Utilisation of Domiciliary Dental Services

Objectives : To develop undergraduate dental student understanding of the attitudes of elderly people towards dentistry and of the barriers which prevent them from seeking treatment. Design : Each student interviewed a) an elderly person already known to them and b) an elderly person at a Day Rehabilitation Unit using a questionnaire. Students were not trained nor standardised. Setting : a) in the student's home locality, b) in a Rehabilitation Unit in Sheffield. Subjects : 161 people were interviewed with mean ages a) 78 years and b) 85 years. Main outcome measures: Perceptions of treatment need and domiciliary treatment by these elderly people. The results are summarised but not analysed because of the inherent limitations of data derived by unsupervised students. Conclusions : This educational exercise successfully engaged the studentsí minds and, for some, generated enthusiasm. They achieved valuable insight into the topic and realised that many people who inevitably have dental problems either feel that this is acceptable or do not know that they can obtain domiciliary dental care.     

Staff attitudes to oral health care. A comparative study of registered nurses,nursing assistants and home care aides

This study compares differences in attitude, of oral health care of nursing personnel working with dependent elderly and severely disabled patients. A questionnaire was administered to 398 personnel covering (1) personal oral health care habits. (2) experiences and attitudes in assisting oral care and (3) willingness to assist patients/residents with their daily oral hygiene. Three hundred and sixty - four persons answered the questionnaire, including 70 registered nurses, 148 nursing assistants and 146 home care aides. The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities. Although registered nurses were found to have more positive attitudes toward oral care assistance than the other nursing groups, they were seldom invoked in the daily practice of oral hygiene care. The results indicate a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.     

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 hygiene of elderly people in long-term care institutions--a cross-sectional study

Objective: The aim of this cross‐sectional study was to assess the level of oral hygiene in elderly people living in long‐term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness. Materials and methods: Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes. Results: Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score = 3) and the mean denture plaque score was 2.13 (maximum possible score = 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43). Conclusion: Oral hygiene was poor, both for dentures and remaining teeth in residents in long‐term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively.     

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.     

Dental disease and risk of coronary heart disease and mortality.

OBJECTIVE--To investigate a reported association between dental disease and risk of coronary heart disease. SETTING--National sample of American adults who participated in a health examination survey in the early 1970s. DESIGN--Prospective cohort study in which participants underwent a standard dental examination at baseline and were followed up to 1987. Proportional hazards analysis was used to estimate relative risks adjusted for several covariates. MAIN OUTCOME MEASURES--Incidence of mortality or admission to hospital because of coronary heart disease; total mortality. RESULTS--Among all 9760 subjects included in the analysis those with periodontitis had a 25% increased risk of coronary heart disease relative to those with minimal periodontal disease. Poor oral hygiene, determined by the extent of dental debris and calculus, was also associated with an increased incidence of coronary heart disease. In men younger than 50 years at baseline periodontal disease was a stronger risk factor for coronary heart disease; men with periodontitis had a relative risk of 1.72. Both periodontal disease and poor oral hygiene showed stronger associations with total mortality than with coronary heart disease. CONCLUSION--Dental disease is associated with an increased risk of coronary heart disease, particularly in young men. Whether this is a causal association is unclear. Dental health may be a more general indicator of personal hygiene and possibly health care practices.     

Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment

doi: 10.1111/j.1741‐2358.2011.00490.x
Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment Objective: Investigating oral health’s relationship with dependency and cognitive state. Background: Oral hygiene is poor in the institutionalised elderly. There are problems regarding the oral care of residents having poor mobility or cognitive impairment. Material and methods: Cross‐sectional study involving 135 participants (mean age 85.7, SD 8.8 years) in two categories: nurses doing tooth cleaning and residents doing tooth cleaning. Those cleaned by nurses were categorised as co‐operative or unco‐operative. The oral hygiene status, presence of caries, retained roots and denture‐related stomatitis were recorded. Results: Of the participants, 70% had only natural teeth. The prevalence of caries was 28%. A significant correlation showed that having more teeth gave a poorer Simplified Oral Hygiene Index (OHI‐S) (p = 0.018). The number of retained roots increased with the severity of cognitive impairment (p < 0.05). Significant differences were found between nurses or residents doing the tooth cleaning on the OHI‐S (p = 0.05) and percentage of dental plaque (p = 0.003). Unco‐operative residents had poorer oral hygiene (p = 0.028), more caries (p = 0.008) and were more often moderate–severe cognitive impaired (p = 0.016). Conclusions: A high percentage of participants had unacceptable oral hygiene. Residents whose teeth were cleaned by the nurses had poorer oral hygiene. Unco‐operative residents had the worst oral hygiene and more caries.     

