Geriatric dentistry: a new specialty in Brazil

Objective: To present the current status of geriatric dentistry in Brazil. Background: In 2001, the Brazilian Dental Council established a new specialty: geriatric dentistry. This decision was based on the increase in both the elderly population and the demand for dental treatment of this cohort. Materials and methods: Data were obtained through online searches of the Brazilian Dental Council and the Brazilian Institute of Geography and Statistics. Results: Brazil has 170 dental schools offering around 14 000 undergraduate vacancies every year. At the postgraduate level, there are 19 recognised dental specialties, one of which is geriatric dentistry, comprising 18 certificate programmes, with the potential to produce 216 new specialists every 18 months. The dentist/habitant ratio was 1:870, higher than that recommended by the Word Health Organization. The Brazilian population consists of around 14.5 million elderly people (8.6%). There were 124 specialists in geriatric dentistry distributed irregularly throughout the country. The specialist/elderly population rate was 1:117 249. At the undergraduate level, this new specialty is not included in the curricula of most dental schools in Brazil. Conclusions: Geriatric dentistry should be included in the undergraduate curricula of dental schools in Brazil. Postgraduate degree courses should be developed to produce more clinical academics and researchers in this field.     

Undergraduate education in gerodontology in Germany: the Leipzig Programme

Objective: To evaluate students’ attitude towards the clinical component of the Leipzig Programme of undergraduate Education in Gerodontology (LPEG). Background: Undergraduate student education has long been recognised as a mainstay of fostering the aims of gerodontology. Extramural clinical education with direct exposure to various groups of vulnerable elderly is known to contribute to the formation of positive attitudes. LPEG has been designed to include didactic components and six visits to a long‐term care facility (LTC) spread over 4 of the 5 years of the dental course. Methods: A structured questionnaire with 10 items was administered to 230 students (60.9% female) on three occasions in 2004–05. Total return was 411 questionnaires. The mean age of respondents was 24.3 (SD 2.67) years. Students were asked to indicate the degree of their agreement with seven statements presented using a 5‐point scale. A choice of responses which characterised the course was offered to mark all those deemed agreeable. Results: The vast majority of students responded positively. In the students perception there was no significant difference (Kruskal–Wallis p = 0.24) in the amount of knowledge acquired between subjects participating once, twice or three times. ‘Interesting’ and ‘feel pity for patients’ were the two items that received the most support. Respondents expressed the wish to accompany up to 10 patients during their course with a mean of 3.5 (SD 2.9) but 31 (7.5%) subjects did not wish to see any frail elderly patients at all. Conclusion: The LPEG is well received by dental students. A complex subject including overarching social skills has been integrated seamlessly into the dental curriculum.     

Undergraduate teaching in gerodontology in Austria, Switzerland and Germany

Objective: To survey the present state of undergraduate teaching in the domain of gerodontology in Germany, Switzerland and Austria. Study participants: All universities of Austria (A), Germany (D) and Switzerland (CH). Protocol: A questionnaire on undergraduate teaching in gerodontology was mailed to all Deans (A: n = 3; CH: n = 4; D: n = 31) and all independent departments except paediatric dentistry and orthodontics (A: n = 11; CH: n = 15; D: n = 111). Results: The questionnaires were completed and returned by 29 Deans (A: n = 2; CH: n = 4; D: n = 23) and 102 departments (A: n = 7; CH: n = 8; D: n = 87). In Austria, gerodontology is a very small component of the dental curriculum and the Deans did not want this to be increased. Most German universities claimed to teach some aspects of gerodontology to undergraduate students and 87.4% of the Deans voted for separate lectures in gerodontology. In Switzerland, gerodontology seems well established. The results of questionnaires from the independent departments revealed that in all three countries lectures were more prevalent (A: n = 0; CH: n = 4; D: n = 6) than practical training in nursing homes (A: n = 0; CH: n = 3; D: n = 6). Conclusion: Considering the demographical shift which is leading to an increasing proportion of elderly in the population, the weighting of gerodontology in the undergraduate dental curriculum should be considered for revision in Austria and Germany.     

Undergraduate teaching in gerodontology in Leipzig and Zürich – a comparison of different approaches

Objective: To evaluate undergraduate students’ attitude towards the clinical components of the Leipzig (LPEG) and Zürich (ZPEG) Programmes of Education in Gerodontology. Background: Undergraduate student education is the seedbed for conscientious professionals. Extramural clinical education contributes to the formation of positive attitudes. Students in Zürich participate in three clinical activities (in‐house gerodontology clinic, extramural acute geriatrics ward, mobile dental service), in Leipzig they visit a long‐term care facility on six occasions within 4 years. Methods: A structured questionnaire with 10 items was administered to students in Leipzig [n = 34, 70.6% female, mean age 25.8 (SD 3.04) years] at the beginning and after completion of gerodontology training and to students in Zürich [n = 33, 48.5% female, mean age 27.0 (SD 3.28) years] on three occasions after clinical training. Students indicated the degree of their agreement with seven statements presented using a 5‐point scale. A choice of responses which characterised the course was offered for assessment. Results: Close collaboration with dental tutors, while self‐treating patients in the mobile dental service (mobiDent^?) attracted the most positive responses. Ratings from students completing their training in Leipzig were less favourable than their initial responses. Conclusion: The lack of a dental service and Leipzig students’ inability to offer treatment in the presence of disease was associated with frustrations. Practical training should go beyond dental examinations at a long‐term care facility and include the opportunity for dental treatment. Personnel and equipment required for mobile treatment exceed resources available at most German dental schools.     

