Dental status and satisfaction with oral function in a sample of community-dwelling elderly people in Japan

The purpose of this study was to determine the influence of dental status on oral function and satisfaction among a group of independently living elderly persons in an urban area of Japan. The study sample consisted of participants of the Senior Citizens' College from 1995 to 1999. Their dental status and oral satisfaction were measured by a questionnaire. The number of usable questionnaires was 3967, or 80.8% of the total sample. The mean age of the subjects was 66.5 ± 4.3 years, and 52.2% were male. Twenty‐nine percent of them had a natural dentition, and 7.0% were edentulous in both jaws. The prevalence of edentulism in the study sample was significantly lower (p<0.01) than that for the national survey. Overall, 66.4% of the subjects were satisfied with their ability to chew, 56.2% with the appearance of their teeth, 63.1% with their ability to speak clearly, and 76.5% with their ability to taste food. For complete‐denture wearers, the greatest dissatisfaction was with speech (28.5%); however, for the RPD wearers, it was with chewing ability (21.7%). Sixty‐one percent of complete‐denture wearers reported that they were satisfied with their chewing ability, but only 11% of them could eat all three of the evaluated foods without difficulty. The multiple stepwise logistic regression analyses showed that both dental status and self‐assessed general health had a significant association with dissatisfaction with all four oral functions and self‐assessed impairment of chewing ability. There were significant associations between the elderly subjects' dental status and oral function.     

Results of a seniors' oral health survey in rural Alberta

A questionnaire and oral screening were conducted with seniors in a rural Alberta health authority to determine their oral health needs. Both the dentate and the edentulous had high levels of treatment need. Of the dentate respondents, 41.8 percent had coronal caries, averaging .88 caries per dentate person. All dentate respondents had calculus and/or pocketing as measured by the Community Periodontal Index of Treatment Needs (CPITN). Among denture wearers, 64.4 percent were found to have calculus on one or both dentures, and 61.2 percent of lower dentures exhibited poor retention. In assessing their own oral health, 76.4 percent rated themselves somewhere between good and excellent. Among the dentate, 83.6 percent brushed daily; however 57 percent never flossed. Although 40.6 percent had been to a dentist/denturist within the last year, 70.1 percent saw a dentist/denturist only when they experienced pain or problems. Of those who had not been to a dentist/denturist within a year, 83.9 percent said the primary reason was because there was nothing wrong. Although treatment needs in this group were high, lasting change in the oral health status of this group requires more than immediate treatment. Enduring effects can only be facilitated by educating seniors as to what optimal oral health is, appropriate preventive behaviours, and the effective use of available professional services. Unless these issues are addressed there is not likely to be a great deal of improvement within each cohort.     

Geriatric oral health issues in Germany

A review of the oral health issues for the elderly in Germany is presented. The percentage of aged and very old people in the total population of Germany is increasing rapidly, as is the percentage of the dentate population due to the high standard of dental care. The percentage of the edentulous population has therefore decreased. It has become necessary for all who care for the elderly, to adjust to caring for the dentate patient and to begin to work together and communicate about the patient's needs. Physicians in particular need to be given training in the detection of caries, periodontal diseases and denture problems. They should feel comfortable working with the dentist and dental team as partners in rehabilitation treatment. The dental treatment needs of the German population aged 70 years and older are not yet adequately met although the social insurance of the elderly includes dental treatment. Provision of oral health care for the dependent elderly, especially those who are homebound or in nursing homes, is not effectively organised and has to be completely reconsidered. The social health insurance and the social long‐term care insurance must adjust their insurance coverage to the dental needs of the frail elderly. The development and further improvement of age‐adjusted dental care is of crucial importance with respect to future demographic changes.     

The oral status of elderly removable partial denture wearers

A random sample of 1019 elderly home dwelling persons participated in this study. There were 809 dentate respondents, 28.6% of whom wore removable partial dentures. They were examined for coronal and root caries, gingival recession, pocket depth and loss of gingival attachment. The removable partial dentures were also evaluated. Abutment teeth were found to be more likely to have caries and periodontal disease than all other teeth. Using a manova statistical procedure, the analysis indicated that the partial denture itself, irrespective of any professionally determined problems with the denture, appears to affect coronal and root caries on the teeth of partial denture wearers. Partial dentures judged to need repair or adjustment were related to periodontal status. The data on adverse effects of partial dentures suggest a need for patient education by the dentist and through public health measures, and good oral self care and regular professional recall for people who wear removable partial dentures.     

