Reliability between the two-colour chewing gum and the gummy-jelly tests used for the assessment of masticatory performance

OBJECTIVE

This study aimed to evaluate the reliability of two methods used to assess masticatory performance and attempt to correlate them to achieve interchangeability between the methods.

METHODS

Twelve healthy dentate volunteers (men = 6, women = 6; mean age = 28.3 ± 4.1) with no known dental or medical pathologies were requested to participate in this study. Each participant completed three masticatory performance assessments, including two two-colour mixing-ability tests using chewing-gums (CG: gum#1 and gum#2) and the gummy-jelly (GJ) test. For each method, participants created five samples each (total = 15 measurements per participant, gum#1 = 5, gum#2 = 5, GJ = 5). For the gum#1 and gum#2 methods, the predetermined chewing cycles were fixed at 10, 15, 20, 25 and 30 cycles, and for the GJ method, the time duration was fixed at 10, 15, 20, 25 and 30 s. The parameter measures were submitted to Z-score transformation, and Bland-Altman plots were generated to graphically compare the differences between two techniques against their means. Additionally, mountain plot was used to assess the cumulative distribution of measurement error between the methods.

RESULTS

A total of 180 measurements were recorded. There were significant correlations between the number of chewing cycles/chewing time and masticatory performance using the gum#1 (r = -.753; p < .001), gum#2 (r = -.838; p < .001) and GJ (r = .730). When all tests were considered together for each method, significant correlations were found (p < .001). A descriptive range of mean values aiming to produce reference value ranges for predictive purposes was achieved considering the interchangeably among the methods [CG = GJ (VoH-mg = dL): 10 cycle = 10 s: 0.329 = 110; 15 cycles = 15 s: 0.177 = 164; 20 cycles = 20 s: 0.130 = 205; 25 cycles = 25 s: 0.086 = 200; 30 cycles = 30 s: 0.077 = 267].

CONCLUSION

The strong correlations and high consistency between the two masticatory performance methods found in this study conclude that the two assessment methods are reliable and interchangeable. Further evaluations are warranted to arrive at a conversion formula for translation of the results between the two methods.

Implementation of a 4Ms approach in age-friendly oral health care at an Academic Specialty Care Dental Clinic

BACKGROUND

Implementing the Age-Friendly Health System (AFHS) framework into dental care provides a significant opportunity to link oral health to healthy aging. This project aimed to implement the AFHS 4Ms (what matters, medications, mentation, and mobility) in the provision of oral health care. This article describes the planning, integration, training development, and outcome measurements supporting a 4Ms approach at an academic dental clinic.

METHODS

The Eastman Institute for Oral Health (EIOH) implemented screening instruments based on the 4Ms framework recommended for ambulatory care clinics by the Institute for Health Care Improvement (IHI). These ambulatory instruments were integrated into the workflows of a Specialty Care Clinic through the development of a plan-do-study-act cycle, utilization of available clinic resources, and creation of interdisciplinary collaborations.

RESULTS

This project demonstrated the feasibility of implementing an AFHS checklist and tracking forms in dental practice by integrating available resources and prioritizing the 4Ms elements. This effort necessitated interdisciplinary collaborations between dental, medical, and social service professionals. It also created a new age-friendly focused education and training curriculum for dental residents and faculty.

CONCLUSIONS

This pilot project is the first to establish dental standards for AFHS implementation, adapting the 4Ms assessment and metrics to oral health. This AFHS underscores key oral health processes, including assessment, planning, and personalized oral health care, adapted to the unique needs of the older adult population, especially those with cognitive impairment.

Dental implant considerations in patients with systemic diseases: An updated comprehensive review

BACKGROUND

Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise.

AIM

The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population.

METHODS

The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts.

RESULTS

In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study.

CONCLUSION

In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS)

The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.

Effects of multisensory environment/stimulation therapy on adults with cognitive impairment and/or special needs: A systematic review and meta-analysis

AIM

This review aimed to evaluate the effects of multisensory environments/stimulation (MSE/MSS) therapy, on the behavior and psychological symptoms in adults with cognitive impairment and/or special needs.

METHODS

Online database searches were performed to identify studies reporting on the effects of MSS/MSE therapy in adults (>18 years). Data were extracted for the following investigated outcomes including anxiety, depression, mood, behavioral attributes, biomedical parameters, cognition, motor skills, quality of life (QoL), pain, and end of life quality. Two reciprocally blinded investigators extracted the data. Inter-investigator reliability (𝝹) was calculated. A meta-analysis and a qualitative analysis were performed on the information extracted.

RESULTS

Thirty-six studies were included for data extraction and analysis. Meta-analysis of the included studies revealed a significant improvement with the MSE/MSS therapy, for agitation (p = .018), anxiety (p = .023), cognition (p < .001), and depression (p < .001). MSS/MSE therapy demonstrated a tendency for the improvement of the QoL in adults (p = .05).

CONCLUSION

MSE/MSS therapies are beneficial in cognitively impaired adults and improve their anxiety, depression, cognitive and other behavioral attributes such as agitative behaviors. Promoting these therapies in geriatric care may help to improve/reduce the challenging/care-resistant behaviors in adults and facilitate effective provision of the necessary care.

Singapore dentists' attitudes toward dental care provision for older adults with disabilities

OBJECTIVES

This study aimed to assess dentists' attitudes toward providing dental care for older adults with disabilities in Singapore and the factors influencing their willingness to provide care.

BACKGROUND

Dentists face a rapidly ageing patient demographic. Practitioner unwillingness to circumvent the attending challenges of care provision prevents older adults from accessing the dental care necessary for better oral and systemic health. Previous studies have reported on dentists' attitudes toward caring for older adults with disabilities; however, these are mostly limited to dependent older adults and exclude frail, community-dwelling older persons.

METHODS

A cross-sectional study was conducted in 2020 using a self-administered questionnaire. Quantitative data analysis was presented in the form of descriptive statistics, followed by bivariate analyses.

RESULTS

There were 193 respondents, a response rate of under 9%. Dentists were less willing, confident and involved in the care of older adults with disabilities as the individual's severity of impairments increased. Less than half of respondents were willing to treat individuals with severe disabilities in cooperation (23.3%), swallowing (30.6%), mobility (33.7%) and communication (45.1%). Dentists with training in geriatric dentistry were more willing to provide care. However, younger dentists, general dental practitioners, private practitioners and public sector dentists had specific restraining and driving forces, which further modulated their willingness to provide care.

CONCLUSIONS

The current areas of training needs among Singapore dentists are in severe impairments of swallowing, communication, cooperation and mobility. Further geriatric dentistry training may effectively increase dentists' willingness to provide care; however, additional specific targeted interventions are also needed.

Translation and validation of the ageism scale for dental students in Iran (ASDS-Persian)

AIMS

A longer life and the growing population of older adults are the achievements of the 20th century. The World Health Organization considers ageism an important barrier to age-appropriate care for older adults. The aim of this study was to translate and validate the ageism scale for dental students in Iran (ASDS-Persian).

METHODS

The 27-question ASDS was translated from English into Persian (Farsi) and completed by 275 dental students from two universities in Isfahan, Iran. Principal component analysis (PCA), internal consistency reliability, and discriminant validity were estimated. Furthermore, in this study we conducted an analytical cross sectional study among dental students of Isfahan province (two universities) with the aim of proving data regarding their ageism beliefs and attitudes.

RESULTS

PCA revealed an 18-question, four-component scale with acceptable validity and reliability. The four components are 'barriers/concerns on dental treatment in older adults', 'opinions about older adults', 'practitioner's perspective,' and 'older adults' perspective'.

CONCLUSION

This preliminary validation of ASDS-Persian produced a new 18-question scale with four components with acceptable validity and reliability. This instrument could be further tested in larger samples in Farsi speaking countries.

Effect of various surface treatments on relining bond strength of CAD-CAM denture base materials

PURPOSE

The aim of this study was to analyze the impact of various surface treatments and production methods on the shear bond strength (SBS) between reline material and denture base resins.

