Oral care reduces pneumonia in older patients in nursing homes

OBJECTIVES: Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia. We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people. DESIGN: Survey. SETTING: Eleven nursing homes in Japan. PARTICIPANTS: Four hundred seventeen patients randomly assigned to an oral care group or a no oral care group. INTERVENTION: Nurses or caregivers cleaned the patients' teeth by toothbrush after each meal. Swabbing with povidone iodine was additionally used in some cases. Dentists or dental hygienists provided professional care once a week. MEASUREMENTS: Pneumonia, febrile days, death from pneumonia, activities of daily living, and cognitive functions. RESULTS: During follow-up, pneumonia, febrile days, and death from pneumonia decreased significantly in patients with oral care. Oral care was beneficial in edentate and dentate patients. Activities of daily living and cognitive functions showed a tendency to improve with oral care. CONCLUSION: We suggest that oral care may be useful in preventing pneumonia in older patients in nursing homes.     

Oral health status of inpatients with varying physical activity limitations in rehabilitation wards: A cross-sectional study

Poor oral hygiene can be potentially life-threatening in inpatients. However, no basic protocol on oral hygiene customized for inpatients exists, and lack of oral care related knowledge, attitude, and skills among caregivers could be detrimental to the general health of patients. This study sought to identify the oral care practices and oral health status of inpatients with varying physical activity limitations in a rehabilitation ward.Sixty-one inpatients in a rehabilitation ward were evaluated for their medical and physical conditions and oral health status. These were assessed using the bedside oral exam, decayed, missing, filled teeth index, plaque index, gingival index, and caries activity test.In total, 40 men and 21 women (mean age, 56.6 years) were included in this study. Among them, 50.8% of the patients could brush their teeth unassisted, whereas 49.2% required assistance from an assistant for oral care. The proportion of patients receiving nasogastric tube feeding was higher in the group that could not provide oral self-care; 36.7% and 33.3% of these patients showed moderate and severe dysfunction, respectively, based on bedside oral exam. Scores for the swallowing, tongue, and total domains of bedside oral exam were poorer for patients who could not provide oral self-care (P < .01). The caries activity test indicated a moderate risk for both groups.Our findings suggest that an oral care protocol that considers the physical activity limitations in inpatients in rehabilitation wards is necessary to minimize negative influences on the systemic health of these patients.     

Understanding oral health beliefs and practices among Cantonese‐speaking older Australians

Aim: The present study was conducted to explore how older immigrants from Hong Kong or Southern China manage their oral health in Melbourne. Methods: We used six focus groups involving 50 Cantonese‐speaking immigrants who were 55 years and over and living in Melbourne. Results: Four major themes relevant to oral health care emerged from the discussion: (i) traditional Chinese health beliefs; (ii) traditional medicine and oral health; (iii) attitudes towards dentists; and (iv) access to oral health‐care services. Language, communication and cost of dentistry were identified as major barriers to oral health care. Conclusion: Older Chinese immigrants in Melbourne have concerns about oral health care that are similar to other ethnic groups, they want more oral health‐related support from government, and many of they return to China or Hong Kong for dental treatment.     

Oral health considerations in older women receiving oral bisphosphonate therapy

Recent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased awareness of oral health in patients receiving osteoporosis therapy. This study describes the demographic, oral health, and clinical characteristics of a contemporary population of women aged 50 and older undergoing oral bisphosphonate treatment who returned a mailed questionnaire pertaining to dental symptoms. The study, as previously reported, was conducted within Kaiser Permanente Northern California, a large, integrated healthcare delivery system. The cohort included 7,909 women with bisphosphonate exposure of at least 1 year, with a subset of 923 women reporting dental symptoms who underwent clinical examination. Overall, the average age was 71 ± 9; 70% were white, and 74% had at least some college education. Nearly two-thirds had received oral bisphosphonate therapy for 3 or more years. Most reported daily tooth brushing, 85% had had a dental examination in the past year, 22% reported denture use, and 6% reported moderate to severe periodontal disease. Oral healthcare patterns varied according to age and race and ethnicity. Five hundred seven (6.4%) women reported a tooth extraction in the prior year, of whom two developed BRONJ (0.4%). Tori or exostoses were found in 28% of examined participants with dental symptoms; these were predominantly in the lingual mandible and palate, with palatal BRONJ occurring in 1.6% of symptomatic participants with palatal tori. In summary, among older women with bisphosphonate exposure, oral health varied according to patient characteristics, and BRONJ occurred more frequently after tooth extraction or on palatal tori. These data support efforts to optimize oral health and to identify risk factors for BRONJ in older individuals receiving bisphosphonate drugs.     

