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.     

The masticatory handicap of wearing removable dentures in elderly men

Objective: This study aimed at describing the masticatory handicap of wearing removable dentures measured by some masticatory tests and the intake of hard and soft foods. Materials and methods: The subjects were participants in a comprehensive health examination of 67–68‐year‐old men living in Malmö, Sweden. Four hundred eighty‐three men took part in a clinical oral examination which recorded the number of teeth and removable dentures. One hundred and one had complete dentures in both jaws and 131 had removable partial dentures in different combinations. Masticatory tests used almonds to record the number of stokes to the first swallow, and two‐coloured chewing gums for recording bolus kneading and shaping. A nutritionist paid a home visit to assess dietary habits including the consumption of hard and soft foods. The data could be split into groups of different tooth and denture situations which were large enough to enable statistical analysis to be carried out. The results of a regression analysis of the group with different numbers of natural teeth (NT) and no removable dentures could be used as a reference for correlation with the masticatory capacity of removable denture wearers. Results: Number of strokes to the first swallow revealed no masticatory limitations of wearing removable dentures, while chewing gum colour‐mixing and shaping revealed more differentiated impairments equivalent to the function of five to 16 teeth in a remaining natural dentition. Hard food intake for the removable denture groups was comparable to 17–19 NT. Soft food intake was not influenced by denture wearing. In a ranking of oral conditions, those with more than 24 NT had the highest test values for all tests, and those with complete sets of dentures the lowest except for the number of strokes to the first swallow of an almond. Conclusion: Removable denture wearing can be regarded as a handicap when measured with objective masticatory tests using chewing gum and the intake of hard foods. The number of chewing strokes to the first swallow of an almond and the intake of soft foods is not affected by the wearing of removable dentures.     

The impact of oral health on stated ability to eat certain foods; findings from the National Diet and Nutrition Survey of Older People in Great Britain

Objectives. To assess how the dental status of older people's mouths affected their stated ability to eat common foods. Design. Cross sectional study. Subjects. Survey was part of the oral health component of the nationwide British National Diet and Nutrition Survey: people aged 65 years and older. Two separate representative samples aged 65 and over: a free-living and an institutional sample. 881 free-living and 275 institution subjects had a dental exam and were interviewed about ability to eat key foods. Results. Significant percentages of free-living people had difficulty or could not eat at least 4 of 16 foods, and about 1 in 5 dentate stated they had difficulty eating or could not eat raw carrots, apples, well-done steak or nuts. More of the edentate subjects stated that they had difficulty eating than the dentate. Perceived chewing ability increased with increasing numbers of natural teeth and pairs of opposing posterior teeth. Subjects reporting a sociodental impact were more likely to consider that they were unable to eat foods that required more chewing. Associations remained valid after correction for the effects of age, sex, social class and denture wearing status and region. Perceived dryness did not affect significantly the stated ease of eating most foods. There were more dietary restrictions reported by the institution sample. Some foods, such as nuts, apples and raw carrots could not be eaten easily by over half of edentate people in the institution sample. Conclusions. The stated selection of foods are substantially affected by numbers of teeth and occluding pairs of posterior teeth and presence of full dentures in significant percentages of older people.     

Masticatory performance in 80-year-old individuals

Objective: To evaluate the masticatory performance of elderly people at the age of 80 years. Subjects: A total of 283 individuals of 80 years of age took part in a general and dental health survey. Main outcome measures: A dental examination including the number of remaining teeth, occlusion, prostheses, bite force recording, and a questionnaire regarding masticatory performance were recorded. Setting: Five municipalities (Okazaki city, Tokoname city, Tahara town, Atsumi town and Minami‐chita town) in Aichi prefecture, Japan. Results: There were 20 or more teeth in 7.4% subjects, and 44.5% were edentulous. Subjects with no occlusion accounted for 77.4% of the total. Subjects with prostheses accounted for 90.8%. Maximum bite force and masticatory ability score for patients with 20 or more teeth or not wearing prostheses were higher than other groups. The non‐wearing prostheses group had a low masticatory ability score. Conclusion: Most of the 80‐year‐old individuals recovered their masticatory ability with the assistance of prostheses. Several individuals with 20 or more remaining teeth or without removable dentures present in both jaws had a high score for bite forces and masticatory abilities.     