MATERIALS AND METHODS

One-hundred-twenty specimens were produced using conventional heat-polymerization, subtractive, and additive techniques. Each group consisted of 40 specimens. The specimens were divided into four subgroups, each with 10 samples, for surface treatments. These subgroups were: (1) Control-only monomer application, (2) 50 μm airborne-particle abrasion, (3) 110 μm airborne-particle abrasion, and (4) Roughening with tungsten carbide bur. Representative specimens from each subgroup were examined under SEM. Then, auto-polymerized resin was condensed in the center of the specimens. Specimens were subjected to thermal aging (5000 cycles at 5-55°C). The SBS test was conducted and failure loads were recorded. The data were evaluated by two-way ANOVA and Tukey pairwise multiple comparisons method (p < 0.05).

RESULTS

The additively produced group showed significantly lower SBS than conventional and subtractive groups (p < 0.001), with no significant differences between the subtractive and conventional groups. Specimens that underwent monomer application only showed the lowest SBS among surface treatments, while 50 μm airborne-particle abrasion showed the highest SBS. Based on the partial eta-squared analysis results, the surface treatment mainly impacted SBS.

CONCLUSIONS

Among the surface treatment methods, treating denture bases with 50 μm airborne-particle abrasion is more effective for maintaining adhesion, especially in the additive technique.

Exploring the acceptance of geriatric dentistry programming for undergraduate dental students through stakeholder interviews

PURPOSE/OBJECTIVES

Older adults frequently report unmet oral healthcare needs. Current research suggests a lack of provider willingness to perform geriatric dental care plays a role in limiting older adults' access to dental services. To better understand the acceptance of geriatric dentistry programming in Ontario, and to explore considerations for successful implementation, we completed consultations with dental students and dental education stakeholders. Findings from a scoping review we conducted previously (Alicia C. Brandt and Cecilia S. Dong) were used to guide this research.

METHODS

Consultations involved a questionnaire and semi-structured individual interviews. Descriptive and parametric statistics such as Pearson's bivariate correlation and One-way analysis of variance were completed on questionnaire data using SPSS V.28. Interview data were transcribed verbatim, and the content was analyzed using emergent coding and thematic analysis in NVivo. Student and faculty data were analyzed separately and then consolidated.

RESULTS

Ten students and 12 dental faculty members completed the questionnaire of which ten students and nine faculty members also participated in interviews. Themes were organized into barriers and facilitators, with a subsection on interprofessional collaboration. Barriers included: 1. Student anxiety and skill level; 2. Constraints of the learning environment; 3. Patient factors; and 4. Knowledge gaps. Facilitators included: 1. Learning environment and culture; 2. Volume of exposure; 3. Soft skills; and 4. Desired interventions.

CONCLUSIONS

Both students and faculty stakeholders demonstrated acceptance of geriatric dentistry programming at the undergraduate dentistry level that supports improved access to care for this population. Pilot programs integrating different intervention elements which were viewed as most promising would be beneficial.

AI's Role in Improving Social Connection and Oral Health for Older Adults: A Synergistic Approach

KNOWLEDGE TRANSFER STATEMENT

This study explored how artificial intelligence (AI) can revolutionize geriatric care by improving oral health and alleviating social disconnection among isolated older adults. The findings can guide clinicians in integrating AI tools into practices, assist policymakers in developing AI-inclusive health policies, and inform patients about the potential benefits of AI in enhancing their health outcomes and social connection.

Clinical parameters that affect performance and patient satisfaction of root-retained overdentures: A systematic review of randomised controlled clinical trials

OBJECTIVE

To evaluate clinical parameters that affect the performance of root-supported overdentures (ROD) and to identify the possible factors that may affect it.

BACKGROUND

ROD still serve as an alternative and successful treatment plan nowadays for partially edentulous patients. Nonetheless, there is not yet conclusive evidence about their clinical evaluation.

MATERIALS AND METHODS

A search strategy was developed following a PIO (Population, Intervention, Outcome) framework including an electronic search in the following databases: PubMed, Cochrane Library and Scopus. The systematic search included only randomised controlled clinical trials (RCTs), published until January 2023 in English language and was performed by two independent reviewers. Quality assessment of the included studies was conducted according to the Cochrane Risk of Bias tool.

RESULTS

The final selection of studies included 11 RCTs. Clinically relevant variables derived from this search were: Complications, with caries being the most frequently reported, periodontal aspects and bone changes around abutment teeth. Additionally, methods and clinical suggestions for the maintenance of these restorations and patient-related outcomes were assessed. According to the risk of bias assessment, nine studies were considered of high risk, whereas only 2 of low risk. A meta-analysis was not feasible.

CONCLUSION

Within the limitations of this systematic review, ROD remain a viable treatment plan, offering better denture stability and bone preservation around abutment teeth and high patient satisfaction. Thorough oral hygiene and regular follow-ups are of utmost importance. Further well-designed RCTs are necessary for firmer conclusions.

Tooth loss and dementia amongst older adults residing in long-term care facilities in Vancouver: A case-control study

OBJECTIVE

The purpose of this case-control study was to determine the association between dementia and the number of missing teeth, functional occlusal units and denture use in older adults residing in Long-Term Care (LTC) facilities.

BACKGROUND

Many studies have shown an association between dementia and tooth loss. However, few studies with a large sample size have been reported describing the relationship between dementia and the number of missing teeth, remaining teeth and functional occlusal units.

METHODS

An oral health assessment database of 2160 older adults admitted to LTC facilities in Vancouver, Canada, between 2015-2019 was utilised. Participants with a diagnosis of dementia in their medical records (N = 1174) were compared to those without dementia (N = 986). Multiple logistic regression analysis was used to explore a potential association between the number of missing teeth, functional occlusal units and the use of dentures and dementia.

RESULTS

The number of remaining teeth (OR = 1.0, 95% Confidence Interval = 1.0-1.0; P = .054) and number of functional occlusal units (OR = 1.0, 95% CI = 1.0-1.0; P = .059) were not associated with dementia after adjusting for age, sex, oral self-care and systemic conditions. Denture use (OR = 1.1, 95% CI = 0.5-2.4; P = .790) was not associated with dementia in edentulous patients.

CONCLUSION

There was no association between dementia and the number of remaining teeth, functional occlusal units or wearing dentures.

Knowledge and Attitudes of Undergraduate Dental, Allied Oral Health and Nursing Students Towards Patients with Alzheimer's Disease

Purpose Alzheimer's disease (AD) is an age-related illness that is becoming increasingly more prevalent in the United States. The purpose of this pilot study was to assess dental, allied oral health, and nursing students' perceived knowledge, comfort, and attitudes for individuals with AD.Methods A total of 851 students from a university dental and nursing school were invited to participate in this cross-sectional study. A 48-item survey comprising of demographic questions, the Alzheimer's Disease Knowledge Scale (ADKS) and the Dementia Attitudes Scale (DAS) was disseminated via an electronic survey platform. Responses were summarized as means and standard deviations or counts and rates. Comparisons of survey responses by program type and exposure to AD, age group, and prior degree were performed using the chi-square test for association and analysis of variance.Results The response rate was 33.2%. Nursing students demonstrated the highest level of knowledge on AD with mean score of 25.26 (SD 2.87), followed by dental (M=23.4, SD 3.26) and allied oral health students (M=22.10, SD 2.98). Overall, students demonstrated perceived comfort in treating patients with AD and related dementias with mean scores in the "slightly agree" range. Nursing students demonstrated the highest level of perceived comfort (M=5.61, SD 0.71).Conclusions Nursing students demonstrated higher knowledge and more positive attitudes toward AD than dental and allied oral health students. There is a need for improved educational training and an expanded didactic curriculum to enhance knowledge for dental and allied oral health students. This pilot study provides a blueprint for replication on a national level.

Current status of geriatric dentistry education in selected dental schools in Latin America and the Caribbean

OBJECTIVE

Latin American and Carribean (LAC) are currently experiencing a rapid aging of their population, coupled with a significant burden of oral diseases. Despites this, there is a scarcity of evidence regarding the manner in wich geriatric dentistry is being taught in dental schools across LAC. So, the objective of this study is to investigate the current status of geriatric dentistry education at undergraduate and postgraduate levels in selected LAC dental schools.

METHODS

An electronic questionnaire was developed and emailed to all 539 dental schools in 19 LAC countries. The questionnaire recorded activity levels, contents and methodology of geriatric dentistry education as part of dental degree programmes. Reminders by email and telephone calls were used to encourage non-responders to complete the questionnaire.

