[Acute respiratory distress in a frail older patient: spontaneous tooth aspiration]

A 68-year-old man presented at the emergency room with acute difficulty breathing. On account of recent subarachnoidal haemorrhage the patient was a resident of a care facility, and was also being treated for acute bronchitis there. Radiographic imaging of the lungs revealed a tooth with crown and pontic to have been inhaled. The tooth was surgically removed. After 3 weeks in the intensive care unit, the patient died of aspiration pneumonia. Spontaneous tooth aspiration is rare, yet it can have fatal consequences in vulnerable older patients. Aspiration of a foreign body may lead to injury and infection of the trachea and lungs. In order to determine the correct diagnosis in patients with acute respiratory distress, adequate and targeted diagnostics is essential; especially in older patients with multimorbidity and polypharmacy. Sarcopenia, dysphagia, a decrease in functional chewing units and decreased sensation of the palate increase the risk of choking in patients. In addition, dysphagia and poor oral health are known to be strongly associated with aspiration pneumonia. Healthcare providers should pay more attention to oral health in frail older patients.

[Research agenda oral care for older people in the Netherlands and Flanders (Belgium)]

Oral care for older people is an underexposed topic in dentistry as well as in general healthcare, while oral care professionals are increasingly confronted with frail and multimorbid older people with complex care needs. The research agenda 'Oral care for the elderly' was developed to encourage the collaboration of researchers in the Netherlands and Flanders (Belgium) to do more research in this area and in this way, to achieve an expansion and implementation of knowledge. This will make possible the provision of a socially responsible and robust basis for sustainable oral care for frail older people. The focus of the agenda is on 3 themes, namely oral health and oral function for older people; multi/interdisciplinary collaboration within primary care and the costs, benefits and long-term effect(s) of oral care throughout the entire course of life. This article provides an overview of this research agenda and the way in which it has been established.

[A view on collective oral care for frail older people: united we stand]

Oral health in frail older people is often poor. There are a number of reasons for this, such as increased morbity and decreased motivation for (self) care. Good oral health is, however, very important. Studies have revealed poor oral health to cause or aggravate several medical and psychological problems. Illness and medication can, in turn, damage oral health. Oral health among the elderly should therefore be carefully monitored and maintained. This requires multidisciplinary and interprofessional collaboration on the part of healthcare professionals and others involved. Such collaboration is now still very limited; hardly anything has been written about how such collaboration in the area of oral care for frail older people should or could be organised. This article provides an overview of the possibilities and the relevant factors in the area of oral care for the elderly in promoting collaboration among healthcare professionals and others involved. All of this is under the banner of 'united we stand'.

[Autonomy in the individual oral care programme of the care-dependent cognitively impaired older patient]

The decision-making process on oral healthcare issues concerning caredependent, frail older people living in nursing homes may be complex if patients are incapable of (adequately) expressing consent or are legally incapacitated. Therefore, oral healthcare professionals providing care to cognitively impaired patients in nursing homes need background knowledge of healthcare legislation and healthcare ethics, concerning the aspects relevant to developing an individual oral care programme. In this article, attention is given to these aspects of healthcare legislation and ethics, and the guideline 'Mondzorg en verzet bij wilsonbekwaamheid ter zake' (oral healthcare and resistance of the legally incapacitated) is described. This can be applied in comparable cases.

[Aftercare for durability and profitability of single-unit and multi-unit fixed dental prostheses]

An important aim ofa treatment with single-unit and multi-unit fixed dental prostheses is a durable and profitable treatment outcome. That requires aftercare, too. First, the frequency of routine oral examinations should be assessed, using an individual risk profile. The objectives of the routine oral examinations are the prevention and, when necessary, the treatment of pathological conditions and complications. With regard to prevention, attention should be paid to information and instruction, oral biofilm and calculus, non-functional activities, hard tooth tissues, periodontal and peri-implant tissues, and saliva. Subsequently, it can be determined whether the intended durability and profitability have been achieved or can still be achieved, whether or not through indicated adjustments. Special attention should be paid to endodontically treated teeth. Restorative, repair or replacement treatments may be indicated in case ofcomplications, such as loose single- or multi-unitfixed dental prosthesis, fracture of a fixed dental prosthesis unit, lost tooth pulp vitality, tooth root fracture, and implant or implant abutment problems.

[The role of single- and multiple-unit fixed dental prostheses in the strength distribution of the occlusal and orofacial system]

An occlusal system that does not function well, has a negative impact on the functional level of the oral system and the orofacial system. In purely mechanical terms, a limited anatomical reduction of the occlusal system has limited implications for the functional level since the occlusal system has several forms of adaptation, reserve, and compensation. However, following the loss of (parts of) teeth, an occlusal system may be anatomically reduced to such an extent that restoration of the functional level is required, for instance by the use of implant-supported single- and multiple-unit fixed dental prostheses. The mechanical strength of a tooth and a single-tooth fixed dental prosthesis on a similar tooth type is not essentially different. But the same cannot be said of the mechanical strength of a multiple-unit fixed dental prosthesis, because the strength is controlled by the mechanoreceptors in the periodontal ligaments of the abutment teeth. This control system is disturbed by the insufficiency of or, when oral implants are involved, the absence of mechano-receptors. It is unknown whether this is causing noticeable problems.