Translation and validation of the Hindi version of the Geriatric Oral Health Assessment Index

doi: 10.1111/j.1741‐2358.2011.00609.x Translation and validation of the Hindi version of the Geriatric Oral Health Assessment Index Purpose: To translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into Hindi and assess its validity and reliability for use among people in India. Materials and Method: After translation into Hindi, a total of 385 participants aged 55+ demonstrated acceptable validity and reliability when used for people in India. Individual GOHAI items were recorded and summed as originally recommended. The questionnaire sought information about socio‐demographic characteristics and self‐reported perception of general and oral health. Clinical examination included assessment of periodontal status and number of decayed teeth, missing teeth, filled teeth and crowned teeth. Result: Mean GOHAI score was 40.9 (SD, 10.6; range, 12–60). Cronbach’s alpha for the GOHAI score was 0.88, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test–retest correlation coefficient for add‐GOHAI scores was 0.72, indicating good stability. Add‐GOHAI scores increased with poorer perceived general and oral health. Convergent validity, construct validity and discriminant validity of the GOHAI were demonstrated. Conclusion: It could therefore be used as a valuable instrument for measuring oral health–related quality of life for people in this region.     

Geriatric dental education and training in the United States: 1995 White Paper findings

“As the 21st century quickly approaches with an expansive geriatric population growth, are we adequately preparing health professionals to address patient needs? Will there be a shortage of competent clinicians and proficient faculty? Is there a proposed agenda to improve educational outcomes, clinical expertise, and oral health status of older adults? These and related concerns have prompted a focused geriatric education project within the United States. The Bureau of Health Professions (BHPr) of the Health Resources and Services Administration has provided the impetus and leadership through the Geriatric Education Futures Project. Dentistry is one of eleven disciplines invited to participate in this important effort which also includes medicine, nursing, social work, public health, allied and associated health, managed care, long-term care, case management, interdisciplinary education, and ethnogeriatrics. The first two phases of this project were: 1) writing White Papers which give “a critical review of the state of the art of geriatric education, project a future response to societal need and provide policy recommendations to achieve the preferred future;” and 2) sponsoring an invitational National Forum on Geriatric Education and Training in the spring of 1995 to present, discuss, and accept the White Paper findings, as well as enlisting broader participation and support from appropriate educational institutions, professional organizations (including the American Society for Geriatric Dentistry and the American Dental Association), government agencies, foundations, consumer organisations, etc. The third phase is ongoing and includes the development of national innovative educational collaboratives, dissemination of the White Papers and related documents, and continued “catalytic activities directed toward the implementation of a national agenda for action in geriatric education.” The complete text of all discipline-specific White Papers can be found in A National Agenda for Geriatric Education, Volume 1: White Papers¹. In an effort to more extensively disseminate the findings from the Dentistry White Paper, Gerodontology is reprinting the first two-thirds of the Dentistry White Paper which includes the state of the art in geriatric dental education and future vision needed to meet the needs of older adults, as well as summary identification of the 19 dental policy recommendations (See Table 3). Special Care in Dentistry² has recently published the complete text of these specific recommendations including the rationale, action required, responsible agents, and expected outcomes. Although some information contained in this White Paper may be specific only to the United States, it is also apparent that much of its content has relevance to gerodontology efforts in industrialised countries throughout the world.”–Bernice A. Parlak and Susan M. Klein (see endnote)     

Estimates of time and propensity for dental treatment among institutionalised elders

The oral health and concerns of elderly residents were surveyed in a stratified random selection of 41 long-term care facilities in Vancouver. The residents who could participate were examined and interviewed to determine their oral health and concerns about dental treatment. The need and time required for treatment were estimated in six groups to reflect the propensity for treatment in dentate and edentate subjects. The propensity for treatment was high in about one-third of the participants whereas it was unlikely that one-tenth of those examined would ever use a dental service. In general, there was a widespread need for a diagnostic service because so few had been examined by a dentist in the previous year. Prosthodontics accounted for most of the treatment in all of the propensity groups, with substantially more time required by the dentate residents. There was also a substantial need for management of mucosal pathoses and oral hygiene and, to a lesser extent, for dental restorations and endodontics. Overall, our estimates indicate a substantial need for dental treatment among residents of long-term care facilities, although the need is reduced by half if the propensity for treatment is considered.     

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.     

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.     

Oral hygiene and the need for treatment of the dependent institutionalised elderly

Objective: To assessing the oral hygiene and treatment needs of a geriatric institution in southern France. Background: For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments. Materials and methods: From 2003 to 2004, a cross‐sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated. Results: The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment. Conclusion: The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly.     

