Tooth loss and dental caries in institutionalized elderly in Italy

An epidemiological survey of dental health status and needs was conducted in a group of 234 randomly selected institutionalized elderly people in Naples, Italy. The mean age of the patients was 81.4 yr, 71.4% were women and 28.6% men. A total of 140 (59.8%) people were totally edentulous; an additional 13.7% were edentulous in one jaw. A significant increase in prevalence of edentulousness with increasing age was recorded. 44.3% of the edentulous in both jaws wore complete dentures. The mean number of remaining sound teeth, decayed teeth and root remnants in the elderly with maxillary and mandibular natural teeth decreased with increasing age. Of the 94 dentate elderly, 29.8% had no need of dental treatment. Of all dentate patients 68.1% needed one or more dental extractions with a mean need of 3.9 per patient; 37.2% needed restorative treatment for one or more teeth with a mean need per patient of 2.9. Analysis of the results showed poor dental health in this target group and the necessity of improving the dental health services programs for the elderly living in institutions.     

Needs and demands for dental care in patients attending the University Dental Hospital in Sri Lanka

AIMS: To determine the needs and demands for dental care in patients visiting a university dental hospital. Design: A cross-sectional study of first visit patients. SETTING: The University Dental Hospital in Peradeniya, Sri Lanka. PARTICIPANTS: A total of 849 first visit patients. METHODS: The main complaint of each patient was recorded and was considered as a measure of demand for dental care. Tooth based and orthodontic treatment needs were assessed using the WHO basic methods. Periodontal treatment need was assessed by the periodontal treatment needs system. Need for prosthetic care was also assessed. RESULTS: Thirty per cent and 23% of patients demanded treatment for decayed teeth and toothache respectively. Nearly 34%, 27% and 17% of patients needed surgical, restorative and periodontal care respectively for the main complaint. Of those seeking care, 94% needed treatment other than what was required for the main complaint. The predominant normative treatment need was for periodontal care (77%) whilst 47% needed restorations or extractions. CONCLUSION: Normative needs of patients demanding treatment were high and many had demanded treatment before acute symptoms had developed. However, delays in seeking care were evident. Further studies are needed to identify factors for delay in obtaining care.     

Dental treatment outcomes among dentate nursing facility residents: an initial study

This investigation used retrospective methodology to examine the outcomes of previous dental treatment and the incidence of developing restorative and extraction needs, including dental caries, among nursing facility residents. Data were taken from treatment records of 48 dentate residents in 10 nursing facilities who received comprehensive dental treatment delivered through the Geriatric Mobile Unit (GMU) program operated by the University of Iowa College of Dentistry and were examined an average of 2.9 years had a mean age of 84 years at the second exam, and 90% were female. About 18% of all previously placed restorations needed to be replaced, and an additional 11% of teeth that received a restoration needed to be extracted at follow-up. At follow-up, nearly 70% (33/48) of residents needed restorative care, while 44% (21/48) needed extractions. The mean incidence of teeth developing new treatment needs between the two visits was 2.7 teeth/person (14.9% of teeth) for restorative need and 1.1 teeth/person (6.6% of teeth) for extraction need. Results suggest that successful treatment outcomes can be achieved for nursing facility residents, but that dental disease and treatment needs develop at a high rate among these residents.     

Dental treatment and demand for services in a Veterans Administration Nursing Home Care Unit

Planning the provision of dental care in nursing homes requires evaluation of both dental needs and demand for services. Dental treatment needs have been documented for residents of longterm care facilities. This paper examines the actual dental care provided to institutionalized persons demanding care. Dental records of 144 patients at a Veterans Administration Nursing Home Care Unit (NHCU) were reviewed to evaluate needs and treatment demands. About 20 percent of the NHCU patients were currently receiving dental treatment; the remainder were on recall (closed cases). Of the total services needed, slightly over half were denture related services, about a quarter were oral surgical services, and 16 percent were operative procedures. Almost a third refused some or all of the proposed dental treatment; seven percent were unable to be examined or treated. No statistically significant difference was found between the age and the level of nursing home care needed for those receiving treatment and those refusing treatment. Once the backlog of need was met, this NHCU dental program consisted primarily of recall exams, and prosthetic and oral surgical treatment. The case mix and refusal rate may change, however, as future cohorts of elders retain more teeth and have experienced preventive dental services during their lifetimes.     

