Tooth loss and dental caries in community-dwelling older adults in northern Manhattan

doi: 10.1111/j.1741‐2358.2011.00502.x Tooth loss and dental caries in community‐dwelling older adults in northern Manhattan Objective: To examine tooth loss and dental caries by sociodemographic characteristics from community‐based oral health examinations conducted by dentists in northern Manhattan. Background: The ElderSmile programme of the Columbia University College of Dental Medicine serves older adults with varying functional capacities across settings. This report is focused on relatively mobile, socially engaged participants who live in the impoverished communities of Harlem and Washington Heights/Inwood in northern Manhattan, New York City. Materials and Methods: Self‐reported sociodemographic characteristics and health and health care information were provided by community‐dwelling ElderSmile participants aged 65 years and older who took part in community‐based oral health education and completed a screening questionnaire. Oral health examinations were conducted by trained dentists in partnering prevention centres among ElderSmile participants who agreed to be clinically screened (90.8%). Results: The dental caries experience of ElderSmile participants varied significantly by sociodemographic predictors and smoking history. After adjustment in a multivariable logistic regression model, older age, non‐Hispanic Black and Hispanic race/ethnicity, and a history of current or former smoking were important predictors of edentulism. Conclusion: Provision of oral health screenings in community‐based settings may result in opportunities to intervene before oral disease is severe, leading to improved oral health for older adults.     

The Copenhagen Oral Health Senior Cohort: design, population and dental health

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00383.x The Copenhagen Oral Health Senior Cohort: design, population and dental health Background: In order to study the way old age influence oral health, the Copenhagen Oral Health Senior Cohort (COHS) has been established. Objectives: To describe the design, measurement procedures, and baseline values for COHS including spatial distribution of restorations and dental caries as well as reasons for non‐participation. Materials and methods: Seven hundred and eighty‐three individuals aged 65 years or older, from a total of 1918 invited elderly people, underwent an interview regarding oral health‐related behaviour and a clinical oral examination including measurement of unstimulated whole saliva flow rate. Results: Twelve percent of the COHS was edentulous. The number of dental restorations was higher for women compared to men; however, men had more caries than women. Coronal caries was most frequent on mesial and distal surfaces and on the maxillary incisors and canines; root caries was most frequent on labial surfaces and evenly distributed within the dentition. Only 41% of all invited elderly people accepted the invitation, with old age and poor health being the primary reasons for non‐participation. Conclusion: The baseline values for COHS show that a substantial proportion of the participants had retained a natural dentition and that dental caries was prevalent with the anterior maxillary teeth being most affected.     

Assessing oral health promotion determinants in active Greek elderly

doi: 10.1111/j.1741‐2358.2011.00491.x
Assessing oral health promotion determinants in active Greek elderly Objective: To explore older adults’ patterns and risk behaviours to be invoked in the allocation of strategies to promote oral health. Background: Access to dental services is determined by factors that serve as barriers to or enablers of older adults’ behaviour and attitudes towards oral health. Appropriate oral health promotion activities are of particular importance among the elderly in altering oral health behaviour through education, prevention and health protection. Methods: A cross‐sectional study was conducted among 108 dentate elderly subjects. They were attending a University Prosthetic Dentistry Clinic in Greece as patients seeking treatment. Participants underwent a clinical examination and an interview. Results: Data extracted revealed that cost and no disease awareness were the most frequently mentioned barriers to regular dental visits. Most of the participants presented low level of income and education and reduced presence of adverse dental health symptoms compared with the actual oral health status. Besides some predisposing factors, enabling and need variables significantly affected access to dental care services, participants’ number of remaining teeth and as a consequence oral health status. Conclusion: Profiling older adults’ demographics, economic, social and cultural status and their attitudes and beliefs could further contribute in developing universal activities and strategies for oral health promotion so as ageing challenges are favoured.     

