3D printing vs traditional workflow for the fabrication of mandibular implant overdentures: study protocol for a mixed-methods cross-over RCT

BACKGROUND

Complete tooth loss is a significant global oral health issue, particularly impacting older individuals with lower socioeconomic status. Computer-assisted technologies enhance oral healthcare access by the elderly. Despite promising in vitro reports on digital denture materials, evidence from randomized clinical trials (RCTs) is lacking to verify their performance. This cross-over RCT will investigate whether 3D-printed implant-retained mandibular overdentures (IMO) are more satisfactory for edentulous seniors than those made through traditional methods.

METHODS/DESIGN

We will recruit 26 completely edentulous participants (any sex/gender) based on the following eligibility criteria: age ≥ 60 years, no tooth extraction in the past 12 months, two implants in the lower jaw, and need for new dentures in both jaws. Each participant will receive two denture pairs, either manufactured by 3D printing or traditionally, to be worn in a random order. A timeline of 3 months with each denture pair will be considered for outcome assessment (total: 6 months). Patient satisfaction with dentures will be measured by the McGill Denture Satisfaction Questionnaire. We will evaluate other patient-reported outcomes (including oral health-related quality of life) as well as clinician-assessed quality and cost. At the end of the trial, participants will choose which denture pair they wish to keep and interviewed about their experiences with the 3D-printed IMO. The quantitative and qualitative data will be incorporated through an explanatory mixed-methods strategy. A final quantitative assessment will happen after 12 months with the preferred IMO to assess the long-term performance and maintenance needs.

DISCUSSION

This mixed-methods RCT will explore patient experiences with 3D-printed IMOs, aiming to assess the potential for altering clinical practice and dental public health policies. Our results will inform policies by showing whether 3D printing offers comparable outcomes at lower costs, facilitating greater access to oral care for the elderly.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06155630, Registered on 04 December 2023. https://classic.

CLINICALTRIALS

gov/ct2/show/NCT06155630.

Association between oral health-related quality of life and symptoms of temporomandibular disorder among older adults: A cross-sectional study

OBJECTIVE

Evaluate the association between oral health-related quality of life (OHRQoL) and self-reported symptoms of TMD.

METHODS

Representative samples of older adults (≥60 years) were included (n = 569). Both TMD symptoms and OHRQoL were assessed by Fonseca Anamnestic Index (FAI) and Oral Health Impact Profile-14 (OHIP-14), respectively. Prevalence (those answering "frequently" or "always" in at least one question), severity (total means scores), and extent (number of questions answered as "frequently" or "always") of OHRQoL were estimated.

RESULTS

Overall, 33.4% and 9.5% had mild or moderate/severe TMD symptoms. Those with any symptom of TMD had a prevalence ratio (PR) 38% higher for the worst OHRQoL (95% confidence interval [95%CI]:1.04-1.82) compared to those without TMD symptoms. Worst OHRQoL were observed for those with mild (PR:1.35; 95%CI:1.01-1.81) and moderate/severe TMD (PR:1.53; 95%CI:1.04-2.26). Similar results were detected in the severity and extent of OHRQoL.

CONCLUSION

Severity TMD was associated with worse ORHQoL.

Oral health and healthy ageing: a scoping review

BACKGROUND

Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.

METHODS

A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework.

RESULTS

The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.

CONCLUSION

There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

Palatal microbiota associated with membranous substances in older Japanese individuals undergoing tube feeding in long-term care: A cross-sectional study

Objective

Tube feeders are prone to membranous substance formation on the palate, and those with membranous substances have a risk of fever, with the probable involvement of their oral bacteria. However, the palatal microbiota of those with membranous substances has not been elucidated. Therefore, we evaluated the differences in palatal microbiota between tube-fed individuals with and without membranous substances to clarify the microbiota.

Materials and methods

This study included 19 participants aged 65 years who required tube feeding. The participants' characteristics were collected from nursing records and oral examinations. If membranous materials were found on the palate, a specimen was collected. Membranous substances were defined as keratotic degeneration observed under a microscope. Additionally, we performed a comprehensive microbiome analysis by extracting DNA from the samples and performing 16 S rRNA gene sequencing. Finally, we compared the participant demographics and oral microbiota between patients with and without membranous substances.

Results

A total of 11 participants had membranous substances associated with "mouth dryness" (p < 0.001) and "constant mouth opening" (p = 0.020). Palatal microbiota differed between those with and without membranous substances. Among the bacteria with a relative abundance greater than 1.0%, the abundance of Streptococcus (p = 0.007), Fusobacterium (p = 0.041), Streptococcus agalactiae (p = 0.009), and Fusobacterium nucleatum subsp. vincentii (p = 0.026) was significantly higher in the membranous substance group than in the non-membranous substance group.

