Oral health promotion among older persons and their care providers in a nursing home facility

Objectives: To assess oral health status and oral health‐related quality of life (OHRQoL) of residents in an extended care facility and to assess the care providers’ oral health attitudes and knowledge. Methods: Participants included 137 residents (58.1% female, age range 32–94 years, 91% African–American) and 22 care providers. Residents received an oral examination and completed the Oral Health Impact Profile (OHIP‐14), an OHRQoL questionnaire. Care providers completed an oral health knowledge (OHK) questionnaire before and after the on‐site geriatric oral health education and training programme. Results: Oral examinations showed that 58% of the residents had extensive oral health needs. On the OHIP‐14, the mean severity was 9.2 (SD = 12.0), extent (number of items rated as ‘fairly often’ or ‘often’) was 1.2 (SD = 2.6) and prevalence (participants rating at least one item at least ‘fairly often’) was 37.8%. Most prevalent negative impact items were about ‘oral pain’, ‘appearance’ and ‘self‐consciousness’. Regarding OHK, caregivers’ knowledge improved following instruction from 65% correct on the pre‐test to 90% correct on the post‐test (p < 0.05). Subsequent to the eight in‐service workshops, providers reported that physical limitations, fear of getting bitten and time constraints were barriers to providing oral hygiene to their residents. Conclusion: Examination data showed a high level of dental needs among the majority of residents, accompanied by significantly reduced OHRQoL. Although care providers’ OHK improved following the geriatric service programme, they reported specific barriers regarding their provision of oral hygiene care to the residents.     

Oral health-related quality of life--associations with oral health and conditions in Swedish 70-year-old individuals

doi: 10.1111/j.1741‐2358.2011.00495.x Oral health–related quality of life – associations with oral health and conditions in Swedish 70‐year‐old individuals Objective: The aim of this study was to evaluate oral health–related quality of life (OHRQoL) in relation to different chronic oral conditions and perception of oral health among elderly individuals. Background: Health‐related quality of life is important to assess and understand the impact of different diseases and conditions on individuals’ well‐being. Material and methods: Randomly selected 70‐year‐old individuals (N = 561) were included in this analysis. They were clinically examined and answered a questionnaire. Variables used were perceived oral health, satisfaction with appearance of teeth, problems with chewing and dry mouth, burning mouth syndrome, dental anxiety and dental visiting habits. To measure the participants′ perception of the impact of oral conditions on their well‐being, the Oral Health Impact Profile (OHIP‐14) was used. Results: The OHIP‐14 distribution of sum of scores showed a floor effect but revealed acceptable psychometric properties with regard to reliability and validity. Multivariable logistic regression revealed three highly predictive variables for individuals with high OHIP‐14 scores: using dentures, having chewing problems and being dissatisfied with appearance of teeth. Conclusion: Use of dentures, having chewing problems and being dissatisfied with appearance of teeth are associated with high OHIP‐14 sums, indicating strong influence on OHRQoL.     

Perceived sleep quality among edentulous elders

doi: 10.1111/j.1741‐2358.2010.00426.x Perceived sleep quality among edentulous elders Background: Anatomical changes associated with edentulism are thought to disturb seniors’ sleep. Objectives: (1) To determine sleep quality and daytime sleepiness of edentulous elders. (2) To examine the association between oral health‐related quality of life and sleep quality. Methods: Data were collected at a 1‐year follow‐up from 173 healthy edentulous elders who had participated in a randomised controlled trial and randomly received two types of mandibular prosthesis. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI, range 0–21), with higher scores indicating poorer sleep quality. The Epworth Sleepiness Scale (ESS) was used to measure the level of perceived daytime sleepiness, and scores ≥10 indicated sleepiness. Results: The mean global PSQI and ESS scores were 4.7 ± 3.5 and 5.3 ± 3.9. There were no differences in sleep quality or sleepiness between those who wore their dentures at night and those who did not. Elders with frequent denture problems were sleepier during the day than those with fewer problems (p = 0.0034). General health (p = 0.02) and oral health‐related quality of life (p = 0.001) are significant predictors of sleep quality. Conclusion: Healthy edentulous elders, independent of nocturnal wearing of their prosthesis, are good sleepers. Maintaining high oral health quality of life could contribute to better sleep.     