Oral health of aged inpatients

Objectives: The proportion of the population aged 65 years and over in Australia is expected to increase substantially, and more people in this age group are retaining their teeth and will require dental care. The objective of this study was to assess the oral health status of inpatients over the age of 65. Methods: Dental examinations were performed on inpatients at Fremantle Hospital. Standardised assessment forms were used to investigate factors related to medical history, hospital admission and oral health needs. Results: A total of 104 persons were examined, 56% were dentate. The dentate participants had an average decayed, missing and filled (DMF)‐index of 21.6 (SD 7.1). All edentulous participants had dentures and the estimated average age of their dentures was 18.1 years. Although the majority of participants (70.2%) were satisfied with their oral health status, 76.6% were professionally assessed to be in need of immediate dental care. Among the edentulous participants, 47.1% needed new dentures. Among all the participants, 75.3% also needed improved oral hygiene. Conclusion: There is a need to fully assess availability, appropriateness and effectiveness of models of oral health care delivery among the older population. This study clearly indicates a current problem and high levels of unmet need. With an increasing ageing population and higher retention levels of natural dentitions, this will result in higher levels of oral disease and need for prevention and care.     

Factor analysis on oral health care for acute hospitalized patients in Japan

Aim: We conducted a survey to investigate the status regarding the implementation of oral health care for inpatients aged 65 years and older who were in the acute stages of stroke and to examine the factors related to the details of excellent model hospitals. Methods: We sent a questionnaire on oral health care targeting all 8089 hospitals in Japan. On the basis of the responses obtained from the hospitals, we conducted a survey to analyze the factors defining what are known to be excellent model hospitals. We then conducted a logistic regression analysis using a stepwise procedure. Results: Replies were received from 2444 of the 8089 hospitals (30.2%): 91.8% of the hospitals reported that oral health care was a part of the daily nursing routine while 91.2% of the hospitals considered that aspiration pneumonia could be prevented by appropriate oral health care. Only 30% of the nurses had undergone oral hygiene training. Among the factors involved in excellent model hospitals, we observed a strong correlation with a sense of the necessity for oral health care, oral hygiene training for nurses and a large number of hospital beds. Conclusion: Large scale hospitals tend to be more interested in oral health care than smaller hospitals. Providing oral health care is already common in acute hospitals in Japan. There is a great demand for oral hygiene training and obtaining information from dental professionals. It is important to promote the cooperation between dental and nursing personnel within hospitals regarding oral hygiene training. Geriatr Gerontol Int 2011; 11: 460–466.     

Need for dental care in older veterans: assessment of patient-based measures

OBJECTIVES: There is a need for brief and accurate identification of older patients in need of dental care. This study examines the sensitivity and specificity of two screening instruments. DESIGN: Cross-sectional study conducted in older community-dwelling male veterans. SETTING: Four Department of Veterans Affairs (VA) clinics in greater Boston and the VA Dental Longitudinal Study (DLS). PARTICIPANTS: Two hundred thirty-two participants from the Veterans Health Study (VHS) who were outpatients in one of four Department of Veterans Affairs clinics in greater Boston and 206 participants from the VA DLS, community-dwelling veterans who do not use VA for their health care. MEASUREMENTS: Self-report measures included a single-item global self-report of oral health (OH-1) and a six-item dental screening measure called the D-E-N-T-A-L. The D-E-N-T-A-L queries whether participants have Dry mouth, Eating or swallowing problems, Not had a dental examination in the last 2 years, Tooth or mouth problems, Altered eating habits because of teeth or mouth, or Lesions or sores in the mouth. The criterion standard for need for treatment was determined by a clinical examination. Sensitivities and specificities were calculated and receiver operating characteristic curves plotted to identify the best cutpoints for each measure. RESULTS: Need for care was nearly universal (97%) in the VHS and present in 64% of the DLS participants. The single-item self-report of oral health performed as well as the D-E-N-T-A-L in identifying persons in need of care. Compared with the clinical criterion, the OH-1 had a sensitivity of 0.75 and a specificity of 0.67 in identifying persons with severe need for denture care, whereas the D-E-N-T-A-L had a sensitivity of 0.80 and a specificity of 0.62 in identifying persons with severe periodontal need. CONCLUSION: Self-reports of fair or poor oral health are useful in identifying veterans in need of dental care, especially in populations with a large number of persons who do not usually use dental care. The D-E-N-T-A-L may also be useful as a self-screening measure and community education device to encourage older persons to seek regular dental care.     

