthodontist assessed denture quality 3 months after delivery. Groups presented no difference for OHRQoL, denture quality and general satisfaction. Differences regarding patient satisfaction with some aspects of the dentures were found after 3 months (S > C), but were insignificant at 6 months. It was concluded that the simplified method is able to produce dentures of a quality comparable to those produced by the conventional method, influencing OHRQoL and patient satisfaction similarly.

National survey on edentulism and its geographic distribution, among Mexicans 18 years of age and older (with emphasis in WHO age groups)

To determine the prevalence of edentulism in adults aged 18 years and older in Mexico and to describe its distribution in 20 of the 32 States in Mexico, highlighting the experience in the WHO age groups. A secondary analysis of the National Performance Evaluation Survey 2002-2003 (representative at the state level and part of the Word Health Survey) was undertaken. The sample design was probabilistic, stratified and through conglomerates. Data on dental conditions were available only for 20 of the 32 states of Mexico, leading to a total of 24 159 households (N = 54 638 654). The percentage of edentulism was determined as the proportion of subjects that self-reported complete loss of teeth. Data were analyzed using the SVY module for complex surveys in STATA 8.2. The mean age was 41.3 +/- 17.0 years (range 18-99). An estimated 6.3% (N = 3 437 816) of the population > or =18 years was edentulous. Lowest prevalences were observed in the states of Tlaxcala, Puebla and the Estado de Mexico with 3.4%, 3.8% and 4.5%, respectively. Highest prevalences were observed in San Luis Potosí, Colima, and Michoacán with 10.3%, 10.2% and 10.1%, respectively. Following the WHO age groups, the prevalence ranged from 2.4% in the 35-44 group through 25.5% in the 65-74 group. No obvious association between socio-economic and socio-demographic indicators at the state level and prevalence of edentulism was found. The prevalence of complete tooth loss observed in the present study varied greatly across states, although no straightforward association was found with socio-economic and socio-demographic indicators at the state level. This study could serve as a baseline to enable future evaluations of the oral status of Mexican adults and elders, following WHO age groups.

Chewing problems and dissatisfaction with chewing ability: a survey of older Tanzanians

This study assessed the prevalence and correlates of reported chewing problems and dissatisfaction with chewing ability. Discrepancy between reported chewing problems and satisfaction/dissatisfaction with chewing ability was examined. A household survey was conducted in Tanzania in 2004/2005. A total of 1,031 adults (mean age 62.9 yr) underwent clinical examination and a personal interview. Forty per cent [95% confidence interval (CI): 37-43] reported problems with chewing at least one food item, and 25% (95% CI: 22-28) were dissatisfied with their chewing ability. Adjusted odds ratios (OR) for reporting problems with chewing any food were 1.6, 1.2, and 4.2 if having intact anterior/reduced posterior, reduced anterior/intact posterior, and reduced anterior/posterior occluding units, respectively. Subjects dissatisfied with their chewing ability were less likely to be female (OR = 0.6) and more likely to have reduced anterior/posterior occluding units (OR = 3.4), to report dental pain (OR =2.5), chewing problems (OR = 4.7), and oral impacts on daily performances (OIDP) (OR = 3.2). The OIDP scores discriminated between satisfied and dissatisfied groups, irrespective of confirmed chewing problems. Chewing problems and dissatisfaction with chewing ability was prevalent among older Tanzanians. Clinical measures of dentition status, together with reported functional and psychosocial impact scores, determined the subjects' evaluation of their chewing ability and should be taken into account when estimating treatment needs.

Factors associated with taste dissatisfaction in the elderly

The purpose of this study was to investigate taste sensation in the elderly, and to determine relationships between subjective dissatisfaction with taste ability and factors such as age, gender and oral status among independently living elderly individuals. Participants were older adults (mean age, 66.0 +/- 4.2 years; 321 men and 319 women) voluntarily attending a Senior Citizen Educational Program supported by local government in 2003 and 2004. The questionnaire included self-assessed items on general health, dry mouth, chewing satisfaction and taste satisfaction. Respondents underwent investigation of salivary flow rate, dental status and gustatory testing using the filter-paper disc method for sweet, salty, sour and bitter. Chi-squared tests showed that the factors associated with dissatisfaction with taste ability were older age, dissatisfaction with chewing, dry mouth during eating and wearing dentures covering the entire hard palate. The sensation for each taste was not significantly related to taste satisfaction by chi-squared test. Multiple logistic regression analysis showed that dry mouth during eating, dentures covering the entire hard palate, dissatisfaction with chewing and discriminatory threshold for the sour taste were associated with dissatisfaction with taste ability. We found a significant association between subjective taste dissatisfaction and certain oral factors; hence, when patients complain about diminished taste, dentists must assess oral status as well as taste sensation.

