Edentulousness and associated risk factors in a south Brazilian elderly population

Aim: To examine the relationship between edentulousness and the socioeconomic and behavioural variables collected in a cross‐sectional study of an elderly population. Methods: The study was conducted on 277 elderly (60 years or older) in the municipality of Biguaçu, Southern Brazil. The oral examinations and questionnaires were conducted by two calibrated dentists. The criteria used followed the WHO and FDI standards. Results: Prevalence of edentulousness reached 48.4%. A significant association was found in bivariate analysis for gender, satisfaction with appearance, time since last dental visit, the type of dental service sought in the last 5 years, educational level of the elderly and their children, and age of the elderly. In the multivariate analysis, gender, time since last dental visit and level of education of the elderly were significantly associated with edentulousness. Conclusions: Female sex and low educational level were the main risk factors for edentulousness in this population. Although various Brazilian studies suggest a decline in edentulousness in the country, methodologically robust research into edentulousness in Brazil is still limited, demanding further studies into this highly prevalent yet preventable health problem amongst the elderly.     

Periodontal health status in the elderly with different levels of education: a 5-year follow-up study

doi: 10.1111/j.1741‐2358.2010.00437.x Periodontal health status in the elderly with different levels of education: a 5‐year follow‐up study Objective: To assess the association between the periodontal health status and level of education over a 5‐year period among the elderly aged 75 years and older. Background: Oral health among the higher educated is known to be better than among the less‐well educated. On the other hand, the prevalence and severity of periodontal disease has been found to grow with increasing age. Methods: The participants were derived from a population‐based Helsinki Aging Study, a random sample of 76‐, 81‐ and 86‐year‐old elderly. The 170 dentate elderly who underwent clinical oral examinations at baseline and 71 who participated in the follow‐up were included in this study. The data was collected from intraoral and radiological examinations and from a structured questionnaire. Results: Subjects with a higher level of education had more retained teeth than subjects with a lower level of education. According to CPITN index, better‐educated participants had more healthy sextants, but they also had more sextants with periodontal pockets. Radiographic examination showed similar results. Conclusion: Level of education has a clear effect on the periodontal health status in the elderly. More treatment need seems to polarise into those elderly who are better educated as they retain more teeth into old age.     

Oral health and treatment needs of the long-term hospitalised elderly

Objectives: To determine the oral health and treatment needs of the long‐term hospitalised elderly. Setting: The Laakso long‐term hospital, Helsinki, Finland. Design: A cross‐sectional study with clinical oral examinations. Subjects: All long‐term patients (n = 260) aged 60 and older. Main outcome measures: Edentulousness, presence and hygiene of dentures, mucosal findings, number of teeth, functioning teeth and tooth remnants, level of dental hygiene, and need for operative treatment. Results: Subjects’ mean age was 83.3 years (SD = 8.1); 42% were edentulous, 45% of women and 33% of men (p = 0.12). With no gender difference, 41% had removable dentures, but one in four were considered to be in need of repair or replacement. Denture hygiene was good in 19%, moderate in 44%, and poor in 37%, and for men worse than for women (p = 0.02). Stomatitis was found in 25%, and angular cheilitis in 28% of the denture wearers. The dentate subjects had on average 12.4 (SD = 8.6) teeth with a clear difference by age (p = 0.03), but no difference by gender. Dental hygiene was considered poor. Of the dentate subjects, 37% were in need of restorations, 51% of periodontal therapy and 42% of extractions. Conclusions: Oral cleanliness should be improved with regards to dentures and teeth. More attention should be focused on dental care of the long‐term hospitalised elderly.     

