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Zhang M, Mi N, Ying Z, Lin X, Jin Y. Advances in the prevention and treatment of Alzheimer's disease based on oral bacteria. Front Psychiatry 2023; 14:1291455. [PMID: 38156323 PMCID: PMC10754487 DOI: 10.3389/fpsyt.2023.1291455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023] Open
Abstract
With the global population undergoing demographic shift towards aging, the prevalence of Alzheimer's disease (AD), a prominent neurodegenerative disorder that primarily afflicts individuals aged 65 and above, has increased across various geographical regions. This phenomenon is accompanied by a concomitant decline in immune functionality and oral hygiene capacity among the elderly, precipitating compromised oral functionality and an augmented burden of dental plaque. Accordingly, oral afflictions, including dental caries and periodontal disease, manifest with frequency among the geriatric population worldwide. Recent scientific investigations have unveiled the potential role of oral bacteria in instigating both local and systemic chronic inflammation, thereby delineating a putative nexus between oral health and the genesis and progression of AD. They further proposed the oral microbiome as a potentially modifiable risk factor in AD development, although the precise pathological mechanisms and degree of association have yet to be fully elucidated. This review summarizes current research on the relationship between oral bacteria and AD, describing the epidemiological and pathological mechanisms that may potentially link them. The purpose is to enrich early diagnostic approaches by incorporating emerging biomarkers, offering novel insights for clinicians in the early detection of AD. Additionally, it explores the potential of vaccination strategies and guidance for clinical pharmacotherapy. It proposes the development of maintenance measures specifically targeting oral health in older adults and advocates for guiding elderly patients in adopting healthy lifestyle habits, ultimately aiming to indirectly mitigate the progression of AD while promoting oral health in the elderly.
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Affiliation(s)
| | | | | | | | - Ying Jin
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang, China
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Hillebrecht AL, Waterkotte R, Ludwig E, Barbe AG. [Integrating risks for oral diseases into Structured Information Collection: A practice development project]. Pflege 2023. [PMID: 37772331 DOI: 10.1024/1012-5302/a000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Integrating risks for oral diseases into Structured Information Collection: A practice development project Abstract. Background: Deficient oral hygiene and oral diseases are highly prevalent among nursing staff. Up to now, there is no assessment for nursing professionals integrated in the daily nursing routine, which depicts the complex risks for oral diseases. The Structured Information Collection (SIS) is a concept to guide the nursing process and enables individual action planning. Aim: The aim was to integrate oral diseases as a nursing-relevant risk into the SIS and to develop an assessment instrument for oral hygiene deficits/diseases integrated into the SIS topic areas. Methods: Based on a literature search, 21 systematic reviews describing SIS topic areas and oral health risks were analysed by a panel of experts. The caregiver-relevant oral health risks identified in this way were compared with existing oral health assessment instruments and with screening criteria recommended in the German national expert standard for the promotion of oral health in care. Since none of the oral health assessments covers all nursing-relevant oral health risks and the recommended screening criteria of the expert standard, the area of "oral diseases" was integrated into the SIS as an additional category, and an oral health assessment adapted to the SIS was developed. Results: This article presents the SIS expanded to include nursing-relevant oral disease risk and the newly developed Oral Risk Assessment Prevention (Mu-RAP) for use by nurses. Conclusions: The SIS expanded to include oral disease and the Mu-RAP for identifying oral hygiene deficits/diseases cover all nursing-relevant oral health risks. Further studies on the applicability, reliability, and validity of the instrument, as well as on care-effective and patient-relevant effects of its use are needed.