Conclusions

The palatal microbiota of individuals undergoing tube feeding differed depending on the presence or absence of membranous substances. Membrane substance formation associated with dry mouth purportedly alters the palatal microbiota. Streptococcus, Fusobacterium, S. agalactiae, and F. nucleatum subsp. vincentii were more abundant in the oral microbiota of patients with membranous substances. Thus, preventing this formation may help in controlling the growth of these microbes.

[Oral health in nursing homes as an interprofessional task : Results of qualitative interviews with nurses and dentists on their current and future collaboration]

BACKGROUND

People with long-term care needs have significantly poorer oral health than their peers without care needs. Internationally, this is increasingly being addressed through interprofessional collaboration and expanded roles of nurses. This article investigates the perspectives of dentists and nurses in Germany on the current status and future of their collaboration in nursing homes.

METHODS

A total of eight expert interviews were conducted with four practising dentists and nurses from the Westphalia-Lippe region via Zoom or by telephone. The fully transcribed interview material was analyzed by thematic coding on a case-specific and cross-case basis.

RESULTS

From the perspective of the interviewees, collaboration of dentists and nurses is indispensable for promoting the oral health of nursing home residents. They describe a lack of time and competence in the oral and dental care of home residents, which should be countered with new roles of responsibility for specially qualified nurses in cooperation with dentists. At the same time, they advocate a stronger anchoring and embedding of (dental) medical care in the routines of nursing homes.

CONCLUSION

New forms of cooperation between dentists and nurses in nursing homes should be piloted and further developed in Germany.

Pairs of natural teeth rather than use of dental prosthesis are associated with nutritional status in older adults: A cross-sectional study

OBJECTIVE

To evaluate the association between pairs of natural teeth and nutritional status among older adults.

METHODS

This cross-sectional study evaluated a total of 569 home-dwelling adults from two southern Brazilian cities aged ≥60 years. Present teeth were counted, and pairs of natural teeth were defined as antagonistic teeth. Nutritional status was assessed using Mini Nutritional Assessment. Sociodemographic, behavioral, medical and dental history were collected. Sample was dichotomized into well-nourished and at nutritional risk (including at risk of malnutrition and malnourished). Multiple multivariate models were performed considering different categorizations of pairs of natural teeth.

RESULTS

For each number of present teeth, a decrease of 1.8 % in the prevalence ratio (PR) for nutritional risk was detected (p = 0.040). For each pair of natural teeth, there was 4.4 % decrease in PR for nutritional risk (95 % confidence interval [95 % CI]: 0.917 - 0.997). No statistically significant association was found for pairs of natural anterior teeth (p = 0.222). For pairs of natural premolar, molar and posterior teeth, reductions of 15.4 %, 22.8 % and 11.5 %, respectively, in PR for nutritional risk were observed (p < 0.05). The presence of at least two pairs of natural molars or three pairs of natural posterior teeth was significantly associated with nutritional risk (p < 0.05).

CONCLUSION

Older adults with fewer teeth or pairs of natural teeth, especially posterior teeth, presented poorer nutritional status.

CLINICAL SIGNIFICANCE

Demonstrating threshold correlation between natural teeth and nutrition, data showed significant association between at least two pairs of natural molars or three pairs of natural posterior teeth and lower nutritional status.

Exploring Associations between Oral Health and Frailty in Community-Dwelling Older People

BACKGROUND

In frail older people with natural teeth factors like polypharmacy, reduced salivary flow, a decrease of oral self-care, general healthcare issues, and a decrease in dental care utilization contribute to an increased risk for oral complications. On the other hand, oral morbidity may have a negative impact on frailty.

OBJECTIVE

This study explored associations between oral health and two frailty measures in community-dwelling older people.

DESIGN

A cross-sectional study.

SETTING

The study was carried out in a Primary Healthcare Center (PHC) in The Netherlands.

PARTICIPANTS

Of the 5,816 persons registered in the PHC, 1,814 persons were eligible for participation at the start of the study.

MEASUREMENTS

Two frailty measures were used: 1. Being at risk for frailty, using Electronical Medical Record (EMR) data, and: 2. Survey-based frailty using 'The Groningen Frailty Indicator' (GFI). For oral health measures, dental-record data (dental care utilization, dental status, and oral health information) and self-reported oral problems were recorded. Univariate regression analyses were applied to determine the association between oral health and frailty, followed by age- and sex-adjusted multivariate logistic regressions.