First-time dental care and the most recent dental treatment in relation to utilisation of dental services among dentate elderly patients in Lithuania

Objectives: To describe the initial dental treatments of Lithuanian dentate elderly patients and the content of the most recent treatment in relation to their dentist‐visiting behaviour. Materials and methods: A cross‐sectional questionnaire study was carried out at two public dental offices in Kédainiai, Lithuania, among dentate patients aged 60+ years. A self‐administered questionnaire covered first‐time dental care, the most recent dental treatment, check‐up behaviour, interval since the most recent dental visit, and number of teeth. Age, gender and education served as background information. Statistical evaluation was by chi‐squared test, anova and logistic regression for odds ratio (OR). Results: In all, 174 dentate elderly responded, mean age being 69.2 (SD = 6.6) years. The mean age at the first visit was 16.3 years [95% confidence interval (CI) 14.9–17.6]. Regular dental check‐ups were reported by 30%, and 36% had visited a dentist within the past 12 months. As to the content of the most recent treatment, 78% of the elderly reported filling therapy, 50% endodontics, 48% tooth extraction, 21% radiography, 10% cleaning or scaling and 6% polishing of fillings. Those going for check‐ups were more likely to report diagnostic (OR 1.9; 95% CI 1.1–2.8; p = 0.01) and preventive (OR 4.8; 95% CI 2.5–9.0; p = 0.002) treatment when analysed by a logistic regression model, controlling for age, gender, education and number of teeth. Conclusions: Check‐up‐orientated utilisation of dental services should be encouraged among the Lithuanian elderly. Dentists and health officials should place greater emphasis on prevention.     

Prevalence of oral and dental disorders in institutionalised elderly people in Rasht,Iran

doi:10.1111/j.1741‐2358.2009.00313.x
Prevalence of oral and dental disorders in institutionalised elderly people in Rasht, Iran Objective: The aim of this study was to determine the prevalence of dental and oral mucosal lesions in institutionalised elderly people in Rasht. Background: Oral health in the elderly people is important to tailor the health programmes for this increasing age group within the population. Methods: A total of 216 elderly people residing in a geriatric nursing home were included in the study. Subjects were interviewed and examined clinically and registered in a data collection form and analysed using spss version 11 program (SPSS Inc, Chicago, Illinois, USA). Results: The prevalence of dental and oral disorders was 44.9% and 86.1% respectively. The most frequent oral disorders were dry mouth (42.1%), fissure tongue (25.9%), atrophic of tongue (25%), sublingual varicosity (22.7%), burning sensation (16.7%) and varix (15.3%). The prevalence of edentulousness was 56% (95%CI: 49–63%). The mean level of retained teeth was 3.22. The odds of an oral mucosal disorder in females were significantly more than in males (OR = 2.79, 95%CI: 1.25–6.23). Discussion: The findings revealed a high prevalence of dental and oral disorders in institutionalised elderly people in Rasht in comparison to similar studies. The mean of retained teeth was also much lower than in other reports. Therefore, the necessity for regular oral examination of these rapidly expanding age groups of people is essential.     

Number of teeth in relation to oral health behaviour in dentate elderly patients in Lithuania

Aim: To describe oral self‐care practices and the use of dental services among dentate elderly patients attending public dental service in Kédainiai, Lithuania, and relate these parameters to the number of remaining teeth. Design: Cross‐sectional questionnaire study. Setting: Two public dental offices in Kédainiai, Lithuania. Participants: Dentate patients aged 60+. Methods: A self‐administered questionnaire covering oral hygiene practices, use of sugar, utilisation of dental services, and number of teeth. Age, gender, and education served as background factors. Results: In all, 174 dentate elderly people responded, their mean age being 69.2 years (CI 95% 68.2–70.2) and mean number of teeth reported 16.2 (CI 95% 15.4–17.1). Of these respondents, 30% reported that they brushed their teeth twice daily and 57% that they always used fluoridated tooth paste. Having 21+ teeth was strongly associated (p < 0.001) with these habits, with brushing in the evening, and with enrolment in higher education, but not with gender. After controlling for various self‐care and background factors, frequent tooth brushing remained as the only significant factor in the logistic regression model (OR 2.0, CI 95% 1.2–3.3, p = 0.01) to explain subjects’ retention of 21+ teeth. Conclusions: Elderly Lithuanians’ oral self‐care is far from meeting recommendations. To preserve their natural teeth, dentate elderly people should improve their oral self‐care practices, in particular as regards tooth brushing. To reach that goal, all efforts by the community and dental profession are welcomed.     