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Affiliation(s)
- Anna-Lena Hillebrecht
- Department für Zahn-, Mund- und Kieferheilkunde, Klinik für Zahnärztliche Prothetik, Universitätsklinikum Freiburg, Deutschland
| | - Ramona Waterkotte
- Fort- und Weiterbildung, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
| | - Elmar Ludwig
- Referat Alterszahnheilkunde, Landeszahnärztekammer Baden-Württemberg, Stuttgart, Deutschland
| | - Anna Greta Barbe
- Poliklinik für Zahnerhaltung und Parodontologie, Sektion Parodontologie, Zentrum für Zahn-, Mund- und Kieferheilkunde, Uniklinik Köln, Deutschland
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Bashirian S, Khoshravesh S, Ayubi E, Karimi-Shahanjarini A, Shirahmadi S, Solaymani PF. The impact of health education interventions on oral health promotion among older people: a systematic review. BMC Geriatr 2023; 23:548. [PMID: 37697260 PMCID: PMC10494401 DOI: 10.1186/s12877-023-04259-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND One of the most common pathologic changes in older people is oral and dental problems. The oral health of older people is a public health concern. Promotion of good oral health for this cohort will have beneficial impacts on the longer-term quality of life. This study aimed to identify the types of health education interventions for the oral health of older people and to determine their effects on the oral and dental health of older people. METHODS Potential articles were retrieved from four electronic databases (PubMed/Medline, Scopus, Web of Sciences, and Embase) up to 31 September 2022 in English without limit of time. Experimental and quasi-experimental interventional studies investigating the impact of educational interventions on oral and dental health among older people over 60 years old in both sexes were considered. The quality assessment tool was the Effective Public Health Practice Project (EPHPP). RESULTS In the initial search, 1104 articles were retrieved. Finally, according to the inclusion criteria, 23 studies (seventeen randomized controlled trials (RCT) and six quasi-experimental studies) were reviewed. In this review, educational interventions for older people and their caregivers are classified. Theoretical frameworks were used in only three interventions related to older people. Outcome measures were both self-reported and objective measures. Fifteen of the included studies were of moderate quality. CONCLUSION This review provides evidence that the use of oral and dental health educational interventions was effective in improving the oral health of older people. Educational interventions were carried out both among older people and among their caregivers. Although a variety of interventions were used in the reviewed studies, more lectures were used in the interventions related to older people. In the interventions related to caregivers, in addition to lectures, practical education was also used. It is recommended to perform higher quality studies for assessing the effectiveness of interventions in this field.
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Affiliation(s)
- Saeid Bashirian
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sahar Khoshravesh
- Department of Community Health Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Erfan Ayubi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Karimi-Shahanjarini
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Samane Shirahmadi
- Department of Community Oral Health, School of Dentistry, Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Parshang Faghih Solaymani
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Larvin H, Gao C, Kang J, Aggarwal VR, Pavitt S, Wu J. The impact of study factors in the association of periodontal disease and cognitive disorders: systematic review and meta-analysis. Age Ageing 2023; 52:afad015. [PMID: 36794714 PMCID: PMC10789237 DOI: 10.1093/ageing/afad015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/06/2022] [Indexed: 02/17/2023] Open
Abstract
AIM The aim was to assess study factors that impact the association of cognitive disorders in people with periodontal disease (PD). METHOD Medline, EMBASE and Cochrane databases were searched until February 2022 using keywords and MeSH: (periodon* OR tooth loss OR missing teeth) AND (dementia OR Alzheimer's Disease OR cognitive*). Observational studies reporting prevalence or risk of cognitive decline, dementia or Alzheimer's disease (AD) in people with PD compared with healthy controls were included. Meta-analysis quantified the prevalence and risk (relative risk[RR]) of cognitive decline, dementia/AD, respectively. Meta-regression/subgroup analysis explored the impact of study factors including PD severity and classification type, and gender. RESULTS Overall, 39 studies were eligible for meta-analysis: 13 cross-sectional and 26 longitudinal studies. PD demonstrated increased risks of cognitive disorders (cognitive decline-RR = 1.33, 95% CI = 1.13-1.55; dementia/AD-RR = 1.22, 95% CI = 1.14-1.31). Risk of cognitive decline increased with PD severity (moderate-[RR] = 1.14, 95% confidence interval [CI] = 1.07-1.22; severe-RR = 1.25, 95% CI = 1.18-1.32). For every 10% population increase in females, the risk of cognitive decline increased by 34% (RR = 1.34, 95% CI = 1.16-1.55). Self-reported PD showed a lower risk of cognitive disorders compared with clinical classification (cognitive decline-RR = 0.77, 95% CI = 0.65-0.91; dementia/AD-RR = 0.86, 95% CI = 0.77-0.96). CONCLUSION The prevalence and risk estimates of cognitive disorders in association with PD can be influenced by gender, the disease classification of PD and its severity. Further homologous evidence taking these study factors into consideration is needed to form robust conclusions.
