Improving Nursing Home Residents' Oral Hygiene: Results of a Cluster Randomized Intervention Trial

OBJECTIVE

A 2-year cluster randomized trial of Mouth Care Without a Battle (MCWB) was conducted in nursing homes (NHs) to determine if recommended mouth care practices provided by NH staff could improve residents' oral hygiene and denture outcomes.

DESIGN

Cluster randomized trial of NHs.

SETTING AND PARTICIPANTS

Seven MCWB NHs and 6 control NHs. A total of 219 NH residents completed baseline and 24-month oral examinations and, if applicable, denture assessments (control = 98, intervention = 121).

INTERVENTION

The intervention consisted of training NH staff in the MCWB protocol, and providing support in its use for 2 years.

MEASURES

Descriptive data from the Minimum Data Set and clinical oral health assessments: the Plaque Index for Long-Term Care (range 0‒3), the Gingival Index for Long-Term Care (range 0‒4), and the Denture Plaque Index (range 0‒4), with lower scores indicating better oral health.

RESULTS

There were no significant demographic or health differences between groups at baseline. Residents' mean age (standard deviation) was 77.8 years (13.5), 71% were female, and 49% had cognitive impairment. At 24 months, there were significant improvements in oral and denture hygiene in the intervention group compared with control (all P < .05) with mean changes in indices that were 0.44 (Plaque Index for Long-Term Care), 0.55 (Gingival Index for Long-Term Care), and 0.67 (Denture Plaque Index) points lower in intervention NHs than control NHs.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Training NH staff to attend to residents' oral hygiene and denture care had a sustained, favorable impact on residents' oral and denture hygiene after 24 months compared with usual care. The protocol, MCWB, can be used by direct caregivers to improve the oral hygiene and denture care of NH residents.

[A PhD completed. Oral health care and oral health-related quality of life of frail and care-dependent older people]

When older people become frail, they often give up making dental visits, while their oral health care and oral health deteriorate. Open interviews and questionnaires were used to explore why frail older people change their oral health care behaviour and which (frailty-related) factors contribute to this change. These are mainly motivation-related factors. There seems to be a turning point where frail older people discontinue their oral health care routines and stop caring whether or not they loose teeth, because the perceived efforts no longer outweigh the perceived benefits of making dental visits and upkeep of oral hygiene. The use of standard questionnaires such as the validated Geriatric Oral Health Assessment Index-NL to measure oral health-related quality of life is limited, because they do not provide personal context required to interpret the outcomes. From a pre-frail stage (oral) care providers should monitor specific factors that might negatively affect oral health and oral health care behaviour, like chronic pain or diminished mobility, dexterity, cognition, will to live, energy and social support.

[The attitude of elderly people living in Samara to organizational forms in gerontostomatology (based on materials of medical and sociological research)]

This article presents the results of medical and sociological research devoted to the study of elderly patients' opinion about different organizational forms providing gerontostomatological assistance. We came to the conclusion that the citizens of the old age groups have different preferences. The introduction of new organizational forms into dentistry for the elderly should be based on the results of sociological research.

Quantity and quality analysis of dental prosthodontics among retirement age residents from nursing homes in different regions of Latvia and retirement age patients from dental clinic in Riga

INTRODUCTION

The quality of life is closely related with condition of oral health, influence of subjective factors on the whole human body and patients perception of their oral health. In spite of the fact that the most part of Latvian retirement age residents use low-quality dentures and assess them satisfactory, these patients often have problems associated with quality of dentures. The aim of the present study was to evaluate oral health status, prosthodontics indicators and patients satisfaction with oral health among Latvian retirement age residents.

PATIENTS AND METHODS

There were examined 465 retirement age volunteers (170 men and 295 women), 116 of them in dental clinic Sandent (Riga, 24.9% - control group), 137 (29.5%) in nursing homes in Zemgale and 212 (45.6%) in nursing homes in Kurzeme (Zemgale and Kurzeme are districts of Latvia). There were assessed quantity of prosthodontics among patients with partial defects of dental arches, there were estimated quality of dentures and patients satisfaction with existing prosthodontics.

RESULTS

Oral health indicators among Latvian retirement age population are better than the same indicators among elderly residents of nursing homes. Among nursing homes residents with partial edentulousness in most of cases in oral cavities remained only few residual teeth which needed treatment. Removable and fixed dental prostheses used by nursing homes residents do not meet denture's quality criteria. Self-evaluation of dentures quality among retirement age residents of nursing homes is better and not correspond with existing dentures quality.

