The relationship between seven health practices and oral health status in community‐dwelling elderly Thai

Gerodontology 2012; doi: 10.1111/j.1741‐2358.2012.00672.x The relationship between seven health practices and oral health status in community‐dwelling elderly Thai Objective: This study aims to analyse the relationship between seven health practices, oral health behaviors, and oral health status in community dwelling elderly Thai. Materials and methods: The subjects were 612 elderly people (mean age = 68.8 ± 5.9 years). Questionnaires survey about sociodemographics, self‐reported seven health practices and oral health behaviors were conducted by trained interviewers. Oral examinations investigated the number of teeth present, decayed teeth, periodontal status and functional tooth units (FTUs). Oral malodor was assessed by Organoleptic Test, and unstimulated saliva was collected for 5 min. Results: Five health practices (smoking, drinking, physical activity, breakfast and weight maintenance) were significantly related with oral health behaviors. ancova analysis demonstrated the following significant associations: (i) smoking behavior with number of teeth present, number of FTUs, decayed teeth, periodontal disease, oral malodor and salivary flow rate, (ii) drinking alcohol behavior with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (iii) eating breakfast behavior with periodontal disease, oral malodor and salivary flow rate, (iv) eating between‐meal snack with number of teeth present, number of FTUs, decayed teeth and periodontal disease, (v) maintaining weight with number of teeth present, number of FTUs, periodontal disease and oral malodor, (vi) sleeping with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (vii) physical activity with periodontal disease and salivary flow rate. Conclusion: Good health practices were related with good oral health behaviors. Moreover, general health practices were associated with the clinical oral health status such as number of teeth present, decayed teeth, FTUs, periodontal disease, oral malodor and salivary flow rate. The elderly with good general health practices were considered to have good oral health status. Improving general health habits are suggested to lead to better oral health for the elderly, and vice versa.     

Assessing changes in oral health‐related quality of life and its factors in community‐dwelling older Brazilians

doi: 10.1111/j.1741‐2358.2012.00656.x Assessing changes in oral health‐related quality of life and its factors in community‐dwelling older Brazilians Objective: To describe changes in oral health‐related quality of life and to evaluate the associations of these changes in community‐dwelling older people. Materials and methods: In this longitudinal study a representative sample of 872 older people, living in Brazil, was evaluated during 2004. The follow‐up was carried out during 2008, with 587 older persons evaluated. A questionnaire assessing socio‐demographic information, health history, oral health‐impact profile and number of natural teeth was used. Changes in oral health‐related quality of life were categorized as improvement or deterioration. Data analysis was performed using a hierarchical approach based in a conceptual framework. A hierarchal approach was carried out using Poisson regressions. Results: Older persons living in rural areas, those who reported brushing once a day or less and older persons with fewer natural teeth had an increased chance of reporting deterioration in oral health‐related quality of life. Women and participants who received a minimum wage of less than US$219.50 were more likely to report improvement in oral health‐related quality of life. Conclusion: The results of this study suggest that changes in the oral health‐related quality of life are influenced by many of the variables that were included in the conceptual framework.     

The importance of oral health to older people's quality of life

Objectives This study was designed to determine whether older people perceive oral health as being important to Quality of Life (QoL) and if so, to identify the most important ways in which their lives are affected. In addition, to identify if subgroups of older people perceive its importance differently. Design: Nationwide qualitative face to face interviews with older people were carried out utilising the Office for National Statistics Omnibus survey in Great Britain. Subjects and methods 454 adults aged 65 or older took part in this study, part of a random probability sample of adults in the UK. Setting Respondents were interviewed in their homes. Results 72% (313) perceived their oral health status as important to their QoL through a variety of physical, social and psychological ways. Most frequently its impact on function: eating (29%, 126) and symptoms: comfort (14%, 59) were considered most important. Gender and social class variations were apparent (P<0.05). Conclusion Older people perceive oral health as being important to life quality in a variety of different ways. There are significant social class and gender variations which must be taken into consideration when assessing oral health needs of older people.     

Relationships between higher‐level functional capacity and dental health behaviors in community‐dwelling older adults

doi: 10.1111/j.1741‐2358.2012.00654.x Relationships between higher‐level functional capacity and dental health behaviors in community‐dwelling older adults Objective: The aim of the present study was to elucidate relationships between higher‐level functional capacity and dental health behaviours in community‐dwelling older adults. Background: In ageing society, it is necessary to promote oral health in the elderly, because good oral health is a significant contributing factor to good general health. Higher‐level functional capacity has been considered a crucial factor for successful independent living in the elderly. We hypothesised that functional capacity is a significant indicator of dental health behaviours. Methods: Three hundred and thirty‐eight adults aged 65 years or older were enrolled in this study. Higher‐level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG‐index). Univariate and multivariate models were constructed with dental health behaviours, such as regular visits to a dentist, brushing frequency and use of extra cleaning devices, as the dependent variable, and the total TMIG‐index score and its subcategory scores as the principal independent variable. Results: Univariate logistic regression analysis demonstrated a significant correlation between low TMIG‐index and ‘intellectual activity’ subcategory scores to lack of regular visits to a dentist and not using extra cleaning devices. Using a multivariate model, significant relationships remained after adjusting for a number of variables including demographics, medical status, lifestyle and number of remaining teeth. Conclusion: Intellectual activity of higher‐level functional capacity may be an accurate indicator of dental health behaviours in community‐dwelling older adults. Intellectual activity should be taken into consideration to effectively promote oral health behaviours and oral hygiene in elderly persons living independently.     

Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care

doi: 10.1111/j.1741‐2358.2009.00274.x
Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care Background: Older people represent a growing and diverse section of the population. As age increases, people are more likely to experience health and mobility problems and be at higher risk of developing oral disease. Nevertheless, few older people utilise primary oral healthcare services. It is therefore important to understand the value older people place on oral health and dental services to inform providers and planners of oral health care. This research was conducted as part of a study to identify potential ways of minimising barriers to oral health care in older people. Objectives: To explore perceptions of oral health and oral healthcare services amongst older people living in a socially deprived inner city area and how these are related to service utilisation. Methods: A qualitative approach was utilised to explore the range of issues related to older people’s perceptions of oral health and their views on health care. This involved a combination of focus groups and semi‐structured individual interviews with older people and their carers. Data analysis was conducted using the Framework approach. Results:

• ? Response: Thirty‐nine older people and/or their carers participated in focus groups.
• ? Oral health perception: Oral health was associated with the presence of natural teeth, the absence of pain, practical/social functioning, preferably supported by positive assessment by a dentist.
• ? Oral health life‐course: Older people have a long and complex dental history. Past negative experiences with oral health care, especially in childhood, strongly influenced present attitudes towards dentistry and dental personnel.
• ? Citizenship and right to health care: There was a strong perception that, as ‘British citizens’, older people should have a right to free health care and that the National Health Service (NHS) should support them in this phase of their life.

Conclusions: The oral health life‐course of older people is an important influence on their perceptions of oral health and dental attendance. They consider oral health of importance and place great emphasis on their citizenship and rights of access to state funded oral health care. This raises important issues for the funding and delivery of NHS oral health care for older people.     

Oral health‐related quality of life of older people from three South American cities

Objective: To describe subjective oral health status and its association with overall health conditions and socioeconomic factors in the elderly (60 years and older) living in the capital cities with the oldest average populations in South America. Background: Oral diseases are a public health problem, frequently neglected in older adults. In recent years, the subjective assessment of psychological and social consequences of the problems related to oral health has been valued. One of the instruments used to estimate the Oral Health‐Quality of Life is the Geriatric Oral Health Assessment (GOHAI). Material and methods: Representative samples from SABE study (1999–2000) of Santiago (n = 1301), Buenos Aires (n = 1043), and Montevideo (n = 1450) aged 60 and over community‐dwelling people. We assessed OH‐QoL (GOHAI), self‐reported missing teeth, denture use, and self‐rated‐health, among other indicators. Logistic regression models(GOHAI < 58) for each city, adjusted by sex and age, were applied. Results: GOHAI average scores were higher in Montevideo (54.8 ± 6.1) than in Buenos Aires (53.1 ± 7.4) and Santiago (49.9 ± 8.6). A pronounced gradient of the oral condition and GOHAI scores were observed within the three‐cities. Denture use ‐less prevalent in Santiago and more common among women‐ is a protective factor against a poor OH‐QoL. Conclusion: Socioeconomic inequalities in oral health status and OH‐QoL are observed in the three cities. The increasing life expectancy emphasizes the need to integrate prevention and treatment efforts, as a way to improve OH‐QoL over the course of a lifetime.     

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.     

The potential benefits of dental implants on the oral health quality of life of people with Parkinson’s disease

Objective: To investigate how dental implants impact on the oral health quality of life of people with Parkinson’s disease (PD). Background: PD is a progressive neurological disorder that can result in a number of oral health care challenges, including denture difficulties. Lack of evidence related to use of implants in PD prompted this study to investigate their use in this group of people. Materials and methods: Nine people with PD were provided with either fixed or removable prostheses using Astra‐Tech implants. Participants completed the socio‐dental questionnaire, ‘The Dental Impact on Daily Living Assessment’ (DIDL) prior to implant surgery, and at 3 and 12 months after provision of the final prosthesis. DIDL comprises two components – the Oral Health Quality of Life Inventory (OH‐QoL) and the Self‐Reported Assessment of Oral Health and Functional Status (SROH). Results: Nine people (with an age range of 54–77 years) had implants placed. The implant success rate was 85 and 81% in the maxilla and mandible, respectively. The OH‐QoL and SROH results (analysed using the one‐way analysis of variance and pairwise multiple comparisons) demonstrated a significant improvement in the domains of eating and satisfaction with the prosthesis after 3 months, which was maintained at the twelve month review. The OH‐QoL indicated a gradual improvement in oral well‐being over the 12‐month period. Conclusion: The oral health quality of life of people with PD was improved by the use of dental implants, indicating this as a viable treatment option.