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Affiliation(s)
| | - Chenyi Gao
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jing Kang
- Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | | | - Susan Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Jayasinghe TN, Harrass S, Erdrich S, King S, Eberhard J. Protein Intake and Oral Health in Older Adults-A Narrative Review. Nutrients 2022; 14:4478. [PMID: 36364741 PMCID: PMC9653899 DOI: 10.3390/nu14214478] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 08/31/2023] Open
Abstract
Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein-energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults.
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Affiliation(s)
- Thilini N. Jayasinghe
- The Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sanaa Harrass
- School of Life Sciences, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Sharon Erdrich
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Shalinie King
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Joerg Eberhard
- The Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Jockusch J, Hahnel S, Nitschke I. Use of handgrip strength measurement as an alternative for assessing chewing function in people with dementia. BMC Geriatr 2022; 22:769. [PMID: 36153477 PMCID: PMC9509657 DOI: 10.1186/s12877-022-03452-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/14/2022] [Indexed: 11/12/2022] Open
Abstract
Background Chewing ability and handgrip strength can be independent explanatory factors of physical fitness. The usability of measurement procedures for assessing chewing function in people with dementia seems to be limited. This study aimed to show an association between handgrip strength and chewing function to enable the use of handgrip strength measurement as an alternative for determining chewing parameters in people with dementia. Methods The data analysed here are part of the OrBiD (Oral Health, Bite Force and Dementia) pilot study. A total of 120 participants were assigned to five evaluation groups based on their cognitive abilities using the Mini-Mental State Examination (MMSE). The MMSE groups in this data analysis were “no dementia” (noDem, MMSE 28–30), “mild cognitive impairment” (mCI, MMSE 25–27), and “mild dementia” (mDem, MMSE 18–24). Handgrip strength, maximum occlusal force, and chewing efficiency were measured. Results The Mini-Mental State Examination scores among all participants (n = 71) resulted in a median of 27 and a range of 18–30. An association between maximum handgrip strength and the cognitive impairment of the participants was shown. Nevertheless, the use of handgrip strength measurement as an alternative for determining chewing function was not verified in this study. Conclusions The feasibility and reliability of chewing function measurements in people with dementia should be investigated. Existing measurement procedures may need to be adapted or new assessments may need to be developed to be usable in people with dementia. Trial registration ClinicalTrials.gov NCT03775772.
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Nitschke I, Ulbrich T, Schrock A, Hopfenmüller W, Jockusch J. What Counts for the Old and Oldest Old?-An Analysis of Patient Criteria for Choosing a Dentist-Part II: Personal Characteristics and Soft Skills. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148621. [PMID: 35886473 PMCID: PMC9316874 DOI: 10.3390/ijerph19148621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023]
Abstract
Soft skills include communication skills and personality traits that are important when choosing a dentist, but other factors within the dental office also seem to be important for patients. The aim of this study is to evaluate factors that are important to people in a dentist as well as characteristics of the ideal dentist and to evaluate possible age-, gender-, and residence of living specific differences. A telephone survey with participants aged 35 years or older (ag—age group: ag 1: 35−50 years, ag 2: 70−84 years, ag 3: >85 years) in three German cities was conducted. Data were analyzed with respect to gender and age. Most of the participants (n = 298, 64.2%), regardless of their own gender, age, or place of residence did not care about the gender of the dentist. In general, the price of the treatment does not play a role in choosing the ideal dentist. Women differ significantly from men in their choice of dentist (ANOVA p < 0.001 (preference of non-smoker), ANOVA p < 0.001 (preference, that the dentist does not smell of smoke, importance of appearance (ANOVA p < 0.001) and psycho-social skills, etc.). As age increases, professional experience and psycho-social competencies are rated as important. With the increase in age, the mean value of the desired years of professional experience increases without significant differences between age groups. The importance of advanced training (ANOVA p < 0.001; Bonferoni correction: significant difference between ag 1 and ag 2 p < 0.001, and ag 1 and ag 3 p < 0.001) decreases with age. Especially for participants aged 70 to 84 years, a relationship of trust is important. Between the places of residence, statistical differences for almost all surveyed items were found (e.g., importance that the dentist speaks the patients’ native language ANOVA p < 0.001, Bonferoni correction: significant difference between Berlin and Leipzig, Berlin and Mainz, and Leipzig and Mainz (each p < 0.001), dentist has a specialization ANOVA p < 0.001, Bonferoni correction: significant difference between Berlin and Leipzig and Berlin and Mainz (each p < 0.001), etc.). Dentists should be trained to develop psycho-social skills to meet the special demands of the increasing older population.