Masticatory ability in 80-year-old subjects and its relation to intake of energy,nutrients and food items

Objective: The aim of the present study was to analyse the relationship between masticatory ability (self‐assessed masticatory ability and bite force) and intake of energy, nutrients and food items in a population sample of elderly subjects. Design and Subjects: From a population sample of 80‐year‐old people, 160 individuals (74 men and 86 women) took part in an odontological study. Main Outcome Measures: A dental examination including bite force recording, a questionnaire focusing on self‐assessed masticatory ability, and a dietary interview. Setting: Department of Geriatric Medicine, Göteborg University, Sweden. Results: The dental status among the participants varied much (from edentulous in both jaws ‐ 22% ‐ to more than 20 natural teeth ‐ 30%). The mean maximum bite force was higher in men (165 N) than in women (105 N). Bite force was significantly correlated to the Eichner index and to the number of teeth. One third of the subjects reported no masticatory problem, whereas 18% identified 3 such problems. The intake of energy and nutrients varied much but the means were well above recommended values. The correlations between dental status and bite force on one side and dietary intake on the other side were in general weak and most often statistically non‐significant. Impaired general health and reduced dentition were both associated with more masticatory problems. Conclusion: The examined sample of 80‐year‐old subjects had a great variation in dental status, bite force and self‐assessed masticatory ability, but these factors had only a minor influence on dietary selection and intake, which on average were well above recommended values.     

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.     

Salutogenic factors that may enhance lifelong oral health in an elderly Japanese population

Objectives: The objective of this study was to assess which factors affected the maintenance of more than 20 teeth in Japanese patients aged 80 years and older, using a life‐course perspective. Subjects and methods: The oral examination was carried out by dentists. The questionnaire asked about family background, background during various stages of growing up, tooth brushing, snacking, job history, health examination, war experience, number of children, oral health condition and dietary preferences. Some of the questions asked about conditions when they were a primary school student, 20 years old, 40 years old and 60 years old. Multivariable logistic‐regression analysis was used to adjust for sex at significant life stages. Results: The group with mothers who did not prefer sweet food had an approximately four times greater chance of having ≥20 teeth compared with the group with mothers who preferred sweet food. Those participants who did not prefer sweet food themselves were approximately three to five times more likely to be in the ≥20 tooth group compared with those who preferred sweet food at all stages of their life course. Non‐smokers and those who quit smoking were three times more likely to be in the ≥20 tooth group than those who smoked throughout the years from 20 to 60 years of age. Conclusions: Factors associated with the maintenance of a sufficient number of functioning teeth were: not having a mother with a preference for sweet food, not having a preference for sweet food themselves and not smoking over a long period.     

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.     

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.     