CONCLUSIONS

In Latvia the quantity of prosthodontics in respect of partial removable dentures among the retired who regularly visit a dentist does not significantly differ from European retirement age population's dental prosthodontics quantity. Dental prosthodontics indicators of residents of nursing homes in Latvia are unsatisfactory (p<0.001). In retirement age population self-evaluation with quality of dentures is higher than actually existing.

[Dental treatment strategies for elderly patients]

The elderly are influenced from a various and complex combination of factors, such us individual genetic predispositions, lifestyle, society and environment, the sum of all the individual life experiences concerning the dental care, the caries, the periodontal and iatrogenic diseases.

AIM

This paper evaluates the dental treatment in the elderly.

MATERIAL AND METHODS

The study was performed on 112 patients, aged over 65, at the Clinical Department of Dental Semiology und Geriatric Dentistry, Iaşi, Romania.

RESULTS

The treatment interventions were dental hygiene procedures (in 97 patients), restaurations (in 29 patients), removable partial and total denture preocedures (in 50 patients), fixed prosthetic procedures (in 18 patients), rebasing of dentures (in 25 patients) and teeth extractions (in 26 patients). There were 36 endodontic emergencies and 15 periodontal emergencies and 8 emergencies that resulted from other causes.

CONCLUSIONS

The periodical dental examinations and the proper daily oral hygiene routine are still important in the old age and they should not be neglected, because the prosthetical components request also treatment interventions.

[Quality of life in gerodontology]

In clinical decision-making on whether or not to treat an oral disease and on making a choice from the spectrum of treatment options, the influence of the treatment on the physical and psycho-social well-being of the patient should play a crucial role. This awareness originates from gerodontology. To assess the value of a potential treatment, the concept quality of life has been advanced and various related questionnaires have been developed and employed. In the meantime, doubts have arisen about the value of these questionnaires. The present-day trend is to return to so-called qualitative research, which consists of systematic interviews of groups of older people using open-ended questions without making use of structured response options.

Teaching, learning, and assessment in geriatric dentistry: researching models of practice

Changing demography due to the increasing population of elderly persons the world over has raised new challenges in every sphere of life. The greatest challenge is to provide affordable, accessible, and equitable health care to this population. Oral health is an integral part of general health and affects physical and mental well-being and quality of life of elderly persons. To provide quality oral health care to the elderly, it is important to focus on education in geriatric dentistry, since it is known that education is closely linked to health care provision. It has been found that education in geriatric dentistry has wide variations in different parts of the world. Also, it is being taught at different levels: the predoctoral curriculum, postdoctoral certificate/diploma courses of varying duration by direct or distance mode using computer-assisted learning, degree courses of three years' duration, or continuing education programs. This article attempts to study geriatric dentistry education in global perspective. It is discussed in three sections: 1) varying concepts and methods of teaching, learning, and assessment in dental education; 2) status of geriatric dental education in developed and developing countries with emphasis on the Indian scenario; and 3) challenges and opportunities in developing geriatric dental education.

Educational systems and the continuum of care for the older adult

This article outlines educational developments for adaptive and adapted work roles, current educational systems and practice, and aspects of educational research to illuminate issues for the future of geriatric oral health and well-being. The concept of work roles is used as a proxy to point up continuity of care issues, albeit limited, for patients/clients/consumers. Interdisciplinary learning for the initial education of dental providers/team members requires review with specific reference to geriatric care. Experienced dental and other health and social care professionals should review their roles in meeting the oral health needs of the aging cohorts. The relationship of dental schools/faculties in higher education institutions to those organizations that deliver education to various health and social care sectors-the personnel being at key points in the delivery of care-is also worthy of review.

Meeting oral health needs to promote the well-being of the geriatric population: educational research issues

This article reviews some of the more recent demographic changes affecting aging populations. The author expands the concept of aging to include persons who may be chronologically young but biologically old because they are medically compromised or developmentally disabled. It is not known how many persons can be included in this definition who will need care, and the question is what are their needs and how are we going to teach dental students and dentists to care for them. These problems are discussed, and some models of care are described.