Translation and validation of the Hindi version of the Geriatric Oral Health Assessment Index

doi: 10.1111/j.1741‐2358.2011.00609.x Translation and validation of the Hindi version of the Geriatric Oral Health Assessment Index Purpose: To translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into Hindi and assess its validity and reliability for use among people in India. Materials and Method: After translation into Hindi, a total of 385 participants aged 55+ demonstrated acceptable validity and reliability when used for people in India. Individual GOHAI items were recorded and summed as originally recommended. The questionnaire sought information about socio‐demographic characteristics and self‐reported perception of general and oral health. Clinical examination included assessment of periodontal status and number of decayed teeth, missing teeth, filled teeth and crowned teeth. Result: Mean GOHAI score was 40.9 (SD, 10.6; range, 12–60). Cronbach’s alpha for the GOHAI score was 0.88, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test–retest correlation coefficient for add‐GOHAI scores was 0.72, indicating good stability. Add‐GOHAI scores increased with poorer perceived general and oral health. Convergent validity, construct validity and discriminant validity of the GOHAI were demonstrated. Conclusion: It could therefore be used as a valuable instrument for measuring oral health–related quality of life for people in this region.     

A 30-year review of a geriatric dentistry teaching programme

doi: 10.1111/j.1741‐2358.2011.00471.x A 30‐year review of a geriatric dentistry teaching programme Objective: To review the development of the Geriatric Dental and Special Needs Education programme at the University of Iowa over the last 30 years. Background: The programme at Iowa evolved from a didactic elective programme taught by a single faculty person to a required didactic and clinical programme, which includes a Special Care Clinic in the dental school and a mobile unit with portable dental equipment which serves ten area nursing homes with comprehensive care. Materials and methods: Changes have been made in the programme over time based on formal and informal feedback from students and graduates, and we have also looked at the impact of the programme on dental services to our target population. Results: The factors influencing the curriculum development are identified and discussed. Conclusion: As no dental schools are the same, some general applications are suggested from the Iowa experience.     

Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders

doi: 10.1111/j.1741‐2358.2010.00402.x Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders Background: Most research on older people’s oral health has been quantitative. A need for more in‐depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. Objective: To explore experiences and perceptions of oral health and oral health care among an ethnically‐mixed sample of older New Zealanders. Methods: In‐depth interviews were conducted with 24 older people in two communities in New Zealand’s South Island. Thematic analysis of transcribed data was undertaken. Results: Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. Conclusions: We identified a number of shared experiences which affect older people’s ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received.     

European College of Gerodontology: undergraduate curriculum guidelines in Gerodontology

Effective undergraduate teaching of gerodontology to present and future dental students is important if good oral health care of older people is to be assured. A review of the undergraduate curriculum for gerodontology is presented and indicates the need for a knowledge base from which new graduates can develop a special interest in care of older patients. The aim is improved care of older patients, satisfaction for teaching staff involved and improved professional standing for Dentistry. Motivation of students could also be achieved by the positive match between rising patient awareness and ethical responsibility of the profession for those older patients. As it stands, the undergraduate curriculum should include topics on specific care for the elderly and other patient groups, which extend the competences already agreed by the Association for Dental Education in Europe (ADEE). The logistics of teaching these topics will need co‐ordination of those staff with appropriate skill and interest, preferably as a development of existing curriculum content.     

Dental utilisation for older Americans aged 55–75

Objectives: The purpose of this study was to analyze a comprehensive nationally representative data set to determine the effect of economic and non economic determinants on the decision to seek care and the decision to select a specific number of dental visits. Design: The conduct of this study involved the examination and analyses of secondary data available from the National Health Interview Survey. A two-pan choice logistic regression model was utilized to first describe the decision to seek care and second to describe factors associated with the decision to select a specific number of dental visits as a function of income, education, family size, age, marital status, presence of teeth, employment status, health status, gender, race, insurance status, and reason for dental visit. Subjects: Data analysis focused on 5.327 non-institutional older adults between the ages of 55 and 75 who were not eligible for Medicaid. Results: Results provide supporting evidence that income, presence of dental insurance, presence of teeth, gender, family size, education race and age are associated with the decision to seek dental care and that income, presence of dental insurance, gender, family size, education, and race are associated with the number of dental visits among users even when the effects of other variables are controlled for. Discussion : Analyses suggest that employment may have a surprisingly limited effect on dental utilisation and that among explanatory variables there are differences in significance and magnitude between the decision to seek care and the decision to select a specific number of dental visits. In addition, in contrast with some prior studies, health status does not appear to be associated with the decision to seek care or associated with the number of dental visits among respondents.