Need for dental hygiene and dental care in Veterans Administration patients

The Periodontol Treatment Needs System (PTNS) was used to classify needs of 102 patients, 97 males and five females, at the VAMC Dental Service. The PTNS is based on the presence or absence of plaque, calculus or overhangs, inflammation, and pocket depth. In addition, need for restorative and prosthetic care was added to the PTNS based on dentists' diagnosis. All classification was done by quadrant. All subjects required dental hygiene or periodontal care; 45% of the subjects need restorative treatment, prosthetic treatment, or both. Differences in numbers of patients requiring each type of treatment were highly significant. Multiple regression showed that age was positively related to type of treatment needed, with a significant difference in dental hygiene or periodontal needs by quadrant. The results of this study show greater need for dental hygiene and periodontal treatment than for dental treatment in these patients.     

Dental health and treatment needs in institutionalized psychiatric patients in Italy

Abstract The caries prevalence, oral hygiene status, periodontal health and the treatment needs were assessed in a group of institutionalized psychiatric patients in Catanzaro, Italy. Of the total sample of 297 subjects, 165 (55.6%) were males, the mean age was 55.1 yr, the great majority (90.6%) was able to care for themselves, on average they had been institutionalized for 12.9 yr, and almost two-thirds were schizophrenic (65%). They did not receive any assistance in daily oral hygiene procedures, only 7.4% had visited a dentist and exclusively for emergency care. A total of 33 (11.1%) patients were edentulous, and the multiple logistic regression analysis showed a highly significant increase of edentulousness with increasing age (P < 0.001). No caries-free subjects were found and among the dentate the DMFT and DMFS scores for all age groups were respectively 15.5 and 88.6. The stepwise linear regression analysis showed that the mean DMFT index increased with age (t = 6.86; P < 0.00l), and in the partly or totally helpless patients it was significantly higher than in the self-sufficient patients (1=2.78; P= 0.006). Of the 264 dentate subjects, only 25 (9.5%) had no need of dental treatment: 213 (80.7%) required extractions with a mean number per person of 6.3 and the need for conservative dental care was recorded in 154 (58.3%) patients with a mean need for patient of 2.8. Mean OH1-S score was 4.2 and the stepwise linear regression analysis showed that it increased with age (t = 5.73; P < 0.01) and with the length of institutionalization (t =3.42; P < 0.001). Only 0.9% of the entire sample was found with healthy periodontal tissue; bleeding on probing or a higher score was found in 4.6% of examined sextants; calculus in 10.1%; shallow pockets and deep pockets in 19.6%. and 64.8% of all sextants. The results of the multiple logistic regression analysis indicated that the number of subjects with deep pockets as highest score increased with increasing age (P < 0.001), and with the increasing length of institutionalization (P=0.005). The findings of this study demonstrate high caries prevalence, poor oral hygiene and periodontal health, and extensive unmet needs for dental treatment. More coordinated efforts between the social and dental care sector must be maintained to serve adequately the need of this disadvantaged group.     

Other dental treatment needs in patients who requested removable partial dentures

The aims of this study were to determine the dental and periodontal status and the associated treatment needs, other than that for prosthetic care, in patients who requested removable partial dentures. Forty-six patients who had never worn removable partial dentures before were examined for plaque index, tooth status, gingival index, loss of periodontal attachment and tooth mobility. Prior to prosthetic treatment, 15% of the teeth needed conservative treatment and 1% needed extractions. From the periodontal point of view, 65% of the teeth needed some form of related therapy, and 2% of the teeth were at risk of extraction due to advanced mobility.     