The effect of comprehensive oral care program on oral health and quality of life in patients undergoing radiotherapy for head and neck cancer: A quasi-experimental case-control study

Objectives:The purpose of this study is to investigate the effect of the comprehensive oral care program on oral health status and symptoms in head and neck cancer (HNC) patients undergoing radiotherapy.Methods:This was a quasi-experimental study using a non-equivalent control group in non-synchronized design. All participants including control and experimental group were asked for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N35 (EORTC QLQ-H&N35) and given an oral health education 4 times at baseline, immediate postradiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy. In each visit except for final, the experimental group was given fluoride varnish application and fluoride mouth rinsing solution for daily use. Oral health examination for dental caries, plaque score (PS), bleeding on probing (BOP), and salivary flow rate was performed in baseline and 6 months after radiotherapy. Statistical analyses were done by paired t-tests and mixed ANCOVA repeated-measures analysis.Results:From November 1, 2013 to October 31, 2015, a total 61 patients undergoing radiotherapy for HNC cancer were enrolled (30 in control and 31 in experimental groups). Decrease in salivary flow rate was comparable between 2 groups. Dental caries increased in control group (P = .006); PS and BOP were decreased in experimental group (P < .001 and .004, respectively). Experimental group showed lower swallowing, speech problems, and less sexuality scores in EORTC QLQ-H&N35 than control group.Conclusion:We found improvement in oral health and the quality of life in HNC patients with comprehensive oral care intervention by dental professionals. Communicating and cooperating between the healthcare and dental professionals is needed to raise the quality of health care services for HNC patients receiving radiotherapy.     

Effect of oral health intervention on cognitive decline in community-dwelling older adults: A randomized controlled trial

PurposeThe incidence of dementia is rapidly increasing worldwide, especially in developed countries. Little is known regarding the effectiveness of dental intervention to prevent dementia or a decline in cognitive functions among community-dwelling older adults, but a few studies have reported a correlation between the lack of regular dental checkups and dementia. For that reason, this study aimed to investigate the effects of oral health intervention on cognitive functions in community-dwelling subjects with a mild cognitive decline via a randomized controlled trial.Patients and methodsFifty-five community-dwelling older adults with a Mini-Mental State Examination score of ≥21 to ≤26 who had not visited a dental clinic in the previous year were randomized to an intervention group (n = 28) or a control group (n = 29). The intervention group received monthly oral health intervention by dental hygienists for 8 months while the control group did not. Data on demographics, cognitive function and oral parameters were collected before and after the intervention.ResultsTwenty-five subjects in the intervention group (mean age 77.0 years) and 25 in the control group (mean age 72.8 years) completed the study. Significant improvements were observed in the Trail Making Test (TMT)-A, TMT-B, bleeding on probing rate, oral diadochokinesis, tongue pressure and chewing ability in the intervention group (P < 0.05). There were also significant interactions between the TMT-A and TMT-B scores, oral diadochokinesis, tongue pressure and chewing ability (P < 0.05).ConclusionOral health intervention by dental hygienists may be effective for improving the oral health and executive function of cognitive function assessed via TMT.     

An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care‐dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture‐related conditions, hyposalivation, and oral pre‐ and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person‐related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non‐dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.     