RESULTS

In total, 317 schools from 17 countries responded to the questionnaire (response rate: 58.8%). Geriatric dentistry was taught in 54.6% of the schools at the undergraduate level and in 6.9% at the postgraduate level. Thirty two percent of the schools had a programme director trained in geriatric dentistry. Geriatric dentistry was taught as an independent course in 14.5% of the schools. Dry mouth, periodontal disease, denture-related conditions and prosthodontic management, oral mucosal disease and age-related changes of the orofacial complex were the most frequently covered topics. Clinical teaching of geriatric dentistry was reported by 26.5% of the schools, with 38.0% providing clinical training in outreach facilities.

CONCLUSIONS

Geriatric dentistry education remains incipient in LAC, with only one in every four dental school offering it as a standalone course. There is an urgent need to further develop geriatric dentistry education in the continent, including further research to develop a minimum geriatric dentistry curriculum.

Amount of toothpaste used by dental students

PURPOSE

This study analyzed associations of cumulative learning, demographic characteristics, fluoride content, and toothbrush head size with the amount of toothpaste used by dental students.

METHODS

Students in the third and fifth year of dental school were recruited. Each participant was asked to dispense three toothpastes (pediatric, regular fluoride, and high fluoride) on five toothbrushes (rotation-oscillation, sonic, manual pediatric, and two manual adult toothbrushes). The length and weight of the toothpaste dispensed were recorded. The data were evaluated by nonparametric correlation analysis (P < 0.05).

RESULTS

Eighty-one students (third year = 42; fifth year = 39; mean age: 26.2 ± 5.3 years) participated in the study. More toothpaste was dispensed by third-year students than by fifth-year students (weight: P = 0.014; length: P = 0.037). Men dispensed more toothpaste than did women (weight: P < 0.001; length: P = 0.042). Participants with higher educational attainment dispensed less toothpaste (weight: P < 0.001; length: P < 0.001). The type of toothbrush was associated with the weight of toothpaste dispensed (P < 0.001). Toothbrush head size was inversely associated with the length of toothpaste dispensed (P < 0.001).

CONCLUSION

The amount of toothpaste used by dental students was associated with cumulative learning, educational attainment, sex, and toothbrush head size but not with the fluoride content of the toothpaste.

Dentists' Approaches to Treatment Decision-Making for People with Dementia: A Qualitative Study

INTRODUCTION

Globally, the number of people living with dementia (PLwD) is projected to increase substantially. Dentists will encounter an increasing number of PLwD retaining natural teeth who need dental care. Dental treatment planning can be complex for PLwD as both oral diseases and dental treatment can be detrimental to patients' oral and social function and comfort. In addition, patients may lack the capacity to make decisions about their treatment, posing further challenges for dentists.

OBJECTIVE

This study aimed to explore dentists' approach to treatment decision-making with or for PLwD.

METHODS

Semistructured one-to-one interviews were completed with 22 dentists between April 2020 and March 2021. Data generation and analysis followed the principles of constructivist grounded theory with data being collected and analyzed simultaneously using a maximum variation sample. Interviews were recorded, transcribed verbatim, and then analyzed, leading to a theoretical understanding of how dentists approach treatment decisions for PLwD.

RESULTS

Four data categories describe dentists' approaches to treatment decision-making for PLwD. Dentists sought to provide individualized care for PLwD. However, they described planning care based on risk-benefit analyses that primarily considered biomedical factors and generic assumptions. There was an underemphasis on the psychological or social implications of dental care or its delivery. Furthermore, while some dentists attempted to involve patients in treatment decisions, they reported fewer attempts to identify the views and preferences of PLwD identified as lacking decisional capacity. In this scenario, dentists reported leading the decision-making process with little regard for patients' known or identified preferences and minimal involvement of PLwD's family.

CONCLUSIONS

Dentists acknowledge the complexity in treatment decision-making for PLwD yet focused heavily on biomedical considerations, with an underemphasis on individuals' preferences and autonomy. Considering psychosocial aspects of care alongside biomedical factors is essential to support holistic person-centered care for this growing patient cohort.

KNOWLEDGE TRANSFER STATEMENT

This study highlighted that dentists may only be considering biomedical aspects of care when considering what treatment is appropriate for people living with dementia. When making or supporting treatment decisions, dentists should explore patients' preferences and actively consider relevant psychosocial factors. These can be actively identified through considered discussions with patients as well as their family members. Gathering this information should support more person-centered and value-concordant decision-making for people living with dementia.

A novel prosthesis presentation test to screen for cognitive and functional decline

OBJECTIVES AND BACKGROUND

To validate a novel screening test for cognitive and functional decline in older patients rehabilitated with complete removable dental prostheses (CRDPs).

MATERIALS AND METHODS

Edentate old in-patients rehabilitated with CRDPs were included in this study. Participants were requested to remove their prostheses before their intraoral examinations. The prostheses were then presented in an inverted orientation. Participants had to correct the orientation of the prostheses and insert them in the appropriate jaws. The test was repeated after the intraoral exam. Appropriate statistical models were used (⍺ = .05) to associate the test results with the participants' mini-mental state examination (MMSE) score, functional independence measure (FIM), age and sex.

RESULTS

Among the 86 participants (mean-age: 85.4 ± 6.4 years; mean MMSE: 19.8 ± 5.5; mean FIM: 77.9 ± 20.8), 21 (24.4%) failed to correctly insert the prosthesis. The prosthesis presentation test (PPT) was associated with the FIM but not the MMSE. Regression models further confirmed an association with age (P = .043), but not sex. Additional analyses revealed the PPT test is associated with the FIM's cognitive sub-sets of memory, problem solving and social interaction.

CONCLUSION

The PPT is a novel, simple and quick screening tool that can help detect functional difficulties in older people. It can easily be performed during an oral examination. Future studies are needed to determine whether the PPT can be used to detect deficits in executive function, as a complement to the MMSE and also as a first assessment of a patient's ability to manage dentures independently.

Validation of ageism scale for dental students in India: (Ageism Scale for Dental Students- India) - a cross sectional study

Background: Ageism persists in many different societies as it is innate and subconscious in nature. Negative effects such as loneliness, mistreatment, and occupational discrimination are frequently present due to ageism. The dental students in our study were wary of the possible benefits of expensive dental care because ageism is rife in their field. There is no validated and reliable ageism scale to assess how dental students perceive ageism in India. The current study was carried out to validate the ageism scale for dental students in the Indian context.

METHODS

This was a cross sectional analytical study carried out among both males and females in Manipal College of Dental Sciences, Mangalore in which the instrument was 27-item Ageism scale for dental students. Content validity was done by six subject experts. The final version was administered to 213 students/Residents of dental school. The factorability of data was confirmed with KMO = 0.61 and Bartlett's Test of Sphericity resulting in p < 0.001.

RESULTS

Final PCA model resulted in 15 items and six components that together accounted for 70.37% of overall variance. The six components had reliability ranging from marginal 0.51 (Component 6) to a high of 0.81 (Component 3). As per the gender differences by component females showed less ageism than men in "non-compliance" (-0.9(-1.66-0.14), p<0.05) and "practitioner perspective" (1.43 (0.84, 2.03), p<0.01). Statistical significance was seen in Barriers/concerns in dental treatment of elderly where residents showed reversed (1.4 (0.41, 2.38), p<0.01). Urban group showed more ageism for component 'time restraint' (-0.79 (-1.57, -0.02), p<0.05.

CONCLUSION

Preliminary validation resulted in 15 item scale with six components with acceptable validity of the ageism scale and could be further tested in large samples. This scale will help recognize ageism in Indian context and provide necessary information to make changes in the curriculum as required.