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Affiliation(s)
- Ina Nitschke
- Gerodontology Section, Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (I.N.); (T.U.); (A.S.)
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Thomas Ulbrich
- Gerodontology Section, Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (I.N.); (T.U.); (A.S.)
| | - Annett Schrock
- Gerodontology Section, Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (I.N.); (T.U.); (A.S.)
| | - Werner Hopfenmüller
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany;
| | - Julia Jockusch
- Gerodontology Section, Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (I.N.); (T.U.); (A.S.)
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, CH-8050 Zurich, Switzerland
- Correspondence:
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Nitschke I, von Chlingensperg R, Schrock A, Hopfenmüller W, Jockusch J. What Counts for the Old and Oldest Old?-An Analysis of Patient Criteria for Choosing a Dentist-Part I: Awareness and Selection Criteria, Infrastructure, and Dental Office Equipment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148307. [PMID: 35886163 PMCID: PMC9324363 DOI: 10.3390/ijerph19148307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
Utilization of a dentist is influenced by many factors. The aim of this study is to present the factors relating to how patients become aware of a dentist, according to which criteria they select the dentist, and which factors in the infrastructure, equipment of dental offices, and human interactions are important for patients. A telephone survey with 466 participants (female 59.9%) in three age groups (ag 1: 35−50 years, ag 2: 70−84 years, ag 3: >85 years) in three German cities was conducted. Data were analyzed with respect to age, gender, and place of residence. Hardly any differences in the selection of the dentist and the selection criteria applied were found between the sexes, the age groups, or the places of residence. Recommendation seems to be the major aspect regarding how patients become aware of or select their dentist (n = 278, 65.6%), while modern technologies, e.g., the internet, play a subordinate role (n = 31, 7.3%). The unimportance of modern technologies increases significantly with the increase in age. As age increases, factors such as infrastructure (e.g., elevator available (ANOVA p < 0.001; Bonferoni correction: significant differences between ag 1 and ag 2 p < 0.001, ag 1 and ag 3 p < 0.001, and ag 2 and ag 3 p = 0.009); accessibility by wheelchair (ANOVA p < 0.001; Bonferoni correction: significant differences between ag 1 and ag 2 p = 0.006; and ag 1 and ag 3 p < 0.001); etc.) and dental office equipment become significantly important and influence the choice of dentist, while the importance of good parking facilities significantly decreased with age (ANOVA p = 0.003; Bonferoni correction: significant differences between ag 1 and ag 3 p = 0.004, and ag 2 and ag 3 p = 0.023). With increasing age, e.g., the importance of a television in the waiting room (ANOVA p = 0.012; Bonferoni correction: significant differences between ag 1 and ag 3 p = 0.014; and ag 2 and ag 3 p = 0.011), a modern waiting room (ANOVA p < 0.001; Bonferoni correction: significant differences between ag 1 and ag 3 p < 0.001; and ag 2 and ag 3 p < 0.001) or the possibility to visualize the oral situation on a screen decreases significantly (ANOVA p < 0.001; Bonferoni correction: significant differences between ag 1 and ag 2 p < 0.001; ag 1 and ag 3 p < 0.001, and ag 2 and ag 3 p < 0.001). If dentists want to welcome and treat older people, they should adapt the accessibility, infrastructure and equipment of their practice to the needs of older people in order to be able to guarantee continuous lifelong dental care regardless of the need for assistance or care.
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Affiliation(s)
- Ina Nitschke
- Gerodontology Section, Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany or (I.N.); (R.v.C.); (A.S.)
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Richard von Chlingensperg
- Gerodontology Section, Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany or (I.N.); (R.v.C.); (A.S.)
| | - Annett Schrock
- Gerodontology Section, Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany or (I.N.); (R.v.C.); (A.S.)
| | - Werner Hopfenmüller
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany;
| | - Julia Jockusch
- Gerodontology Section, Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany or (I.N.); (R.v.C.); (A.S.)