The educational challenge of dental geriatrics

Education in dentistry as in medicine is guided principally by the ontology and theory of science, which provides definitions of health and disease, legitimizes research methods, and influences the role of the clinician. The challenge of managing chronic oral disease and disability prompts interest in social theory as much as science. Therefore, dental geriatrics requires a solid foundation in the humanities from the belief that the determinants of health and the cause of chronic diseases lie within an intermingling of biology, economics, sociocultural structure, and human behavior. The dental curriculum in many places is reorganizing from the horizontal foundation of basic sciences to an integration of foundational and clinical knowledge focused on clinical competencies and integrated care. The impact of this integration on dental geriatrics necessitates a more humanistic and naturalistic perspective in dental education to balance and challenge the current evidence for best clinical practice, which at present is based almost exclusively on science. Consequently, dental students should be exposed to a consilience of the science and the humanities if dentists are to address effectively the needs of an aging population.

[Dementia and oral health]

The first part of this article is a translation of an editorial which appeared in the journal Gerodontology. The author warns that a great increase is expected in the number of dementia patients in the United Kingdom and he argues that care for these patients be given a high place on the national agenda. Dementia was also a major issue at the meeting of the International Association for Dental Research in March 2007. Several international studies presented there indicated that elderly people with dementia constitute a group at risk with respect to oral health. In the evaluation of the editorial, the situation in The Netherlands is described. There is also serious concern in The Netherlands about the statistics with respect to dementia. Due to the growing number of frail elderly people having a natural dentition, the need for professional oral care will increase. General practitioners have the important task of providing adequate oral health care for elderly people suffering from dementia who are still living at home. Guidelines for Oral Care, having to do with the improvement of oral care in institutions, appeared recently. With the guidelines, a good basis for developing adequate oral health care of frail elderly people is available. However, the implementation of these guidelines will require some attention.

[Oral health care guidelines for elderly people in long-term care facilities. Effectiveness and implementation in The Netherlands and Flanders]

Oral health care includes self-care, volunteer care, and professional care for maintaining or advancing appropriate oral health. It has been demonstrated that the oral health care in long-term care facilities for elderly people in The Netherlands and Flanders (Belgium) is not adequate. Daily oral hygiene care, carers' knowledge and skills providing adequate oral health care, (co)morbidity, and drug usage are points of special interest in realizing an improvement of oral health care and oral health. The Dutch Association of Nursing Home Physicians has formulated oral health care guidelines for elderly people in long-term care facilities. A research project on the effectiveness and implementation will be carried out, determining the guidelines'quality. The aim of the project is improving the quality of oral health care for and the quality of oral health and life of elderly people in long-term care facilities in The Netherlands and Flanders.

Prevalence and Quality of Endodontic Treatment in the Northern Manhattan Elderly

Pulpitis results in significant morbidity among the elderly, particularly in underserved communities. We collected panoramic oral radiographs from 244 (mean age 67) participants of the Northern Manhattan Study, a prospective cohort study of stroke risk in a multiethnic urban population. Radiographs were evaluated for missing teeth, caries, restorations, periodontal bone loss, adequacy of endodontic treatment, and periapical radiolucencies. In the study 206 subjects were dentate (mean 17.1 teeth). 5.1% of teeth had periapical radiolucencies, and 4.8% had been endodontically treated; 37.5% of endodontically treated teeth had periapical radiolucencies. Teeth with restorations, periodontal bone loss, pulpotomy, and inadequate root canal filling had a significantly higher occurrence of periapical radiolucency (p < 0.05). Among all root filled teeth, only 26% were deemed satisfactory. We conclude that apical periodontitis is widely prevalent and the technical standard of root fillings is poor in this cohort. There is a substantial need for improved dental care among the northern Manhattan elderly.

[Specialties in dentistry. 4. Post-academic specialization in geriatric dentistry]

In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational programme aims at an increase in dentists serving in geriatric care who are well prepared for delivering care. In the programme attention is paid to the special aspects of care delivery and the special somatic, mental, and social characteristics of frail elderly people. The goal is to formulate an individual oral care programme for every frail elderly person. An individual oral care programme may contain 5 different oral care activities: continuing care, prevention, support, treatments, and evaluation. These activities define the scope of specialists in geriatric dentistry. This scope in turn defines the profile of required knowledge and skills, and the profile is the foundation of the educational objectives of the educational programme. The educational programme contains 7 modules: affinity; somatic and mental disabilities; communicative skills and coping with behavioural disturbances; emergency medical care; history taking, assessment, prevention, treatments and evaluation; organization and legislation; scientific training.

Oral and nutritional status--Is the MNA a useful tool for dental clinics

OBJECTIVES

To determine the oral status of elderly residents in nursing homes (NH) and long term care wards (LT) and to describe associations between oral status and nutritional status among institutionalized elderly residents.

DESIGN

Descriptive, cross-sectional study.