Effect of Tooth Loss on Cognitive Function among Older Adults in Singapore

Evidence suggests a longitudinal association between tooth loss and cognitive function. However, the temporality of this association is not well understood. We investigated the effect of several emulated tooth loss prevention scenarios on cognitive function. We used data from 3 waves (baseline: 2009, second wave: 2011-2012, and third wave: 2015) of the Panel on Health and Ageing of Singaporean Elderly (PHASE). PHASE targeted older adults, aged ≥60 y, in Singapore. Number of teeth was used as a time-varying exposure (baseline, second wave). Cognitive function (Short Portable Mental Status Questionnaire score) in the third wave was assessed as the outcome. Multiple time-invariant (baseline) and time-varying (baseline and second wave) covariates were included. The "longitudinal modified treatment policy approach" combined with targeted minimum loss-based estimation was used to define and estimate additive effects of emulated tooth loss prevention scenarios. Emulated scenarios were the following: what if edentate people retained 1 to 4 teeth (scenario 1), what if those with <5 teeth retained 5 to 9 teeth (scenario 2), what if those with <10 teeth retained 10 to 19 teeth (scenario 3), and what if everyone retained ≥20 teeth (scenario 4)? A total of 1,516 participants, excluding those with severe cognitive impairment, were included (male: 41.6%). The mean age at baseline was 70.6 y (SD = 7.1). The mean SPMSQ score at baseline was 2.06 (SD = 0.02) for edentulous, 1.55 (SD = 0.04) for 1 to 4 teeth, 1.61 (SD = 0.03) for 5 to 9 teeth, 1.73 (SD = 0.02) for 10 to 19 teeth, and 1.71 (SD = 0.02) for ≥20 teeth. Additive effect of hypothetical intervention gradually increased with intensity of prevention from scenario 1 to scenario 4 (scenario 1: -0.02 [95% CI, -0.08 to 0.04], scenario 2: -0.05 [95% CI, -0.11 to -0.00], scenario 3: -0.07 [95% CI, -0.14 to -0.00], scenario 4: -0.15 [95% CI, -0.23 to -0.06]). Emulated tooth loss prevention interventions were associated with better cognitive function score. Therefore, preventing tooth loss could potentially benefit maintenance of cognitive function among older adults.

Interactions between systemic diseases and oral microbiota shifts in the aging community: A narrative review

As a gateway to general health and a diverse microbial habitat, the oral cavity is colonized by numerous microorganisms such as bacteria, fungi, viruses, and archaea. Oral microbiota plays an essential role in preserving oral health. Besides, the oral cavity also significantly contributes to systemic health. Physiological aging influences all body systems, including the oral microbial inhabitants. The cited effect can cause diseases by forming dysbiotic communities. Since it has been demonstrated that microbial dysbiosis could disturb the symbiosis state between the host and the resident microorganism, shifting the condition toward a more pathogenic one, this study investigated how the oral microbial shifts in aging could associate with the development or progression of systemic diseases in older adults. The current study focused on the interactions between variations in the oral microbiome and prevalent diseases in older adults, including diabetes mellitus, Sjögren's syndrome, rheumatoid arthritis, pulmonary diseases, cardiovascular diseases, oral candidiasis, Parkinson's disease, Alzheimer's disease, and glaucoma. Underlying diseases can dynamically modify the oral ecology and the composition of its resident oral microbiome. Clinical, experimental, and epidemiological research suggests the associations of systemic disorders with bacteremia and inflammation after oral microbial changes in older adults.

Analysis of 358 histopathological reports of oral and maxillofacial lesions in elderly patients from Tanzania: a cross-sectional study

In Tanzania, roughly 6% of the total population is elderly, which is the age group that is vulnerable to several diseases in the orofacial region. This study aimed to determine the incidence of oral and maxillofacial lesions in elderly Tanzanian patients.

Material and Methods

This was a cross-sectional study of histopathological results of patients with oral and maxillofacial lesions attended at Muhimbili National Hospital. All patients aged 60 years and above diagnosed with oral and maxillofacial lesions between 2016 and 2021 were included in the study. The information gathered included the age and sex of the patients, histopathological diagnosis, and anatomical location of the lesion. The Statistical Package for the Social Sciences, version 26 computer program was used for data analysis.

Results

A total of 348 histopathological reports of 348 elderly patients with oral and maxillofacial lesions were obtained. There was an equal distribution by sex. Majority (78.2%) of the lesions were malignant, followed by benign ones (12.6%). The frequently affected site was the tongue (18.1%) and the mandible (15.4%). Squamous cell carcinoma was the most (60.3%) frequently encountered lesion. Others included adenoid cystic carcinoma (5.5%) and ameloblastoma (3.7%).

Conclusions

The burden of oral and maxillofacial lesions among the elderly Tanzanian population was substantial. There was no sex predilection. A majority of the lesions were malignant, and the tongue was the frequently involved site.

Educating dental students to provide compassionate age friendly care for older adults

As the world population ages, the need for age friendly care increases. In dentistry, age friendly care requires an appropriate comprehension of multiple factors that can be categorized in socio-economic circumstances, systemic health problems, and oral health conditions. In addition to the understanding of these factors and its relationships among each other, the future dental workforce should also be aware of unconscious and pervasive societal stereotypical perception of older persons, aging, and being old, which results in ageism and ageist attitudes. Dental schools can play an important role on raising ageism awareness and combating ageism in healthcare, thus preparing the future of the dental workforce to provide compassionate age friendly care. This paper will discuss ageism in dental schools and learning strategies used to combat it and increase compassionate care delivery for older adults.

Association between Oral Hygiene Information Sources and Daily Dental and Denture Care Practices in Urban Community-Dwelling Older Adults

The purpose of this cross-sectional study was to explore the sources of daily oral hygiene information among urban community-dwelling older adults in Athens, Greece and associate them with their dental and denture care habits. One hundred and fifty-four older adults (aged 71.7 ± 9.2 years) participated in the study, and their dental status, denture use, daily oral care habits according to current gerodontology recommendations, and oral care information sources were investigated. Daily oral hygiene practices were poor, and a small number of individuals recalled having received oral hygiene advice from a dentist. Only 41.7% of the 139 dentate participants performed toothbrushing with fluoride-based toothpaste at least twice a day, and 35.9% completed regular interdental cleaning. Among 54 denture wearers, 68.5% removed their denture(s) at night, and 54% cleaned them at least twice a day. Oral hygiene information sources included dentists (for approximately half of the participants), media, friends/relatives, non-dental health care providers and dental technicians. Dentate participants who had received oral hygiene information from dentists had a greater probability of brushing their teeth with fluoride toothpaste at least twice a day (p = 0.049, OR = 2.15) and performing regular interdental cleaning (p < 0.001, OR = 29.26). Denture wearers who had received instructions about denture hygiene from dentists were more likely to use a brush and mild soap (p = 0.016, OR = 14.67) and remove their denture(s) at night (p = 0.003, OR = 8.75). Dentists should improve their oral health prevention and promotion strategies for their older patients.

Oral health issues of late Baby Boomers (1956-1964)

OBJECTIVE

To examine the issues and forces on the oral health of late Baby Boomers born in 1956-1964 that have shaped their oral health status and the opportunities and disparities in oral health care that this generational cohort has experienced.

METHODS

Past and current literature on the oral health status of this cohort was reviewed in light of concurrent social, political, and economic climates in order to better understand current and future needs in oral health care for this generation.

RESULTS

The majority of late Baby Boomers have not yet had their 65th birthday. They have benefitted from more opportunities for education, preventive health care, and technological advances in dentistry and medicine than any other prior generation, including their big brothers and sisters-the early Baby Boomers. Yet they have had fewer economic advantages than the early Boomers. Age prevalent diseases, conditions, and medications common to older adults will pose new risks to oral health. Discrete, longitudinal data on oral health status and needs by generational cohort-such as for the late Baby Boomer cohort-is lacking.

CONCLUSIONS

Despite retaining more of their dentition than any other generation, it also evident that over the course of their lifetime, poverty, racism, and limited education have been unrelenting barriers to oral healthcare and undermine outcomes of care.

Pharmacotherapeutic challenges for treating the baby boomer cohort

As the baby boomer cohort ages, they have an ever-increasing number of comorbidities and associated poly-pharmaceutical treatment needs. The challenge for healthcare providers is to stay current of advancements in providing for this aging population. Baby boomers can expect a longer life expectancy than any previous generation. Yet, longevity has not correlated with better health. This cohort is noted for being goal driven and more self-assured than younger generations. They are resourceful and will often attempt to fix things themselves, including their healthcare. They believe hard work deserves justifiable rewards and relaxation. These beliefs have resulted in baby boomers utilizing more alcohol and illicit drugs. Altogether this means today's healthcare providers must be aware of potential interactions from the polypharmacy of prescribed medication, and they must include and understand additional complications associated with supplemental medications and illegal drugs.

Oral Health and Nutritional Intake in Community-Dwelling 90-Year-Old Japanese People: A Cross-Sectional Study

INTRODUCTION

This study aimed to determine the relationship between dentition, mastication, salivation and nutritional intake in 90-year-old Japanese people.