The prevalence of dental impacts on daily performances in older people in Northern Thailand

Objective: To assess the prevalence of oral related impacts on the quality of daily life in older Thais. Desing: A cross‐sectional study on a non‐random sample. Setting: Metropolitan area of Chiang Mai, Thailand Subjects: 707 older individuals living independently, aged 60 to 74 years, 549 were dentate, 158 were edentate. Methods: Clinical examination and questionnaire for the Oral Impacts on Daily Performances (OIDP) index and on dental behaviours. Results: About one half of the older people interviewed (52.8%) had at least one OIDP oral impact. The most common performance affected was eating (47.2%). The two main symptoms that caused oral impacts in the total sample were functional limitation and pain. The majority of older people had low OIDP scores below 8.0 (76.4%). Almost one in 10 had OIDP scores above 16.0. Individuals with a high income were more likely to have lower OIDP score (p<0.001). Subjects who had attended a dentist were more likely to have no oral impacts (p=0.02). There was a significant difference between OIDP scores related to some clinical variables; dental status (p=0.002), having mobile teeth (p=0.005), periodontal attachment loss (p<0.001), missing anterior and posterior teeth (p<0.001). Conclusions: Oral impacts that affected quality of life of older people were relatively common but not severe. The impacts were related to some social and clinical variables.     

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark

doi: 10.1111/j.1741‐2358.2011.00486.x
A cross‐sectional study of oral health and oral health‐related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark Aim: To describe the oral health and the oral‐health‐related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health‐care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. Methods: A cross‐sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health‐care programme. Clinical data and data from interviews comprising social factors, life‐style, dental visit habits, oral hygiene practices and self‐perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. Results: Sixty‐eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1–9 teeth and tooth mobility. Conclusion: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.     

Association between number of teeth, edentulism and use of dentures with percentage body fat in south Brazilian community-dwelling older people

doi: 10.1111/j.1741‐2358.2010.00411.x Association between number of teeth, edentulism and use of dentures with percentage body fat in south Brazilian community‐dwelling older people Objective: To evaluate if poor oral status was associated with percentage body fat in a representative sample of south Brazilian community‐dwelling elderly. Background: Evidence suggests that elders with extensive tooth loss and edentulism present with compromised chewing function, which results in dietary changes. However, few studies have assessed whether poor oral status is associated with percentage body fat in community‐dwelling elderly. Materials and methods: A random sample of 471 south Brazilians =>60 years of age was evaluated. Measurements included a questionnaire to assess socio‐demographic, behavioural, general, and oral health data. Percentage body fat was measured with a Tanita TBF 612 digital scale, which measures foot‐to‐foot bioelectrical impedance; and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prostheses. Correlates of risk of inadequate percentage body fat were assessed by means of multinomial logistic regression. Results: Edentulous participants were more likely to be underfat [OR: 3.11 (1.27–7.61)] or overfat/obese [OR: 1.82 (1.05–3.16)]. Conclusion: The present study shows that edentulous older people had higher odds for inadequate percentage body fat. The maintenance of teeth had a crucial role in increasing the chance of having an adequate body fat percentage in the study population.     

A cross-sectional analysis of the prevalence of dental anxiety and its relation to the oral health-related quality of life in patients with dental treatment needs at a university clinic in Switzerland

