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.     

Functional tooth units and nutritional status of older people in care homes in Indonesia

Gerodontology 2012; doi: 10.1111/j.1741‐2358.2012.00673.x Functional tooth units and nutritional status of older people in care homes in Indonesia Objectives: To investigate the relationship between functional tooth units (FTUs) and nutritional status. Methods: One hundred females (mean age: 72.4 ± 8.2 years) at four private care homes in Jakarta, Indonesia were interviewed and clinically examined. The oral examination included the assessment of teeth, prosthetic status, and number of FTUs. The total number of FTUs was further divided by tooth composition: natural tooth against natural tooth (NN‐FTUs), natural tooth against denture (ND‐FTUs), and denture against denture (DD‐FTUs). Nutritional status was evaluated using the body mass index (BMI) and the Mini Nutritional Assessment (MNA). Results: The mean numbers of teeth present, NN‐FTUs, ND‐FTUs, DD‐FTUs, and total FTUs were 13.1 ± 10.4, 1.7 ± 3.0, 1.2 ± 3.3, 0.4 ± 1.2 and 3.3 ± 4.4, respectively. The mean BMI and MNA scores were 24.8 ± 5.0 and 22.6 ± 2.8, respectively. Subjects with a normal BMI had a significantly higher total number of FTUs (3.6 ± 4.6) compared with underweight subjects (0.1 ± 0.3). Subjects with a normal MNA had a significantly higher number of NN‐FTU (2.6 ± 3.7) compared to those who were at risk or in a state of under‐nutrition (1.2 ± 2.4). Conclusion: This study revealed significant relationships between the number of FTUs and nutritional status. Keeping the posterior occlusion should be emphasized in order to maintain good nutritional status in older subjects.     

Relationship between salivary haemoglobin and number of remaining teeth in older Koreans

Objective

We investigated the relationship between saliva and dental biofilm characteristics, oral hygiene behaviours and the number of remaining teeth in a sample of older Koreans.

Materials and methods

This cross‐sectional study included 133 participants, aged 65 years and older, recruited from senior welfare facilities in Incheon, South Korea. The outcome variable was the number of remaining teeth, and its associations with the independent variables of participants’ general characteristics, salivary haemoglobin level, dental biofilm acidogenicity, salivary flow rate and oral hygiene behaviours were assessed. For statistical analyses, chi‐squared test and step‐wise multiple linear regression were used.

Results

The multiple linear regression model, which included all related factors identified in the bivariate analyses, showed that older adults who had high salivary haemoglobin levels (P < .05), brushed their teeth using the horizontal scrub method (P< .001), and did not use an interproximal cleaning device (P < .01) were more likely to have fewer remaining teeth. However, dental biofilm acidogenicity was not associated with the number of remaining teeth.

Conclusion

The number of remaining teeth was associated with salivary haemoglobin level, appropriate toothbrushing technique and interdental cleaning. These findings suggest that the monitoring of salivary haemoglobin may contribute to the prevention of tooth loss caused by periodontal disease.     

Assessment of the efficacy of the utilisation of conventional and electric toothbrushes by the older adults

Objective: To evaluate the efficacy of electric and conventional toothbrushes for a group of elderly individuals. Background: Although the electric toothbrush has been recommended for elderly individuals, there had previously never been a study regarding its efficacy. Material and methods: Sixty independent elders of both genders with different oral conditions from the Center Adult Day Vitória, Espírito Santo, Brazil, were randomly divided into two groups of 30 individuals. One group received the Oral B CrossAction Power electric toothbrush, whereas the other received a conventional Bitufo Class 32 soft toothbrush to perform oral hygiene. The bacterial plaque index (O’Leary Plaque Index) and DMFT index were assessed as a measure of oral hygiene and oral health. The data were analysed using the Shapiro–Wilk, Mann–Whitney and Wilcoxon tests. Results: The results of the efficacy of the Oral B Cross Action Power electric toothbrush demonstrated that on the 7th and 15th days, the bacterial plaque indexes were 24.91 ± 12.81 and 22.11 ± 14.46, respectively, which corresponds to a 50.24% removal of bacterial plaque on the 7th and 55.83% on the 15th days. Although the electric toothbrush removed more bacterial plaque than the conventional toothbrush, the difference was not statistically significant. Conclusion: Both the conventional and the electric toothbrushes were effective in removing bacterial plaque within the elderly group. More studies are necessary to test the efficacy of electric toothbrushes in relation to conventional toothbrushes for elderly patients.     