Analysis of four diverse population groups indicates that a subset of cystic fibrosis mutations occur in common among Caucasians.

To determine the nature and frequency of non-delta F508 cystic fibrosis (CF) mutations among diverse populations, we have sequenced exons 9-12 and 19-23 of the CF transmembrane conductance regulator (CFTR) gene from 128 CF chromosomes (39 U.S. Caucasian, 27 African-American, 42 Northern Irish, and 20 Israeli chromosomes). These regions were chosen because they encode the two putative ATP-binding folds of CFTR, domains which appear to have functional significance. In addition, CFTR exons 1 and 2 were analyzed in the American patients. Mutations were found on 49 of the 128 CF chromosomes. Nineteen different mutations were observed; six were novel, while the remaining 13 had been reported previously by our group or by other investigators. Six of nine different mutations found in African-American patients were unique to that population. However, the vast majority of the mutations found in U.S. Caucasians (eight of nine), Northern Irish (four of five), and Israelis (three of three) also occurred in other Caucasian groups. The preponderance of previously reported mutations in these three groups suggested that a subset of the non-delta F508 mutations occur in common among Caucasians. A survey of mutation frequencies in other Caucasian groups confirmed this observation. Unfortunately, this subset accounts for less than half of non-delta F508 CF mutations in most groups. These data suggest that screening for delta F508 and this select group of mutations will efficiently and economically maximize the number of CF mutations identified in Caucasian groups. However, it will be difficult to detect more than 90% of mutant CFTR alleles except in ethnically and geographically discrete populations where CF is the result of founder effect.     

Dental health of elderly confederate veterans: evidence from the Texas State Cemetery

Analysis of the skeletal remains of 50 Confederate veterans provided a unique opportunity to explore the dental health of a geriatric sample. These men, who died between 1907-1932, had an average age at death of 76.7 years. Ninety percent were institutionalized at the Confederate Home for Men (Austin, TX) prior to their deaths. This elderly sample was assessed in terms of caries, antemortem tooth loss (AMTL), abscesses, and linear enamel hypoplasias. On a per tooth basis, the AMTL rate was 57.2%. Of 39 dentate men, 33 (84.6%) had dental caries, and 24.4% (121 of 496) of teeth were carious. Ten (25.0%) of the dentate men had hypoplastic teeth. At least one abscess was seen in 14 (28%) of 50 individuals. Results from this geriatric institutionalized sample are compared to contemporaneous historical samples. Disparities in dental health among these groups may be due to differences in average age at death, and these comparisons allow a better understanding of dental changes that occur with age. The sample is also compared to modern elderly samples: modern groups have higher caries rates, possibly because they retained more teeth. This finding may be due in part to diets in the United States becoming increasingly cariogenic over time. In addition, dental care has moved from the reactive practices seen in the nineteenth and early twentieth centuries (such as tooth extractions) to modern proactive solutions dedicated to preserving and restoring teeth (such as tooth brushing, fluoride treatments, and dental fillings).     

Rural and Urban Students’ Perceptions of and Attitudes toward Brown Bears in Turkey

Many studies have examined adults’ perceptions of and attitudes toward large carnivores to assess human–wildlife conflict and inform conservation strategies, but there have been few studies concerning children. I studied secondary school students’ perceptions of and attitudes toward brown bears (Ursus arctos) and other large mammals in Turkey via a questionnaire survey. The questionnaire, consisting of 18 questions, was completed by 215 rural and 98 urban secondary school students. Both sets of students liked bears; they were also afraid of them and unsure about living with them in the future. While there were no gender differences in attitudes and perceptions, there were marked differences between urban and rural students. Urban students had less contact with nature, gained more of their knowledge about bears from documentaries, and had less positive attitudes toward bears. They were also more likely to be afraid of species not present in Turkey, for example, anaconda, while rural students were most afraid of wild boars. Factor analysis identified three important themes: familiarity with bears, conservation of bears, and experiencing conflict with bears, which explained 49.8% of the variance in attitudes toward bears. The most important factor for the development of negative attitudes toward bears was personal experience of human–bear conflict, suggesting that measures to reduce human–bear conflict in rural areas may help to sustain students’ positive attitudes toward the conservation of bears.     