RESULTS

In total 1,202 community-dwelling older people were included in the study, 45% were male and the mean age was 73 years (SD=8). Of all participants, 53% was at risk for frailty (638/1,202), and 19% was frail based on the GFI (222/1,202). A dental emergency visit (Odds Ratio (OR)= 2.0, 95% Confidence Interval (CI)=1.33;3.02 and OR=1.58, 95% CI=1.00;2.49), experiencing oral problems (OR=2.07, 95% CI=1.52;2.81 and OR=2.87, 95% CI= 2.07;3.99), and making dietary adaptations (OR=2.66, 95% CI=1.31;5.41 and OR=5.49, 95% CI= 3.01;10.01) were associated with being at risk for frailty and survey-based frailty respectively.

CONCLUSIONS

A dental emergency visit and self-reported oral health problems are associated with frailty irrespective of the approach to its measurement. Healthcare professionals should be aware of the associations of oral health and frailty in daily practice.

Utilisation of dental services for people with special health care needs in Australia

Background

To explore the profile of patients and treatment delivered at specialist referral centres for individuals with special needs.

Methods

A cross-sectional audit was conducted of the health records of all patients with appointments at two of Australia’s largest referral centres for patients with special needs, the Integrated Special Needs Department at the Royal Dental Hospital of Melbourne and the Special Needs Unit at the Adelaide Dental Hospital, for the month of August 2015.

Results

The profile of patients treated at these specialist units demonstrates the diversity of individuals with additional health care needs that general dentists feel require specialised oral health care. The Adelaide-based clinic had a greater proportion of complex medical patients in comparison to those treated in Melbourne who were more likely to have a disability or psychiatric condition and were less likely to be able to self-consent for treatment. Interestingly, despite similar workforce personnel numbers, there were approximately twice as many appointments at the Special Needs Unit in Adelaide than the Integrated Special Needs Department in Melbourne during the study period which may have reflected differences in workforce composition with a greater use of dental auxiliaries at the Adelaide clinic.

Conclusions

The results of this study provide an initial profile of patients with special needs referred for specialist care in Australia. However, the differences in patient profiles between the two units require further investigation into the possible influence of service provision models and barriers to access of care for individuals with special needs and to ensure equitable access to health care.

Single-implant overdentures retained by the Novaloc attachment system: study protocol for a mixed-methods randomized cross-over trial

BACKGROUND

Overdentures retained by a single implant in the midline have arisen as a minimal implant treatment for edentulous mandibles. The success of this treatment depends on the performance of a single stud attachment that is susceptible to wear-related retention loss. Recently developed biomaterials used in attachments may result in better performance of the overdentures, offering minimal retention loss and greater patient satisfaction. These biomaterials include resistant polymeric matrixes and amorphous diamond-like carbon applied on metallic components. The objective of this explanatory mixed-methods study is to compare Novaloc, a novel attachment system with such characteristics, to a traditional alternative for single implants in the mandible of edentate elderly patients.

METHODS/DESIGN

We will carry out a randomized cross-over clinical trial comparing Novaloc attachments to Locators for single-implant mandibular overdentures in edentate elderly individuals. Participants will be followed for three months with each attachment type; patient-based, clinical, and economic outcomes will be gathered. A sample of 26 participants is estimated to be required to detect clinically relevant differences in terms of the primary outcome (patient ratings of general satisfaction). Participants will choose which attachment they wish to keep, then be interviewed about their experiences and preferences with a single implant prosthesis and with the two attachments. Data from the quantitative and qualitative assessments will be integrated through a mixed-methods explanatory strategy. A last quantitative assessment will take place after 12 months with the preferred attachment; this latter assessment will enable measurement of the attachments' long-term wear and maintenance requirements.

DISCUSSION

Our results will lead to evidence-based recommendations regarding these systems, guiding providers and patients when making decisions on which attachment systems and implant numbers will be most appropriate for individual cases. The recommendation of a specific attachment for elderly edentulous patients may combine positive outcomes from patient perspectives with low cost, good maintenance, and minimal invasiveness.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03126942 . Registered on 13 April 2017.

ASSESSING PATIENT'S PERCEPTION OF ORAL TELECONSULTATION

OBJECTIVES

The evaluation of telemedicine from the patient's point of view has focused on the patient pathway and patient satisfaction. However, research in this field does not provide us with the means to assess a patient's perception of the procedure if their reasoning ability is impaired. In this study, we use direct observation of a patient's behavior and mood to assess their perception of an oral teleconsultation procedure.

METHODS

This study has been conducted in the context of a pilot project using an asynchronous teleconsultation to improve access to dental care for the dependent elderly, disabled people, and prisoners, some of whom may be cognitively impaired. We use a direct observation form consisting of five behavioral variables and eight affect variables to reflect the patient's experience of the oral teleconsultation procedure.