Oral health status in a group of the elderly population residing at home

doi: 10.1111/j.1741‐2358.2011.00556.x Oral health status in a group of the elderly population residing at home Objectives: To determine the oral health status and treatment needs of subjects aged 65 years and older residing in different districts of Ankara. Materials and methods: A total of 1300 patients, 751 females and 549 males, age 65 and over with a mean age of 72.8 ± 6.34 were included in this study. The subjects were visited at home and toothbrushing habits, visiting the dentist, tooth loss, denture needs were questioned and body mass index values were recorded. Results: 52.5% of the subjects were completely edentulous, 83.3% subjects reported wearing a removable denture. Females had a higher total tooth loss frequency when compared to males (p < 0.05). Total tooth loss between 65 and 69 ages was 47.3%, and increased to 62.4% among those aged 75 and over (p < 0.05). 16.2% of the subjects had not visited a dentist in the last 10 years, and only 3% visited a dentist for control check‐ups; no gender‐based difference was observed as to the frequency of dental visits (P > 0.05). No significant relationship was found between tooth loss and BMI values (P > 0.05). 46.3% of the subjects had chewing problems. Conclusions: The subjects included in this study showed high tooth loss frequency and poor oral hygiene habits. Education regarding maintenance of oral hygiene and regular dental check up should be stressed for the elderly.     

Denture stomatitis and its risk indicators in south Brazilian older adults

doi:10.1111/j.1741‐2358.2009.00295.x
Denture stomatitis and its risk indicators in south Brazilian older adults Objective: The purpose of this study was to evaluate if socio‐demographic, behaviour and health variables are risk indicators for denture‐related stomatitis in community‐dwelling older adults from Carlos Barbosa, Brazil. Materials and methods: In this cross‐sectional study, 872 subjects aged 60 years or more were evaluated. Data collection included dental examinations and questionnaires to assess socio‐demographic, behaviour, general and oral health data. All questionnaires and examinations were carried out during 2004. Associations between the independent variables and the outcomes ‘prevalence of denture stomatitis’ or ‘prevalence of granular stomatitis’ were adjusted by means of multivariate logistic regressions. Results: Participants with denture stomatitis were significantly more likely to be females, to display increased amounts of plaque, and significantly less likely to visit the dentist for treatment. Participants with granular stomatitis were significantly more likely to be females and participants with granular stomatitis were significantly more likely to be females, aged 70 years or more and current smokers. In addition, participants with granular stomatitis displayed increased amounts of plaque. Conclusion: The data presented here confirms the central role of denture biofilm accumulation in denture stomatitis. It also indicates that smoking may increase susceptibility to infection in its most severe form.     

Compliance with dietary guidelines in grocery purchasing among older adults by chewing ability and socio‐economic status

doi: 10.1111/j.1741‐2358.2012.00631.x
Compliance with dietary guidelines in grocery purchasing among older adults by chewing ability and socio‐economic status Background: Dietary guidelines promote good nutrition through healthy eating. Chewing deficiencies may hinder food intake while lower socio‐economic status (SES) may restrict food purchasing. The aim was to examine compliance of grocery purchasing behaviour with dietary guidelines by chewing ability and SES. Methods: Adults aged 60–71 years in Adelaide, South Australia were surveyed in 2008. Dietary guideline compliance was measured using 16 grocery purchasing items. Chewing ability was based on a 5‐item Chewing Index. SES was assessed using a subjective social status rating representing where people stand in society. Results: Responses were collected from n = 444 persons (response rate = 68.8%). Among dentate persons, 10.3% were chewing deficient and 21.3% were in the lower SES group. Prevalence ratios (PR: 95%CI) controlling for SES showed chewing deficiency was related to (p < 0.05) non‐compliance with dietary guidelines in relation to bread (1.7: 1.1–2.5), juice (2.7: 1.6–4.5), tinned fruit (2.9: 1.5–5.6), yoghurt (2.1: 1.2–3.7) and tinned fish (1.5: 1.2–1.9). Conclusions: Chewing deficiency was associated with lower compliance with dietary guidelines in relation to fibre, sugar, fat and salt. Chewing deficiency may have a direct effect on diet as well as reflect a clustering of risk in relation to a range of health behaviours.     

Relationship between nutritional status and tooth loss in an older population from Sri Lanka

doi: 10.1111/j.1741‐2358.2011.00518.x Relationship between nutritional status and tooth loss in an older population from Sri Lanka Objective: To determine the relationship between tooth loss and nutritional status in older individuals in Sri Lanka. Background: In developing countries, both the prevalence of malnutrition and oral disease are high among older individuals. Materials and methods: Four hundred and eighty subjects aged 60 years and above were selected to be included in the sample, of which 437 responded giving an overall response rate of 91%. Data were collected by means of an interviewer administered questionnaire, an oral examination and a physical examination to determine height and weight to calculate the body mass index (BMI). Results: Based on the WHO cut‐offs for BMI, 62, 20 and 18% of the sample were normal, under‐ and over‐weight, respectively. A multinomial logistic regression analysis with normal weight as the reference category revealed that missing teeth and denture status were associated with being underweight but not with being overweight. Conclusion: In older individuals, tooth loss is significantly associated with being underweight.     