A Geriatric Dental Resident Training Program

The exponential increase in the size of the U.S. population 75 years and older places new demands on the health care delivery system. Primary among these is the need to train professional manpower in the attitudinal, cognitive, and clinical skills essential to the management and treatment of medically compromised and functionally dependent elderly patients. The university-affiliated skilled nursing facility with a rehabilitation-oriented interdisciplinary staff offers an ideal setting for these educational objectives. The rationale, organization, and experience of a unique geriatric/general practice dental resident training program in such a teaching nursing home is delineated in this presentation.     

Bacteriological Studies of the Effects of Cow's Milk on Dental Plaque and Dental Caries in Rats

The effects of liquid milk and skim milk powder on the bacterial composition of rat dental plaque and dental caries were examined in two separate experiments. First, groups of rats fed a cariogenic diet plus one or other of three types of liquid milk had. after 28 d. similar plaque flora. Those rats receiving reconstituted spray-dried skim milk had a significantly higher incidence of dental caries than those receiving either pasteurized and homogenized milk or ultra-heat treated milk. The differences in caries scores may be related to differences in inorganic phosphate and calcium levels of the milks. Secondly, rats fed a diet containing 65% phosphate-free sucrose plus 32% spray-dried skim milk in powder form had a significantly lower dental caries score than did rats receiving a diet containing 65% sucrose plus 32% autoclaved roller-dried skim milk powder. At the end of this experiment, the plaque flora had changed significantly and the difference in caries incidence was related to the reduction in the percentage of potentially cariogenic bacteria.
These results indicate that the mechanism by which milk reduces dental caries incidence may be (a) by remineralizing incipient carious lesions or (b) by mediating changes in the bacterial composition of dental plaque.     

Digit Sucking Habit and Association with Dental Caries and Oral Hygiene Status of Children Aged 6 Months to 12 Years Resident in Semi-Urban Nigeria

Objectives

Non-nutritive sucking (NNS) is a common behavior in childhood. The association between digit sucking, dental caries and oral health has been studied with inconclusive results. The objectives of this study were to determine the prevalence of, and the association between digit sucking, caries and oral hygiene status of children age six months to 12 years, resident in Ile-Ife, Osun State, Nigeria.

Methods

A cross-sectional study was conducted in Ife Central Local Government Area of Osun State. Data were collected through a household survey using a multi-stage sampling procedure from children between six months and 12 years. Details of each child’s socio-demographic characteristics, digit sucking habits, caries status and oral health status were collected. The association between digit sucking, caries status and oral hygiene status was determined using Chi square and Logistic regression.

Results

The mean age of the 992 study participants was 5.8 ± (3.2) years. The prevalence of digit sucking, caries and poor oral hygiene were 7.2%, 10.5% and 2.4% respectively. The mean dmft score was 0.22 ± (0.80), mean DMFT score was 0.04 ± (0.30) while mean Oral Hygiene Index score was 1.27 ± (0.73). Digit sucking increased the odds of having caries (OR: 1.28; CI: 0.58–2.81) but decreased the odds of having poor oral hygiene (OR: 0.58; CI: 0.34–1.01) insignificantly.

Conclusions

Digit sucking was not a significant predictor of caries and oral hygiene status, although the odds of having caries increased while the odds of having poor oral hygiene decreased with digit sucking.     

