Oral health care and aspiration pneumonia in frail older people: a systematic literature review

Objective: To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia. Background: Oral health care seems to play an important role in the prevention of aspiration pneumonia in frail older people. Methods: Pubmed, Web of Science, Cochrane Library, EMBASE and CINAHL were searched for eligible intervention studies. Only publications with regard to hospitalized or institutionalized older people, who were not dependent on mechanical ventilation were eligible. Two authors independently assessed the publications for their methodological quality. Results: Five publications were included and reviewed. Two studies showed that improvement of oral health care diminished the risk of developing aspiration pneumonia and the risk of dying from aspiration pneumonia directly. The three studies remaining showed that adequate oral health care decreased the amount of potential respiratory pathogens and suggested a reduction in the risk of aspiration pneumonia by improving the swallowing reflex and cough reflex sensitivity. Conclusions: According to the results of the current systematic literature review oral health care, consisting of tooth brushing after each meal, cleaning dentures once a day, and professional oral health care once a week, seems the best intervention to reduce the incidence of aspiration pneumonia.     

Association between clinical and subjective indicators of oral health status in an older adult population

Since the mid–1970s a number of investigators have developed measures of the extent to which oral disorders compromise functional, social and psychological well-being. They have also examined the associations between clinical indicators of oral health status and these subjective indicators. In general, these associations have been inconsistent and weak. One reason for this might be that the subjective indicators employed were rudimentary and insensitive to the health outcomes of oral disorders. The development of the Oral Health Impact Profile, a more sophisticated measure of the health outcomes of oral disorders, provided a method to examine this hypothesis. Using data from an oral health survey of older adults, we examined the associations between OHIP scores and a variety of clinical indicators of tooth loss, caries and periodontal disease. Even with this measure the associations were predominantly weak, the strongest of the correlations being 0.53. We also examined the influence of personal and sociodemographic characteristics on the relationship between tooth loss and its psychosocial outcomes. Five variables reflecting expectations and resources explained as much variance in OHIP scores as did the number of missing teeth. This analysis illustrates the essential distinction between disease and health and the way in which measures of oral health can be used to pursue fundamental issues in behavioural science and health services research.     

An oral health care guideline for institutionalised older people

Institutionalized older people are prone to oral health problems and their negative impact due to frailty, disabilities, multi-morbidity, and multiple medication use. Until recently, no evidence-based oral health care guideline for institutionalized older people has been available. For that reason, the Dutch Association of Nursing Home Physicians developed the Oral health care Guideline for Older people in Long-term care Institutions (OGOLI), meeting the requirements of the AGREE instrument for assessing a guideline's quality. This short report presents the keynotes and the content of the Oral health care Guideline. Most recommendations are based on expert opinions. Only 4 recommendations (education, pneumonia, use of an electric toothbrush, and fluoride rinsing in case of a sudden increase of oral plaque amount) are based on evidence level A2 conclusions. This emphasizes the need for further research on oral health of institutionalized older people.     

Association between circadian preference and academic achievement: A systematic review and meta-analysis

The association between circadian preference and academic achievement has been assessed through a systematic review and meta-analysis. The literature searches retrieved 1647 studies; 31 studies, with a total sample size of 27?309 participants, fulfilled the inclusion criteria and were included in the meta-analysis. With reference to all these 31 studies, before running the meta-analysis, the sign of the correlation between the investigated variables was set in a way that a positive correlation showed that eveningness was related to worse academic performance. The meta-analysis yielded a small overall effect size of 0.143 (CI [0,129; 0,156]) under a fixed effects model (Z?=?20.584, p?<?0.001, I^2?=?72.656; Q?=?109.715) and of 0.145 (CI [0.117; 0.172]) under a random effects model (Z?=?10.077, p?<?0.001). A random effects model with a grouping variable (participants) revealed 15 studies based on school pupils and 16 on university students. The random model showed a higher effect size in school pupils (0.166, CI from 0.127 to 0.206) compared to university students (0.121, CI from 0.080 to 0.163). Self-report measures of grades revealed a stronger effect size (0.171; CI: 0.137 to 0.206; N?=?20) compared to objective measures (0.093; CI: 0.047 to 0.140; N?=?19). Overall, the present results suggest that evening orientation is associated with a worse academic performance, both in school pupils and university students; for the first time, it has been shown that such relationship changes over time, being weaker in university students.     