SETTING

All elderly residents in all NH and LT in Helsinki, the capital of Finland.

PARTICIPANTS

The study included 2036 out of 2424 (84 %) eligible subjects in NH, 1052 out of 1444 (73%) eligible subjects in LT, and all wards in NH (N = 92) and LT (N = 53).

MEASUREMENTS

A structured questionnaire, oral examination, and Mini Nutritional Assessment (MNA) were completed by ward nurses for all participating residents. The structured questionnaire included information on oral status and oral health problems, demographic characteristics, functional status, diseases and medication. One questionnaire for each ward was used to evaluate the daily ward routines related to nutritional care and meal management.

RESULTS

11 % of the NH residents and 3 % of LH patients were well nourished. Of NH residents 60 % were at risk of malnutrition and 29 % were malnourished. The respective figures for LT patients were 40 % and 57 %. Nutritional status was significantly associated with oral status and with the number of oral health problems. Those with mixed dentition or complete dentures tended to have better nutritional status than those totally edentulous without prosthesis. Malnutrition increased consistently with the increasing number of oral health problems (including chewing problems, swallowing difficulties, pain in mouth and xerostomia).

CONCLUSION

In the population of institutionalized frail elderly, malnutrition was related to both poor oral status and oral health problems.

[Active oral health care for frail elderly people. An increasing responsibility]

The number of elderly people in the Dutch society is increasing. As a result their number will grow in any dental practice. More elderly people keep (at least part of) their own dentition which requires pro-active oral health care. Ageing is associated with a greater prevalence of chronic diseases and disability. General self-care might decrease when frailty comes. As a consequence, problems with oral self-care will occur. Dental general practitioners have a responsibility to provide adequate oral care for their elderly patients. Information on their general medical conditions and the effects these might have on their oral health should be collected for individual oral health care programmes. Preventive and individual oral care programmes are recommended.

Principles of geriatric dentistry and their application to the older adult with a physical disability

The older adult living with a physical disability faces many daily challenges. Limited hand function or impaired cognition often has profound effects on activities of daily life including oral hygiene. This article explores age-related changed in dentition and common causes of pathology of the oral cavity with special emphasis in populations with impaired hand function or cognition. This article will also assist the treating physician as it relates to oral diagnosis and patient management.

[Oral health care in nursing and old people's homes and institutions for the mentally handicapped]

Staff members and residents of nursing homes and old people's homes were interviewed about the facilities and provision of oral health care. Clinical examinations were performed to obtain data about the oral health status of the institutionalised elderly. Results show that in most cases the oral health care facilities were insufficient to give care to persons with natural teeth. Of the edentulous elderly 43% reported that the retention of the lower denture was insufficient.

More than a set of teeth: assessing and enhancing dental students' perceptions of older adults

Dental professionals play a key role in maintaining the well-being of older adults by identifying problems that disturb systemic health. A 3-part instrument was used to assess dental students' knowledge of aging, comfort with patient diversity and patient care strategies (Years 1-4; N = 321). Collaborative education and services were developed by the Schools of Dental Medicine and Social Work. Results indicate that dental students' knowledge of aging was low (Palmore's FAQ 1 Range = 58%-64%), comfort with geriatric issues improved after the first year of intervention, and strategies for patient care changed with experience. Group differences suggest the importance of utilizing educational "turning points" as teachable moments.

Underserved elderly issues in the United States: burdens of oral and medical health care

The elderly represent approximately 12.4% of the general population (2000 Census), yet their health care expenditure and consumption represent 14% of the total (2003). Although 10% of the elderly had no medical insurance in 2000, 78% had no dental insurance. Elderly Americans' burden of medical care overuse is worsened by their out-of-pocket expenses for oral health, because this is usually not a covered benefit. In underserved communities, the management of the oral health and dental care needs of older Americans approaches negligence.

A review of satisfaction with dental service at a Jerusalem community clinic serving elderly patients

AIM

The audit of dental satisfaction and its association with the reported outcome of a dental health care programme for elderly patients.

DESIGN

A telephone survey of 162 patients in a Jerusalem municipal dental clinic for geriatric patients, who had completed a treatment course in oral rehabilitation.

RESULTS

The average age of the respondents was 73.2 +/- 8.45 years, over 80% of who were very satisfied or satisfied with the treatment given by the dental clinic staff. Only 1.8% were not satisfied (the remaining 17.9% were unable to answer the question). Among those who responded, 91.6% were currently using their full dentures, 80.4% reported an improvement in chewing ability, and 82.3% an improvement in appearance. Respondents who reported daily use of dentures and improved chewing and appearance, also reported higher levels of satisfaction with the clinic.

