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.     

Geriatric dentistry in Brazilian universities

The World Health Organization has predicted an increase in the population of elderly people. Objective: The purpose of this study was to investigate the teaching of geriatric dentistry in Brazilian universities. Materials and methods: This study consisted of questionaires regarding the training in geriatric dentistry in 104 dental schools included in the National Institute of Education Research (INEP) in 2001. In order to calculate the sample (a random stratified one), the confidence interval was set at 99% and a maximum permitted error of 3% was adopted. Pearson's chi‐square test was used in the inferential analysis. Results: From the 64 dental courses which were studied, only 25 included geriatric dentistry in the curriculum. From 1857 students who were involved in the study, 41% sought knowledge outside the dental school and 98% considered that it was important that this subject should be included in the curriculum. There was statistical significance between geriatric dentistry teaching and the students’ preference as well as the prospect of working with this group of the population. Geriatric dentistry as an individual subject was absent from the curriculum in two‐thirds of the dental courses investigated. Knowledge was often transmitted as part of dental prosthetics and most of the students stated that they would want to be able to treat elderly people. It was relevant to note that senior students expected to work in this field. Conclusion: Dental students in Brazil do not have adequate training in geriatric dentistry.     

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.     

The Yad Sarah geriatric dental clinic, a different model

Introduction: There are not sufficient dental services for elderly people around the world. Yad Sarah is an Israel‐wide network of volunteers aiding sick, elderly, isolated and housebound people with an array of services aimed at making home care possible. It provides medical and social services to more than 380 000 elderly persons per year and in addition, lends medical equipment free of charge, has day rehabilitation centres, legal aid council for seniors, provides transportation for the disabled, meal deliveries and geriatric dental services. Materials and methods: The latter are equipped with five dental units (one mobile unit) and a dental laboratory. During the 5 years from 2000 to 2004 the dental services provided dental care for 3890 elderly patients with the main clinic located in Jerusalem. Patients pay an average of 70% of the cost price of their dental care, with the difference being subsidised by Yad Sarah. Of the 515 patients who applied for treatment in 2004, 54% possessed natural teeth in both jaws, 28% were fully edentulous, 12% were edentulous in the maxilla and 6% were edentulous in the mandible. Females applied for dental treatment more often than the male population. Older patients (75–101 years old) required oral care at their homes or at old age residences, more frequently than the younger age groups (60–74 years old). Conclusion: Dental treatment was administered by 70 volunteer dental surgeons, two certified dental hygienists and dental hygienist students. The clinical staff was provided with a comprehensive in‐service training in geriatric dentistry during the 3‐year service learning period. A survey in 2004 showed that 83% of the selected patients were satisfied, compared with 14% who were not. The reasons for satisfaction were, mainly, the personal relationship with the attending staff (41%) and the professional ability of the dental team (46%).     

Geriatric dentistry--meet the need

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal ageing and age-related diseases as part of an inter-disciplinary team with other health care professionals. Geriatric health is an ignored and under-explored area worldwide. Oral health reflects overall well being for the elderly population. Conversely, elderly patients are more predisposed to oral conditions due to age-related systemic diseases and functional changes. The major barriers to practising geriatric dentistry are the lack of trained faculty members, a crowded curriculum and monetary concerns. For successful treatment, the practitioner must adopt a humanitarian approach and develop a better understanding of the feelings and attitudes of the elderly. Prevention and early intervention strategies must be formulated to reduce the risk of oral diseases in this population. In future, dental professionals must have a proper understanding of the magnitude of the services to be provided to the elderly. This could only be realised through an education programme in geriatric dentistry, which should be started without further delay. This article hence sets out the objectives, needs, present scenario, strategies and types of dental treatment required by the elderly population.     

Geriatric dental education and training in the United States: 1995 White Paper findings

