Effect of oral health interventions for dependent older people-A systematic review

BACKGROUND

There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health.

OBJECTIVE

The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people.

METHODS

We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta-analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system.

RESULTS

We included a total of 30 randomised clinical trials assessing educational and non-educational interventions for community-dwelling older people (n = 2) and those residing in long-term care facilities (n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long-term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system.

CONCLUSION

Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long-term effect of interventions, and further research is needed, especially targeting community-dwelling older people.

PROSPERO ID

CRD42021231721.

Health status, care dependency and oral care utilization among older adults: a register-based study

BACKGROUND AND OBJECTIVES

The aim of the study was to examine oral care utilisation among older Danes and to describe the extent to which oral care use is associated with the co-existence of challenges relating to general health and care dependency.

MATERIALS AND METHODS

The study used registry data covering the entire population of older adults (≥65 years) in seven municipalities in Denmark (N = 178 787 individuals). Oral care services utilisation was computed from administrative data on oral care contacts up to and including 2019, including both private oral care and a municipal oral care programme (MOCP). Various registry data sources were used to compute risk factors to describe oral care utilisation across indicators of general health and care dependency.

RESULTS

Indicators for poorer health were associated with larger proportions of individuals enrolled in the MOCPs and larger proportions of non-users of any type of oral care. Higher degrees of care dependency were associated with larger proportions of individuals enrolled in MOCPs and individuals with no use of any oral care services, with the exception of nursing home residents, who comprised a lower proportion of non-users than individuals receiving at-home care. Municipal oral care mainly enrolled older adults who were nursing home residents (60% of nursing home residents were enrolled).

CONCLUSION

Our findings support existing evidence on the link between oral care utilisation and general health and frailty. While the municipal care programmes assisted in covering oral care for those with the highest level of care dependency, future preventive strategies for ensuring care continuity for older adults that are increasing in frailty may want to focus on the earlier stages of frailty and of general health deterioration.

A cross-sectional study on oral health-care habits and oral-health-related quality-of-life in marginalized persons in Copenhagen

OBJECTIVE

The aim of this cross-sectional study was to investigate the oral-health-related quality-of-life (OHRQoL) and oral health-care habits in a population of marginalized persons in Copenhagen.

MATERIALS AND METHODS

Patients attending a dental clinic for marginalized persons filled in the 14-item version of the oral-health-impact profile (OHIP-14) regarding their OHRQoLand a questionnaire on their oral health-care habits. Age, gender, smoking habits, need for general and oral health-care, and living conditions were further registered.

RESULTS

Of the 212 participants, 72% had not visited a dental clinic within the past two years and in 68% of the cases, the last dental visit was related to dental treatment. Tooth brushing at least once a day was reported by 93%. The mean OHIP-14 score in the participants was 24.9 (SD: 13.6). The most frequent problems were pain, chewing difficulties, being self-conscious, tense, and embarrassed as well as affected life. The mean OHIP-14 score was significantly higher in participants in need of general health-care (29.5, SD: 12.2) than in participants not in need of general health-care (22.8, SD: 13.9). The same applied to participants referred for dental treatment (26.1, SD: 12.7) compared to participants not being referred (20.2, SD: 15.9).

CONCLUSIONS

The OHRQoLis poor in the population with pain, chewing difficulties and aesthetic issues as the most prominent problems. The participants had low and treatment-oriented use of the dental care system. This indicates a high need for dental care in the population with a focus on including them in the dental care system.

Utilization of a public subsidy scheme for dental care services among socially vulnerable citizens out of labor in Copenhagen, Denmark

OBJECTIVE

Addressing social inequality in oral health and access to dental care is a global concern. This study aims to describe the utilization of a public subsidy scheme targeting vulnerable individuals out of labor in Copenhagen municipality (2013-2018) and to identify key characteristics of individuals eligible to apply.

MATERIAL AND METHODS

Data from Copenhagen municipality were combined with data from population and health registers. Employing logistic regression analyses, we examined the association between demographic, socioeconomic, and health-related characteristics and (1) having applied, (2) being granted, and (3) using the subsidy.