Relationships between Geriatric Oral Health Assessment Index scores and general physical status in community-dwelling older adults

doi: 10.1111/j.1741‐2358.2011.00597.x Relationships between Geriatric Oral Health Assessment Index scores and general physical status in community‐dwelling older adults Objective: The aim of this study was to investigate the relationships between Geriatric Oral Health Assessment Index (GOHAI) and general physical status among community‐dwelling older adults. Background: Geriatric Oral Health Assessment Index is a patient‐centred assessment of oral health for older adults. We hypothesised that GOHAI is a significant indicator of general physical status of older adults. Methods: This study included 354 adults (age, ≥65 years) living independently. Body mass index, handgrip strength and one‐leg standing time with eyes open were used to evaluate the general physical status. Spearman’s rank correlation coefficients were calculated to examine the relationships between the GOHAI scores, its three subdivided categories (physical function, psychological function and pain and discomfort) and each physical status measurement. A stepwise linear regression model was applied with each physical status measurement as the dependent variable and the GOHAI scores and its subdivisions as the principal independent variable. Results: Positive correlations were found between the GOHAI scores, its three subdivided categories and handgrip strength. The physical function category positively correlated with one‐leg standing time. The GOHAI and the pain and discomfort category scores were retained in the final models of stepwise regression for handgrip strength, and significant relationships persisted after adjustments for demographic, psychosocial, medical and dental status. Conclusion: The GOHAI scores and its pain and discomfort category score may be significant indicators of body muscle strength.     

Association between functional dental state and dietary intake of Chinese vegetarian old age home residents

Objective: To examine the association between dental functional status and dietary intakes of Chinese vegetarian old age home residents. Subjects and methods: A cross‐sectional survey was performed in a group of 76 older vegetarian Chinese women living in an old age home. Oral examination was performed by a dental surgeon. Sixty‐eight of them had a 24‐hour food record by direct observation, analysed by a Chinese food composition table. Nutritional status was measured by Body Mass Index (BMI), and the functional status by modified Barthel Index (BI). Results: Forty‐two subjects (55.3%) were edentulous; 59 subjects (77.6%) had chewing difficulties; 35 subjects (46%) had poor dental functional status defined by having five or less functional teeth unit (FTU). When compared with those older people with better dental functional status, the poor dental functional status group was more likely to have chewing difficulties, tolerate soft diet only, and be functionally dependent (BI < 15/20). Poor dental functional status was associated with lower mean daily fibre intake, but not with intakes of macronutrients and micronutrients, after adjustment by BI categories. Conclusion: Poor dental functional status is associated with impaired chewing and lower fibre intake in Chinese vegetarian old age home residents, but it is not associated with reduced intakes of macronutrients or micronutrients.     

Factors associated with missing teeth in the Brazilian elderly institutionalised population

doi:10.1111/j.1741‐2358.2012.00655.x Factors associated with missing teeth in the Brazilian elderly institutionalised population Objective: Identify factors associated with missing teeth in the elderly institutionalised population in Brazil. Methodology: Cross‐sectional study of elderly institutionalised Brazilians with 1192 subjects. A questionnaire was applied as well as an epidemiological survey of oral health conditions in accordance with WHO. Factorial analysis was carried out with variables related to missing teeth, as well as the Fisher’s exact test, chi‐squared test and multiple logistic regression. Results: Mean age was 76.3 (±9.8), 53.5% (638) of subjects were women and 717 (60.2) were dependent. Mean of Decayed Missing and Filled Teeth Index (DMFT index) was 29.4 (±4.9). The subjects that did not use upper and lower dentures were 61.5% (732) and 79.2% (944), respectively. Median number of missing teeth per person was 27.88 (±6.8) with a mean of 4 (±6.6) teeth present and 2.4 (±4.5) caries‐free teeth. Factors associated with missing teeth following multivariate analysis were: age, sex, self‐assessment of oral health, access to health services, type of institution and area of the country. Conclusions: High level of tooth loss and low level of rehabilitation demonstrate precarious oral health. It is therefore necessary to improve institutional access mechanisms to public health facilities for the institutionalised elderly.     

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.     

Relationship between oral health, nutrient intake and nutritional status in a sample of Brazilian elderly people

Objective: To evaluate the relationship between the oral health condition, the nutrient intake and the body mass index (BMI) in elderly people. Background: Impaired dentition has been associated with an inadequate consumption of key nutrients and with changes in nutritional status in elderly people. Materials and methods: The sample comprised 887 elderly people, aged 60 and over, of whom 816 underwent a clinical oral examination and were allocated into groups according to the numbers of teeth and number of posterior occluding pairs of natural teeth. Nutritional status was determined using the BMI. Dietary intake was assessed by a 24‐h diet recall interview and the data from these records were converted to nutritional intake using Diet Pro software. Differences between means were evaluated using anova , together with the Tukey test or Dunnet test, according to the normality of the data. Associations between categorical variables were tested using chi‐square analysis. Results: Ages ranged from 60 to 96 years (mean, 71.46 years), with 47% of the respondents in the 60‐to 69‐year‐old group. A high DMFT index (mean, 27.81) was observed with the missing component accounting for 88.8% of the index. Significant differences were observed between the mean intake of nutrients and the number of posterior occluding pairs of natural teeth (p < 0.05). No significant differences were found between the number of teeth and BMI. Conclusion: Nutrient intake is associated with the oral health status as defined by clinical measures.