Oral hygiene care status of elderly with dementia and in residential aged care facilities

doi: 10.1111/j.1741‐2358.2011.00472.x
Oral hygiene care status of elderly with dementia and in residential aged care facilities Objective: To explore the effectiveness of oral hygiene care on plaque and gingival status of residents with dementia. Background: Oral hygiene and oral hygiene care has been reported to be poor among the institutionalised elderly with dementia. The severity of oral diseases has been shown to increase with the severity of physical and cognitive impairment related with dementia. Little research has been carried out on plaque and gingival status of elderly with dementia and the impact of disability related with dementia on oral health in residential aged care facilities (RACF). Materials and methods: A cross‐sectional study of 205 elderly residing in RACF in Perth. Results: Forty‐one percent of the residents in RACF had dementia. Sixty percent of the residents with dementia and 75% of the residents with an Activities of Daily Living Oral Health score of D were assisted with oral care. Mean plaques scores and extent of gingival inflammation were higher for residents in the DD and D subgroups and resident with dementia. Residents assisted with brushing had higher mean plaque score and more moderate gingival inflammation. Conclusion: Oral hygiene care status in residents with dementia was poor despite the fact that oral care assistance was being provided.     

Behind the screens: care staff observations on delivery of oral health care in nursing homes

Objective: To identify qualitatively carer staff attitudes, practices and clinical comments related to oral health care of functionally dependent nursing home clients. Design: Open-ended questions included in a longer quantitative questionnaire. Setting: 22 randomly selected nursing homes in the Bristol area. Subjects: 416 carers employed in these homes. Results: The majority of carers thought that clients had a right to good oral health, accepted the carers' role in helping clients with oral and denture hygiene, but recognised that oral health care provision was deficient. However, some carers believed oral health care to be solely the clients' responsibility despite high disability levels. Main barriers to providing oral health care were low prioritisation of oral health by nursing management, lack of co-operation from cognitively impaired clients, and lack of training. Carers were critical of homes' lack of arrangements for routine professional dental cheeks, lack of commitment to staff training, low standards of oral health care by colleagues, and lack of provision of oral hygiene aids and cleansing materials for clients. Many responses indicated ways in which nursing home oral health care could be improved. Carers reported contrasting experiences of dental treatment, and deplored recent decreased availability of subsidised dental care. Conclusions: Carers' generally positive attitudes towards clients' oral health care should encourage health educators. Insights gained from qualitative data can help to identify the less obvious causes for poor oral care delivery, which can then be addressed in education and training initiatives in nursing home settings.     

The orodental status of a group of elderly in-patients: a preliminary assessment

Objective: To provide a preliminary assessment of the orodental status and dental treatment requirements of a group of elderly in-patients. Design: Cross-sectional. Setting: Acute Care of the Elderly and Stroke Rehabilitation units at teaching hospitals in Merseyside. Subject: 150 patients aged 58 to 94 years, in which a history could be validated at interview. Intervention: Questionnaire administered by dentist and clinical examination. Main outcome measures: Registration with a dentist, prosthetic status and difficulties with dentures, denture hygiene and identification marking, dental treatment needs and evidence of mucosal pathology. Results: Only 27% of patients claimed registration with a dentist. Three quarters of the patients were edentulous and 66 patients wore full dentures; 18 had no prostheses. Difficulties were experienced by one quarter of patients with upper dentures, compared with a half of lower denture wearers. Of the dentures available for inspection, 61 % had removable soft debris, 66% were left out at night and 75% were cleaned by the patient, whilst on the ward. No dentures had evidence of identification marking. Of the 39 partially dentate patients, 75% required interventive dental treatment. Denture stomatitis was diagnosed in 29% of patients and 19 had evidence of benign mucosal pathology. Conclusions: The orodental status of this group of elderly in-patients was poor, with a high proportion being edentulous. Few were registered with a dentist and denture hygiene was inadequate. Lack of identification marking is a matter of concern. Closer liaison between hospital staff responsible for elderly in-patients is required, to improve the orodental health and quality of life of this medically compromised group of patients.     

Geriatric Considerations for Prosthodontic Therapy

The geriatric population is increasing and dentists are needed who are sensitive its problems and technically competent to provide a full rante og complete, fixed, and removable prostheses as well as preventive prosthodontics. The dental profession and schools must prepare today's graduates to meet the dental needs of tomorrow's elderly population including prosthodontic therapy.