广东省视力残疾学生口腔健康状况及行为调查

目的研究广东省12～15岁视力残疾学生的龋病、牙龈出血状况及口腔健康行为,为其口腔卫生保健工作提供信息支持。方法参照第三次全国口腔健康流行病学调查的相关调查内容及检查标准,调查广东省161名12～15岁在校视力残疾学生的恒牙患龋、牙龈出血状况以及相关口腔健康行为。结果广东省12～15岁在校视力残疾学生恒牙龋均为1.58,12岁组为1.53,13～15岁组为1.60,差异无统计学意义(P=0.848);平均牙龈出血牙数为10.53颗,其中12岁组10.13颗,13～15岁组10.73颗,差异无统计学意义(P=0.559);每天刷牙1次或以上者占调查人数的98.1%。每天进食至少一种含糖食品的人数比例为31.1%,过去12个月有口腔就诊经历的人数比例为15.5%。结论视力残疾学生的恒牙龋病患病情况、牙龈探诊出血状况严重,应当加强视力残疾学生口腔健康教育,关注其口腔健康。     

Evaluating dental status and prosthetic need in relation to medical findings in Greek patients suffering from idiopathic Parkinson's disease

Parkinson's disease is one of the common neurological conditions which predominantly affects the elderly but increasingly also younger people. Sufferers present persistent problems with oral health aggravated by extensive tooth loss leading to an impaired dentition. Greece and other countries experiencing the same demographic trends, face growing numbers of sufferers. This study surveyed the dental status and the need for dental treatment of a sample of Greek patients with Parkinson's disease. A structured questionnaire was used. 30% of the participants were younger sufferers. 80% of the elderly group were young elderly. 98% of the participants were denture wearers. Extensive oral problems were recorded in all participants.     

The oral health and attitudes to dental treatment of a dentate elderly population in Mosgiel, Dunedin.

As part of the Mosgiel Community Study, a longitudinal investigation of the health of the elderly, a dental survey was used to determine the oral health status and treatment needs, both objective and subjective, of a group of dentate older adults. Sixteen percent of the 817 subjects were dentate. Of these, 95 were available for the dental survey, and they were questioned and examined at their homes. The mean age was 77 years, and 55 percent of subjects were male; disproportionately more older males than females had retained some of their natural teeth. Seventy-two percent regularly sought dental treatment, and 39 percent felt they were in need of treatment. Few real barriers to treatment were identified, although a major obstacle preventing many from seeking treatment was their lack of perceived need. However, even the realisation that they required treatment was not sufficient cause for many to seek treatment. All subjects required some form of dental treatment. Eighty-five of the 95 subjects required at least one restoration, and 16 percent advanced restorative treatment. The frequencies of coronal and root surface caries were similar. Oral mucosal pathology was also common. Sixty-five percent of denture wearers required prosthetic treatment. Most subjects needed simple periodontal treatment, but 11 percent required advanced therapy. The main oral health problems of this group related to the simple management of plaque-related disease, and the wearing of dentures. However, 24 percent of people required complex restorative and periodontal treatment, or both.     

Oral health disparities and food insecurity in working poor Canadians

Objectives: This study explored oral health disparities associated with food insecurity in working poor Canadians. Methods: We used a cross‐sectional stratified study design and telephone survey methodology to obtain data from 1049 working poor persons aged between 18 and 64 years. The survey instrument contained sociodemographic items, self‐reported oral health measures, access to dental care indicators (dental visiting behaviour and insurance coverage) and questions about competing financial demands. Food‐insecure persons gave ‘often’ or ‘sometimes’ responses to any of the three food insecurity indicators used in the Canadian Community Health Survey (2003) assessing ‘worry’ about not having enough food, not eating enough food and not having the desired quality of food because of insufficient finances in the previous 12 months. Results: Food‐insecure working poor persons had poor oral health compared with food‐secure working poor persons indicated by a higher percentage of denture wearers (P < 0.001) and a higher prevalence of toothache, pain and functional impacts related to chewing, speaking, sleeping and work difficulties (P < 0.001). Fewer food‐insecure persons rated their oral health as good or very good (P < 0.001). Logistic regression analyses showed that oral health disparities between food‐insecure and food‐secure persons related to denture wearing, having a toothache, reporting poor/very poor self‐rated oral health or experiencing an oral health impact persisted after adjusting for sociodemographic factors and access to dental care factors (P < 0.05). Food‐insecure working poor persons reported relinquishing goods or services in order to pay for necessary dental care. Conclusions: This study identified oral health disparities within an already marginalized group not alleviated by access to professional dental care. Working poor persons regarded professional dental care as a competing financial demand.     