doi: 10.1111/j.1741‐2358.2011.00465.x A cross‐sectional analysis of the prevalence of dental anxiety and its relation to the oral health‐related quality of life in patients with dental treatment needs at a university clinic in Switzerland Objectives: The aim of this observational, cross‐sectional study was to analyse the relationship between dental anxiety (DA) and health‐related quality of life aspects associated with oral conditions of a population with dental treatment needs in Switzerland. Methods: The measurements of DA were collected by means of two questionnaires, the Dental Anxiety Scale (DAS) and a Visual Analogue Scale (VAS). Oral health‐related quality of life (OHRQoL) was assessed with the Oral Health Impact Profile (OHIP). The sample included 223 patients enrolled at a university clinic which specialises in oral prosthetic rehabilitation and temporomandibular disorders. Of them, 78.9% were at or above the age of 50. Results: No gender or age dependencies were observed. A comparison of answers regarding OHRQoL and DA revealed a significant interdependence (p = 0.0118); highly anxious patients were 3.55 times more likely to suffer from poor quality of life compared with less anxious ones. Conclusion: This cross‐sectional study of mostly elderly patients seeking dental treatment in Switzerland found that increased DA was associated with an impaired OHRQoL. The average DA was slightly higher than the results of other industrialised countries and the average OHRQoL was reduced.     

Correlates of dental visits among community‐residing Latino elders: a public health alert

doi:10.1111/j.1741‐2358.2009.00335.x
Correlates of dental visits among community‐residing Latino elders: a public health alert Objectives: To examine oral service utilisation in a probability sample of community‐residing Latino elders. Background: Older Latinos are at a potential increased risk of oral diseases, given their higher prevalence of co‐morbidities and lower rate of dental service utilisation. Methods: A prevalence survey was conducted among a random sample of Latino (largely Puerto Rican) elders (n = 205; mean age = 75.8; SD ± 5.3) in New York City during 2001–2002. A systematic random sample was drawn from the Centers for Medicare and Medicaid Services Beneficiary tape files. Current use of oral health services and self‐reported health conditions was obtained. Functional and cognitive impairment were assessed. Results: Less than half of the sample reported a dental visit in the previous year. The average time since the last dental visit was 54 months (SD ± 84.5). Last year dental visit compliers were more likely to be unmarried, living alone, with higher levels of education, fewer health conditions and less impairment with activities of daily living. In multivariate analyses, problem‐oriented behaviour, Medicaid beneficiary, education, living alone, chronic health conditions and mobility impairment explained 14% of the ‘time since last dental visit’ variance. Conclusions: Given that socio‐demographic and level of functioning determinants appear to influence the frequency of dental visits, a multilevel approach to oral health promotion is imperative.     

Validity and reliability of the Oral Impacts on Daily Performance (OIDP) scale in the elderly population of Bosnia and Herzegovina

doi: 10.1111/j.1741‐2358.2011.00584.x Validity and reliability of the Oral Impacts on Daily Performance (OIDP) scale in the elderly population of Bosnia and Herzegovina Objectives: To adapt the Oral Impacts on Daily Performance (OIDP) index for elderly people in Bosnia and Herzegovina and test its validity, reliability and responsiveness to change. Background: Clinical measures alone may not be adequate for assessing the oral health of individuals. Subjective oral health indicators tested within a particular cultural context may not be relevant across cultures. Materials and methods: The study population comprised 231 free‐living adults aged 65 years or older. The OIDP was cross‐culturally adapted from English into the Serbian language and its psychometric properties were tested. Data were collected using a clinical examination and a questionnaire containing the OIDP. Results: In terms of reliability, Cronbach’s alpha coefficient was 0.82 and the intraclass correlation coefficient 0.88. The very high correlation of OIDP with self‐rated oral health (r = 0.78) verified criterion validity, while construct validity was demonstrated through its significant and graded associations with other subjective health measures. OIDP change scores on a treated subsample showed moderate effect size (0.59) and were associated with perceptions of oral health change, providing evidence for its responsiveness to change. Conclusion: The Bosnian version of the OIDP showed satisfactory validity, reliability and responsiveness to change confirming its appropriateness for use among older populations in Bosnia and Herzegovina.     