Food choices and eating difficulty among elderly edentate patients in Greece

Aims: To evaluate food choice and eating difficulty experienced by older Greek edentate patients. Subjects: Three samples of patients seeking provision of replacement dentures were studied. A primary study of urban mainland U1 (n=54) and island rural R1 samples (n=84) was followed by a mainland urban U2 sample (n=119) in the Secondary study. Setting: Greek dental clinics. Intervention: Semi‐structured interviews (SSI) were employed, using both open and closed questions. Design: The primary study used SSI to identify eating difficulty experienced by two culturally different Greek groups. The secondary study established patterns of difficulty for comparisons between an urban Greek population and northern European urban studies. Main Outcome Measures: The prevalence of eating difficulty, the degree of difficulty eating specified foods and the exclusion of foods because difficult. Results: Most patients expressed difficulty eating at least one type of food, a high percentage of these patients were willing to eat foods found difficult, while others use particular methods of food preparation that make food easier to eat. Chicken illustrated the importance of specifying the method of cooking when questioning eating difficulties. Roast meats provided insight into the more difficult end of the food range. Raw vegetables were rated difficult. Apples and oranges were also food of particular interest. Conclusions: The semi‐structured interview method provides a succesful method to identify eating difficulty and food choices by older Greek complete denture wearers. Differences, probably largely cultural, were identified between Greek island rural and mainland urban communities. Greek food choices differed favourably from an English sample, strikingly in that Greek patients report continuing to eat difficult foods despite difficulty eating them. This may be relevant to health data on Greek populations that show better mortality statistics despite adverse factors such as high prevalence of smoking.     

Masticatory muscular activation in elderly individuals during chewing

Background: Old‐age is the last stage of human evolution and, unfortunately, the ageing of the oral cavity and masticatory system seems accelerated. As a consequence, there is a reduction in the amount of food ingested, which can lead to an imbalance in nutrition. Objective: The purpose of this study was to investigate the levels of muscular activation of elderly individuals, during chewing, and to compare with young individuals. Materials and Methods: An electromyographical analysis of the masticatory system in 10 individuals aged between 60 and 75 years (elderly group) and a similar number between 23–30 years old (young group ‐ control) was carried out. The analysis was performed using a MyoSystem‐Br1 electromyographer with differential active electrodes. The test was recorded during functional conditions, and the muscles assessed were the temporalis and masseter. Data were normalised by maximum voluntary contraction (MVC), and the results were analysed using an independent t‐test for comparison between the groups. Results: The normalised electromyographic data obtained showed significant differences in both groups. Comparing the normalised values obtained for MVC, the mean values for the masseter and temporalis muscles of elderly group were statistically lower (p ≤ 0.05) than control group for harder foods, but there were no significant differences for food with the lowest consistency. Conclusion: It can be concluded that elderly individuals show slight hypoactivity of their masticatory musculature during chewing when compared to young individuals.     

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.     

Food choice by older people: the use of semi-structured interviews with open and closed questions

Objective: To evaluate difficulty chewing, consequent food choice and impacts using both open and closed questions within a semi‐structured interview format. Design: A cross‐sectional study using a semi‐structured interview (SSI) with open and closed questions Setting: Independently living people in South‐West London interviewed in their own homes Subjects: A group of 54, edentate people (mean age 82, R= 60‐93 years) were studied. Results: Most subjects (69%) expressed difficulty eating at least one type of food, half were unwilling to eat the foods they found difficult, others were conscious of cooking longer or cutting smaller in order to manage these foods, although no one accepted that they overcooked food. There were dramatic differences in the number of subjects expressing difficulty to chew various foods when responding to open and closed questions. Roast beef proved a good discriminator in this group of predominantly English subjects. The importance of the questioning process was also shown by the discrepancy of responses between variously prepared apples and the inability of any subjects to bite an unpeeled apple. Conclusions: For sensitive appraisal of food choice it is obviously essential to assess relevant foods, for the culture of the group being studied. Open questions provide a way of exploring which are the appropriate foods and food preparation as criteria to assess perceived chewing ability and treatment benefit. The semi‐structured interview method is particularly valuable for the study of older people. Closed questions provide different information which is also necessary to secure recall by older people.     

Aging and food source effects on mandibular stylets teeth wear of phytophagous stink bug (Heteroptera: Pentatomidae)

Studies were conducted to test the effect of age and food sources on wear of the mandibular teeth of the phytophagous pentatomid, Euschistus heros (F.). The total length (μm) of the area bearing the mandibular teeth, the length of the 1st tooth, and the height of the 2nd tooth for teneral (< 1 day-old) adults were significantly greater than that of adults fed on natural [green bean, Phaseolus vulgaris pods, raw shelled peanuts, Arachis hypogaea, and mature soybean, Glycine max seeds] for 30 or 60 days. Adults fed on artificial dry diet showed, in general, similar results to those of teneral adults. Force (Newtons) required penetrating the natural foods was significantly greater than that required penetrating the artificial diet. The greater hardness of the natural foods caused increased mandibular serration wear.     