Knowledge and attitude of elderly persons towards dental implants

doi: 10.1111/j.1741‐2358.2011.00586.x Knowledge and attitude of elderly persons towards dental implants Background: Despite their unrivalled place in restorative treatment, dental implants are still scarcely used in elderly patients. Introduction: The aim of this survey was therefore to identify potential barriers for accepting an implant treatment. Materials and methods: Participants were recruited from a geriatric hospital, two long‐term‐care facilities and a private clinic. The final study sample comprised 92 persons, 61 women and 31 men with an average age of 81.2 ± 8.0 years. In a semi‐structured interview, the participants’ knowledge of implants and attitude towards a hypothetical treatment with dental implants were evaluated. Results: Twenty‐seven participants had never heard of dental implants, and another 13 participants could not describe them. The strongest apprehensions against implants were cost, lack of perceived necessity and old age. Univariate and multiple linear regression analysis identified being women, type and quality of denture, having little knowledge on implants and being hospitalised as the risk factors for refusing implants. However, old age as such was not associated with a negative attitude. Conclusion: The acceptance of dental implants in the elderly population might be increased by providing further information and promoting oral health in general. Regardless of the age, dental implants should be placed when patients are still in good health and live independently.     

An assessment of the oral health knowledge and recall after a dental talk amongst nurses working with elderly patients: a pilot study

Objective: To assess the oral health knowledge amongst nurses working with elderly people in a local hospital run by a Primary Care Trust before and after a dental training talk. Method: Nursing staff working at Swanage Cottage Hospital completed a questionnaire designed to assess their knowledge of dental decay, periodontal disease, oral hygiene, denture care and palliative care. One month after receiving a dental talk, the questionnaire was redistributed to the participants. A t‐test was used to compare the number of correct answers before and after the talk. Results: Twenty members of the nursing staff completed the initial questionnaire and 14 completed it 1 month after the talk. Prior to the talk, of the 45 questions, the mean number of correct answers per member of staff was 23.95 ± 3.83. One month after the talk this had risen by 25% to 34.9 ± 3.83. This increase was statistically significant (p < 0.0001). Conclusion: A dental talk to a group of nursing staff caring for elderly people in a local hospital produced a significant increase in the level of oral health care knowledge.     

The uptake of dental services by elderly Germans

Objective: The aim of the study was to assess the uptake of dental services by the old and very old population within the scope of the Berlin Aging Study (Berliner Altersstudie BASE ). Design: A multi‐disciplinary structured interview was performed on 928 subjects, aged from 70 to 103 years of whom 516 persons volunteered to take part in a 14‐session intensive protocol. Six representative study groups were matched for age and gender. Subjects were asked to recall the timing of their most recent dental visit. Data were validated by sending for dental records and compared with all study participants from the multi‐disciplinary intake assessment. Data were related to age group, dental state, dementia and education. Results: Reported last contact with dental services ranged from 2 weeks to 52 years (median 18 months) with a higher time lapse in the study groups aged 85 and older. Dentate subjects had seen their dentist more recently than edentate subjects. Higher education correlated with an increased dental utilisation. Subjective memory on the time lapse since the last dental appointment coincided in 13% of the subjects with available dental records (n=84), was misjudged between one and six months in 55%, and by more than six months in the remainder. Moderately or severely demented subjects who remembered their last dental appointment (n=48 of 70) showed no consistently different utilisation to healthy or mildly demented studs participants. Conclusion: Edentate old and very old subjects show the least frequent utilisation of dental services. Data on motivation and barriers to care are needed to develop strategies to improve the use of dental services and thus promote oral health in late life.     

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

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

Oral health in nursing home residents with different cognitive statuses

Objective: To compare oral health in nursing home (NH) residents with different cognitive statuses. Background: Oral health is a significant issue for NH residents because of its relationships to quality of life, systemic health and well‐being. It is known that oral health is poor in NH residents. However, how oral health differs in NH residents with different cognitive statuses remains unclear. Materials and methods: Nine hundred and two NH residents were retrospectively recruited from a community‐based geriatric dental clinic in Minnesota, USA. Comprehensive medical, dental, cognitive and functional assessments were completed for the participants. On the basis of medical history and cognitive status, participants were categorized into three groups: without cognitive impairment (non‐impaired group), with cognitive impairment but no dementia (impaired group) and with dementia (demented group). ANOVA, Chi‐square and Fisher’s exact tests were used to compare medical, dental and functional statuses between groups. Results: Oral hygiene was poor in NH residents. Forty per cent of participants in the impaired group were edentulous, significantly higher than the edentulism rate in the demented group (29%, p = 0.01). More than 60% of the participants lost 16 or more teeth prior to examination. Depending on their cognitive status, 82–92% of the participants arrived with one or more caries or retained root. Dentate participants in the impaired and demented groups averaged about six caries or retained roots, significantly more than 4.7 caries or retained roots in the non‐impaired group (p = 0.01). Conclusion: Oral health was poor but slightly different in NH residents with different cognitive and functional statuses.     