Geriatric dentistry in Brazilian universities

The World Health Organization has predicted an increase in the population of elderly people. Objective: The purpose of this study was to investigate the teaching of geriatric dentistry in Brazilian universities. Materials and methods: This study consisted of questionaires regarding the training in geriatric dentistry in 104 dental schools included in the National Institute of Education Research (INEP) in 2001. In order to calculate the sample (a random stratified one), the confidence interval was set at 99% and a maximum permitted error of 3% was adopted. Pearson's chi‐square test was used in the inferential analysis. Results: From the 64 dental courses which were studied, only 25 included geriatric dentistry in the curriculum. From 1857 students who were involved in the study, 41% sought knowledge outside the dental school and 98% considered that it was important that this subject should be included in the curriculum. There was statistical significance between geriatric dentistry teaching and the students’ preference as well as the prospect of working with this group of the population. Geriatric dentistry as an individual subject was absent from the curriculum in two‐thirds of the dental courses investigated. Knowledge was often transmitted as part of dental prosthetics and most of the students stated that they would want to be able to treat elderly people. It was relevant to note that senior students expected to work in this field. Conclusion: Dental students in Brazil do not have adequate training in geriatric dentistry.     

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.     

Geriatric dentistry: a new specialty in Brazil

Objective: To present the current status of geriatric dentistry in Brazil. Background: In 2001, the Brazilian Dental Council established a new specialty: geriatric dentistry. This decision was based on the increase in both the elderly population and the demand for dental treatment of this cohort. Materials and methods: Data were obtained through online searches of the Brazilian Dental Council and the Brazilian Institute of Geography and Statistics. Results: Brazil has 170 dental schools offering around 14 000 undergraduate vacancies every year. At the postgraduate level, there are 19 recognised dental specialties, one of which is geriatric dentistry, comprising 18 certificate programmes, with the potential to produce 216 new specialists every 18 months. The dentist/habitant ratio was 1:870, higher than that recommended by the Word Health Organization. The Brazilian population consists of around 14.5 million elderly people (8.6%). There were 124 specialists in geriatric dentistry distributed irregularly throughout the country. The specialist/elderly population rate was 1:117 249. At the undergraduate level, this new specialty is not included in the curricula of most dental schools in Brazil. Conclusions: Geriatric dentistry should be included in the undergraduate curricula of dental schools in Brazil. Postgraduate degree courses should be developed to produce more clinical academics and researchers in this field.     

A scoping review and research synthesis on financing and regulating oral care in long-term care facilities

doi: 10.1111/j.1741‐2358.2011.00575.x A scoping review and research synthesis on financing and regulating oral care in long‐term care facilities Background: Oral health care for frail elders is grossly inadequate almost everywhere, and our knowledge of regulating and financing oral care in this context is unclear. Objective: This scoping study examined and summarised the published literature available and the gaps in knowledge about regulating and financing oral care in long‐term care (LTC) facilities. Methods: We limited the electronic search to reports on regulating and financing oral care, including reports, commentaries, reviews and policy statements on financing and regulating oral health‐related services. Results: The broad electronic search identified 1168 citations, which produced 42 references, including 26 pieces of grey literature for a total of 68 papers. Specific information was found on public and private funding of care and on difficulties regulating care because of professional segregation, difficulties assessing need for care, uncertainty on appropriateness of treatments and issues around scope of professional practice. A wide range of information along with 19 implications and 18 specific gaps in knowledge emerged relevant to financing and regulating oral healthcare services in LTC facilities. Conclusions: Effort has been given to enhancing oral care for frail elders, but there is little agreement on how the care should be regulated or financed within the LTC sector.     

Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders

doi: 10.1111/j.1741‐2358.2010.00402.x Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders Background: Most research on older people’s oral health has been quantitative. A need for more in‐depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. Objective: To explore experiences and perceptions of oral health and oral health care among an ethnically‐mixed sample of older New Zealanders. Methods: In‐depth interviews were conducted with 24 older people in two communities in New Zealand’s South Island. Thematic analysis of transcribed data was undertaken. Results: Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. Conclusions: We identified a number of shared experiences which affect older people’s ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received.     

Geriatric dentistry in the next millennium: opportunities for leadership in oral health

"The twentieth century will be remembered chiefly, not as an age of political conflicts and technical inventions, but as an age in which human society dared to think of the health of the whole human race as a practical objective." Arnold Toynbee, British historian. Individuals throughout the world often view the passage of a new year as a time for re-evaluation of personal and/or professionals goals. The new millennium offers the dental profession a chance to view the future and observe the challenges and opportunities facing it. Professor Toynbee's observation is particularly poignant when one considers the improvements in oral health made in the last 100 years. Caries, once considered a ubiquitous oral disease, has been prevented in some children in developed countries. Research on periodontal disease continues to identify risk factors and the pathobiological mechanisms underlying the disease. Concurrently the population of the world is aging presenting new opportunities for improving oral health. In this paper the data on aging, chronic diseases and oral health is largely from the US but reflects to varying degrees other industrial countries. By integrating these demographic, epidemiologic and biologic data, one can paint a portrait of the future dental patient and their oral health needs. From this portrait, dental professionals can identify leadership opportunities to improve the oral health of an aging world population.     

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.