RESULTS

A total of 135 patients were evaluated; 10 refused the procedure. Psychotic patients (n = 33) had a somewhat negative experience during the oral teleconsultation procedure. Patients who were not psychotic had a positive experience; this decreased as we moved from the autonomous to the semi-autonomous and then to the dependent sub-group. Some gender differences were also noted.

CONCLUSIONS

Improving evidence on evaluating the acceptance of the cognitively impaired is required to improve the technology development process so that it can be translated into an improved patient experience and adherence. Although the study was specifically focused on teledentistry, the approach described in this study could be adapted to other forms of teleconsultation.

Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis

BACKGROUND

Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents.

METHODS

We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence.

RESULTS

We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%).

CONCLUSIONS

We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.

Differences in willingness to pay for an extraction, a filling, and cleaning teeth at various levels of oral health-related quality of life, as measured by oral impacts on daily performance, among older adults in Singapore

OBJECTIVE

To examine the differences in Willingness to pay (WTP) for an extraction, a filling, and cleaning of teeth among older adults with varying levels of Oral Health-related Quality of Life (OHQoL).

BACKGROUND

OHQoL has been used extensively to measure utilities as reported by individuals of interest. Currently there are no reports that examine the WTP of individuals at various levels of OHQoL.

METHODS

A convenience sample of adults 60 years or older were recruited. Besides other domains, questionnaires were used to assess WTP (extraction, filling, and cleaning of teeth), OHQoL (using Oral Impacts on Daily Performance-OIDP), McArthur scale, and access to care.

RESULTS

Tamil ethnicity was related to higher WTP for an extraction (mean ratio, 1.63-3.98; 95% Confidence Interval [CI]), increase of age in years was related to lower WTP for extraction (mean ratio, 0.96-1.00 [95%CI]) and increasing OIDP score was related to lower WTP for extractions (mean ratio, 0.80-0.99 [95%CI]). Tamil ethnicity was associated with higher WTP for fillings (mean ratio, 2.69-6.44 [95%CI]); higher age in years was associated with lower WTP for fillings (mean ratio, 0.94-0.99 [95%CI]), and higher OIDP scores was trending to be associated to lower WTP for filling (mean ratio, 0.80-1.00 [95%CI]). Tamil Ethnicity was also associated with higher WTP for cleaning (mean ratio, 2.14-7.19 [95%CI]), higher age in years was also associated with cleaning (mean ratio, 0.94-0.99 [95%CI]).

CONCLUSION

Individuals with higher OIDP scores tended to have lower WTP for extraction, filling and cleaning; with significant differences reported for extraction.

Oral/dental items in the resident assessment instrument - minimum Data Set 2.0 lack validity: results of a retrospective, longitudinal validation study

Background

Oral health in nursing home residents is poor. Robust, mandated assessment tools such as the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 are key to monitoring and improving quality of oral health care in nursing homes. However, psychometric properties of RAI-MDS 2.0 oral/dental items have been challenged and criterion validity of these items has never been assessed.

Methods

We used 73,829 RAI-MDS 2.0 records (13,118 residents), collected in a stratified random sample of 30 urban nursing homes in Western Canada (2007–2012). We derived a subsample of all residents (n = 2,711) with an admission and two or more subsequent annual assessments. Using Generalized Estimating Equations, adjusted for known covariates of nursing home residents’ oral health, we assessed the association of oral/dental problems with time, dentate status, dementia, debris, and daily cleaning.

Results

Prevalence of oral/dental problems fluctuated (4.8 %–5.6 %) with no significant differences across time. This range of prevalence is substantially smaller than the ones reported by studies using clinical assessments by dental professionals. Denture wearers were less likely than dentate residents to have oral/dental problems (adjusted odds ratio [OR] = 0.458, 95 % confidence interval [CI]: 0.308, 0.680). Residents lacking teeth and not wearing dentures had higher odds than dentate residents of oral/dental problems (adjusted OR = 2.718, 95 % CI: 1.845, 4.003). Oral/dental problems were more prevalent in persons with debris (OR = 2.187, 95 % CI: 1.565, 3.057). Of the other variables assessed, only age at assessment was significantly associated with oral/dental problems.

Conclusions

Robust, reliable RAI-MDS 2.0 oral health indicators are vital to monitoring and improving oral health related quality and safety in nursing homes. However, severe underdetection of oral/dental problems and lack of association of well-known oral health predictors with oral/dental problems suggest validity problems. Lacking teeth and not wearing dentures should be considered an indicator for urgent oral/dental treatment needs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12963-016-0108-y) contains supplementary material, which is available to authorized users.