Evaluation of a modified version of the index of Oral Impacts On Daily Performances (OIDP) in elderly populations in two European countries

Objective: To examine the psychometric properties of a modified version of the index of Oral Impacts on Daily Performance (OIDP) in elderly populations in two European countries, namely Great Britain and Greece. The psychometric properties examined in this study refer to internal consistency and face, content, criterion and construct validity. Design and Setting: Cross‐sectional epidemiologic surveys of independently living people aged 65 years or older. Data were collected by interviewers through structured questionnaires. The British sample consisted of the randomly selected independently living persons that participated in the dental component of the National Diet and Nutrition Survey (NDNS) of adults aged 65 years or over. The Greek sample is an opportunity sample drawn from eligible people living in two municipalities of the Athens region. Subjects: 753 people participated in the British and 681 in the Greek sample. Results: Through pilot work in both countries, the OIDP index was modified and both Greek and British modified versions demonstrated satisfactory face and content validity. In the main studies, Cronbach's alpha of the modified OIDP was 0.77 for the Greek and 0.69 for the British sample. In both samples, the index showed very significant associations with perceived dental treatment need (p<0.001), perceived general health (p<0.001 in Greek, p=0.002 in British) and intermediate oral impacts (p<0.001), as well as with satisfaction with oral health in the Greek sample (p<0.001). Conclusions: Overall, this study has demonstrated that the modified OIDP is a valid and reliable measure of oral health related quality of life in elderly people in Great Britain and Greece.     

Self-reported dry mouth in Swedish population samples aged 50, 65 and 75 years

doi: 10.1111/j.1741‐2358.2010.00420.x Self‐reported dry mouth in Swedish population samples aged 50, 65 and 75 years Background: Reduced salivary flow may have a negative impact on general well‐being, quality of life and oral health. Objectives: To examine xerostomia in 50‐, 65‐ and 75‐year‐olds, background factors and effect on Oral Impacts on Daily Performances (OIDP). Methods: In 1992, a questionnaire was sent to all 50‐year‐old persons (n = 8888) in two Swedish counties. In 2007, the same questionnaire was sent to all 65‐year‐olds (n = 8313) in the two counties and to all 75‐year‐olds (n = 5195). Response rate was for the 50, 65 and 75 year olds 71.4, 73.1 and 71.9%, respectively. Results: Xerostomia was higher in women than in men in all age groups. There was higher prevalence of xerostomia with increasing age in both sexes and it was more frequent at night than during daytime. ‘Often mouth dryness’ was 2.6–3.4 times more prevalent in those who reported an impact from OIDP. The highest odd ratios were for daytime xerostomia and for the variables burning mouth (17.1), not feeling healthy (4.5), daily smoking (4.4), and medication (4.1). Conclusions: The dramatic increase of xerostomia between age 50 and 75, especially amongst women, needs to be considered in the management of this age group.     

Factors associated with oral health perception in older Brazilians

Objectives: To investigate the self‐perception of oral health in older people, aged 65–74, from the central region of southern Brazil. Methods: Cross‐sectional population‐based study using data from the Oral Health Conditions Survey of Southern Brazil, developed between the years 2002 and 2003, by the State Health Secretary (SHS) of Rio Grande do Sul (RS), Brazil. Socioeconomic and demographic variables, self‐perception of oral health and clinical data, as well as dental pain were evaluated in 618 elderly people. Multinomial logistic regression was used to evaluate the effect of explanatory variables on the self‐perception of oral health. Results: Almost half of the elderly were edentate and rated their oral health as good or very good. With regard to dental pain, 28.8% of the people declared that they had experienced dental pain in the 6 months before the interview. There was a significant relationship between dental pain and classification of oral health, and chewing ability. Following adjustment, the need for dental prostheses remained associated with the influence of oral health on establishing relationships. Similarly, personal income remained associated with the elderly's perception of their ability to talk. Finally, the level of education remained related to the influence of oral health status in people's relationships. Conclusion: Dental pain and the need for dental prostheses were the main factors that affected the self‐perception of oral health of elderly people from southern Brazil.     