Jaw muscles in older overdenture patients

Objective: To determine, using computer tomography (CT), whether the retention of a small number of teeth in the older adult used to support overdentures could affect the cross‐sectional area (CSA) and X‐ray density of two jaw closing muscles. Design: Cross‐sectional study of a group of older patients subdivided into dentate, edentulous and those wearing overdentures supported by two to five teeth. Subjects: The sample consisted of 24 subjects aged 55–68 years. Outcome measures: CSA and X‐ray density of two jaw closing muscles, masseter and medial pterygoid were measured and evaluated using CT. Results: There were no significant differences between left and right jaw muscles, but the CSA of the masseter muscles were significantly larger than the medial pterygoid muscles. The CSA of the masseter and medial pterygoid muscles was significantly smaller in edentulous subjects compared with dentate subjects but no significant difference was observed between subjects wearing overdentures and those with a natural dentition. No significant differences were observed with the X‐ray density between different muscles or dental states. Conclusion: The retention of a small number of teeth in the older adult used to support overdentures appears to sustain the CSA of two jaw closing muscles and therefore could enhance these patients’ masticatory ability compared with those who were edentulous.     

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.     

Differences in the desire to eat in children and adults in the presence of an obese eater

Previous research has shown that the desire to eat foods decreases in adults in the presence of an obese eater compared to a normal-weight eater. This study investigated whether or not this decrease in eating desire was observed in younger children in the same way as in adults. Children aged 5 and 8 years old, as well as adults, were presented with photographs of liked and disliked foods presented either alone or with normal-weight and obese eaters expressing three different emotions--pleasure, disgust, and neutrality--toward these food products. The results showed that the eater's weight status had a greater effect on the adults' desire to eat than on that of the children. Adults were influenced by the eater's weight status, regardless of the facial expression or the food category. Compared to adults, the impact of the eater's weight status on the children's desire to eat depended on the emotional facial expression and the children's food preferences. Thus, when children did not like the foods, their eating desire was negatively influenced by the eater's obese status, as was that of adults. On the other hand, when children liked the food products, the eater's weight status had no effect on their eating desire. They were more influenced by the eater's facial expressions. Thus, an expression of pleasure increased the desire to eat the liked foods in the younger children, whereas an expression of disgust decreased it. These results are discussed in terms of the high sensitivity of young children to emotional facial expressions.     

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.     

Edentulism and dental caries in Victorian nursing homes

doi: 10.1111/j.1741‐2358.2011.00510.x Edentulism and dental caries in Victorian nursing homes Objectives: The aim of this project was to investigate edentulism and dental caries in nursing home residents in Victoria, Australia. Background: The Australian population is ageing with a growing number of people living in nursing homes. These residents are at increased risk for dental caries, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Materials and methods: Clinical dental examinations were conducted at 31 nursing homes in Melbourne and regional Victoria between May 2005 and June 2006. A total of 510 residents were examined out of 1345 eligible participants. Socio‐demographic and medical history was collected via questionnaire. Results: Just over half of the residents were dentate (53.9%), and dentate residents had a mean of 14.4 teeth present and 2.66 untreated decayed teeth. Residents who required total assistance with oral hygiene had more decayed teeth and fewer filled teeth than residents who did not require assistance. Conclusions: Nursing home residents in Victoria are retaining an increasing number of natural teeth and have more tooth surfaces at risk for dental caries. Untreated dental caries was a significant problem for residents, particularly for those who are dependent on others for their daily oral hygiene care.