RESULTS

The study included 65,174 individuals aged 18-65. Of these 10,369 (15.9%) applied for subsidies, submitting a total of 18,529 applications. Overall, 83% of the applications were granted and 85% were used. Significantly increased odds of applying for subsidies were observed among individuals receiving social benefits non-stop over the past year versus none (odds ratio [OR] = 15.45, 95% confidence interval [CI] = 14.24-16.76), aged 50-65 versus 18-29 years (OR = 4.41, CI = 4.15-4.69), and having combined indicators of social vulnerability versus none (OR = 2.90, CI = 2.73-3.07).

CONCLUSIONS

While the utilization of the public subsidy scheme is low, individuals who apply are likely to be granted a subsidy and use it. Vulnerability was associated with greater utilization of the scheme, yet a substantial portion of those at risk of poor oral health did not take advantage of it.

Orofacial function and temporomandibular disorders in Parkinson's Disease: a case-controlled study

BACKGROUND

The difficulties and challenges faced by people with Parkinson's disease (PD) in performing daily orofacial function are not systematically investigated. In this study, specific orofacial non-motor and motor symptoms and functions were systematically examined in PD patients in comparison to a matched control group.

METHODS

The clinical case-controlled study was conducted from May 2021 to October 2022 and included persons with PD and age- and gender-matched persons without PD. The participants with PD were outpatients diagnosed with PD at the Department of Neurology at Bispebjerg University Hospital in Copenhagen, Denmark. The participants underwent a systematic clinical and relevant self-assessment of the orofacial function and temporomandibular disorders (TMD). The primary outcomes were objective and subjective assessments of the general orofacial function, mastication, swallowing, xerostomia and drooling. The secondary outcomes were the prevalence of TMD and orofacial pain. The difference in outcome measures between the two groups was analysed using chi-square and Mann-Whitney U test.

RESULTS

The study included 20 persons with PD and 20 age- and gender-matched persons without PD. Both objectively and subjectively, persons with PD had poorer orofacial function than the control group. Persons with PD had also a significantly more severe limitation of jaw mobility and jaw function. The objective masticatory function was also significantly reduced for persons with PD compared to the control group, and 60% of persons with PD found it difficult to eat foods with certain consistencies while 0% of the control group reported that problem. Persons with PD could swallow less water per second and the average swallowing event was significantly longer for PD persons. Even though PD persons reported more xerostomia (58% for persons with PD and 20% for control persons), they also reported significantly more drooling than the control group. Additionally, orofacial pain was more prevalent in PD persons.

CONCLUSIONS

Persons with PD have a compromised orofacial function. Furthermore, the study indicates a link between PD and orofacial pain. In order to screen and treat persons with PD accordingly, healthcare professionals should be aware of and address these limitations and symptoms.

TRIAL REGISTRATION

The trial was approved by the Regional Committee on Research Health Ethics of the Capital Region (H-20,047,464), the Danish Data Protection Agency (514 - 0510/20-3000), and registered at ClinicalTrials.gov (NCT05356845).

Dental care utilization among persons with Parkinson's disease in Denmark

OBJECTIVES

Persons with Parkinson's disease (PD) have a higher prevalence of oral diseases and orofacial dysfunction, but knowledge about the use of dental care and whether their dental care needs are met is sparse. This study aimed to investigate the dental attendance and usage of dental care services of the total PD population in Denmark and compare it with a control group.

METHODS

National registers were used to identify the total PD population in Denmark (n = 6874) and to obtain data on their dental care from 2015 to 2019. These data were compared with a five-fold age-, gender- and geographically matched control group without PD (n = 34 285). Register data on age, gender, civil status, educational level, income, nursing homes status and mortality were also collected and adjusted for in the analyses. The dental attendance was analysed using χ² -test with Bonferroni correction, and the type of dental care services was analysed using negative binomial regression analysis.

RESULTS

A significantly higher proportion of persons with PD were irregular attenders of the dental care system (21.0%), compared with the control group (16.9%). Persons with PD had a significantly higher overall usage of dental cares services. Most prominent was the high usage of treatment services, where persons with PD had a 1.50 times higher incidence rate of tooth extractions and a 1.71 times higher incidence rate of tooth fillings in the five years compared with the control group.