Factors associated with the oral health-related quality of life in elderly persons in dental clinic: validation of a Mandarin Chinese version of GOHAI

Gerodontology 2011; doi: 10.1111/j.1741‐2358.2009.00360.x
Factors associated with the oral health‐related quality of life in elderly persons in dental clinic: validation of a Mandarin Chinese version of GOHAI Objectives: To translate the original English version of Geriatric Oral Health Assessment Index (GOHAI) into Mandarin Chinese and assess its reliability and validity for use among the elderly in inland China and to explore the factors associated with oral health‐related quality of life (OHRQoL). Methods: The original English version of GOHAI was translated, back‐translated and cross‐culturally adapted. The psychometric properties of GOHAI‐M were assessed in a sample of 263 people aged 60 years and over and OHRQoL was examined in 221 subjects using GOHAI‐M. Multiple regression analysis was conducted. Results: Internal consistency of the GOHAI‐M was excellent (Cronbach’s α : 0.81). Split‐half reliability coefficient was 0.80, and item‐scale correlation coefficient ranged from 0.25 to 0.71. Self‐rated oral health was significantly associated with OHRQoL (r_s = 0.505, p < 0.01). The relation coefficient between GOHAI‐M and self‐perceived need for dental treatment and number of missing teeth were 0.231 and ?0.653, respectively (p < 0.05). Multiple regression analysis found that better OHRQoL was significantly associated with better self‐ratings of oral health (β = 0.497, p = 0.01), number of missing teeth (β = 0.187, p < 0.01) and life satisfaction (β = 0.132, p < 0.05). Conclusion: The Mandarin Chinese version of GOHAI demonstrates acceptable reliability and validity. OHRQoL is associated with self‐rated oral health, number of missing teeth and satisfaction with life.     

Social interactions, body image and oral health among institutionalised frail elders: an unexplored relationship

doi: 10.1111/j.1741‐2358.2011.00523.x Social interactions, body image and oral health among institutionalised frail elders: an unexplored relationship Objectives: This paper draws on theories of ageing, body image and disfigurement, to explore the potential for relationships between oral health, body image and social interactions between institutionalised elders. Background: Social relationships are important at all stages of life. A positive body image increases confidence in social interactions, which contributes substantially to health, well‐being and quality of life. Body image can be negatively impacted by oral conditions, particularly those that are appearance related and do not meet cultural ideals. Results: Typically, the oral health of frail elders in long‐term care facilities is poor, but to what extent poor oral health and dysfunction influence body image, and social behaviours is unclear. Conclusions: We conclude that there is the potential for poor oral health conditions to contribute negatively to the social well‐being in this population, but suggest that it requires further investigation.     

Oral health knowledge,beliefs and practices of a sample of Chinese elders in Inner London,UK, aged 54 years and over: a pilot investigation.

Objectives: To explore the self-reported oral health and health behaviours of a sample of Inner London Chinese elders and the impact of their sell-reported oral health on their social functioning and eating ability. Design: Cross sectional. Setting: Luncheon clubs in Central and East London, UK. Subjects: 54 Chinese elders aged 54–81 years. Intervention: A structured questionnaire, administered by two interviewers in Cantonese. Main outcome measures: Knowledge and beliefs about the causes and prevention of tooth decay and gum disease, the oral conditions experienced in the previous twelve months and the impact of these conditions. Results: Overall health was rated more positively than oral health, although those who reported below average oral health were more likely to report below average overall health. Whilst over half thought that sugar and sweet food could cause tooth decay, only 19% thought that poor oral hygiene could cause gum disease. Over half thought that “hot air” caused gum disease. Three quarters brushed their teeth at least twice a day. Two thirds had experienced at least one oral condition in the previous twelve months, with the more elderly being more likely to report this. Social impacts affected 41% of the sample whilst 44% of suffered at least one dietary impact. Conclusions: The burden of oral conditions is substantial, especially on the more elderly members, impacting on the performance of social functions. These burdens indicate a need for oral health services. Beliefs in the traditional Chinese explanation of “hot air” as a cause of gum disease were common. Health promotion effort should consider these when developing health messages.     