Oral health among institutionalised elderly in Zagreb, Croatia

Objective: A survey of dental health status was conducted in the institutionalised elderly in Zagreb, Croatia in order to assess the dental and oral health of the elderly population. Participants: In 139 institutionalised elderly from a single nursing home in Zagreb, dental and oral status was registered according to World Health Organization criteria. There were 108 (77.7%) female and 31 (22.3%) male subjects aged 58–99 years. Results: The results showed that 45.3% of the interviewed persons were totally edentulous in both jaws. A significant increase in prevalence of edentulousness with the increasing age was recorded. The mean decayed, missing and filled teeth number was 27. The average number of teeth with caries was 1.03 per person, the number of the teeth extracted was 6.9 per person and teeth with fillings 0.74 per person. The average number of teeth with root caries was 0.17. Approximately 9 teeth per person were in need of treatment. Filled teeth were found 25.9% of subjects and decayed teeth in 30.9%. The mean number of remaining sound teeth, decayed teeth and residual roots in the elderly decreased with increasing age. Complete periodontal treatment was required in 5.8% of the participants and no significant differences between genders in periodontal status could be noticed. Conclusion: The results of this study suggest poor dental health in this group of the institutionalised elderly and the necessity of improving and implementing some special features in the dental health services programs for the institutionalised elderly.     

Oral health status in elders from South Brazil: a population-based study

doi: 10.1111/j.1741‐2358.2011.00617.x Oral health status in elders from South Brazil: a population‐based study Objective: To assess the oral health status of community‐dwelling adults aged 60 years and older from southern Brazil and to determine demographics, socioeconomic, behavioural and dental risk indicators. Materials and methods: This cross‐sectional study used a multistage, probability sampling method to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. A subsample of 217 subjects was included in this analysis. Oral mucosal lesions, dental caries, tooth loss and periodontal status (full‐mouth, six sites per tooth exam) were assessed by calibrated examiners. Results: Prevalence of edentulism was 39.5%, and mean tooth loss was 20.2 (SE = 0.6). Older individuals [Odds Ratio (OR) = 2.2], women (OR = 2.3), white people (OR = 5.9), individuals of lower socioeconomic status (OR = 5.6) and smokers (OR = 3.5) had higher likelihood of being edentulous. Approximately 36% of dentate individuals had caries and/or restoration affecting, in average, 5.0 teeth. Periodontitis affected 79% of subjects, and it was associated with older age (OR = 4.0), men (OR = 3.4) and large amounts of supragingival plaque (OR = 3.0). Conclusion: Poor oral health was observed in this elderly population from South Brazil. Sociodemographic disparities accounted for most of the burden of disease and treatment needs.     

Oral health status of the elderly in a residential home in Turkey

Objectives: To determine the oral health status and treatment needs of elderly residents of a residential home in Ankara, Turkey. Background: Little is known about oral health problems of elderly living in the institutions. Methods: Among 216 elderly, 193 of them were interviewed and were clinically examined according to WHO criteria. Age, gender, educational and occupational status, oral hygiene practices, dental insurance, access to dental care and systemic diseases were recorded using a structured questionnaire. Coronal and root caries, periodontal disease, dental status and related treatment needs were assessed by two calibrated dentists. Results: The mean age of the subjects were 75.2 ± 8.3 in males, 79.1 ± 7.9 in females; 32.6% of subjects were dentate and the mean number of teeth was 3.7 ± 7.0 (median = 0). A functional dentition was present in 7.3% of subjects (≥20). The mean decayed, missing and filled teeth (DMFT) was 29.3 ± 5.8 (median = 32) and mean root caries was 2.2 ± 3.1 (median = 1.0). The major reason for tooth extraction was dental caries. Of the subjects, 20.7% had at least one untreated coronal caries and 18.1% root caries. The assessment of periodontal status according to CPI revealed that only four persons had nine healthy sextants with the score of ‘0’. Edentulousness was 67.4% while 11.9% of them lacked denture in both jaws. Conclusion: The results illustrated poor dental health and showed extremely high demand for the dental health services programmes for the elderly living in these institutions.     

