Oral disease burden of dentate older adults living in long-term care facilities: FINORAL study

Clinically estimated signs of hyposalivation in older adult residents of long-term care

OBJECTIVE

To assess whether the estimation of clinical signs of hyposalivation is applicable in recognising long-term care facility (LTCF) residents with poor oral health, and which individual characteristics are important in that respect.

BACKGROUND

A common inconvenience among older adults, dry mouth, particularly hyposalivation, can cause many complications, such as greater susceptibility to root caries and oral infections, and it can lead to further deterioration of oral health. However, very little is known about the association of clinically assessed signs of hyposalivation with the oral health status of LTCF residents.

METHODS

The study sample comprised 362 individuals (dentate n = 266, edentate n = 96) aged 65 or older. The examinations included a questionnaire and clinical oral examination. Participants were categorised into three groups based on clinically assessed oral dryness: normal salivation (n = 83, 22.9%), lower salivation (n = 182, 50.3%) and dry mouth (n = 97, 26.8%). The association between signs of dry mouth with aspects to oral health was evaluated and further tested with logistic regression analysis.

RESULTS

The signs of oral dryness were observed among females, those with dementia, and those with longer stays in the current facility. Root caries (odds ratio, OR 1.3) and diagnosis of periodontitis (OR 4.1), together with several individual periodontal parameters, as well as having less than ten occluding pairs of natural teeth (OR 3.5) were associated with dry mouth. Edentate participants showed an increased likelihood of having dry mouth with advancing age, and lesions on the lips were associated with dry mouth with OR 3.0.

CONCLUSION

Clinical estimation of signs of oral dryness can be a useful adjunct in evaluating the oral health status of dentate LTCF residents. Poor oral health was a frequent finding, especially among dentate LTCF residents with signs of dry mouth.

Development and validation of a nomogram for predicting depressive symptoms in dentistry patients: A cross-sectional study

Depressive symptoms are frequently occur among dentistry patients, many of whom struggle with dental anxiety and poor oral conditions. Identifying the factors that influence these symptoms can enable dentists to recognize and address mental health concerns more effectively. This study aimed to investigate the factors associated with depressive symptoms in dentistry patients and develop a clinical tool, a nomogram, to assist dentists in predicting these symptoms. Methods: After exclusion of ineligible participants, a total of 1355 patients from the dentistry department were included. The patients were randomly assigned to training and validation sets at a 2:1 ratio. The LASSO regression method was initially employed to select highly influrtial features. This was followed by the application of a multi-factor logistic regression to determine independent factors and construct a nomogram. And it was evaluated by 4 methods and 2 indicators. The nomograms were formulated based on questionnaire data collected from dentistry patients. Nomogram2 incorporated factors such as medical burden, personality traits (extraversion, conscientiousness, and emotional stability), life purpose, and life satisfaction. In the training set, Nomogram2 exhibited a Concordance index (C-index) of 0.805 and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.805 (95% CI: 0.775-0.835). In the validation set, Nomogram2 demonstrated an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.810 (0.768-0.851) and a Concordance index (C-index) of 0.810. Similarly, Nomogram1 achieved an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.816 (0.788-0.845) and a Concordance index (C-index) of 0.816 in the training set, and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.824 (95% CI: 0.784-0.864) and a Concordance index (C-index) of 0.824 in the validation set. Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) indicated that Nomogram1, which included oral-related factors (oral health and dental anxiety), outperformed Nomogram2. We developed a nomogram to predict depressive symptoms in dentistry patients. Importantly, this nomogram can serve as a valuable psychometric tool for dentists, facilitating the assessment of their patients' mental health and enabling more tailored treatment plans.

Integration of a dental hygienist into the interprofessional long-term care team

BACKGROUND

To address poor oral health of residents in long-term care homes (LTCH), this study explored the process of integrating an educational resource and a dental hygienist on the interprofessional care team.