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, 8050 Zurich, Switzerland
- Correspondence: or
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Interventions to Improve the Oral Hygiene of Individuals with Alzheimer's Disease: A Systematic Review. Dent J (Basel) 2022; 10:dj10050092. [PMID: 35621545 PMCID: PMC9139279 DOI: 10.3390/dj10050092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 12/10/2022] Open
Abstract
This systematic review evaluates published evidence on oral hygiene interventions conducted in Alzheimer’s disease (AD) patients. PubMed, Embase, Cochrane Library, CINAHL, Dentistry & Oral Sciences Source, and Web of Science were searched for articles published up to 19 April 2021. The main outcomes of interest were the Plaque index score (PI), oral health knowledge of participants or their caregivers, and behaviors and attitudes towards oral hygiene. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Institutes of Health. The study was conducted under PROSPERO registration code CRD42021247733. Two studies met the inclusion criteria. One was a pre-post study conducted in Brazil, and the other was a prospective cohort study carried out in China. The sample sizes of these studies were 29 and 168, respectively. Both studies were carried out in institutionalized patients and presented a significant loss to follow-up. The PI and gingival index scores both improved after the application of the respective interventions, yet the differing methodologies used precluded further comparisons. The studies were deemed to be of good and regular quality, respectively. Despite the need for more comprehensive interventions to ensure a better oral health status and a higher quality of life for AD patients, an alarming lack of studies have been conducted in this population.
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Jockusch J, Hahnel S, Sobotta BBAJ, Nitschke I. The Effect of a Masticatory Muscle Training Program on Chewing Efficiency and Bite Force in People with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073778. [PMID: 35409460 PMCID: PMC8997984 DOI: 10.3390/ijerph19073778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 12/04/2022]
Abstract
Until now, no study has investigated the effects of masticatory muscle training on chewing function in people with dementia. This study aimed to investigate whether physiotherapeutic exercises for the masticatory muscles have an influence on chewing efficiency and bite force in people with dementia. In a clinical trial with stratified randomization subjects were assigned to three groups based on the Mini Mental State Examination (MMSE: group 1—28–30, group 2—25–27, group 3—18–24). Each group was divided into an experimental (ExpG, intervention) and control group (ConG, no intervention). As intervention a Masticatory Muscle Training (MaMuT) (part 1: three physiotherapeutic treatments and daily home exercises, part 2: daily home exercises only) was carried out. Chewing efficiency and bite force were recorded. The MaMuT influenced the masticatory performance regardless of the cognitive state. Bite force increased in ExpG 1 and 2. Without further training, however, the effect disappeared. Chewing efficiency increased in all ExpG. After completion of the training, the ExpG 2 and 3 showed a decrease to initial values. Subjects of ExpG 1 showed a training effect at the final examination, but a tendency toward the initial values was observed. ExpG 3 seemed to benefit most from the physiotherapeutic exercises in terms of improving chewing efficiency by the end of the intervention phase. ExpG 1 showed the greatest gain in bite force. The MaMuT program is a potential method of improving masticatory performance in people with cognitive impairment or dementia when used on a daily basis.
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Affiliation(s)
- Julia Jockusch
- Department of Prosthodontics and Materials Science, Gerodontology Section, University of Leipzig, 04103 Leipzig, Germany; (S.H.); (B.B.A.J.S.); (I.N.)
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Andreasstrasse 15/Box 2, 8050 Zurich, Switzerland
- Correspondence: or
| | - Sebastian Hahnel
- Department of Prosthodontics and Materials Science, Gerodontology Section, University of Leipzig, 04103 Leipzig, Germany; (S.H.); (B.B.A.J.S.); (I.N.)
| | - Bernhard B. A. J. Sobotta
- Department of Prosthodontics and Materials Science, Gerodontology Section, University of Leipzig, 04103 Leipzig, Germany; (S.H.); (B.B.A.J.S.); (I.N.)
| | - Ina Nitschke
- Department of Prosthodontics and Materials Science, Gerodontology Section, University of Leipzig, 04103 Leipzig, Germany; (S.H.); (B.B.A.J.S.); (I.N.)