Correlates of partial tooth loss and edentulism in the Brazilian elderly

BACKGROUND

In South American older adults the association between tooth loss and demographic, predisposing and enabling factors has not been determined. The purpose of this study was to evaluate the association between partial and complete tooth loss and demographic, predisposing, enabling and need factors, and quality of life variables in the Brazilian older adults.

METHODS

In this cross-sectional study, 5349 subjects aged 65-74 years were evaluated using conglomerate random sampling. Data collection included dental examinations and questionnaires evaluating demographic, predisposing, enabling and need factors, and quality of life variables. Multinomial logistic regression was carried out to evaluate correlates of tooth loss. The number of teeth was set as the outcome and categorized as: edentulous, subjects with 1-19 teeth, and subjects with 20 or more teeth.

RESULTS

Predisposing factors including age, female gender and schooling were independently associated with edentulism. Female gender was associated with partial tooth loss. The only enabling factor associated with edentulism was car ownership. Need factors were associated with edentulism and partial tooth loss. Edentulous subjects perceived the need for dental treatment less frequently. Quality of life factors were associated with partial tooth loss and edentulism. Subjects with 1-19 teeth and edentulous subjects were more likely to rate their chewing ability as not good. Edentulous subjects were more likely to rate their speech ability and their dental appearance as good.

CONCLUSIONS

The results indicate that tooth loss and edentulism were complex phenomena, with intricate predisposing, demographic, enabling and need factors playing a role.

Relationship between cognitive impairment and oral health: results of the Health 2000 Health Examination Survey in Finland

OBJECTIVE

The aim was to study oral health in relation to cognitive impairment in the general population.

MATERIAL AND METHODS

The study population comprised 2320 persons aged 55 years or older who participated in a nationally representative Health 2000 Health Examination Survey in Finland. The data were collected by interviews and clinical oral examinations. Cognition was assessed using a shortened version of the Mini-Mental State Examination (score 0-16). Poisson regression models were used to estimate the relative risk (RR) for continuous variables and logistic regression models to estimate the odds ratio (OR) for dichotomized variables.

RESULTS

The results show that individuals with cognitive impairment have more carious teeth (MMSE 11-10: RR: 1.3, CI: 0.9-1.7, MMSE 9-0: RR: 1.5 CI: 1.0-2.4) than healthy persons. Furthermore, compared to cognitively healthy subjects, those with MMSE 9-0 more often have no teeth and no dentures (OR: 5.2, CI: 1.0-26.6) and less often good denture hygiene (OR: 0.4, CI: 0.2-0.7).

CONCLUSION

Cognitively impaired subjects among older adults in Finland have more carious teeth, are more often edentulous without using a denture, and have poorer denture hygiene than cognitively healthy persons.

Edentulism among Mexican adults aged 35 years and older and associated factors

We used National Performance Evaluation Survey data to estimate the prevalence and associated factors of edentulism among noninstitutionalized adults aged 35 years and older in Mexico. Statistically, the variables positively associated with edentulism were older age (odds ratio [OR]=1.08) and female gender (OR=1.79). Nonsmoking status (OR=0.70) and having a higher wealth index score (OR=0.72) were negatively associated. This information constitutes the first large-scale evaluation in Mexico for one of the World Health Organization's priority oral health problems.

Impact of dry mouth on oral symptoms and function in removable denture wearers in Japan

OBJECTIVE

The purpose of this study was to determine the association of dry mouth with oral symptoms and function, such as denture instability, discomfort, soreness in denture-bearing tissue, and dissatisfaction with chewing, tasting, or speaking in removable denture wearers.