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.     

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

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

Effects of 11-month interventions on oral cleanliness among the long-term hospitalised elderly

Objectives: This trial studied the effects of interventions on the oral cleanliness of the long‐term hospitalised elderly. Background: Oral cleanliness is mostly poor in long‐term facilities. While many agree on the importance of oral hygiene education for nursing personnel, little information and agreement exists on how to organise this education in geriatric institutions. Materials and methods: This is a longitudinal study with interventions. After a baseline clinical examination, the patient wards were divided into three groups (A, B and C) and the type of intervention was randomly assigned. In group A, dental hygienists provided oral hygiene measures for the subjects once every 3 weeks. In group B, the nursing staff first received hands‐on instructions after which they assumed responsibility for the subjects’ daily oral hygiene. Group C served as a control. Denture hygiene and dental hygiene were recorded at baseline and in the end of the 11‐month study period. In total, 130 subjects completed the interventions; their mean age was 82.9 years. Results: The best outcome in both denture and dental hygiene occurred when nursing staff at the wards took care of hygiene (group B). The increase in the proportion of those with good denture hygiene was the most prominent in group B (from 11% to 56%). The proportion of subjects with poor overall dental hygiene decreased from 61% at baseline to 57% in the end, for group B from 80% to 48%. Conclusions: Organised oral health education of the nursing staff should receive more attention.     

A preliminary investigation into tooth care, dental attendance and oral health related quality of life in adult stroke survivors in Tayside, Scotland

Objective: The aim of this study was to investigate patterns of oral care, dental attendance and oral health‐related quality of life among adults who had suffered a stroke. Background: Stroke is the most common cause of adult disability in the UK. Seventy per cent of strokes occur in adults over 65 years of age. A mild stroke may leave little residual disability but in cases of moderate or severe stroke the disability may be significant and may impact on oral health and function. Materials and methods: A cross‐sectional survey was conducted among adults surviving 1 year after stroke, between January and July 2001. A medical screening was carried out which included an assessment of disability and handicap using the modified Rankin scale. A structured interview was conducted to identify normal patterns of oral care and dental attendance and to elicit if since suffering a stroke any changes had occurred or were likely to occur. The Short Form Oral Health Impact Profile (OHIP‐14) was administered prior to an oral examination. Analysis used SPSS 11.0 for Windows. Parametric and nonparametric tests were undertaken (t‐tests and chi‐squared tests with Yates correction where appropriate). Results: Forty‐one adults were recruited into the study comprising 21 female and 20 male. They ranged in age from 50 to 87 years and the mean age was 69 years (SD = 9.8). Forty per cent of participants experienced moderate disability or greater following their stroke. Thirty‐seven per cent had difficulty with tooth cleaning. The most frequently reported problem was being unable to use one hand properly as a result of the stroke. There was a significant association between the degree of disability following stroke and difficulty with tooth cleaning (P = 0.015). Disability as a result of the stroke was cited as the main reason for reported or projected attendance pattern change. The most frequently experienced OHIP‐14 dimension was functional limitation (39%). Conclusion: Individuals who have been left disabled after a stroke may require help with or advice on oral care and information on how to access dental services in a setting appropriate to their disability. Further research is needed to identify the dental needs of adults with stroke and to identify appropriate interventions to meet these needs.     