Factors contributing to dentists' extraction decisions in older aduits

To evaluate which dental and nondental factors contributed to dentists' extraction decisions in a sample of older adults, an archival study was conducted using community-dwelling and long-term-care older adults receiving dental care at an urban seniors' clinic. Four dentists who provided dental care to older adults reviewed patient records for whom they had extracted at least one tooth over a 21-month period. They identified one or more factors contributing to their extraction decisions. From 105 adults (mean age, 80.61, there were 221 extractions. Frequent contributors to dentists' extraction decisions included non-restorability in 53.8% of all extractions, dental caries (45.6%), prosthetic considerations (45.2%), and Periodontal disease (40.3%). The non-dental contributors in 13% to 17% of extractions included patient/family request, inability to care for one's teeth, and financial limitations. When identiwing the "most important" (or "primary") factor in their extraction decisions, dentists most frequently indicated non-restorability, followed distantly by patient/family request, periodontal disease, and financial limitations. This investigation demonstrates tbat non-dental factors are important in dentists extraction decisions. Of these, patient/family request and financial limitations appear to be most influential.     

Oral health status and treatment needs of Canadian adults aged 85 years and over

In an oral health survey, 1375 adults aged 85 and older were examined in North York, Canada. Only 31% of dentate nursing home residents and 47% of dentate independently living subjects had received dental care in the year previous to examination. The overall prevalence of edentulism was 66%, and about 80% of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated decay, and 47% of nursing home residents had untreated root decay. Regarding clinically defined treatment needs, high levels of unmet need were identified in subjects from both types of residences. Among nursing home residents, about 45% of dentate subjects required tooth extraction, and 56% required prosthodontic treatment. Although only 27% of dentate independently living residents required tooth extraction, over 60% needed restorative treatment. Higher prevalence of both untreated decay and unmet treatment needs was associated with lower utilization of dental care for dentate subjects. For edentulous subjects, prosthetic treatment was required by 70% of nursing home residents and by 51% of independently living subjects. These results indicate that, for both nursing home and independently living residents, dental diseases and treatment needs continue throughout the lifespan.     

Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including prophylactic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1%) patients developed radiation caries and 5 out of 23 cases (21.3% - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental conditions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.     

Trends in treatment performed in the Phelophepa Dental Clinic: 1995-2000.

Mobile clinics are a cost-effective method of meeting the dental needs of rural communities in South Africa. Phelophepa, the first primary health care train of its kind world-wide, provides eye care, education, medicine, basic health care and since June 1995 dental treatment to rural communities. All services are rendered by students under supervision of qualified staff. The aim of this study was to analyse and report the data for treatment performed in the dental clinic from June 1995 to May 2000. During its first five years of operation, dental services were provided at 183 towns in all provinces except Gauteng. Of the 42,073 patients treated during this time (an average of 229.9 per town), 67.4% were adults. 71.3% of the 103,283 procedures performed were extractions, 15.7% could be classified as preventive with the remaining 13% as restorative procedures. The average value of the service provided to each patient was R218.53. The exposure of dental, dental therapy and oral hygiene students to rural areas of South Africa serves the important purpose of sensitising students to the realities of oral diseases in these communities.     

Guided self diagnosis: an innovative approach to triage for emergency dental care

BACKGROUND: The basic model of triage, developed more than 200 years ago by the French, is based on categorization of patient needs and thus the urgency and time required for care. This model in various forms is used in most hospitals throughout the world. METHODS: In this study, a fully computerized guided self-diagnosis system (based on a neural network design) was designed, prototyped, developed and trialled by front line non-clinically trained personnel in emergency dentistry. RESULTS: A total of 699 patients were seen as a result of the triage assessment within 14 days of their initial phone call and/or first contact. Patients categorized as requiring care on the day (Category 1) were provided more items of care (50 per cent of all items) and the greatest number of extractions (76 per cent) and endodontic treatments (78 per cent). Other categories were found to require less urgent care. CONCLUSIONS: The triage system developed in this study clearly holds significant promise in reducing the impact of emergency dental patients on dental health care systems. However, it is recognized that the system still requires some adjustment to ensure all Category 1 patients are examined before less urgent categories.     

Does dental disease presence equate to treatment need among care home residents?

Objectives

This study aimed to explore the relationship between dental disease, complexity and dental treatment needs of care home residents.

Methods

Survey of residents in care homes in Wales. Random sample of participants from a random selection of care homes across Wales, UK. Data collection involved questionnaires and dental examinations.