METHODS

This cross-sectional study included 84 participants (39 men and 45 women) aged 90 years. We used questionnaires to collect demographic information, smoking status, nutritional intake and higher-level functional capacity. Nutritional intake was assessed using the validated Brief-Type Self-Administered Diet History Questionnaire, and higher-level functional capacity was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) questionnaire. Oral examinations, masticatory performance tests, stimulated salivary flow rate (SSF) tests, blood tests, blood pressure tests and body mass index (BMI) assessments were conducted. Univariable and multivariable linear regression analyses were performed.

RESULTS

Multivariable linear regression analyses adjusted for sex, education, TMIG-IC and BMI ≤20 kg/m² showed that participants with masticatory performance <173 mg/dL had lower intake of folic acid and vitamin A than those with masticatory performance ≥173 mg/dL. SSF was positively associated with intake of vitamin A. The number of teeth was positively associated with the intake of β-carotene. With smaller effect sizes, masticatory performance, SSF and number of teeth were also associated with the intake of various micronutrients and carbohydrates.

CONCLUSION

Lower masticatory performance, lower SSF and fewer teeth were associated with a lower intake of several micronutrients, such as vitamin A, β-carotene and folic acids, in Japanese individuals of advanced age. Oral health practitioners should pay careful attention to the nutritional intake of older people with poor mastication, dry mouth and severe tooth loss.

Oral health for baby boomers: Past, present, and future

AIMS

This paper reviews the oral health services which were available for early (1945-1955) and late (1956-1964) baby boomers, as well as predicts their future oral healthcare needs.

METHODS AND RESULTS

The knowledge, beliefs, and attitudes of the parents of the baby boomers toward dental hygiene and oral healthcare, are reviewed. The introduction of dental health screenings occurred from 1910 to early 1970s, the creation of the first dental hygiene school and the introduction of water fluoridation influenced oral healthcare. Technology introduced in the dental offices in the 1960s included the high-speed handpiece, followed by intraoral suction in 1979. Baby boomers are keeping their teeth at higher rates than preceding generations due to improved prevention and advances in the treatment of periodontal disease, and overall lower rates of smoking in older adults, when compared to younger adults. However, access to dental care remains an issue for many. Advances in prevention and treatment of periodontal disease, early detection of root caries, new restorative techniques, and improved technologies to replace teeth are also discussed.

CONCLUSIONS

Early detection of periodontal disease, oral, and oropharyngeal cancer, risk factors for tooth loss and untreated caries are needed to improve the oral health for baby boomers. Access to oral healthcare is still an issue due to socio-economic disparities in America.

The Efficacy of Dental Caries Telediagnosis Using Smartphone: A Diagnostic Study in Geriatric Patients

Background and aim The major barrier to oral health care for geriatrics is access to dental care. Teledentistry is the field of dentistry that uses telecommunication with digital imaging for the exchange of valid information for diagnosis, treatment, and continuing dental education, enabling some means of approach to oral health care. This study aimed to assess the accuracy of diagnosing dental caries in the older age group by examining intraoral photographs taken by smartphone camera compared with standard clinical dental examination. Methods and material A calibrated dentist examined 18 patients aged 60-75 for six variables: sound tooth, decayed tooth, filled tooth with and without caries, missing tooth, and the presence of prosthesis. Intraoral photographs of each patient were taken using a smartphone. The photographs were then sent to six different examiners through WhatsApp. The accuracy of the diagnosis was measured by applying Cohen's kappa, sensitivity, and specificity. Fleiss' kappa was used to measure the agreement index using the software R (R Foundation for Statistical Computing, Vienna, Austria) version 4.2.1. Results The overall agreement between the tele-examiners and the control was measured, with the kappa scores ranging from 0.897 to 0.921, and the mean kappa score was 0.909. There was high specificity and sensitivity in the value observed. The agreement index, measured through Fleiss' kappa for six teeth conditions, reported the perfect agreement (0.867) among six examiners. Conclusions Under the limitations of the study, teledentistry using a mobile phone has acceptable accuracy for diagnosing caries in the older age group compared to a standard clinical dental examination.

Relationship between tongue pressure and handgrip strength: A systematic review and meta-analysis

OBJECTIVES

Muscle strength decreases with age, causing a decline in physical and oro-facial function. However, the impact of physiological and pathophysiological factors on tongue pressure (TP) has not been clarified. The purpose of this systematic review and meta-analysis was to compare and analyse TP and handgrip strength (HGS) between individuals aged <60 and ≥60 years, gender and need for care (independent older adults (IC) and older adults receiving nursing care (NC)). Furthermore, the effect of HGS in physical function on TP was examined.

METHODS

Human clinical studies reporting HGS and TP were searched systematically using PubMed and Ichushi-Web published from 1969 to Nov 2021. Random-effects meta-regressions were performed to compare between subgroups and to examine the association between HGS and TP (α < .05).

RESULTS

Forty-four studies with a total of 10 343 subjects were included. TP and HGS values were significantly higher in people aged <60 years relative to ≥60 years and in IC relative to NC (all p < .001). Regarding gender, there was no significant difference in TP (p = .370). However, a significant gender-dependent difference in TP was observed in people aged <60 years (p < .001), but not in aged ≥60 years in IC group (p = .118) and aged ≥60 years in NC group (p = .895). There was a significant positive correlation of HGS and TP (p < .001).

CONCLUSIONS

Similar to decrease in HGS, age-related sarcopaenia seems to have an effect on oro-facial muscles like the tongue. Research on rehabilitation measures for oro-facial muscle strength, similar to HGS might be beneficial to improve the personally acquired oro-facial potential.

Factors Associated with Self-reported Oral Health Among Community-Dwelling Older Adults in a Rural Province of Thailand

Background

Limited research has focused on self-reported oral health in older Thai individuals.

Objective

We explored the factors associated with self-reported oral health among older adults residing in rural Thailand.

Methods

This cross-sectional study included males and females aged ≥ 60 years living in Phon Thong district, Roi Et province, a rural area in northeast Thailand. This community-based study was conducted between May 2021 and December 2021. A trained interviewer administered a face-to-face interview questionnaire. Study data were analyzed using descriptive statistics, Pearson’s chi-squared test, and binary logistic regression.

Results

In total, 249 older individuals completed the interviews. Most study participants were aged ≥ 67 years (55.8%), with a mean age of 66.92 years. Pearson’s chi-squared test showed statistically significant associations between self-reported oral health and age (P = 0.035) and chewing ability (P = 0.005). The multivariate binary logistic regression analysis revealed significant associations between self-reported poor oral health and older age (AOR = 0.290, 95% CI: 0.091–0.925) and chewing discomfort (AOR = 4.032, 95% CI:1.119–14.56). We observed no significant associations between self-reported oral health and sex, toothbrushing frequency, and speaking ability.

Conclusion

Younger respondents with chewing discomfort were more likely to self-report poor oral health. In rural areas, nonprofessional health providers can use a single-item self-reported oral health question as a simple tool for evaluating oral health status in the elderly. Moreover, dental health education programs are needed to help older individuals improve their oral self-care, access dental services, and achieve appropriate oral function. Such programs are essential for promoting good oral health in this population, particularly among “younger” elders.

Undergraduate Dental Education in Gerodontology in Germany between 2004 and 2019-A case for compulsory teaching?

INTRODUCTION

The study surveys the present state of undergraduate dental education in gerodontology in Germany and highlights changes between 2004 and 2019.

MATERIALS AND METHODS

In 2019, questionnaires were emailed to the department heads of all German dental schools. Data were analysed descriptively and compared to existing data from 2004, 2009 and 2014.

RESULTS

Thirty-nine (86.7%) out of forty-five responding department heads stated to teach aspects of gerodontology in traditional core subject lecture series. Overall, 15 (55.6%) out of 27 responding dental university schools are offering special education in gerodontology (dedicated lecture series and/or practical training). A stronger focus on non-dental topics has been observed over the years.

DISCUSSION

The 15-year observation period in Germany shows that teaching gerodontology should be mandatory. There is a lack of specialists in gerodontology at the dental schools, although specialisation has been possible for many years in the German professional association. Students should be sure that, as in other subjects, they are well trained for the very heterogeneous patient group of seniors. The financial and personnel prerequisites for the universities need to be established.