CONCLUSIONS

These results indicate a potentially important role of satisfaction with dental staff in optimal compliance and success of a geriatric oral health care programme.

Dental health of Fiji institutionalized elderly (2003)

This study provided comprehensive information concerning oral health status and prevalence of oral diseases in institutionalized elderly home residents. The oral health survey included questionnaire and oral examination. Oral examination was carried out by a calibrated examiner. A structured interview on socio- economic status, oral health habits and a clinical evaluation of oral health status and treatment needs were recorded. 37.2 % of the 125 residents from the six nursing homes were medically compromised, functionally dependent, cognitively impaired and behaviourally difficult older adults to caregivers and to dental practitioners. 43% of the study population was edentulous. Dentate residents had a mean DMF of 23 with severe periodontal diseases and treatment need. Oral hygiene was generally poor among the residents and periodontal disease was found to be present in all the dentate subjects examined. The prevalence and experience of coronal and root caries, gingival recession and plaque accumulation was very high in dentate residents especially, those who smoke and those who were severely handicapped. These elderly residents had more retained roots, root caries, missing teeth, mobile teeth, grossly carious teeth and fewer filled teeth when compared with data for community dwelling elderly patients. This study highlighted the poor oral health status of these institutionalized elderly home residents and the great impact of dementia on their high levels of oral diseases.

Oral health disparities among the elderly: interdisciplinary challenges for the future

The elderly, like other population groups, have experienced varying levels of oral health among their diverse demographic subgroups. For those in poverty, experiencing social isolation, residing in long-term care institutions, and with complex medical illness, oral health care may be unreachable. Various models of training, education, and community, public, and professional collaboration have been proposed, yet few strategies have been implemented. Interdisciplinary approaches that bring interested partners together as equal stakeholders may create faster tracks in improving access to health care for those geriatric patients who lack it. This article explores past and present recommendations for interdisciplinary collaborations, reviews the current and future needs of the geriatric population, discusses educational models and content, and expresses the need for leadership to address oral health disparities in the elderly. Finally, strategies for making improvements in the existing oral health disparities are discussed.

Oral health in relation to wearing removable dentures provided by dentists, denturists and laboratory technicians

The aim of this study was to evaluate the oral health of elderly Finnish men wearing removable dentures supplied either by dentists, denturists or laboratory technicians. From a sample of 550 men, 362 subjects were both interviewed and clinically examined. The subjects were asked a range of questions related to their oral health and dentures. Clinical examinations were carried out by one dentist using well-defined criteria and without knowing the information the respective subjects had given in the interview. The 242 denture wearers had a higher frequency (P < 0.001) of mucous membrane lesions (78.7%) than the 120 non-wearers (27.5%). Differences between the denture providers were small, although subjects with dentures provided by dentists had less often most of the recorded mucous membrane lesions than other denture wearers. Coating of tongue and cheilitis angularis were the most commonly encountered lesions. High levels of yeast growth were observed more frequently (P < 0.02) among subjects who had obtained their dentures from dentists (41.3%) than from either denturists (17.1%) or laboratory technicians (18.2%). Among dentate subjects, the average number of remaining teeth was higher (P < 0.05) among those who had obtained their dentures from dentists (8.7) than among subjects wearing dentures from denturists (5.9) or laboratory technicians (6.2). Subjects wearing dentures supplied by dentists had slightly better oral health than other denture wearers. The observed differences can be at least partly explained by dentists' patients having higher number of remaining teeth and also more frequent check-up visits.

Clinical quality of removable dentures provided by dentists, denturists and laboratory technicians

The aim of this study was to evaluate the clinical quality of removable dentures of elderly Finnish men, which had been prepared either by dentists, denturists or dental laboratory technicians. The participants comprised 242 denture-wearing subjects, with 231 maxillary and 177 mandibular removable dentures which had been prepared either by dentists, denturists or dental laboratory technicians. Clinical examinations were carried out without the examining dentist knowing who had provided the dentures. Complete dentures which had been illegally provided by laboratory technicians had significantly poorer retention and fitted less well in tuber and alveolar areas than those provided by either dentists or denturists. Complete maxillary dentures which had been provided illegally by laboratory technicians had significantly (P < 0.01) higher occurrence (90%) of some unacceptable characteristics than those (43%) provided by dentists or denturists. The difference between complete mandibular dentures was also obvious, 86% versus 59%, although statistically non-significant. Of those partial maxillary dentures provided by dentists 53% had some unacceptable characteristics, compared with 80% of those illegally provided by denturists or laboratory technicians (NS). In the case of partial mandibular dentures, 36% of those provided by dentists and 32% of those by denturists or laboratory technicians had some unacceptable characteristic (NS). Illegal provision of removable dentures seemed to be related to decreased clinical quality.