Tooth loss and associated factors in long-term institutionalised elderly patients

Objective: To compare partial and total tooth loss in dependent institutionalised elderly patients and identify any associated factors. Background: A poor oral health status, together with a reduction of autonomy can seriously affect the general health and increase the risk of death in elderly people. Those with total tooth loss and in need of assistance are the most at risk. Materials and methods: In 2004, a cross‐sectional study of 321 elderly patients was conducted in long‐term hospital services provided in Montpellier, France. Socio‐demographic, behavioural, medical and oral health information was recorded for each patient. Multivariate logistic regression models were performed to test the relationship between those covariates and partial or total tooth loss. Pearson chi‐squared tests were used for bivariate analyses. Results: The proportion of edentulousness was 26.9%; among these12.6% had no dentures. The factors significantly associated with edentulism were: an age ‘older than 87 years’ [odds ratio (OR) = 9.4], the presence of a nephropathy (OR = 6.8), and inadequate oral hygiene (OR = 0.1). The factors most significantly associated with partial tooth loss (at least 21 missing teeth) were ‘cancerous disease’ (OR = 9.9), the presence of a nephropathy (OR = 5.6) and the presence of a neurological disease (OR = 4.1). The factors significantly related to dentate status (20 or more natural teeth retained) were ‘hypertension treatment’ (OR = 2.4), and ‘cortisone treatment’ (OR = 0.2). Conclusion: General health problems as well as a poor oral condition were significant risk indicators for tooth loss among the long‐term institutionalised elderly. This suggests that the number of remaining teeth has a strong effect on oral health‐related quality of life.     

Home or away? Differences between home‐ and clinic‐based dental examinations for older people

Objective: To determine whether home‐based and clinic‐based dental examinations of older people are comparable. Background: Despite a number of studies which have examined the concordance between different examiners or examination circumstances, none has directly compared an oral examination conducted at home with one conducted in an appropriate clinical setting. Materials and methods: Dentate participants (n = 61) aged between 65 and 74 years underwent two clinical examinations, one in a conventional dental clinic and the other in the person’s home. Kappa statistics, intra‐class correlation coefficients and ‘Difference against mean’ plots were used to determine the nature and extent of any bias. Results: The summary estimates for missing teeth and dental caries were close, although the home‐based examinations resulted in a lower estimate of the mean number of decayed teeth and of untreated coronal decay. The lowest reliability statistics were observed with respect to the prevalence of untreated coronal caries, filled root surfaces and root surface (Decayed or Filled Surfaces) DFS. The periodontitis prevalence estimates were closer, but the reliability statistics were relatively low. The extent of bleeding on probing was relatively under‐estimated in the home‐based examinations. ‘Difference against mean’ plots indicated that, overall, the clinic‐based examinations detected more disease (although this was not observed for all clinical parameters which were measured). Conclusion: While clinic‐based examinations will remain the preferred option, the potential loss of information associated with home‐based examinations is unlikely to be great enough to preclude using them where required, although surveys with larger samples (and therefore more accurate estimates) should restrict their proportion of home‐based examinations to no more than 10%. As they are less precise, surveys with samples of 300 or fewer can safely accommodate up to about one‐third of their examinations being conducted in participants’ homes.     

Continuing dental care for Highlands elderly: current practice and attitudes of dental practitioners and home supervisors

Objective : To investigate current practice and attitudes of Highland dentists and home supervisors to continued dental care of elderly residents. Methods : A cross‐sectional questionnaire was designed to survey the current practice and attitudes of Highland dentists and residential care supervisors in their provision of dental care for the elderly at home and in long stay accommodation. Results : The response rate was 94% of dentists and 79% of homes. Despite 86% of dentists providing domiciliary care and 93% of homes transport to a surgery, no more than a quarter of residents had had contact with a dentist in the previous year. The distribution of residents varied with dependant individuals living in nursing units and the least dependant in residential homes. Only 1% of all residents were totally bed bound. Domiciliary patients were less likely to receive continuing care compared with those seen in a surgery and 75% of homes had to initiate dental care. In terms of patient referral, the majority of GDPs would refer uncooperative patients, salaried dentists would refer those with complex medical histories and community dentists would refer those requiring complex treatments. A dental assessment was undertaken in 46% of homes and 81% of these kept a record of dental care. Conclusion : This study highlights the need for a co‐ordinated, seamless continuing dental care service, tailored to the actual needs of the elderly individuals it is designed to serve, particularly in a remote and rural area.     