CONCLUSION

Persons with PD are more often irregular users of dental care and receive more treatment services than the control group. This indicates a need for high-quality prophylactic initiatives to prevent high filling and tooth extraction rates. Furthermore, this knowledge can be used by clinicians and decision makers to ensure optimal dental care for persons with PD.

Impact of the Covid-19 pandemic on dental practices in Denmark

OBJECTIVE

To investigate the impact of the Covid-19 pandemic on the patient flow and economy as experienced by dental practices in Denmark.

MATERIAL AND METHODS

A survey regarding experience of patient flow, economical turnover, financial strain and willingness to pay for large treatments during the first year of the Covid-19 pandemic (March 2020 to March 2021), along with information on the characteristics of the practice (specialist practice, ownership, practice operation and size) was distributed to all dental practices in Denmark in March 2021.

RESULTS

Of the 1728 practices, 581 (33.6%) answered the survey. A decline in patient flow and a decline in economical turnover were reported by 79% and 84.4% of the practices, respectively. Financial strain was reported by 15.8% and an increased willingness to pay for large treatments was reported by 32.1%. A large decline in turnover and financial strain were associated with non-specialized practices, practices with a single owner and small practices. Logistic regressions showed that practices not receiving referrals had an odds ratio of 2.34 (CI: 1.32-4.14) for having a large decline in economic turnover compared with practices receiving referrals and that small practices had an odds ratio of 1.92 (CI: 1.16-3.19) for reporting financial strain compared with large practices.

CONCLUSIONS

Reportedly, the Covid-19 pandemic resulted in a decline in both patient flow and economical turnover in Danish dental practices. Large and more specialized practices seem to have managed the economic crisis better.

Oral health promotion and labour market prospects among socially disadvantaged, unemployed citizens

Background

Poor oral health do not only affect individuals' general health and quality of life but can also have a devastating impact on employability. Few studies indicate that poor teeth may constitute a barrier for labour market success in unemployed citizens. This study examines if an oral health promotion (OHP) intervention has an effect on economic self-support (ESS) and proximity to the labour market (PLM) among socially disadvantaged and unemployed citizens.

Methods

From April to June 2018, we enrolled 273 recipients of cash benefits in a randomised controlled trial. Participants were allocated to either control (n = 159) or intervention (n = 114), which consisted of information and individual help to attend a dentist and apply for dental care subsidy. Ten participants were excluded, leaving 263 participants (intervention n = 110, control n = 153) for analyses. A national register was used to assess ESS and PLM within 1.5 years post intervention. Information on health and socio-demographics were obtained from a questionnaire and national registers. Logistic- and multiple linear regression models were performed.

Results

Overall, higher frequencies of ESS and PLM was found in the intervention group, although no significant results were seen for ESS alone. Adjusted models revealed significantly higher odds (odds ratio (OR)=1.852, 95% CI 1.084 to 3.166) in the intervention group of achieving PLM after 12 months. After 18 months, the intervention group had on average obtained 5 more weeks (95% CI 0.015 to 9.994) with PLM.

Conclusions

Overall, the OHP intervention had a positive effect on labour market prospects in the intervention group, especially within the first year of the study. Our findings highlight the potential of oral treatment in social rehabilitation and for reducing inequality. This is relevant for decision-makers, who should consider oral health promotion among socially disadvantaged citizens when allocating resources and providing services.

Key messages

Receiving information and individual help to attend dental care increased the odds of enhancing labour market prospects among socially disadvantaged unemployed persons. The effect of the OHP intervention was greatest within the first year of the study and facilitated better labour market prospects sooner in the intervention group compared to the control group.

Effect of orofacial physiotherapeutic and hygiene interventions on oral health-related quality of life in patients with Parkinson's disease: A randomised controlled trial

Background

Parkinson's disease (PD) has a negative effect on oral health and orofacial function, but the subjective experience of orofacial symptoms and their impact on the quality of life is not fully investigated. In addition, knowledge of how to improve the subjective oral symptoms is lacking.