CONCLUSION

Inclusion of gerodontology in the national syllabus is a decisive factor for the integration of the subject into undergraduate courses. The recommendations of the European College of Gerodontology (2009) and of the German Association of Gerodontology (DGAZ) regarding didactical and practical teaching should be implemented in the respective compulsory syllabus to prepare current undergraduate dental students for the demographic challenges of tomorrow.

The teaching of geriatric dentistry in South Korean dental schools

OBJECTIVE

The purpose of this study was to investigate the curriculum of geriatric dentistry for undergraduates in Korean dental schools.

BACKGROUND

For development purposes, it was necessary to compare geriatric dentistry education programmes in South Korea to programmes in the United States and Europe.

METHODS

The most recent curriculum and related information on geriatric dentistry at the undergraduate level in all 11 dental schools in South Korea were collected by both official letter and e-mail. A symposium for gathering expert opinions to improve geriatric dentistry education in South Korea was also held. The collected data were analysed, and the expert opinions at the symposium were summarised.

RESULTS

Six of 11 schools had a didactic course as compulsory and three schools as elective. The course was usually conducted as a form of integrated lectures, and the level of standardisation of lecture content was very low. There were no topics for older people who cannot access dental clinics due to functional frailty or disability. No dental school-affiliated hospitals had an independent department for geriatric dentistry. No schools provided clinical teaching for geriatric dentistry. There were no outreach programmes for geriatric dentistry.

CONCLUSIONS

The educational curriculum for geriatric dentistry in South Korea was insufficient to cope with social and demographic changes. Curriculum content should include clinical practice education and needs to be focused on frail and dependent older adult patients. An essential educational curriculum and core competency for geriatric dentistry should be prepared.

Relationship between Food Crushing and Oral Function in Older Adults Requiring Nursing Home Care: A Pilot Study

We investigated how jelly is crushed and examined the relationship between tongue pressure and tongue food crushing ability among older adults requiring nursing home care. Seventy-two participants were instructed to freely crush the test foods soft jelly (SJ) and hard jelly (HJ). We visually evaluated the crushability of the test food and identified the intraoral tissues (active sites) used to crush the test food. The active sites were consistent for all participants for both SJ and HJ, and they included the maxillary and mandibular teeth in 41 participants, teeth and residual ridges in 15 participants, maxillary and mandibular residual ridges in 10 participants, and tongue and palate in six participants. Two participants failed to crush the SJ; the active sites in both participants were the tongue and palate. No participant using the tongue and palate as active sites could crush the HJ. Furthermore, 64 participants could crush the SJ and 23 could crush the HJ using the tongue and palate. The cutoff value of the tongue pressure for crushability of the HJ was 22.0 kPa. Assessing tongue pressure and intraoral active sites involved in food crushing could help determine an appropriate diet for older adults requiring nursing home care.

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

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.

Utilization of dental services and health literacy by older seniors during the COVID-19 pandemic

Background

This study aimed to investigate the utilization of dental services by older seniors during the COVID-19 pandemic and to evaluate their ability of finding, understanding, and using information on COVID-19.

Methods

At the end of February 2021, a survey addressing demographic characteristics of the participants, (pain-associated) utilization of dental services, worries regarding a potential COVID-19 infection, the individual use of protective masks, and difficulties regarding the access to information on COVID-19 (by using the modified European Health Literacy Questionnaire [HLS-EU-Q16]) was developed. It was sent to all patients of the Dental Clinic of University of Leipzig who were either 75, 80, or 85 years old (n = 1228). Participation was voluntarily and anonymously; questionnaires had to be returned within six weeks, no reminders were sent.

Results

Of the 439 replies (response rate 35.7%), twelve were excluded from data extraction due to disinterest, dementia, or lack of age information. Of the older seniors, 81.5% (n = 348) had utilized at least one dental examination and 54.2% of the dentulous patients (n = 199) had attended at least one dental hygiene appointment within the past year. Up to 55.8% of all participants said it was “difficult” or “very difficult” to find, understand, and use information on COVID-19, especially when judging reliability of information presented in the media, which was especially true for seniors with assigned care levels presenting odds ratios up to 5.30.

Conclusions

The investigation revealed a frequent utilization of dental services by older seniors during the COVID-19 pandemic. However, the older seniors encountered difficulties finding, using, and understanding information about COVID-19.

Translation and validation of an ageism scale for dental students in Switzerland

PURPOSE

This study aimed to validate an ageism scale for dental students in Switzerland.

METHODS

The original scale was first translated to German and then evaluated by 14 experts for relevance; four items were eliminated. Validation of the resulting questionnaire was performed at three Swiss dental schools. Principal component analysis (PCA) was performed; Cronbach's alpha (α) was used to assess the internal consistency reliability, and Pearson's coefficient to identify any correlations with demographic parameters (P < 0.05).

RESULTS

PCA revealed 11 items among 4 factors (Overall: 11 items, α = 0.63, variance = 56.6%; Factor #1 (F1): items = 3, α = 0.64; Factor #2 (F2): items = 3, α = 0.42; Factor #3 (F3): items = 3, α = 0.35; Factor #4 (F4): items = 2, α = 0.37). F1 and F4 were correlated with clinical experience (F1: P = 0.042; F4: P = 0.006) and participation in a gerodontology course (F1: P = 0.021; F4: P = 0.004). F1 was correlated with experience of dealing with the elderly (P = 0.031), while residence locality was correlated with F3 (P = 0.047) and F4 (P = 0.043). F2 was correlated with the presence of elderly in the family (P = 0.047).

CONCLUSION

The translated dental ageism questionnaire for Switzerland resulted in an 11-item scale with acceptable reliability.

One-year prospective study on single short (7-mm) implant overdentures in patients with severely resorbed mandibles

OBJECTIVE

This prospective study aimed to assess the effectiveness of using a single short implant to retain a single-implant mandibular overdenture (SIMO) in participants with severely atrophic edentulous mandibles.

MATERIAL AND METHODS

The study sample included 18 edentulous participants with severely resorbed mandibular ridges and limited bone height in the symphyseal region sufficient for the insertion of a 7.0-mm-height implant. First, patients received new conventional dentures or had their dentures relined, followed by the insertion of a 3.75 x 7 mm morse-taper implant, and the incorporation of a stud-type attachment and a nylon retentive insert after a 3-month healing period. Implant stability quotient (ISQ) was measured at baseline and after 3 and 12 months. Patient-reported outcomes (satisfaction with the dentures and oral health-related quality of life) were assessed before implant placement and at the 3-, 6-, and 12-month follow-ups. Clinical-radiographic outcomes and the incidence of prosthodontic events were assessed throughout the follow-up period.

RESULTS

The implant survival rate was 100%. ISQ increased from baseline (72.7 ± 6.6) to the 3-month (82.0 ± 3.3) and 1-year (85.4 ± 2.9) follow-ups (p < .001). After 1 year, satisfaction with the mandibular prosthesis increased significantly, and the overall OHIP-Edent score decreased by 79.2%. No effects were found for the maxillary denture (p = .420). Due to dissatisfaction with treatment, two participants (11.1%) required additional implants after the 1-year follow-up and were considered as prosthodontic failures.

CONCLUSION

Single-implant mandibular overdenture retained by a short implant showed favorable outcomes after 1 year. Further studies with larger samples and longer follow-up periods are needed to confirm the findings of this single-group prospective study. The present study was registered at the Brazilian Clinical Trials Registry (REBEC), identifier RBR-7p2xmg. The trial registry occurred during the study execution, and its final approval was delayed because of several formatting adequacies required by the platform REBEC.

Lower Masticatory Performance Is a Risk for the Development of the Metabolic Syndrome: The Suita Study

Objectives: Declined masticatory function has recently been receiving attention as a risk factor for poor general health. The present longitudinal analysis was conducted to clarify the relationship between decreased masticatory performance and the development of the metabolic syndrome (MetS) in a general urban cohort in Japan.

Methods: We surveyed 599 participants (254 men, 345 women; mean age at baseline, 65.8 ± 7.8 years) who underwent physical health checkups in the Suita study. We evaluated masticatory performance at baseline using test gummy jelly and divided participants into two groups: a “Lower group,” comprising participants in the lower 25% of the masticatory performance at baseline; and a “Normal group,” comprising all others. We estimated hazard ratios (HRs) for the Lower group by using Cox proportional hazard regression analysis to develop the MetS and the components of the MetS at follow-up, adjusting for age, smoking status, and periodontal status.