Level of education and incidence of caries in the elderly: a 5-year follow-up study

Objective: This study aimed to examine the possible association between level of education and 5‐year caries increment in the elderly inhabitants of Helsinki. Background: Low salivary flow and high numbers of salivary microorganisms are associated with the presence of caries, but cannot predict the increment in caries in the elderly. Materials and methods: This study group was derived from a population‐based Helsinki Aging Study, which consisted of a random sample of elderly born in 1904, 1909 and 1914. The 71 dentate elderly who underwent clinical oral examinations at baseline (1990–91) and 5 years later (1995–96) were included in the study group. Decayed, Missing or Filled Tooth (DMFT) and Root Caries Index (RCI) indexes were used to study subject’ caries experience. Data on subjects’ education came from questionnaire studies. The subjects were divided into four groups according to their level of education and occupation. Bivariate and multivariate analyses were used to evaluate relationships between subjects’ caries experience and level of education. Results: At baseline the elderly with high level of education had more teeth and more root surfaces at risk than those with low level of education. Number of teeth decreased (?1.085, p < 0.0001), while both DMFT (1.164, p < 0.0001) and RCI (0.081, p < 0.0001) indices increased during follow‐up. The increments in DMFT and RCI were not directly associated with the level of education. Multivariate analysis in which subjects’ gender, number of teeth, level of education, frequency of eating and frequency of brushing were taken into consideration, showed no significant association with caries increment. Conclusions: Within the limitations of this study it can be concluded that the level of education of the elderly is not directly associated with the increment in caries.     

Patterns of dental caries and treatment experience in elderly Lithuanians

Objective: The aim of the study was to evaluate patterns of caries experience in a representative sample of Lithuanians, aged 65‐74. Methods: This cross‐sectional study included 301 participants (response rate 54%). Information was obtained from a clinical examination (caries experience, stimulated salivary flow rates and oral hygiene levels) and a questionnaire. The questionnaire comprised questions about oral, general, physical, mental and social health and about background, knowledge, attitudes and lifestyle. The study had a multidimensional approach to negative consequences of disease and positive aspects of health. For bivariate testing, t‐test, ANOVA and Spearman's correlation were used. Factor analysis was combined with linear multiple regression for a multivariate study of caries experience patterns. Results: Elderly Lithuanians were found to have lower levels of edentulousness (range 11‐15%) than elderly people in other European countries. The mean number of missing teeth was also lower than in any of the neighbouring countries. A comparison of dentate and edentulous groups did not show any major differences. Those who reported that they had general disease had higher levels of oral health maintenance. In dentate elderly, caries experience differed according to place of residence, fluoride content in the drinking water, socio‐economic status, gender, lifestyle, and many other factors. The multivariate approach explained 52%. 61% and 55% of the variation in the number of filled or sound teeth (FS‐T), delayed (DT) and missing teeth (MT) respectively. Conclusion: Levels of oral health maintenance and caries experience show substantial variation among elderly Lithuanians, according to many health‐related characteristics. These elderly people require appropriate oral care, just as much as people in other population sub‐groups.     