STUDY DESIGN

The subjects were 493 removable denture wearers with a mean age of 67.3 years. Perception of oral dryness was measured by a questionnaire. A multiple logistic regression analysis was used to determine the effect of the dry mouth on oral symptoms and function after controlling for age and gender.

RESULTS

Oral dryness during eating was related to dissatisfaction with chewing (odds ratio, 10.5; P < .001) and speaking (odds ratio, 3.5; P < .05) and overall dissatisfaction (odds ratio, 6.3; P < .01) in complete denture wearers. Feeling of dry mouth was likely to be associated with soreness in denture-bearing tissues in both complete and removable partial denture wearers.

CONCLUSIONS

There was a significant association of the perception of dry mouth among a group of denture wearers with oral symptoms and function.

A comparison of patient's satisfaction between complete and partial removable denture wearers

OBJECTIVES

The aim of this study was to compare satisfaction between complete denture (CD) and Kennedy Class I removable partial denture (RPD) wearers.

MATERIALS AND METHODS

A total of 156 CD and 112 RPD wearers took a part in this study. From the primary group of the examined patients, only those whose RPDs and CDs were assessed as excellent or very good by the dentist, took a part in this study. Patients graded satisfaction of their dentures by using an analogue scale from 1 to 5 (1=unsatisfactory; 5=excellent).

RESULTS

Both CD and RPD wearers were mostly satisfied with their dentures (the distribution of the scores of the patients' assessments was skewed towards the highest scores; more than half of the patients scored all the examined variables to the best score category). Complete Denture wearers were significantly more satisfied with chewing, speech and retention of maxillary denture than RPD wearers (P<0.05). Removable partial denture wearers were significantly more satisfied with the retention and the comfort of wearing mandibular denture (P<0.05). There was no significant difference between CD and RPD wearers for general satisfaction with their dentures, aesthetics and comfort of wearing maxillary denture (P>0.05; N.S.).

CONCLUSIONS

A majority of CD and RPD wearers were satisfied with the dentures. CD wearers were more satisfied with speech, chewing and retention of maxillary denture, while RPD wearers were more satisfied with the retention and the comfort of wearing mandibular denture. Different groups of denture wearers have to make significant, but different adjustments to wear their dentures successfully.

Factors influencing eating ability of old in-patients in a rehabilitation hospital in Japan

OBJECTIVES

This study was designed to determine the factors influencing eating ability of old in-patients in a rehabilitation hospital.

DESIGN

Cross-sectional investigation.

SETTING

Forty-six in-patients in the rehabilitation ward of Hashimoto Hospital in Kagawa Prefecture in Japan were investigated using a multidisciplinary approach.

MAIN OUTCOME MEASURES

Age, gender, state of dentition, muscle activity of lip, cheek and tongue, biting force, salivary flow rate per a minute (SFR), masticatory ability for gummy jelly, swallowing ability, texture of meal, independency of walking (Functional Independence Measure = FIM) and ability to communicate.

RESULTS

Bivariate analysis for the relationship between surveyed items and masticatory ability (chi-square test) identified that better masticatory ability for gummy jelly was associated with age (< 85years), gender (male),state of dentition (dentate), SFR (high), activity of lip (good), biting force (high), swallowing ability (good) and activity of communication (high). Among these items, SFR (p = 0.001), gender (p = 0.004), ability to communicate (p = 0.005) and age (p = 0.012) were found having an influence on the masticatory ability (logistic regression analysis). On the other hand, age (< 85years), gender (male), SFR (high), activity of lip (good), activity of cheek (good), biting force (high), masticatory ability (good) and swallowing ability (good) had a relationship with normal texture of meal. In regression analysis, only two items, activity of lip (p = 0.003) and swallowing ability (p = 0.024) emerged as factors on texture of meal.

CONCLUSIONS

Masticatory ability for gummy jelly was influenced by cognitive function and was excluded from the factors on the state of meal. These results suggested the limitation of evaluation using test food, so dentists should observe eating behaviour of in-patients. In addition, dentists should pay attention to the activity of the lip and swallowing ability as well as dentition and prostheses in the rehabilitation of eating ability. As SFR was the most significant factor on masticatory ability, this emphasizes the necessity of care for dry mouth caused by side effects of multi-medication.