Results: On Cox proportional hazard regression analysis, the multivariable adjusted hazard ratio for the development of the MetS in the Lower group was 2.24 (95% confidence interval, 1.12–4.50) in men. The multivariable adjusted hazard ratio for the development of high blood pressure was 3.12 (1.42–6.87), for high triglycerides was 2.82 (1.18–6.76), and for high fasting plasma glucose was 2.65 (1.00–7.00) in men.

Conclusions: Lower masticatory performance suggested to be a risk factor for the development of the MetS as well as MetS components such as high blood pressure, high triglycerides, and high fasting plasma glucose in Japanese men.

Evaluation of oral-health behavioral attitudes of dental students in Switzerland and Brazil

PURPOSE

This study evaluated the effect of progressive training on the oral health behaviors of dental students from Switzerland and Brazil.

METHODS

Dental students from two dental schools (in Zurich, Switzerland, and Goiania, Brazil) were recruited for this study. Dental behaviors of the students in the final 3 years of their 5-year dental curriculum were assessed with the 20-item Hiroshima University-Dental Behavior Inventory (HU-DBI). Nonparametric tests were used to assess intergroup and intragroup differences (significance level: α = 0.05).

RESULTS

190 students (Zurich: n = 121, mean age ± SD = 25.5 ± 4.5 years; Goiania: n = 69, mean age ± SD = 23.5 ± 2.9 years) of a possible 277 students completed the survey (response rate = 68.6%). The overall mean HU-DBI score was 8.16 ± 1.35 (8.02 ± 1.27 in Switzerland and 8.41 ± 1.47 in Brazil). Age (P = 0.225) and sex (P = 0.145) were not associated with the scores, but the respondent's nationality seemed to play a role (P = 0.024). Progressive training had no effect on the scores (P = 0.766).

CONCLUSIONS

The present findings show that progressive training has no effect on the oral health behaviors of dental students but the nationality might be a factor.

Proposal for a Conceptual Framework for the Development of Geriatric Dentistry

Demographic changes with an increasingly higher proportion of older adults worldwide and an epidemiologic transition resulting in more teeth retained and higher demand and expectations set up new scenarios for the oral health of the older population. Thus, geriatric dentistry must be reconfigured, transitioning from the traditional focus on prosthesis to a more holistic discipline, actively incorporating geriatric and gerontologic aspects. We describe some situations that provide the rationale for a new conceptual framework for the advancement of geriatric dentistry as a clinical specialty. On the basis of scientific evidence and our academic experience, we propose 4 concepts that should steer the discipline during the following years and become its structural pillars: minimal intervention dentistry, oral functionality, patient-centered care, and interdisciplinary teamwork. Since data and evidence are limited, a special focus on poor and developing countries is incorporated. Adjusting clinical guidelines and public health policies around these concepts will increase access to oral care for older people, including those with physical or social barriers, and will ensure better oral health-related quality of life and well-being. These concepts have deep consequences in the education and training of new dentists and specialists, at the public and private levels.

Translation and preliminary validation of the Serbian version of an ageism scale for dental students (ASDS-Serb)

AIMS

The ageist attitudes among dental clinicians may result in inadequate treatment planning and reduce quality of life for older adults. This study aimed at performing a preliminary validation of an ageism scale for dental students (ASDS) in Serbia (ASDS-Serb).

METHODS AND RESULTS

The 27-item ASDS was translated from English into Serbian and completed by 129 dental students. Principal component analysis (PCA), Confirmatory factor analysis (CFA), internal consistency reliability and discriminant validity were estimated. PCA produced a 17-item scale distributed into five factors that explain 64.24% of the total variance. All items showed high to moderate reliability (0.50-0.83). CFA indicates an acceptable model fit with significant standardized factor loadings ranging from 0.14-0.99. The first factor dealt with negative views of older adults' life and dental treatment, the second factor related to ethical values about older people, the third factor compared younger and older adults in dental care and the fourth factor related to difficulties in medical history taking. The fifth factor related to perceptions of oral health and treatment of older adults. Discriminant validity revealed significant differences related to the semester of studies, gender and having older people in the family.

CONCLUSION

The preliminary validation of the ASDS-Serb resulted in a 17-item scale distributed into the five factors with acceptable validity and reliability.

Impact of the COVID-19 pandemic on the University of British Columbia Geriatric Dentistry Program: Clinical education and service

Background and Objective

In Canada, the COVID‐19 pandemic was associated with significant morbidity and mortality in older adults, particularly those in long‐term care (LTC). Access to oral health services was limited during the pandemic due to public health restrictions. The aim of this paper was to describe the impact of the pandemic on the clinical education and service of the University of British Columbia (UBC) Geriatric Dentistry Program (GDP), which provides care to LTC residents.

Methods

Data were collected from UBC GDP AxiUm dental software records, including number of dental appointments in 2019 and 2020. Data on revenue in 2019 and 2020 based on clinical production were collected through financial summary reports. Data on the number of educational rotations were collected from summary reports from scheduling software.

Results

In 2020, significant reductions in clinical service, revenue, and productivity were observed in the UBC GDP relative to 2019. The number of GDP appointments for June‐December 2020 was lower by 68%. The clinical productivity reduced by 67% for the same period. Expenses were slightly reduced. The overall number of LTC clinical rotations for students were only slightly lower for undergraduate students in 2020 than in 2019, and it increased for graduate students.

Conclusion

The COVID‐19 pandemic and associated public health restrictions had a negative impact on the clinical service and productivity of the UBC GDP in 2020 relative to 2019. However, clinical educational rotations to LTC were slightly increased in 2020 relative to 2019. Dental care for LTC residents can be provided if rigorous administrative controls, engineering controls and personal protective equipment are employed.

Impact of Periodontal Disease on the Quality of Life of Older People in Indonesia: A Qualitative Study

Introduction:

The impact of periodontal disease on oral health–related quality of life (OHRQoL) has often been investigated from a quantitative research perspective, which is based on clinical findings and an OHRQoL questionnaire. Very few studies have examined the issue from the view of qualitative research. To our knowledge, there have been no previous qualitative studies focusing the effect of periodontal disease on OHRQoL in Indonesian older people.

Objectives:

To explore and understand the impact of periodontal disease on the OHRQoL of older people as a subjective reflection in relation to periodontal disease experiences.

Methods:

Semi-structured interviews were conducted in a sample of 31 older people with generalized chronic periodontitis. Thematic analysis was used to identify the key issues in participants’ accounts. The analysis was undertaken by 2 independent coders to ensure reliability. To achieve thematic saturation, successive interviews were undertaken until 5 sequential interviews did not bring new themes.

Results:

Participants reported the negative effects likely related to periodontal disease. The impacts of periodontal disease were described by these older people as affecting more than pain, physical discomfort, and physical function restrictions. Periodontal disease also affected their psychological and social aspects of daily living. In addition, this study identified themes related to individual and environmental factors that may modify and personalize periodontal disease experiences. Furthermore, this study identified a misleading belief that problems related to periodontal disease were a normal part of aging, which might influence individuals’ expectations toward oral health. Relatedly, participants frequently reported that the progression of tooth mobility to tooth loss was an inevitable part of the aging process.

Conclusions:

Periodontal disease negatively affected participants’ OHRQoL. It is fundamental to understand older people’s perceptions toward their periodontal disease as well as individual and environmental factors that may have an influence on their periodontal disease experiences.

Knowledge Transfer Statement:

This study is a reflection of Indonesian older people’s subjective periodontal disease experiences. Therefore, the present study can be used to understand older people’s perceptions, attitudes, behaviors, and experiences toward periodontal disease and how this disease may affect their quality of life. This study also highlights a widespread and misleading belief that oral problems related to periodontal disease are an inevitable part of aging in this study population.

Scoping review: Facilitators and barriers in the adoption of teledentistry among older adults

OBJECTIVE/BACKGROUND

Access to oral health care among older adults is a key issue in society, which has been exacerbated by social distancing measures and lockdowns during the COVID-19 pandemic. Older adults would greatly benefit from teledentistry, yet little information exists on the enablers and challenges of adopting this technology for use with this group. The aim of this scoping review is to summarise the applications and key factors associated with the adoption of teledentistry among older adults.