Results

Data were collected from 655 care home residents in 213 care homes. Half of all residents reported good or very good oral health but most had dental treatment needs. 73% of dentate residents had active caries, of those, 53% required restorations and 37% needed extractions. All were deemed to require dental examination. 60% of dentate residents and 50% of edentate residents had case complexity, which influenced the delivery of care.

Conclusions

There is significant unmet dental treatment need amongst care home residents. Dental disease presence alone is a poor indicator of the need for care and does not account for case complexity or the shift towards a patient centred rather than disease focussed approach to care. Measures for treatment needs and complexity are required when undertaking assessments of oral health needs in care homes.

Clinical Significance

Traditional oral health surveys measuring dental disease do not necessarily equate to treatments required for care home residents and do not reflect the complexity and difficulties involved in delivering dental care. This survey highlights dental needs in care homes, and the difficulties involved in delivering care to address these needs.     

Perceived oral health status,unmet needs,and barriers to dental care among HIV/AIDS patients in a North Carolina cohort: impacts of race

OBJECTIVE: This prospective observational study examined differences in perceived oral health status, treatment needs, dental care utilization patterns, and barriers to care between HIV-infected non-Hispanic blacks and whites in North Carolina. METHODS: 632 adult HIV-infected medical clinic attendees provided information on their oral health status and dental care history during face-to-face interviews with a trained interviewer. RESULTS: Compared to whites, blacks were significantly more likely to be female, older, less educated, have lower income, and have acquired HIV by heterosexual sex or injecting drug use. Although two-thirds of patients reported good oral health, blacks were significantly more likely to have loose teeth, need extractions, and be episodic dental care utilizers. Primary barriers to dental care were cost (30%), fear (19%), and low motivation (13%). Sixty-five percent of patients had unmet dental needs in the last three years. Race, cost, fear, and immune competence were significantly associated with unmet dental need in a multivariable model. CONCLUSIONS: Disparities exist within this HIV-infected population in oral symptoms, utilization patterns, and perceived unmet dental need. Targeted interventions that address barriers to care are needed to help establish preventive dental care patterns in this region, especially among blacks.     

Oral health status and treatment needs in long-term medicine patients in a Copenhagen hospital department

Oral health and dental treatment needs were investigated in 50 randomly selected long-term medicine patients admitted to The Glostrup Hospital, University of Copenhagen, Glostrup, Denmark. All the patients were clinically and radiologically examined. Oral health generally was poor. Two-thirds (66%) of the patients were totally edentulous, 24 % partially edentulous. Only 10 % were dentate with no dentures. The number of remaining teeth per patient averaged 4.7, that of caries destructed teeth 1.4. All 17 patients with remaining teeth had periodontal disease, and 13 of them suffered from caries. Alveolar ridge atrophy, periapical inflammation, root remnants, impacted teeth and oral mucosal lesions were demonstrated in, respectively, 80, 22, 24, 8, and 26% of the group. In total 82 % of the patients needed some kind of treatment, mainly prosthetic and oral surgery. The estimated total treatment time per patient averaged 165 min.     

Dental surgery attendance amongst patients with moderately advanced dementia attending a day unit: a survey of carers' views

OBJECTIVE: To ascertain the views of carers of patients with dementia, on the patient's dental health needs. DESIGN: Prospective survey using semi-structured interview. SETTING: Dementia day care unit for patients living in their own homes. SUBJECTS AND METHOD: Twenty-eight carers of dementia sufferers were interviewed between March and September 2000, as part of regular clinical reviews of patient's needs. Carers' views on the dental care needs of patients were ascertained. Cognitive and behavioural assessments of patients were also made using the Clifton Assessment Procedure for the Elderly (CAPE). MAIN OUTCOME MEASURE: Dental unmet need ie the carer deciding that the patient needed a dental examination, but anticipating that this would be problematic, the carer would not take them. RESULTS: Twenty one per cent met criteria for dental unmet need. CONCLUSIONS: Carers of people with dementia may be reluctant to take those they care for to the dentist. We need to explore ways to ensure appropriate dental surgery attendance.     