The delivery of oral care services to elderly people living in a noninstitutionalized setting

Advances in medical science are enabling people to survive more illness and disability. As people live longer, their mobility and/or ability for self-care often are reduced by physical or mental disability and other chronic diseases. It may become unreasonable or impractical for them to access mainstream dental services. Increasing numbers of dentate elderly people with expectations of oral health higher than earlier cohorts of elderly people are likely to bring increasing demands to the dental profession for their continuing care. Thus, the oral care for disabled elderly people in noninstitutionalized settings may pose a challenge. The oral care options available to this group of people include the dental surgery/operatory, a mobile dental service, home-based or domiciliary dental care, a mix-and-match combination of surgery-based and domiciliary care, and cyberspace. Noninstitutionalized, disabled elderly people may have to rely on domiciliary care services for their oral health care. This paper explores the training implications, the necessary knowledge and skills base, the benefits and limitations to both the service provider and user, the equipment available, and the cost/funding of domiciliary dentistry. Domiciliary dental care services need to be developed by improving pre- and postdoctoral training programs and by establishing realistic remuneration for dental teams providing this care so that noninstitutionalized, disabled elderly people can access oral health care.     

Oral hygiene, dental visits and age of denture for prevalence of denture stomatitis

Abstract A representative sample of Finnish denture wearers (n= 3875) aged 30 or over were examined clinically and interviewed about their oral hygiene habits, use of dental services and possible prosthetic treatment during last visit to a dentist. Of these denture wearers, over 80% brushed their dentures at least once a day, and 16% visited a dentist at least once in 2 yr. For denture stomatitis the age-standardized risk ratio decreased with brushing frequency in women and increased in men. For frequency of dental visits the prevalence of denture stomatitis increased in both men and women when visits were made over 2-yr intervals. The prevalence of denture stomatitis was higher in the group with dentures over 1 yr old. It seems that the oral hygiene measures as they are generally carried out and regular dental visits are not effective enough methods in preventing denture stomatitis.     

Home care workers' oral health awareness and practice for disabled elderly]

The purpose of this study was to investigate the level of oral health awareness, and to explore the needs for home care workers to provide oral health care for disabled elderly. We conducted a questionnaire survey at two home-help service centers and a social welfare council. Subjects for this investigation were 63 home care workers. The results were as follows: 1. Ninety-six percent of home care workers thought it was necessary to provide oral health care for disabled elderly, but only 11 percent of them put oral care into practice on a daily basis. 2. From the results of a cause and effect diagram, necessities of oral care were summarized as six major causes: 1) Disabled elderly are often unable to brush their teeth, 2) The oral hygiene level may affect physical condition, 3) Disabled elderly should be protected from oral diseases, 4) Disabled elderly should have their mouths kept clean, 5) Eating and swallowing may become increasingly difficult, 6) Disabled elderly should take in adequate nutrition. 3. Sixty-eight percent of home care workers took part in a training course of nursing care including oral care. 4. Home care workers, dentists, dental hygienists, and nurses taught oral health care to home care workers. 5. From the results of a cause and effect diagram, there were three major items that home care workers want to know: 1) denture management, 2) the routine of oral care, 3) infection control. 6. Home care workers recognized that oral care should be provided by family members of disabled elderly or home care workers.     

Prosthodontics, care utilization and oral health-related quality of life

The main aim of this thesis was to study the impact of oral health and oral prostheses on oral health-related quality of life (OHRQOL) in an adult Swedish population. Additional aims were to study social inequalities in oral health, attitudes towards the cost for dental care and dental care utilization. The study base was 1294 responses to a questionnaire from a random sample of 1974 persons aged 50-75 years, all of whom were resident in the County of Skine, Sweden. There was an association between impaired dental conditions and poor social conditions. Low dental care utilization covaried with impaired dental conditions and with stating a perceived need to obtain dental care but with no possibility to obtain it because of a cost barrier. In factor analysis, three factors captured 22 variables that aimed to measure OHRQOL. The constituent variables were summed into three index variables interpreted as oral health impact on everyday activities, on a psychological dimension and on oral function. The three variables were set as dependent variables in regression models with the independent variables social attributes, individual attributes, dentures, number of teeth and dental care attitudes. The models were run in three steps taking into account the interaction between the type of denture and the number of remaining teeth. The number of remaining teeth was more important than the type of denture when explaining OHRQOL. The type of replacement, in terms of fixed or removable denture, was less important for those with few or no remaining teeth, than for all others. OHRQOL was also explained by general health in relation to age peers as well as by varying attitudes towards dental care costs. Statistically significant interactions were observed between the number of remaining teeth and the type of denture when explaining OHRQOL. As a whole the thesis shows that social and dental conditions and cost for dental care play a great role for dental care utilization as well as for OHRQOL. Prosthodontics has an important role, where type of replacement interacts with tooth loss in its effect on QOL.     