MATERIALS AND METHODS

This scoping review was developed in accordance with Arksey and O'Malley's five-stage framework and the Joanna Briggs Institute scoping review protocol guidelines. Publications on teledentistry involving direct clinical services for older adults aged 60 and above were included. Publications that focused solely on teleeducation were excluded. A systematic search was carried out on major electronic databases until 25 August 2020. Out of 1084 articles screened, 25 articles were included. Facilitators and barriers were categorised using the socio-ecological model.

RESULTS/DISCUSSION

Teleconsultation and telediagnosis were the most reported applications of teledentistry among older adults. Reported policy-level factors were data privacy issues (n = 7) and regulations (n = 17). Community-level facilitators and barriers included the availability of resources (n = 15) and support (n = 3). Familiar care settings (n = 2) and effective administration (n = 20) were key organisational-level factors. Staff attitudes and education (n = 23) and individual patient knowledge, attitudes and practices (n = 10) can influence teledentistry adoption while complex medical conditions (n = 8) may pose a challenge.

CONCLUSION

Key factors in the uptake of teledentistry among older adults span across policy, community, organisational, interpersonal and individual factors. Commonly reported barriers included technical issues, lack of funding, consent issues and cognitive impairments.

Comprehensive evaluation of knowledge and perceptions regarding geriatric dentistry among Saudi Arabian dental students

OBJECTIVES

The purpose of this study was to evaluate the knowledge and perceptions of Arabian dental students on geriatric dentistry.

MATERIALS AND METHODS

A cross-sectional survey was conducted with a total of 100 participants belonging to Group I (25 each from third- and fourth-year students) and Group II (50 fifth-year students and interns ). All participants had completed a three-part questionnaire related to geriatric dentistry: Part I (knowledge), Part II (cognitive evaluation), and Part III (awareness and attitude of psychosocial and health problems). Comparisons were made between the groups, and the data were analyzed using SPSS software.

RESULTS

The responses on the Part I were not statistically significant among the groups (P > 0.05). The knowledge mean scores comparison showed an evident significant relationship among the groups (P < 0.05). Overall the Group II participants achieved the highest scores for all the Parts (all P > 0.05).

CONCLUSIONS

The students belong to Group II, and the interns achieved higher scores than the Group I students. Dental students and interns in Saudi Arabia lack positive approaches in providing primary health care to geriatric individuals despite a rapidly growing geriatric population.

Arabian undergraduates perceptions regarding barriers among the geriatric patients for failing to keep dental appointments: A cross-sectional study

BACKGROUND

Regular visits to the health care providers can develop a relationship that can extend beyond the physical health alone as the patient is transiting towards older age, adapting to changes in physical health, emotional health, and social connections. Apart from limiting access to health care services, the attitudes, beliefs, comfort level of the treating doctors towards the geriatric patients can motivate or demotivate them to access dental care.

AIM

To explore the Saudi Arabian undergraduate students perception of geriatric patients and identify potential barriers that prevent the utilization of their dental appointment.

METHODS

A close-ended questionnaire with one question and eight reasons was administered to the fifth year clinical students. The students were requested to specify their agreement with each question on a 5-point Likert scale. Among the barriers presented, each reason's approval was expressed as the percentage of the total number of responses. In addition, the gender comparison of mean scores was made, and an independent sample t-test was used to analyze the statements agreed by the students. All analyses were performed using Statistical Package of Social Sciences (SPSS) version 21.0 (IBM, USA) with the probability of statistical significance at 0.05 level.

RESULTS

Fifty-one students recorded their perceptions on the questionnaire administered during their clinical posting in the fifth year of the geriatric dental education program. It was concluded that students believed that geriatric patients give overwhelming importance to other problems with minor importance to oral health care. In addition, gender comparison was more evident as the percentage expressed was more in females.

CONCLUSIONS

There is a need for more clinical exposure of geriatric patients during their clinical postings. Student's acquaintance with didactic and clinical settings appears to be a critical element towards positive knowledge and attitude towards the geriatric population.

Effectiveness of a Dental Intervention to Improve Oral Health among Home Care Recipients: A Randomized Controlled Trial

We quantified the effectiveness of an oral health intervention among home care recipients. Seven German insurance funds invited home care recipients to participate in a two-arm randomized controlled trial. At t₀, the treatment group (TG) received an intervention comprising an oral health assessment, dental treatment recommendations and oral health education. The control group (CG) received usual care. At t₁, blinded observers assessed objective (Oral Health Assessment Tool (OHAT)) and subjective (Oral Health Impact Profile (OHIP)) oral health and the objective periodontal situation (Periodontal Screening Index (PSI)). Of 9656 invited individuals, 527 (5.5%) participated. In the TG, 164 of 259 (63.3%) participants received the intervention and 112 (43.2%) received an outcome assessment. In the CG, 137 of 268 (51.1%) participants received an outcome assessment. The OHAT mean score (2.83 vs. 3.31, p = 0.0665) and the OHIP mean score (8.92 vs. 7.99, p = 0.1884) did not differ significantly. The prevalence of any periodontal problems (77.1% vs. 92.0%, p = 0.0027) was significantly lower in the TG than in the CG, but the prevalence of periodontitis was not (35.4% vs. 44.6%, p = 0.1764). Future studies should investigate whether other recruitment strategies and a more comprehensive intervention might be more successful in improving oral health among home care recipients.

Remote Management of Prosthodontic Emergencies in the Geriatric Population During the Pandemic Outbreak of COVID-19

The global pandemic outbreak of coronavirus disease 2019 (COVID-19) has put the world in a panic situation. It has been evident that the geriatric population is more susceptible to acquire this infection. Thus, due to this ongoing crisis, geriatric individuals cannot visit a dental operatory, and there is the possibility of their dental needs and emergencies to remain unattended. Partial or complete edentulism is very prevalent among the geriatric population, and prosthodontic management of these patients is essential for their well-being. However, the prosthesis can lead to various emergencies of the oral and its supporting structures. There are currently no available recommendations to address these prosthodontic emergencies in geriatric individuals during this pandemic period. Hence, the aims of this minireview were to discuss the common prosthodontic emergencies in the geriatric population and provide recommendations to manage these issues during the COVID-19 pandemic outbreak.

Periodontal Disease and Oral Health-Related Quality of Life in the Older Population in Indonesia

Introduction:

Despite being acknowledged as the second global burden of oral disease, periodontal disease has few epidemiologic studies in the literature, particularly for developing countries. Many previous studies have assessed the relationship between periodontal disease and oral health–related quality of life (OHRQoL), with patients attending dental clinic or hospitals rather than a general population. This study attempted to fill the knowledge gap in limited information about periodontal disease and OHRQoL, with reference to a general population in a developing country.

Objectives:

To investigate the relationship between OHRQoL and periodontal diseases in an older population in Indonesia.

Methods:

We invited 582 older people from community health centers. The 369 (63.4%) older people who agreed to participate consented to an oral health examination and a questionnaire capturing demographic, socioeconomic, behavioral, and Oral Health Impact Profile–14 (OHIP-14) data.

Results:

Almost 75% of the older people had generalized periodontitis; 3% had healthy periodontal status; and around 22% had localized periodontitis. There was a lack of statistical evidence for an association between periodontal disease status and OHRQoL. This result was based on the appraisal of the prevalence of the impact (Odds ratio [OR], 0.95 [95% CI, 0.54 to 1.59]; P = 0.77), difference in mean severities (0.07 [95% CI, –1.66 to 1.80]; P = 0.94), and extent of the impact (P = 0.996). However, we found evidence for a relationship between tooth mobility and OHRQoL for all of the OHIP assessments, including prevalence of the impact (OR, 1.87 [95% CI, 1.16 to 3.01]; P = 0.009), difference in mean severities (–2.98 [95% CI, –4.50 to –1.45]; P < 0.001), and extent of the impact (P = 0.001).

Conclusion:

There was a lack of statistical evidence for a relationship between periodontal disease status and OHRQoL in this society. However, we found evidence that tooth mobility, as a sign of periodontal disease progression, is related to OHRQoL.

Knowledge Transfer Statement:

The present study can be used by dentists, community health workers, and policy makers in Indonesia to understand the prevalence, severity, and extent of the negative impacts of periodontal disease on older people’s quality of life. In addition, this study provides information about factors that might considerably affect the oral health–related quality of life in this society, such as brushing habits, dental visit, family income, DMF-T status, and subjective appraisal toward dental health.