[The role of dentistry in the interdisciplinary team: contributing to comprehensive health care for the elderly]

This literature review focuses on dentistry's role in comprehensive health care for the elderly. The authors discuss the need for an interdisciplinary approach. They begin by analyzing the current situation in geriatric dentistry and related problems in Brazil, relating primarily to the lack of specific studies and human resources with training in geriatrics and gerontology. The authors emphasize interactions between dentistry and other health professions for health promotion, specific prevention, and rehabilitation of elderly patients, with special attention to the importance of communication and information exchange.

Oral health care among nursing home residents in Avon

OBJECTIVE

To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention.

DESIGN

Descriptive survey, interview and clinical data.

SETTING

22 randomly selected nursing homes in the Bristol area.

METHOD

412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries.

RESULTS

Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects.

CONCLUSIONS

Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.

Oral care of elderly patients: nurses' knowledge and views

It is important that healthcare professionals caring for the elderly in hospitals have a core knowledge of the orodental care requirements of their patients. The aim of this study was to determine the knowledge and views of nurses working on acute and rehabilitation care of the elderly wards about orodental care. One hundred nurses and healthcare assistants took part in this questionnaire study of which 58 were qualified nurses and 70 had been employed on care of the elderly wards for two or more years. Although the majority of the respondents were registered with a dentist and attended regularly, 40 did have 'some anxiety' about visiting their dentist. Approximately half of the study population regularly gave advice to their patients about dental care but their knowledge of and reasons for providing oral care and advice was often incorrect. The group's understanding of the availability of dental treatment provided by the National Health Service was also often inaccurate. It was concluded that a better core knowledge of the orodental care of older patients is required by all healthcare professionals who care for this group. It is also important that individuals in whom anxiety is associated with their own dental experience do not neglect to give orodental health advice to their patients.

Using the GOHAI to assess oral health status of frail homebound elders: reliability, sensitivity, and specificity

A pilot study assessed the clinically determined and self-reported oral health status of 50 randomly selected homebound patients served by Boston's Home Medical Service. The sample was largely female, low-income, and edentulous. The median age of the patients was 81 years (range, 64-101). While 76% deemed themselves to be in good to excellent oral health, 80% of the patients had not seen a dentist within the last two years, and 80% were found to be in need of routine dental care. To assess whether the Geriatric Oral Health Assessment Index (Atchison and Dolan, 1990) could be used by non-dental health professionals to determine the need for requesting dental consultation, the study physician repeated the administration of the GOHAI for 23 of the 50 subjects within eight weeks of the initial examination. For the 23 subjects having both dentist- and physician-administered GOHAI scores, the intraclass correlation coefficient was r = 0.61 (p = 0.002), indicating good agreement between the dentist's and physician's administrations of the GOHAI. However, given the high prevalence of need for care, the GOHAI appears to be of less value than an examination for identifying persons who need dental care in this population. Future research is needed to examine the GOHAI's sensitivity and specificity in populations with low to moderate prevalence of treatment need.

Evaluation of a mucosal-plaque index (MPS) designed to assess oral care in groups of elderly

An index, called the mucosal-plaque score (MPS), was tested for intra- and inter-examiner agreement at an institution for elderly individuals with mental disabilities. This index was designed to evaluate oral health and oral hygiene in groups of individuals, particularly in hospitals or at other institutions. MPS consists of the sum of a four-point mucosal score (MS) and a four-point plaque score (PS). Intra-examiner agreement was assessed for one dentist (BMH), who examined 24 individuals twice with a one-week interval. Weighted kappa values were 0.60 for MS, 0.62 for PS, and 0.62 for MPS. Inter-examiner agreement between two dentists was conducted by duplicate examinations on 20 persons. Weighted kappa values were 0.47 for MS, 0.71 for PS, and 0.70 for MPS. In a second assessment of inter-examiner-agreement, eight individuals were each examined by a dentist, two dental hygienists, and one medical nurse. Weighted kappa values were 0.79 for MS, 0.80 for PS, and 0.77 for MPS. These results support the conclusion that the MPS can serve as a reliable measure for the assessment of oral health care in groups of older individuals.