Disparities in Oral Health Status Between Older Adults in a Multiethnic Rural Community: The Rural Nutrition and Oral Health Study

OBJECTIVES: To compare oral health status according to ethnicity and socioeconomic status in African-American, American-Indian, and white dentate and edentulous community-dwelling older adults.
DESIGN: Cross-sectional study; data from self-reports and oral examinations.
PARTICIPANTS: A multistage cluster sampling design was used to recruit 635 participants aged 60 and older from rural North Carolina counties with substantial African-American and American-Indian populations.
MEASUREMENTS: Participants completed in-home interviews and oral examinations. Self-reported data included sociodemographic indicators; self-rated oral health status; presence or absence of periodontal disease, bleeding gums, oral pain, dry mouth; and fit of prostheses. Oral examination data included number of teeth and numbers of anterior and posterior functional occlusal units.
RESULTS: African Americans and American Indians had significantly lower incomes and educational attainment than whites. Self-rated oral health was significantly better in whites than in African Americans and American Indians. Prevalence of self-reported periodontal disease and bleeding gums was lower in whites. Of dentate participants, African Americans were significantly more likely than whites to have 11 to 20 teeth and one or two posterior occlusal contacts. Oral health deficits remained associated with ethnicity when adjusted for socioeconomic variables.
CONCLUSION: Oral health disparities in older adults in a multiethnic rural area were largely associated with ethnicity and not socioeconomic status. Clinicians should be aware of these health disparities in oral health status and their possible role in disparities in chronic disease. Further research is necessary to understand whether these oral health disparities reflect current or lifetime access to care, diet, or attitudes toward oral health care.     

Large variations in the use of oral anticoagulants in stroke patients with atrial fibrillation: a Swedish national perspective

OBJECTIVES: To explore nation-wide use of anticoagulation in stroke patients with atrial fibrillation, in routine clinical practice in Sweden. DESIGN: Cross-sectional cohort study. SETTING: Patients included in Riks-Stroke, the Swedish national quality register for stroke care, during 2001. SUBJECTS: Hospitals with incomplete coverage were excluded, leaving 4538 stroke patients with atrial fibrillation amongst 18 276 stroke patients from 75 hospitals in six health care regions. MAIN OUTCOME MEASURE: Treatment with oral anticoagulants. RESULTS: At stroke onset, the proportion of patients with atrial fibrillation and first-ever stroke, receiving oral anticoagulants as primary prevention was 11.0% (range 8.4-13.5% between regions and 2.5-24.4% between hospitals). Younger age, male sex and diabetes at stroke onset independently predicted primary prevention with oral anticoagulants. The proportion of stroke patients with atrial fibrillation receiving oral anticoagulants as secondary prevention at discharge was 33.5% (range 29.9-40.6% between regions and 16.4-61.9% between hospitals). Independent predictors for secondary prevention were younger age, male sex and independent activities of daily life (ADL) function before the stroke, being discharged to home, being fully conscious on admission and health care region. CONCLUSION: There were variations between hospitals and regions that differences in age, sex, functional impairments and comorbidities could not fully explain. This indicates that evidence-based primary and secondary prevention of embolic stroke is insufficiently practised. Local factors seem to determine whether patients with atrial fibrillation gain access to optimal prevention of stroke or not.     

临床护理路径应用于老年口腔癌手术患者健康教育中的效果分析

目的探讨实施临床护理路径在老年口腔癌手术患者健康教育中的作用。方法随机选取本院2012年1月至2013年12月老年口腔癌患者50例,根据护理方法分为常规护理组和临床护理路径组,各25例。评估2组患者的健康知识知晓率、护理工作的满意度、依从性及抑郁、焦虑评分。结果临床护理路径组知识知晓率和护理满意度分别为（89.51±4.03）分和（92.60±3.37）分,均高于常规护理组的（81.03±3.49）分和（84.27±2.64）分,差异具有统计学意义（P〈0.05）;临床护理路径组依从性为（9.82±0.61）分,高于常规护理组的（7.15±0.43）分,差异具有统计学意义（P〈0.05）;临床护理路径组汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评分分别为（19.25±1.90）分和（23.44±2.21）分,均低于常规护理组（24.01±2.38）分和（27.69±2.14）分,差异具有统计学意义（P〈0.05）。结论临床护理路径应用于老年口腔癌手术患者健康教育中能够有效提高患者的健康知识知晓率,提高了患者的依从性并提高了护理工作满意度,降低了患者的焦虑和抑郁,值得临床推广。     

Nutrition and oral health

Reduced chewing function in community-dwelling older people with adequate general health is linked to having fewer than 20 teeth present or to wearing removable dentures. By chewing for longer periods of time or swallowing larger food particles they are normally able to compensate for the impaired function. The masticatory function can be restored by adequate prosthetic therapy, which results in increased activity of the masticatory muscles during chewing and reduces the chewing time and the number of chewing strokes until swallowing. In frail or dependent elderly people undernutrition is prevalent because of health problems, reduced appetite and poor quality of life. Poor oral health and xerostomia are often associated with a reduced body mass index and serum albumin level and the avoidance of difficult-to-chew foods. Maintenance or re-establishment of masticatory function is an integral part of the medical health care of these patients, with the aim of improving their nutritional status and quality of life.     