Oral health‐related quality of life in hospitalised stroke patients

doi:10.1111/j.1741‐2358.2009.00330.x
Oral health‐related quality of life in hospitalised stroke patients Objective: The aim of this study was to test the hypothesis that impairment of orofacial function following stroke affects the patients’ oral health‐related quality of life (OHRQoL). Material and methods: From the University Hospitals of Geneva, 31 stroke patients (18 men, 13 women, mean age 69.0 ± 12.7 years) with unilateral facial and limb palsy were recruited (patient group, PG). In the study, the Oral Health Impact Profile (OHIP)‐EDENT was utilised to assess OHRQoL. Further examinations comprised a test of masticatory efficiency and lip force, stroke severity National Institute of Health Stroke Scale and dental state. The control group (CG) consisted of 24 subjects with similar age, gender and dental state. Results: The PG mean OHIP‐EDENT sum score was 18.8 ± 15.5 and proved higher than one of the CG, indicating a lower OHRQoL in the PG (p < 0.01). The score of the sub‐domains ‘functional limitation’ and ‘physical pain’ were significantly higher in PG (p < 0.03 and p < 0.02, respectively). The masticatory efficiency was significantly lower in the PG (p < 0.0001) and was associated with the OHIP‐EDENT sum score and its sub‐domains, except for ‘physical disability’. This effect was not present in the CG. Conclusion: The OHRQoL is significantly reduced in hospitalised stroke patients whereby functional impairment seems predominant when compared with psychological and psycho‐social aspects.     

Oral health-related quality of life: a critical appraisal of assessment tools used in elderly people

Objective: The purpose of this study was to undertake a critical appraisal of oral health‐related quality of life (OHRQoL) measurements used for research in the elderly. Background: A variety of OHRQoL measurements have been developed in the past 20 years as a result of increased concern about the impact of oral conditions on a person’s quality of life. There is need for an assessment aimed at prioritising the recommended measurements to be used for different purposes in the elderly. Materials and methods: Original English language papers using measurements to assess OHRQoL in the elderly were identified from Web of Science, EMBASE, PubMed, Medline and Lilacs databases. The search included all papers published from 1985 to February 2007. The criteria of assessment were: (i) measurement criteria (number of items and domains, and classification of the results found for each measurement); (ii) quantitative–qualitative criteria (frequency, acceptability, reproducibility, reliability, sensitivity and capability of being reproduced in other language versions). Results: In a total of 152 papers selected, 20 measurements were identified. However, only seven fulfilled all the measurement and quantitative–qualitative criteria. Conclusion: Geriatric Oral Health Assessment Index, Subjective Oral Health Status Indicators, Oral Health Impact Profile‐49, Dental Impact on Daily Living, Oral Health Impact Profile‐14, Oral Impact on Daily Performances and German Version of the Oral Heath Impact Profile were considered as instruments of choice to assess OHRQoL in the elderly. The other 13 instruments identified require further research aimed at a validation process and the use of a language other than English.     

Chewing disability in older adults attributable to tooth loss and other oral conditions

doi: 10.1111/j.1741‐2358.2010.00412.x Chewing disability in older adults attributable to tooth loss and other oral conditions Background: This study evaluates associations between oral health‐related factors and chewing ability, and quantifies the risk contributed by each factor. Materials and methods: Chewing ability and information on number of teeth, dentures and dental problems over the last 12 months were collected by mailing questionnaires to a random sample of 60‐ to 71‐year‐olds from Adelaide, South Australia. Logistic regression was used to model oral status and oral symptoms as predictors of chewing disability, and to estimate the population‐attributable fraction. Results: A total of 444 persons responded (response rate = 68.8%). Among dentate subjects, 10.3% were chewing‐deficient, with chewing disability more prevalent (p < 0.05) among those with <21 teeth (26.4%), dentures (20.4%), painful aching in the mouth (25.4%), pain in the face (16.7%), broken/chipped teeth (15.6%), sensitive teeth (14.1%), loose teeth (37.1%), and sore gums (18.0%). Adjusted Odds ratios (OR) showed inadequate dentition (OR = 4.20), painful aching in the mouth (OR = 4.88), and presence of loose teeth (OR = 4.70) were associated with chewing disability (p < 0.01), and their population attributable fractions were 18.5%, 15.1% and 7.8% respectively. Conclusions: Loose teeth, number of teeth and pain in the mouth were associated with chewing disability, with an inadequate dentition and pain in the mouth contributing most to chewing disability in this population.