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
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Impact of an Oral Hygiene Intervention in People with and without Dementia on Oral Health Parameters-Results from the Oral Health, Bite Force, and Dementia (OrBiD) Pilot Study. J Clin Med 2022; 11:jcm11051356. [PMID: 35268447 PMCID: PMC8911423 DOI: 10.3390/jcm11051356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/20/2022] Open
Abstract
This study aimed to assess the influence of an oral hygiene intervention on oral health, depending on the degree of dementia. A clinical evaluation of oral health parameters (index of decayed, missing, and filled teeth (DMFT-index), periodontal screening index (PSI), oral hygiene index (OHI), and bleeding on probing (BOP)) was performed in 120 subjects assigned to five groups, based on the mini mental state examination (MMSE) at baseline and after 12 months. Each MMSE group (no dementia (noDem, MMSE 28–30), mild cognitive impairment (mCI, MMSE 25–27), mild dementia (mDem, MMSE 18–24), moderate dementia (modDem, MMSE 10–17), and severe dementia (sDem, MMSE ≤ 9)) was split into control (no intervention) and experimental groups (intervention on oral hygiene: increased frequency, daily usage of high-fluoride toothpaste). In total, 99 out of 120 subjects were included in the analysis. The dropout rate was high in subjects with modDem and sDem due to death. In subjects with noDem, mCI, and mDem, no changes in the DMFT were found, but improvements in the OHI, BOP, and PSI were observed. Subjects with modDem or sDem demonstrated a deterioration in DMFT; however, in these patients, OHI improved in all control and experimental groups, BOP improved in the experimental group only, and PSI did not improve at all. The scope of improving oral health parameters by increasing the recall frequency and by continuously using high fluoride toothpaste is at its limits in people with severe dementia. Multidimensional approaches should be sought to improve the oral health of vulnerable older patients.
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Suzuki H, Furuya J, Hidaka R, Miyajima S, Matsubara C, Ohwada G, Asada T, Akazawa C, Sato Y, Tohara H, Minakuchi S. Patients with mild cognitive impairment diagnosed at dementia clinic display decreased maximum occlusal force: a cross-sectional study. BMC Oral Health 2021; 21:665. [PMID: 34961506 PMCID: PMC8711143 DOI: 10.1186/s12903-021-02027-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Previous research indicates that patients with mild cognitive impairment (MCI) are more likely to have poor oral health and impairments in oral functions, which may be due to few remaining teeth and impaired tongue and lip motor function. However, the oral health of those patients following comprehensive cognitive assessment by a dementia specialist has not been sufficiently investigated. Therefore, this study aimed to clarify the oral function of patients with MCI and the association between oral health and lower cognitive function. Methods This cross-sectional study included 96 participants (men: 35; women: 61; mean age: 73.3 ± 8.5 years) who visited a dementia clinic between December 2017 and January 2020. Participants’ cognitive function was assessed by a dementia specialist using neuropsychological and hematological tests and neuroimaging immediately after enrollment. The participants were divided into the healthy and MCI groups according to comprehensive cognitive assessment. Participants’ age, sex, body mass index, primary disease, education level, drinking habits, smoking habits, living environment, employment status, and exercise habits were evaluated. Moreover, oral outcomes, including the number of existing teeth, number of functional teeth (natural and prosthetic teeth which were occluded with antagonists), denture use, oral dryness, tongue and lip motor function, tongue pressure, occlusal force, masticatory ability, and swallowing ability were recorded. The Mann–Whitney U test, χ2, and Fisher’s exact tests were used for between-group comparisons. Furthermore, logistic regression analysis using MCI diagnosis as the target variable was performed. Results A comprehensive evaluation of the cognitive function of the study participants by the dementia specialist revealed that 48 participants (mean age: 69.8 ± 8.8 years) were healthy and 48 (mean age: 76.9 ± 6.7 years) had MCI. MCI participants were significantly older (p < 0.001) and had significantly fewer existing teeth (p = 0.031) and lower maximum occlusal force (p = 0.019) than healthy participants. Age (odds ratio: 1.126, p = 0.002) and maximum occlusal force (odds ratio: 0.978, p = 0.048) were significantly associated with lower cognitive function. Conclusions Patients with MCI had poorer oral health than healthy individuals. Decreased maximum occlusal force was independently associated with lower cognitive function, even when adjusted for age and sex.
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Affiliation(s)
- Hiroyuki Suzuki
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo, 145-8515, Japan. .,Dysphagia Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Rena Hidaka
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Saki Miyajima
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Chiaki Matsubara
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Gaku Ohwada
- Ohwada Dental Office, 1-2-45 Honcho, Kuki City, Saitama, 346-0005, Japan
| | - Takashi Asada
- Memory Clinic Ochanomizu, 1-5-34 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Chihiro Akazawa
- Intractable Disease Research Centre, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo, 145-8515, Japan
| | - Haruka Tohara
- Dysphagia Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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