Objectives

To assess the self‐reported orofacial function and oral health in patients with PD. Furthermore, to investigate the effect of interventions for improvement of oral hygiene and function on oral health–related quality of life (OHRQoL).

Methods

A randomised controlled study with delayed intervention was conducted in 29 patients with moderate to advanced PD. Patients were instructed in a standardised exercise programme for the jaw and orofacial muscles and given an individualised oral hygiene programme. The effect on self‐reported orofacial function and OHRQoL was measured after 2 and 4 months using the Nordic Orofacial Test—Screening (NOT‐S), the oral health impact profile (OHIP‐14), self‐reported drooling score and subjective mastication ability.

Results

Self‐reported oral health and function before the intervention was significantly correlated to the severity and duration of PD. The NOT‐S and drooling score were significantly improved by the interventions after 2 months and the OHIP‐14 after 4 months.

Conclusion

The interventions improve the self‐reported orofacial function and OHRQoL. These simple interventions can be implemented in the allied multidisciplinary health care surrounding the PD patient.

Patients' and health professionals' experience of the Danish fast track treatment pathway for head and neck cancer patients receiving oral rehabilitation

Objective: This study aims to investigate the responsiveness of the Danish treatment pathway for head-and-neck-cancer (HNC) patients receiving oral rehabilitation.Material and Methods: Eighteen HNC-patients who had received oral rehabilitation as well as five medical and four oral health care professionals involved in the treatment of HNC-patients filled in a questionnaire on responsiveness. The responsiveness was further described in individual interviews in the HNC-patients and focus group interviews in the health care professionals. All interviews were semi-structured and analysed using the grounded theory.Results: Patients and health care professionals overall reported good responsiveness of the pathway. Prompt attention was in both groups considered the most important aspect, although the patients found it difficult to cope mentally with the fast-track and the health care professionals reported insufficiencies giving prompt attention. The patients in general described a good relationship with their health care professionals, but along with the health care professionals also reported some problems regarding communication. Further, the health care professionals reported a gap between medical treatment and oral rehabilitation.Conclusions: The Danish treatment pathway for HNC-patients was, in general, evaluated positively. Communication and relationship between patient and health care professional can affect the responsiveness of the pathway.

Associations between tooth loss, prostheses and self-reported oral health, general health, socioeconomic position and satisfaction with life

OBJECTIVES

To investigate whether the location of tooth loss and prosthesis are associated with self-reported oral health, general health, socioeconomic position and satisfaction with life.

METHODS

From the Copenhagen Aging and Midlife Biobank (CAMB) investigation, 1517 persons had their oral status ranked (full dentition, fixed prosthesis in the masticatory zone, tooth loss in the masticatory zone, fixed prosthesis in the aesthetic zone, removable prosthesis, tooth loss in the aesthetic zone). Self-reported oral health, general health, socioeconomic position and satisfaction with life were obtained. Information on gender, normative socioeconomic position, frequency of seeing a dentist, acute dental treatment within the last 5 years and general diseases was also recorded.

RESULTS

Patients with tooth loss in the aesthetic zone and removable prosthesis showed high odds ratios for reporting poor rather than good oral health compared to patients having a full dentition. Having a removable prosthesis was further associated with rating socioeconomic position as low rather than high (odds ratio = 27.7 [95% CI: 5.07; 151.6]) compared to a full dentition after controlling for normative socioeconomic position and gender. In the bivariate analyses, a tendency towards poorer general health and poorer satisfaction with life was found with worse oral status, meanwhile the multiple regression analyses did not show significant associations between oral status and general health and satisfaction with life.

CONCLUSIONS

Missing teeth and having prostheses are associated with worse self-reported oral health compared to having a full dentition. Removable dental prosthesis may be associated with a worse self-perception of socioeconomic status.

Patient-reported effect of oral rehabilitation

OBJECTIVES

To quantify the patient-reported effect of oral rehabilitation and investigate aspects associated with this.