Oral health and frailty in the medieval English cemetery of St Mary Graces

The analysis of oral pathologies is routinely a part of bioarcheological and paleopathological investigations. Oral health, while certainly interesting by itself, is also potentially informative about general or systemic health. Numerous studies within modern populations have shown associations between oral pathologies and other diseases, such as cardiovascular disease, certain types of cancer, and pulmonary infections. This article addresses the question of how oral health was associated with general health in past populations by examining the relationship between two oral pathologies (periodontal disease and dental caries) and the risk of mortality in a cemetery sample from medieval England. The effects of periodontitis and dental caries on risk of death were assessed using a sample of 190 individuals from the St Mary Graces cemetery, London, dating to ～AD 1350–1538. The results suggest that the oral pathologies are associated with elevated risks of mortality in the St Mary Graces cemetery such that individuals with periodontitis and dental caries were more likely to die than their peers without such pathologies. The results shown here suggest that these oral pathologies can be used as informative indicators of general health in past populations. Am J Phys Anthropol, 2010. © 2009 Wiley‐Liss, Inc.     

Association between genetically determined telomere length and health-related outcomes: A systematic review and meta-analysis of Mendelian randomization studies

Emerging evidence has shown that leukocyte telomere length (LTL) is associated with various health-related outcomes, while the causality of these associations remains unclear. We performed a systematic review and meta-analysis of current evidence from Mendelian randomization (MR) studies on the association between LTL and health-related outcomes. We searched PubMed, Embase, and Web of Science up to April 2022 to identify eligible MR studies. We graded the evidence level of each MR association based on the results of the main analysis and four sensitive MR methods, MR-Egger, weighted median, MR-PRESSO, and multivariate MR. Meta-analyses of published MR studies were also performed. A total of 62 studies with 310 outcomes and 396 MR associations were included. Robust evidence level was observed for the association between longer LTL and increased risk of 24 neoplasms (the strongest magnitude for osteosarcoma, GBM, glioma, thyroid cancer, and non-GBM glioma), six genitourinary and digestive system outcomes of excessive or abnormal growth, hypertension, metabolic syndrome, multiple sclerosis, and clonal hematopoiesis of indeterminate potential. Robust inverse association was observed for coronary heart disease, chronic kidney disease, rheumatoid arthritis, juvenile idiopathic arthritis, idiopathic pulmonary fibrosis, and facial aging. Meta-analyses of MR studies suggested that genetically determined LTL was associated with 12 neoplasms and 9 nonneoplasm outcomes. Evidence from published MR studies supports that LTL plays a causal role in various neoplastic and nonneoplastic diseases. Further research is required to elucidate the underlying mechanisms and to bring insight into the potential prediction, prevention, and therapeutic applications of telomere length.     

Association between oral health, cognitive impairment and oral health-related quality of life

doi: 10.1111/j.1741‐2358.2011.00542.x
Association between oral health, cognitive impairment and oral health–related quality of life Objective: Investigating oral health–related quality of life’s (OH‐QoL) relationship with cognitive state. Background: Oral health affects OH‐QoL and is poor in institutionalised and cognitively impaired people. Material and Methods: This was a cross‐sectional study involving 215 institutionalised elderly (82.9 mean age), who were interviewed, examined and cognitively screened using the Pfeiffer test. Results: Mean GOHAI score was 53.1; only 43.7% of the participants reported having a good OH‐QoL. Needing help with dressing or washing (OR 2.14; p = 0.004), having one to nine teeth (OR 4.65; p ≥ 0.001), eight or less occluding pairs (OR 2.74; p = 0.002), one to three caries (OR 1.85; p = 0.005) and being cognitive impaired (OR 0.54; p = 0.034) were significantly associated with altered OH‐QoL in bi‐variate analysis. Being edentulous (OR 3.18; p = 0.0046), having 1–9 teeth (OR 2.62; p = 0.056) and presenting mild cognitive impairment (MCI) (OR 0.32; p = 0.016) appeared as predictive variables in logistic regression for having an altered OH‐QoL. Conclusions: Participants having MCI had significantly better GOHAI score than cognitively normal residents. Performing cognitive screening parallel to applying any OH‐QoL instrument would make the results more reliable and would benefit cognitively impaired people.