METHODS

This convergent mixed-methods study took place at a 472-bed LTCH in Toronto, Canada from February to August 2018. Nurses employed at the LTCH participated in the study. During the study period, a dental hygienist was integrated into an interprofessional LTCH team. Nurses completed an online eLearning module about using the Oral Health Assessment Tool (OHAT) when referring residents' oral health concerns to a. Pre/post knowledge quizzes, module feedback and satisfaction surveys were administered. A retrospective chart review examined OHAT use and compared nurse and dental hygienist oral health assessments. Two cycles of semi-structured interviews with five nurses explored experiences with the eLearning module, OHAT and integration of the dental hygienist into the team.

RESULTS

Nurses scored well on the knowledge quizzes and reported comfort in using the OHAT to refer oral concerns to a dental hygienist; however, actual use was minimal. oral health issues were under-reported by nurses on the Resident Assessment Instrument-Minimum Data Set (RAI-MDS); the dental hygienist reported significantly more debris, teeth lost and carious teeth (all P < 0.0001). Qualitative analysis indicated that the nurses valued dental hygienist integration into the team. Using knowledge mobilisation practices, a new oral health referral tool was developed.

CONCLUSIONS

This study highlights the feasibility and desirability of an oral health eLearning module, practical assessment tools and participation of a dental hygienist on the LTCH interprofessional care team.

Oral health assessment in institutionalized elderly: a scoping review

When elderly become frail and in need for complex care, they can no longer live independently at home and may be admitted to nursing homes. Various studies have shown that oral health in this population is remarkably poor, which may lead to distressing situations and impacts quality of life. A variety of definitions or descriptions for oral health is used. Without a uniform parameter, it is impossible to determine whether oral health in institutionalized elderly is actually improving or deteriorating over time, as well as the effect of (preventive) interventions. In search for an adequate and clinically applicable parameter to determine oral health in this specific patient group, this scoping review aims to give an overview of the currently used parameters for determining oral health in institutionalized elderly. Ninety different parameters were identified, and 50 parameters were solely used by one study. Only 4 parameters were frequently used (in > 20 studies). The relevance of these parameters for this specific patient group is discussed. To aid the planning and commissioning of future research and patient care, there is an urgent need for an adequate and uniform parameter for oral health determination in institutionalized elderly.

Oral frailty among dentate and edentate older adults in long-term care

BACKGROUND

The objectives of this study were to compare oral frailty (OFr) among edentate and dentate older adults living in long-term care facilities (LTCF) and to clarify how edentulism and oral disease burden (ODB) of dentate older adults are associated with OFr.

METHODS

The population of this study comprised 94 edentate and 209 dentate residents in LTCF in Helsinki, Finland, who had previously participated in a nutritional study. The participants underwent a clinical oral examination. The dentate residents were further divided into three ODB groups based on asymptotic dental score. The edentate and different ODB groups were compared with each other regarding demographics and oral and medical findings. OFr was defined as ≥ 2 of following: having a diet of soft/pureed food, residue of food in the oral cavity, inability to keep the mouth open during examination, unclearness of speech, dry mouth. The association between OFr and edentulousness and various levels of ODB was analyzed by a multivariate logistic model.

RESULTS

Participants with low ODB had significantly less OFr than their edentate peers (p = 0.009). Furthermore, the edentate and dentate with high ODB had similar odds for OFr.

CONCLUSIONS

Edentulousness and high ODB are equally harmful conditions and may predispose to OFr. This study suggests that maintaining healthy natural teeth and good oral health (low ODB) may protect against OFr.

TRIAL REGISTRATION

The Ethics Committee of the Hospital District of Helsinki and Uusimaa approved the protocols for the nutritional status and oral healthcare studies and the merging of the data, including patient medical records (Register number HUS/968/2017).

Relationship between oral frailty, health-related quality of life, and survival among long-term care residents

PURPOSE

We evaluated oral frailty (OFr) and its association with health-related quality of life (HRQoL), energy and protein intake, and survival among older long-term care residents.

METHODS

This cross-sectional study with a 3-year follow-up for survival assessed 349 residents in long-term care facilities (73% female, mean age 82 years). We defined OFr with six signs (dry mouth, food residue on oral surfaces, unclear speech, inability to keep mouth open or pain expression during the clinical oral examination, diet pureed/soft) and OFr severity was categorized as Group 1, (mild) = 0-1 signs, Group 2 (moderate) = 2-4 signs, and Group 3 (severe) = 5-6 signs. We measured HRQoL with 15D instrument, and energy and protein intake by a 1- to 2-day food record. Mortality was retrieved from central registers on March 2021.