Oral status and its association with obesity in Southern Brazilian older people

Background and objective: The loss of a functional dentition imposes eating difficulties and food avoidance, which may be detrimental in terms of nutritional status and health. The objective of this study was to investigate whether tooth loss and edentulism that were not rehabilitated with dental prostheses were associated with obesity among elderly in Southern Brazil. Materials and methods: A random sample of 872 independently living elderly was evaluated by means of a cross‐sectional study. Socio‐demographic, medical history and behaviour data were assessed using a standardised questionnaire. Two trained dentists assessed the number of teeth and use of prostheses in accordance with the WHO criteria. Height and weight were assessed and used to generate body mass index (BMI = weight (kilos)/height (cm)²) data. Participants were categorised into non‐obese (BMI ≤ 30) or obese (BMI > 30). Multivariate logistic regression was used to model the relationship between number of teeth and use of dental prostheses with obesity adjusting for confounders. Results: Multivariate logistic regression revealed that edentulous persons wearing only upper dentures (OR = 2.34, 95% CI 1.18–4.27) and dentate participants with one to eight teeth wearing 0‐to‐1 prosthesis (OR = 2.96, 95% CI 1.68–5.19) were more likely to be obese. Conclusion: The results show that a poorer oral status, represented by having fewer teeth that were not replaced by dental prostheses, was associated with obesity in Southern Brazil older people, suggesting a close relationship between poor oral status and systemic conditions that may have important clinical implications.     

种植牙技术对老年牙列游离端缺失修复的疗效分析

目的:了解种植牙技术在老年人牙列游离端缺失修复中的应用价值。方法:对我院2012年3月至2014年3月收治的牙列游离端缺失修复患者进行抽样,选取76例患者随机分成两组,对照组予以义齿修复,实验组应用种植牙技术进行修复,对比两组患者咀嚼率、稳固率、成功率及满意度。结果:实验组咀嚼率、成功率、稳固率(91.18%、94.74%、92.11%)明显优于对照组(71.05%、84.21%、73.68%),且主诉美观效果、固位功能、舒适性(84.21%、94.74%、92.11%)明显优于对照组(63.16%、65.78%、71.05%),组间比较差异具有显著统计学意义(P0.05)。结论:在老年人牙列游离端缺失修复中,种植牙技术具有重要的应用价值,疗效确切,修复成功率高,值得临床大力推广与使用。     

Care Needs of the Elderly Treated at a Dental School1

Increased longevity and recently intensified emphasis on gerodontology mandate that dental students'exposure to clinical care of the elderly be enhanced. The extent to which individual students can be exposed to geriatric dental care depends on the availability of elderly patients to dental school clinics and the treatment needs of these patients. The purposes of this study were (1) to determine the dental treatment needs of geriatric patients who seek care at a dental school, and (2) to ascertain if differences exist between the needs of older versus relatively young geriatric patients. Data collected on 128 elderly patients during a three month period indicate that 57% of the aged were either edentulous at examination or treatment planned to become edentulous and receive two full dentures. The remaining 43% were treatment planned to remain dentulous and receive therapies other than full upper and lower dentures. More older geriatric patients required full dentures than their younger cohorts. More young elderly required prophylaxes, scalings, root planing therapy, dental restorations, and partial dentures. Additional to their denture requirements, aged patients appear to have sufficient non-prosthetic needs to allow for meaningful gerodontic experience by students.     

Oral health-related well-being of the long-term hospitalised elderly

Objective: To investigate oral health‐related well‐being of the long‐term hospitalised elderly as reported by their primary nurses in relation to subject's oral health assessed either by primary nurses or by a clinical dental examination. Background data: Little is known about oral health‐related well‐being of the medically compromised, long‐term hospitalised elderly, most of whom are unable to express their feelings and opinions. Materials and methods: A cross‐sectional study using a questionnaire for primary nurses about oral health and oral health‐related well‐being regarding functional, pain/discomfort‐related, and psychosocial limitations of the subjects (n = 255) and assessment of oral health by clinical examination. The total number of limitations and the number of limitations in each category was calculated. Results: Most (77%) of our subjects were unable to eat normal food. Functional limitations dominated followed by psychosocial and pain/discomfort‐related limitations. Overall assessment by each subject's primary nurse ranked oral health of as good for 9% of subjects, as moderate for 44%, and as poor for 47%. Clinical examination‐based assessment ranked oral health as good for 19%, as moderate for 33%, and as poor for 48% of our subjects, with good oral health being ranked as good for more men than women (26% vs. 16%; p = 0.045). Fewer limitations were recorded for those with better oral health assessed both by primary nurse and by clinical examination. Conclusion: More efforts are called for to maintain the oral health of the long‐term hospitalised elderly so as to improve their well‐being.