Dental status and dental caries in 85-year-old Danes

Objectives: This study reports findings on the dental status and the prevalence of dental caries among a group of 85‐year‐old Danes from the Glostrup 1914 Cohort, Denmark. The purpose of the study was to analyse whether caries experience was related to number of teeth and to indicators of functional ability and cognitive function. Methods: A total of 191 individuals (78 men and 113 women) participated in a cross‐sectional population study conducted in 2000. Using mobile dental equipment, a clinical oral examination and an interview were administered to all participants in their homes. Functional ability was measured by the Mob‐H scale and cognitive function was assessed by the Mini‐Mental State Examination. Results: Fifty‐nine per cent of the participants had their own natural teeth and for the dentate participants, the mean number of teeth was 13 (range 1–27). A high prevalence of active caries on coronal and root surfaces was observed. Older adults with few natural teeth had a higher prevalence of active coronal and root caries and a higher unmet treatment need than older adults with many teeth. Further, the study showed that 85‐year‐old persons with reduced functional ability and cognitive impairment tended to have more active caries than 85‐year‐olds with no impairment. Conclusions: A substantial proportion of 85‐year‐old individuals had retained a natural dentition; however, active dental caries is a problem of concern among the most elderly.     

Characteristics of Women with Persistent Thinness

Objective: Western society has become increasingly obesogenic. Despite this trend, some individuals maintain low weights throughout their lives. Little is known about the characteristics of persistently thin individuals. This study examined demographic, health, and psychiatric characteristics of women who reported having been persistently thin throughout childhood, adolescence, and adulthood. Research Methods and Procedures: Participants were 1022 female members of a population‐based twin registry. Participants completed a mail survey that included questions regarding demographics, body size in childhood, adolescence, and adulthood, health behaviors and satisfaction, disordered eating, perfectionism, and personality. In previous interview waves, participants completed diagnostic interviews assessing psychiatric and substance use disorders. Results: Persistent thinness was associated with a significantly later age at menarche, lower rates of dieting and binge eating, greater health satisfaction, higher self‐esteem, and lower perfectionism and body dissatisfaction. Discussion: Persistent thinness appears to be associated with greater well‐being in the present and a later age of menarche in the past. Whether later menarche is causally related to thinness or whether later menarche, persistent thinness, and enhanced well‐being all result from a third unmeasured variable such as high sports participation is yet to be resolved.     

Comparing Older Adults' Perceived Need for Dental Care with a Normative Hierarchy of Needs1

The elderly are reported to have poor perception of their need for dental care. In a secondary analysis of data from a community interview and clinical examination survey of older adults, we set out to determine the nature and extent of the inconsistency of perceived and normative needs. The data were gathered originally to estimate the oral health status and need for treatment among adults aged 50 and older in East York, Ontario. In the interview, participants responded to four questions dealing with their satisfaction with, and need for, dental care. Dentists conducted clinical examinations following WHO methods which included oral health status and treatment needs. Data were analyzed using SPSSPC +. We placed the clinical needs in order from urgent to no need, following ADA guidelines. The perceptions of subjects were then compared to this normative hierarchy using Kruskal-Wallis analysis of variance. We found that participants' perceptions were closely associated with the normative hierarchy in all comparisons. Our results suggest that the concordance between perceived and normative needs is greater than previously reported.     

Oral health of the elderly living in residential homes in Slovenia

doi: 10.1111/j.1741‐2358.2011.00497.x
Oral health of the elderly living in residential homes in Slovenia Objectives:  To evaluate oral health status of the elderly, living in eight randomly selected residential homes for senior citizens across the country. Background: The percentage of the elderly is growing worldwide. With ageing, risks of various oral diseases, including dental caries and periodontal disease, are growing. Methods: Altogether 296 elderly people (88 men, 208 women) of average age 79.89 ± 7.4 years were questioned about their medical condition and oral health practice and examined orally. Evaluation of clinical examination was carried out by DMFT, plaque index ( 10 ) and Community Periodontal Index of Treatment Need (CPITN). Results: Of 296 participants, 106 (35.8%) were edentulous, 95 (32.1%) had one to nine teeth and 95 persons (32.1%) had 10 or more teeth. The average number of teeth in an individual was small: 6.76 ± 7.47. The average number of teeth with caries lesions was 3.59 ± 4.70, filled teeth 1.94 ± 3.63 and teeth without caries or fillings 1.19 ± 2.41. The average DMFT value was 30.75. In 69.5% of participants, dental plaque was visible with the naked eye. Of 171 subjects, in whom CPITN index was appraised, 81.9% would need oral hygiene education, 56.7% would need scaling and root planning and 21.6% would need periodontal surgical treatment. Conclusions: The results of this study indicate poor oral health of the elderly living in residential homes situated in different towns in Slovenia. It is of utmost importance to highlight the necessity of improving oral health care of this population.     