RESULTS

Of the residents, 15% had 0-1, 67% 2-4 and 18% 5-6 OFr signs. HRQoL decreased linearly from Group 1 to Group 3. OFr correlated with such dimensions of HRQoL as mobility, eating, speech, excretion, usual activities, mental function, and vitality. We found no association between OFr categories and energy and protein intake. Survival decreased linearly from Group 1 to Group 3.

CONCLUSIONS

OFr was common among older long-term care residents and OFr severity predicts poorer outcomes. The six oral signs denoting OFr may be used at the bedside to screen residents at risk for OFr.

Subgingival microbiome at different levels of cognition

Oral health and declining cognition may have a bi-directional association. We characterized the subgingival microbiota composition of subjects from normal cognition to severe cognitive decline in two cohorts. Memory and Periodontitis (MINOPAR) include 202 home-living participants (50-80 years) in Sweden. Finnish Oral Health Studies in Older Adults (FINORAL) include 174 participants (≥65 years) living in long-term care in Finland. We performed oral examination and assessed the cognitive level with Mini Mental State Examination (MMSE). We sequenced the 16S-rRNA gene (V3-V4 regions) to analyse the subgingival bacterial compositions. The microbial diversities only tended to differ between the MMSE categories, and the strongest determinants were increased probing pocket depth (PPD) and presence of caries. However, abundances of 101 taxa were associated with the MMSE score. After adjusting for age, sex, medications, PPD, and caries, only eight taxa retained the significance in the meta-analyses of the two cohorts. Especially Lachnospiraceae [XIV] at the family, genus, and species level increased with decreasing MMSE. Cognitive decline is associated with obvious changes in the composition of the oral microbiota. Impaired cognition is accompanied with poor oral health status and the appearance of major taxa of the gut microbiota in the oral cavity. Good oral health-care practices require special deliberations among older adults.

Translation, cross-cultural adaptation, and validation of the Chinese version of self-efficacy and attitudes for providing Mouth Care scale

Background

In recent years, oral care for older people has received extensive attention in long-term care facilities. The Self-Efficacy for Providing Mouth Care (SE-PMC) and Attitudes for Providing Mouth Care (A-PMC) scale evaluated the self-efficacy and attitude of nursing staff while providing oral care. However, whether this scale is valid and reliable for Chinese nursing staff in China remains unverified. This study aims to translate the English version of SE-PMC and A-PMC into Chinese and determine their reliability and validity.

Methods

After obtaining the author’s consent, the procedure for a double-back translation and cross-cultural adaptation was conducted to develop the Chinese version of SE-PMC and A-PMC. The validity and reliability of the Chinese version of SE-PMC and A-PMC were evaluated in a cross-sectional observational study with 852 nurses from 42 Geriatric Care Facilities (GCFs). Exploratory factor analysis (EFA) (n = 427) and confirmatory factor analysis (CFA) (n = 425) were conducted to test the construct validity and quality of the factor structures. We applied the item discrimination test and homogeneity test for item analysis. Cronbach’s alpha coefficient and split-half coefficient were adopted to evaluate internal consistency.

Results

The Chinese version of SE-PMC (11 items, 3 factors) and A-PMC (11 items, 2 factors) included 22 items, reflecting adequate construct validity and reliability. In addition, test-retest reliability was 0.809 for SE-PMC and 0.811 for A-PMC, evincing good stability. The Cronbach’s α coefficient of SE-PMC was 0.831, with each factor ranging from 0.793~0.906. The Cronbach’s α coefficient of the A-PMC was 0.768, with each factor ranging from 0.814~0.824. Item-Content Validity Index (I-CVI) of SE-PMC and A-PMC ranged from 0.84 ~1.00 and 0.82~1.00, respectively.

Conclusion

The Chinese version of SE-PMC and A-PMC was validated as a reliable assessment tool to evaluate the self-efficacy and attitude of nursing staff in GCFs for providing oral care in China.