“As the 21st century quickly approaches with an expansive geriatric population growth, are we adequately preparing health professionals to address patient needs? Will there be a shortage of competent clinicians and proficient faculty? Is there a proposed agenda to improve educational outcomes, clinical expertise, and oral health status of older adults? These and related concerns have prompted a focused geriatric education project within the United States. The Bureau of Health Professions (BHPr) of the Health Resources and Services Administration has provided the impetus and leadership through the Geriatric Education Futures Project. Dentistry is one of eleven disciplines invited to participate in this important effort which also includes medicine, nursing, social work, public health, allied and associated health, managed care, long-term care, case management, interdisciplinary education, and ethnogeriatrics. The first two phases of this project were: 1) writing White Papers which give “a critical review of the state of the art of geriatric education, project a future response to societal need and provide policy recommendations to achieve the preferred future;” and 2) sponsoring an invitational National Forum on Geriatric Education and Training in the spring of 1995 to present, discuss, and accept the White Paper findings, as well as enlisting broader participation and support from appropriate educational institutions, professional organizations (including the American Society for Geriatric Dentistry and the American Dental Association), government agencies, foundations, consumer organisations, etc. The third phase is ongoing and includes the development of national innovative educational collaboratives, dissemination of the White Papers and related documents, and continued “catalytic activities directed toward the implementation of a national agenda for action in geriatric education.” The complete text of all discipline-specific White Papers can be found in A National Agenda for Geriatric Education, Volume 1: White Papers¹. In an effort to more extensively disseminate the findings from the Dentistry White Paper, Gerodontology is reprinting the first two-thirds of the Dentistry White Paper which includes the state of the art in geriatric dental education and future vision needed to meet the needs of older adults, as well as summary identification of the 19 dental policy recommendations (See Table 3). Special Care in Dentistry² has recently published the complete text of these specific recommendations including the rationale, action required, responsible agents, and expected outcomes. Although some information contained in this White Paper may be specific only to the United States, it is also apparent that much of its content has relevance to gerodontology efforts in industrialised countries throughout the world.”–Bernice A. Parlak and Susan M. Klein (see endnote)     

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 Care for the Elderly

The geriatric population in many parts of the United States is underserved by dentistry. Socioeconomic problems, difficult access to dental facilities, and confusion about the need for dental care often prevent the elderly from seeking dental service. Because dental diseases are not life threatening or outwardly disabling, administrators of institutions for the elderly and health legislators place a low priority on dental care for the elderly. These factors working in concert with the insidious, progressive, and cummulative nature of denture diseases contribute to the poor dental health experienced by some segments of the geriatric population. Dentistry has the manpower and the technology to improve the oral health of the elderly, but society must be made aware of the importance of dental health in the total health of elderly persons in order that dentistry be given a chance to achieve that goal.     

Knowledge and attitudes of dentists regarding ageing and the elderly

doi: 10.1111/j.1741‐2358.2011.00534.x
Knowledge and attitudes of dentists regarding ageing and the elderly Objective: This study was aimed to identify the knowledge and attitudes of dentists regarding ageing and the elderly. Background: As the population ages, there is a greater demand for differentiated care from health professionals. However, the treatment needs of the elderly population are not sufficiently addressed, particularly in developing countries. Materials and methods: An official list of all dentists registered in the city of Belo Horizonte, Brazil, was obtained from the Regional Dentistry Council. A questionnaire was delivered to 276 randomly selected dentists; the survey contained questions designed to characterise the sample and identify dentists’ conduct towards elderly patients. A Likert scale was used to identify knowledge regarding care for the elderly and attitudes towards ageing. Results: Women demonstrated more positive attitudes towards the elderly. Graduates who worked in the public sector demonstrated a greater knowledge of geriatric dentistry (p < 0.05). Attending specific continuing education courses had no influence over the dentists’ willingness to treat the elderly population. Significant associations were not found between attitudes and knowledge regarding the elderly. Conclusion: Dentists who worked in the public sector demonstrated a greater knowledge regarding the elderly. This knowledge did not influence attitudes towards ageing. Women demonstrated a more positive attitude regarding ageing and dental care.     

Access to National Programs and Needs for Continuing Education1

This paper describes the American Dental Association's ongoing efforts aimed at improving access to comprehensive dental care for special population groups. Primary attention is directed to the elderly population, a major priority of the Association's Access Program. In addition to highlighting the basic components of the Access Program, a review of some of the barriers affecting utilization of dental care by the elderly and programs designed to eliminate those barriers is provided. Finally, the author offers some thoughts regarding the need for appropriate continuing education activities directed to the general dentist on the topic of geriatric dentistry.     

Undergraduate geriatric education through community service learning

doi: 10.1111/j.1741‐2358.2010.00444.x Undergraduate geriatric education through community service learning Introduction: Despite the exponential growth of the elderly population worldwide, geriatric education has been a formal component of only a few dental schools’ curricula. Objective: To describe the geriatric community service learning (CSL) component of the professionalism and community service (PACS) module, and to explore a CSL project carried out by a group of first year dental students at a long‐term care facility. Methods: A literature review was performed to present and describe the CSL component of the PACS module. Students’ personal reflections were used to illustrate some of the joys and challenges of experiencing a long‐term care facility environment. Results: The newly developed PACS module combines community service learning with the long‐term care experience. Students develop, apply and evaluate an educational health promotion activity in a long‐term care facility. Conclusions: The PACS module has encouraged students to acquire comprehensive knowledge and awareness of the needs and dynamics of a long‐term care as they collaboratively interacted with personnel from the facility to develop their projects. The authors would like to engage other schools in discussing the need to integrate community‐based geriatric education into their dental curricula.     

Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland

doi: 10.1111/j.1741‐2358.2011.00529.x Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland Introduction: This audit reports on the oral and general health of patients who were treated in a dental consultation clinic of a geriatric hospital. Material and Methods: Dental and medical records were obtained from 112 female and 80 male patients (mean age, 83.7 ± 8.2 years) who attended a dental consultation. Data analysis included the general health [American Society of Anesthesiologists (ASA) classification, number of diagnoses, cognitive function] and dental state in the age strata 60–69, 70–79, 80–89 and 90–99 years. Results: Seventy‐four per cent of patients were aged over 80 years. The prevalence of ASA‐P4 and P3 varied between age groups. Most patients (>86%) had more than three chronic diseases. Cognitive impairment was present in almost half of both older age cohorts (43 and 50%). Half of the patients (52%) were edentulous. In dentate patients, the average number of teeth was 12 ± 6 and differed in the maxilla significantly between age groups (p = 0.005). There was no significant association between dental state, ASA classification and systemic conditions. Conclusions: The profile of this cohort reflects a poor oral and general health status. The results underline the importance of an interdisciplinary consultation in a geriatric ward where oral health care is an integral part.     

Dental Hygienists' and Dental Hygiene Students' Attitudes Toward the Elderly

Dental hygiene students' and graduates' attitudes toward the elderly were evaluated in two different countries representing two different cultures. Five dental hygiene programs in the U.S. and the only dental hygiene program in Israel were selected to participate in addition to graduates from both Colorado-U.S. and Jerusalem-Israel. A total of 180 dental hygiene students of which 44 were Israelis, 70 U.S. graduates, and 52 Israeli graduates, participated. Both American graduates and American dental hygiene students were found, based on the usage of the Rosencranz-McNevin measure, to have significantly more positive attitudes toward the elderly as compared to the Israelis. Israeli and American dental hygiene students had a mean score of 120.92 and 105.96 respectively, Israeli graduates scored 122.39 and American graduates had a mean score of 105.09. The differences in culture, geriatric education in schools, and response to the survey according to what is most socially acceptable in the U.S. were the main reasons for these differences. Yet, it is hypothesized that these gaps in attitudes would decrease with the years, following the slow but stable “Americanization” of the Israeli society.     

Geriatric dentistry: is rethinking still required? A community‐based survey in Indian population

Gerodontology 2012; doi: 10.1111/j.1741‐2358.2012.00667.x Geriatric dentistry: is rethinking still required? A community‐based survey in Indian population Background: India has a large geriatric population (60 years and above) of 77 million; comprising 7.7% of its total population. Poor oral health and loss of teeth not only adversely affect the dietary intake and nutritional status and thereby compromise general health, but can also deny them the pleasure of eating food of their choice. Objective: To assess the level of edentulousness, denture wearing and denture needs of the elderly in the community and to study the correlation between oral health parameters and sociodemographic variables which would help us to define better treatment modalities, counselling and thus improve the oral health of our geriatric patients. Materials and Methods: Subjects who were 60 years and above were considered for this study and were randomly selected. Of the 1360 elderly who were enrolled in the study, 780 (57.35%) were males and 580 (42.64%) were female. This sample size is in proportion to the total population for the pilot study. They were given an oral examination and a questionnaire. Results: Fifty seven percent (57%) of the elderly were not satisfied with their oral health status and function. Conclusion: Complete edentulousness of both the arches was highest in the middle socio‐economic group, and was the lowest in the low socio‐economic group. Less than 50% of edentulous elderly and only 10% of partially edentulous elderly were wearing dentures.     

Oral hygiene and the need for treatment of the dependent institutionalised elderly

Objective: To assessing the oral hygiene and treatment needs of a geriatric institution in southern France. Background: For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments. Materials and methods: From 2003 to 2004, a cross‐sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated. Results: The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment. Conclusion: The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly.     

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.     

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 5‐year follow‐up of older adults residing in long‐term care facilities: utilisation of a comprehensive dental programme

Objective: This study will compare the clinical outcomes of 139 elders residing in long‐term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years. Background: Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care. Material and methods: A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition. Results: Eighty‐three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70–73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56–72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, χ² = 7.9, df = 2). Conclusion: Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.