Evaluation of a Web-based education and counseling pilot program for older heart failure patients

Web-based communication has been reported as a feasible management tool for heart failure (HF) patients and has also been documented to positively impact quality of life (QOL). The feasibility and effectiveness of a Web-based educational and HF management program among older HF patients (60 years and older), however, have not been previously explored. Therefore, a prospective study was conducted. QOL (physical and mental health) and perceived control (PC) scores of 40 participants were measured (baseline and 3 months) and retrospectively compared with an age- and sex-matched control group of 40 patients receiving HF care as usual. Between-group differences over time were statistically significant in the QOL mental health component and PC scores. The authors' findings demonstrate the beneficial effects of a Web-based program on QOL and PC in older patients with HF. This approach may be potentially beneficial in delivering educational and behavioral support to this high-risk group in ways that are affordable and accessible.     

Socioeconomic,sociodemographic, and clinical variables associated with root caries in a group of persons age 60 years and older in Mexico

Aim: To determine the prevalence of root caries and the root caries index in a population of older Mexicans, and its relationship to socioeconomic, sociodemographic and dental factors. Methods: We carried out a cross‐sectional study in 85 persons 60 years and older living either in long‐term care facilities, or independently and attending an elder day‐care group. Each subject underwent an oral examination, performed by a trained and standardized dentist, to determine the root caries index and other clinical variables. Questionnaires were administered to collect socioeconomic, sociodemographic and hygiene data. Statistical analyses were performed using non‐parametric tests. Results: The prevalence of root caries was 96.5%. The root caries index was 37.7% ± 21.7%. Statistically significant differences (P < 0.05) of root caries index were observed across residential arrangements and marital statuses, and were higher in publicly funded long‐term care and among single subjects (P < 0.05). Those who had poor hygiene had more root caries (P < 0.05); persons with a low level of schooling and who brushed their teeth less frequently also showed a difference (P < 0.05). Conclusions: The prevalence of root caries was very high. The type of long‐term care, marital status, schooling and oral hygiene were associated with a higher root caries index. Oral health programs and preventive caries interventions are needed for this age group in general; targeted strategies may be better focused if sociodemographic profiles are used to characterize high need groups. Geriatr Gerontol Int 2012; 12: 271–276.     

Relationship between oral health and nutritional status in the elderly: A pilot study in Lebanon

Background/objectiveOral health is an integral part of the general health and well-being of the elderly. Compromised oral health can have a negative impact on food intake that leads to a deterioration in nutritional status. This study aimed to explore, for the first time in Lebanon, the relationship between oral health and nutritional status in a population of elderly patients newly admitted to a hospital.MethodsA comprehensive survey was administered to 115 persons aged 70 years and older. They were admitted during 3 consecutive months to various wards of the Rafic Hariri University Hospital (RHUH; Beirut, Lebanon), which is the largest public hospital in Lebanon. Medical, socioeconomic, anthropometric, and dietary data were collected. Nutritional status was assessed by the Mini-Nutritional Assessment (MNA) and oral health was assessed by the Geriatric Oral Health Assessment Index (GOHAI), a tool that evaluates an individual's self-perception of oral health status. This was followed by an examination of the oral cavity to count the remaining teeth, to record the presence and status of dentures, and to assess xerostomia.ResultsThe prevalence of undernutrition was 6.1%, with the additional risk of malnutrition observed in 37.4%. More than 50% of individuals in need of dental care (i.e., a GOHAI score > 14) were at risk of nutritional deficits. A negative self-perception of oral status was significantly associated with a risk of nutritional deficit, but the risk disappeared after adjusting for socioeconomic factors, neurosensory disorders, and chronic diseases.ConclusionOur results strongly demonstrate the importance of oral care within the elderly Lebanese population to reduce the risk of malnutrition and improve oral health-related quality of life.