A preliminary report on dental implant condition among dependent elderly based on the survey among Japanese dental practitioners

Maintenance issues of elderly patients requiring nursing care with implant treatments in dental visiting: position paper

PURPOSE

Japan, with an increasing number of elderly people needing long-term care in a super-aged society, urgent needs to develop the clinical guidelines on implant maintenance for elderly people with declining independence. The purpose is to categorize the troubles encountered in the care of patients with dental implants and to indicate actual practices and points of note.

METHODS

From the members of the Japanese Society of Oral Implantology, 12 expert panelists who were experienced with many problems of implant maintenance during dental visits and were familiar with their solutions were selected. Through repeated discussions in the many panel meetings, the problems of implant maintenance during dental visits were distilled.

RESULTS

During a dental visit, the oral cavity, general conditions, and background of elderly patients who cannot orally care for themselves must be grasped, and medical staff, care managers, and patients should understand the changes in these factors as time goes by. The solutions and responses that can be made differ greatly depending on the medical care facilities, the environment, differences in the experience of medical staff, and the patient's background. Thus, it is necessary to select safe treatments appropriate to each situation.

CONCLUSIONS

This paper features many opinions based on clinical experiences. However, clinical guidelines on implant management during dental visits should be formulated in the future based on the accumulation of evidence through the implementation of clinical research.

Prognosis of Implants with Implant-Supported Fixed Dental Prostheses in the Elderly Population: A Retrospective Study with a 5- to 10-Year Follow-Up

This retrospective study aimed to investigate the survival rate of implants from 5 to 10 years after the placement of implant-supported fixed dental prostheses (ISFDPs) and the management of implant loss in the elderly population. Elderly patients (≥65 years old) who had been treated with ISFDPs and followed up with for at least 5 years between October 2009 and March 2020 were enrolled. Patient profiles and implant-related data were extracted. The survival rate of implants up to 5 years as well as the 10-year cumulative survival rate were evaluated. The management of implant loss and prosthetic interventions were also investigated. In total, 195 patients (mean age: 70.1 ± 4.5 years old) and 687 implants (287 ISFDPs) were assessed. The 5-year survival rate was 99.0% and the 10-year cumulative survival rate was 98.1%. Seven of the eleven implants lost were lost due to peri-implantitis. Only three implants in two patients were placed after the loss of the implants; most were restored using non-invasive procedures. Two patients underwent a conversion from ISFDPs to removable prostheses. This study showed that high survival rates were observed in an elderly population with ISFDPs and that non-invasive procedures were often applied after the loss of an implant.

Dental implant status in elderly individuals requiring domiciliary dental care in Japan

Background

The presence of implants is a significant burden not only for dentists but also for caregivers and families of elderly individuals requiring nursing and domiciliary dental care. However, few reports have assessed the status of domiciliary dental care or measures employed to deal with related issues. Hence, we aimed to evaluate the dental implant status in elderly patients requiring nursing and domiciliary dental care and to determine the suitable measures for overcoming the associated limitations. A questionnaire was mailed to 1000 dentists who provided domiciliary dental care in the Tokyo metropolitan area of Japan. The questions were classified into three categories: basic information of the dentists, actual implant status of patients requiring domiciliary dental care, and implants in an aging society.

Results

The response rate was 36.5%. Approximately 2% of patients requiring domiciliary dental care were implant patients. Many implant-related problems were associated with insufficiency or difficulty in cleaning around the implant, resulting in peri-implantitis. Prosthetic and more serious complications such as implant body fracture or loss were reported and frequently managed by routine follow-ups, cleaning the area around the implant, scaling and polishing, and/or pharmacological modalities. Oral care mainly involved simple toothbrushing instructions, which was not adequate.

Conclusions

Our findings suggest the necessity of simplifying the oral environment and making oral care a simple task before aging individuals require nursing and domiciliary dental care.

Dental implant care and trouble among dependent patients based on the questionnaire survey among Japanese dental practitioners

Background

Self-care and professional care of implants may prove difficult for elderly people who require nursing care. However, the actual state of care and problems remains unknown. In this study, we investigated the actual state of implant problems in elderly people living in their own home or in a nursing home who received visiting dental treatment.

Methods

We mailed questionnaire survey forms to 2339 representatives or specialists who were members of the Japanese Society of Oral Implantology, the Japanese Society of Gerodontology or the Japan Prosthodontic Society. We narrowed down the respondents to those who provided visiting dental treatment, and analyzed the actual state of implants observed during visiting dental treatment (type, care, problems, countermeasures, etc.).

Results

Of the 924 dentists who responded to the questionnaire survey, 291 (22%) provided visiting dental treatment. While the majority of implant types encountered in the previous 12 months were root-form implants, there were still a certain number of blade and subperiosteal implants. Daily implant care involved mostly cleaning with a toothbrush + auxiliary tools. The most frequent implant problems encountered in the past were difficulty in cleaning and peri-implantitis. Medication and antiphlogistic treatment were most frequently adopted as countermeasures to implant problems, followed by observation. When we classified the results into those for the dentists who provided implant treatment and those for the dentists who did not, we found that many of the dentists who did not provide implant treatment opted for observation or medication, while those who provided implant treatment also implemented removal of superstructure, retightening of screws, repair and so forth.

Conclusions

We found that many of the implant troubles encountered by dentists who provided visiting dental care were difficulty in cleaning or peri-implantitis, and that the actions taken against these troubles varied depending on the experience of the dentist performing the implant treatment. Our study also revealed that dentists who provide visiting dental care need to acquire knowledge and skills of implant treatment, to have actions prepared in case they encounter such cases, or to closely coordinate with dentists who specialize in implants.

Changes in conditions related to reported oral and general health over a ten-year period as reflected in two cohorts of 75-year-old subjects examined in 2007 and 2017

BACKGROUND

The rapidly ageing and increasingly dentate population puts great demands on society regarding the provision of adequate medical and dental care facilities.

OBJECTIVES

To present changes in reported demographic, general and oral health factors in two cohorts of 75 year olds in 2007 and 2017, and to analyse factors associated with self-reported number of remaining teeth and chewing efficiency.

MATERIAL AND METHODS

All 75-year-old people living in two Swedish counties received a questionnaire in 2007 and in 2017. The response rates in 2007 and in 2017 were 71.9% (n = 3735) and 70.7% (n = 5091), respectively. Reported number of teeth was clinically validated in a selected subgroup.

RESULTS

The 2017 cohort reported significantly better general health and dental state. Edentulousness was 7.8% in 2007 and 2.3% in 2017, while 'very good' chewing efficiency was 55.2% and 60.5%, respectively. Born outside Sweden, single living, not feeling healthy and smoking predicted reduced number of teeth in both cohorts. Impaired chewing efficiency in both cohorts was predicted by being born outside Sweden, lower education, not feeling healthy, reduced number of teeth and denture wearing.

CONCLUSIONS

Seventy-five-year-old people in Sweden reported much better oral and general health in 2017 compared to 2007. In 2017, 75% had practically all natural teeth present and only 2% were edentulous. This development of an increasingly dentate and partially dentate ageing population will put high demands on the oral healthcare system and will need adapting undergraduate/postgraduate education and management strategies to meet the requirements of the elderly.