Assessment of Dental Prosthetic Status and Needs Among Prisoners of Haryana, India

This cross-sectional study was planned to evaluate the prosthetic status and treatment needs using WHO (1997) format among prisoners of Haryana state, India. 1,393 subjects with age range of 35.26 ± 12.29 years were examined. Of the study subjects, 11 (0.8 %) were completely while 606 (43.5 %) were partially edentulous. Of these 617 subjects, 305 (49.4 %) were edentulous only in posterior region. Dental caries accounted for loss of teeth in 325 (52.7 %) subjects. 44 (7.1 %) subjects were wearing some prosthesis. Regarding dental arch wise prosthetic need, 335 (54.3 %) subjects needed prosthesis in maxillary arch while 482 (78.1 %) needed prosthesis in mandibular arch. With advancing age there was an increase in the number of complete dental prosthesis required. There was no statistically significant difference between length of imprisonment and prosthetic need, except for need of a combination of prosthesis. Only one-fourth of the prisons had a dentist. The prisoners were taken to a hospital outside the prison in case of health needs. Prosthetic needs of prisoners were high. The lack of dental infrastructure in prisons makes the provision for multi-visit conservative dental treatments very difficult leading to higher tooth mortality. People who migrate back and forth across the prisons and communities represent a public health opportunity that should be addressed.     

Dental caries and the need for treatment among institutionalized elderly

The main purpose for the study was to determine the occurrence of untreated dental decay, and to assess the expressed demand for operative caries therapy among dentate institutionalized elderly in Denmark. The study population comprised all dentate elderly in eight nursing homes (n = 126) and in five hospital long-term care facilities (n = 75). In both groups of elderly 70% had untreated decay. The mean number of surfaces with untreated decay among the elderly in nursing homes (NH) and in hospital long-term care facilities (LTC) was respectively 9.7 and 7.5. The predominant factors influencing the occurrence of untreated decay were the use of dental services and the degree of helplessness. Regular use of dental services reduced the amount of untreated decay among the NH elderly, and the totally helpless LTC elderly had more decay than those able to manage alone. Half of the NH residents who had decay did not want treatment or were not able to express their demand for treatment due to poor mental or physical health. The realistic need for traditional operative filling therapy is discussed and it is concluded that the goal of an oral health care program for NH elderly should be to meet not only the demand for such treatment but also the need for emergency treatment and non-operative caries treatment.     

A report on the feasibility of establishing a paediatric emergency dental service at Glasgow Dental Hospital.

A six-month pilot emergency service for children was established at Glasgow Dental Hospital to provide care for patients in pain, offer preventive advice and ensure ongoing dental care. The service was staffed by experienced community dental officers. In the main study period 2965 patients were seen. The majority (54 per cent) were referred from general dental practitioners; however, 27 per cent came directly to the hospital without seeking dental advice in their locality. The most common problems were toothache (55 per cent), occasional pain (28 per cent) and swelling (14 per cent). Eighty per cent of the patients were directed to oral surgery for extractions under general anaesthesia and six per cent for extractions under local anaesthesia. Dental caries still causes pain and distress to a large number of Glasgow school children. Clearly water fluoridation would greatly improve dental health and in so doing reduce the proportion of children requiring extractions under a general anaesthetic. The emergency service is currently being reorganised so as to place more emphasis on following up those patients who do not have a dentist, or who presented for care without a referral letter.     

Dental treatment demands among patients in Tanzania

The dental treatment demands of 824 patients attending regional dental clinics were recorded. Overall 86% of the patients sought treatment for pain, ranging from 77% to 97% in the different clinics. Caries was the main cause of pain. The proportion of patients with demands for aesthetics was 5%, prosthetics 2%, and check up 3%. The data indicated a need for emergency care. The type of curative treatment needed, mainly extractions, could well be performed by dental auxiliaries. Since the data was collected from patients among whom many visited the clinics in the late stages of painful oral diseases, it is assumed that it reflects only the tip of an iceberg that represents a much larger dormant demand (want) for emergency care among the population. Any strategy aiming to be effective in improving oral health should at least meet the emergency dental needs of the population. Consequently there is a definite need of data on dental treatment demands and wants for adequate planning of dental health care systems in their infancy in countries with limited financial resources.