Oral status among seniors in nine nursing homes in Styria,Austria

doi:10.1111/j.1741‐2358.2009.00281.x
Oral status among seniors in nine nursing homes in Styria, Austria Objective: To investigate the oral state in participants cared for in residences for senior citizens in Styria, Austria. Materials and methods: Four hundred and nine participants in Styria from nine homes for senior citizens were examined employing parameters in accordance with those of Folstein’s Mini Mental Status (MMS), DMFT, basic periodontal examination, the modified oral hygiene index, pain experienced during the preceding year, the subjective and objective need for treatment, and also requirements involving surgical and prosthetic treatment. Furthermore, the habitual methods of maintaining oral hygiene were examined establishing by whom this was carried out – whether by the patient, the nurse, or by patient and nurse together. Results: Four hundred and nine participants were examined, 48.3% were found to have retained on average 4.9 of their own teeth while 69% were fitted with dentures; however, 81% of the participants required prosthetic treatment. 28.9% of the participants had experienced acute dental pain during the preceding year and surgical treatment was found to be necessary in 47.7% of those with original teeth. Eighty‐four per cent of the participants showed acute inflammation of the periodontium while the state of oral hygiene, measured on a scale of 0–4, reached an average of 2.43. Oral hygiene was carried out by the nurses in only 7.46% of the cases which showed an average MMS measurement of 18. Conclusion: The results compared with those reported in other recent surveys and our data show an urgent need in Austria to improve the standards in dental care for the hospitalised elderly. Regular dental checks, carried out in the actual home by a dental surgeon should be introduced, whilst the nursing staff should be made fully aware of the problems caused by insufficient oral care and receive regular support from specialised oral hygiene assistants. The results of this survey also suggest that nursing staff should be equipped with simple instruments in order to judge to the extent to which the patient is capable of carrying out oral care independently and then according to the results to supplement this with additional care.     

Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years

Objectives: (i) Initially, to devise and examine the validity of a system for determining lesion activity on root surfaces, and (ii) compare the effectiveness of two preventive programmes in controlling root caries in elderly people using the devised system. Materials and methods: (i) Four clinical variables: texture, contour, location and colour of root caries lesions were selected to evaluate lesion activity. The intraexaminer reproducibility of the scoring system was assessed on 28 elderly patients. The accuracy was assessed on 10 of these persons using an impression material (Clinpro, 3M ESPE). (ii) Of total, 215 homebound 75+ year olds were randomly assigned to one of three groups: group 1, once a month a dental hygienist brushed the teeth of the participants and applied Duraphat vanish to active root caries lesions. The participants in groups 2 and 3 received 5000 and 1450 ppm F‐toothpaste, respectively, to use twice a day. This study included an interview, a baseline examination and a final follow‐up examination after 8 months. Results: (i) Intraexaminer reproducibility of the root caries scoring system was 0.86 (Kappa). The sensitivity and specificity was 0.86 and 0.81. (ii) Data from those 189 (88%) who completed the study disclosed that there were no inter‐group differences at the baseline examination concerning relevant conditions. At the end of the study, the root caries status of participants in groups 1 and 2 had improved significantly when compared with group 3 (p < 0.02). No significant difference was observed between groups 1 and 2 (p = 0.14). Conclusion: The data suggest that the root caries scoring system is reliable. Both the intervention programmes controlled root caries development; the hygienist in eight of 10 persons, the 5000 ppm F‐toothpaste in seven of 10. In contrast, five of 10 participants who only brushed with 1450 ppm F‐toothpaste had root caries progression.