METHODS

The patient-reported effect in participants treated with fixed dental prosthesis (FDP; n = 72) or removable dental prosthesis (RDP; n = 58) was measured using the Oral Health Impact Profile 14 (OHIP-14) and global oral ratings (GOR) of aesthetics, chewing and comfort before and after treatment and global transition judgements (GTJ) of aesthetics, chewing and comfort after treatment. Explanatory variables included gender, age, if a prosthetic replacement was present before treatment, type of prosthetic treatment performed, number of teeth replaced and zone of the teeth replaced.

RESULTS

The RDP and FDP treatments both significantly improved the OHIP-14 score with a moderate to large effect and most participants had good patient-reported effect. The effect varied depending on the method used. In the bivariate analyses, the number of participants with good effect was higher in the RDP group than the FDP group when using the OHIP-14 and GOR whereas the effect was higher in the FDP group when using the GTJ. Multiple regression analyses showed that poor chewing ability before treatment was associated with good effect measured by the OHIP-14 and GOR and that poor effect in chewing ability and RDP treatment was associated with poor effect in comfort measured by GTJ. Functional problems after treatment were associated with no/poor effect.

CONCLUSIONS

Oral rehabilitation with fixed or removable prostheses in general yields good patient-reported effect. Masticatory aspects highly influence the patient-reported effect and treatment with RDP is associated with poor effect in oral comfort.

Oral health-related quality of life in socially endangered persons in Copenhagen, Denmark

OBJECTIVE

The aims of this study were to investigate and describe the Oral Health Related Quality of Life (OHRQoL) in a socially endangered group of people and to compare the OHRQoL to other patient groups.

MATERIAL AND METHODS

About 294 socially endangered persons attending a volunteer clinic in Copenhagen Denmark filled in the OHIP-14 questionnaire. The group was compared in mean score and reported problems to a group of patients with tooth loss and about to have a removable dental prosthesis (RDP), a group with tooth loss about to have a fixed dental prosthesis (FDP) and a control group without tooth loss.

RESULTS

Significantly higher OHIP-14 score was seen in the socially endangered group (15.5 (SD 12.6)) compared with the control (1.9 (SD 2.7)) and the FDP group (9.4 (SD 8.2)) but not the RDP group (13.1 (SD 10.5)). This difference was not changed after stratifying in age groups. Problems related to psychological disability, social disability, and handicap were more frequent in the social endangered group than for the other groups. The items pain, tense, diet, relax, life, and function stand out as problems in the socially endangered group compared to the other groups.

CONCLUSION

The OHRQoL is highly impaired in the socially endangered persons and at least to the level of persons with great tooth loss about to have an RDP. The problems seem to be more handicapping in the socially endangered compared with other patient groups known to have high impairment.

Patients' experience of partial tooth loss and expectations to treatment: a qualitative study in Danish and Swedish patients

Knowledge of impairments, wishes and expectations is essential to make correct decisions regarding oral rehabilitation. The purpose of this study was to investigate discomforts, wishes and expectations in patients' with partial edentulism before entering oral rehabilitation. In Copenhagen, Denmark, and Malmö, Sweden, respectively, 20 patients with partial edentulism seeking rehabilitation were interviewed in a semistructured qualitative manner. The interviews were transcribed and analysed yielding overall domains. Six themes appeared as overall domains: (i) experienced impairments, (ii) experienced social awareness, (iii) expectation to treatment, (iv) expectation to durability/survival, (v) coping strategies dealing with the tooth loss including explanations of the tooth loss and (vi) modifications to experienced impairment. The impairments were mostly experienced as problems in social settings. Most participants expressed a simple wish to function normally; a fixed solution was preferred. Many Danish participants accepted a removable solution whereas only few Swedish participants did so. The domains 'coping strategies' and 'modifications' were not part of the chosen topics of interest, indicating a high wish of the participants to explain their tooth loss and how they coped with it. In conclusion, a large degree of social impairment was found in the patient group along with several coping strategies. The impairments were modified by a number of factors indicating that highly individualised care and treatment is needed. A state of normality was described as the primary treatment wish with a higher acceptance of removable solutions in Denmark than in Sweden. For final decision-making, surrounding factors seemed to influence the patients' choices.