Improving access to oral health care in Florida

It is the position of the Florida Dental Association that every Floridian should understand that good oral health is important to overall health and well-being. Good oral health does not just happen; it is the result of both personal responsibility and professional care. The great majority of Floridians (more than 70 percent) receive high quality dental care. Unfortunately, that is not where the story of Florida's oral health ends. For the other approximate 30 percent of Floridians, the system is broken. Only 23.5 percent of Medicaid enrolled children and 11 percent of Medicaid adults receive any dental care annually. This White Paper explains the barriers to accessing dental care in Florida, what is currently being done to address the problem, and what solutions exist that, if implemented in totality, could improve the oral health of millions Floridians. Lack of access to care is the result of many factors, including patients' preceived need for care, lack of oral health literacy, geographic distribution of dentists and dental teams, financial support for care and transportation challenges to name a few. It is important that government, dental professionals, and advocates work together to identify and address the many barriers to access to care.     

Oral disease in the elderly in long-term hospital care

OBJECTIVE: To obtain baseline information on the prevalence of oral problems and disease in institutionalized elderly in a Scottish hospital.
DESIGN: A cross-sectional clinical investigation with complementary microbiological studies as appropriate. SUBJECTS AND METHODS: A cohort of 147 elderly in five long-term care wards; collection of demographic data; clinical examination to determine: i) the dental, and denture status and associated lesions such as Candida-associated denture stomatitis and angular cheilitis, ii) oral mucosal disease; swabs as appropriate for microbiology.
MAIN OUTCOME MEASURES: Dental status, root caries prevalence; denture status and hygiene, and associated disease; oral mucosal health.
RESULTS Median period of institutionalization of 147 patients was 15 months and 65% were aged 80 years or more; the majority were significantly mentally impaired; 52% wore complete dentures, 9% were partially dentate, 19% possessed partial or incomplete dentures; 20% were neither dentate nor had dentures. Of 80 patients who verbalired their complaints, 35% complained of dry mouth and 45% had denture-related problems, principally discomfort. The commonest oral finding was a coated tongue (56%); angular cheilitis was present in 25%, and Candida-associated denture stomatitis in 19%; none had oral ulcers.
CONCLUSIONS: There was considerable unmet dental need with significant oral disease and poor levels of oral and denture hygiene in this target group; both dental and medical professionals should act in concert to deliver curative as well as preventative dental care for the elderly living in institutions to improve their quality of life.     

Self-reported oral health perceptions of Somali adults in Minnesota: a pilot study

Abstract: Objective: To assess self‐reported oral health perceptions and associated factors in an adult Somali population living in Minnesota, USA. Methods: We analysed data from a cross‐sectional study of Somali adults aged 18 to 65+ years attending a dental school clinic for care. A comprehensive oral examination was performed by the dental school outreach team on all patients who attended a 2‐week designated Somali dental clinic. Adults who consented were given an oral health questionnaire to collect information on sociodemographics, marital status, language preference and self‐rated oral and general health. We performed summary statistics and differences between proportions using Fisher’s exact test and a comparison of means using one‐way anova or a two‐sample t‐test. Results: The sample consisted of 53 adults, 75% of whom were females. About 49% of subjects reported poor/fair oral health and 38% reported poor/fair general health. Seventy‐four percent rated their access to dental care as poor/fair and 83% reported that they did not have a regular source of dental care. Self‐rated oral health was significantly associated with marital status (P < 0.05) and self‐rated general health (P < 0.01) using Fisher’s exact test. Conclusion: A substantial proportion of Somali adults rated their oral health and access to dental care as poor/fair. These findings suggest that this population would benefit from improved access to oral health care and culturally appropriate oral health education and promotion programs.     

Dental screening of long stay geriatric patients in West Essex and recommendations for their care

A dental screening programme at a West Essex Health Authority hospital provided data from 151 in-patients, most of whom were in long-stay geriatric care. 71 per cent were female and the mean age of the geriatric patients was 81 years. 61 subjects (40 per cent) suffered predominantly from mental illness. 107 subjects (71 per cent) were edentulous but a higher proportion of elderly mentally ill patients (42 per cent) had retained some of their natural teeth compared with 20 per cent of the others. 26 edentulous subjects were not in possession of any dentures and the standard of oral and denture hygiene was poor. 59 in-patients (39 per cent) had 'expressed' need for dental treatment and a further 51 (34 per cent) were unable or unwilling to communicate their need. An important aspect of their dental care was the provision and maintenance of a preventive dental programme for both dentate patients and denture wearers.     

Geriatric oral health issues in Australia

Aim : To identify and discuss geriatric oral health issues in Australia. Methods : A discussion of the demographic trends, oral health trends, and barriers to dental care for older Australians is presented, together with a review of Australian public and private sector geriatric dental services, geriatric dental research, and geriatric dental education. Conclusions : Key geriatric oral health issues for Australia include: edentulism is decreasing and older Australians are retaining more natural teeth; coronal and root caries are significant problems, especially as older adults become more functionally dependent, cognitively impaired, and medically compromised; the oral health status of institutionalised older Australians is poor; the onset of severe oral diseases appears to occur in many older Australians prior to their institutionalisation, when they are homebound and dependent upon carers; carers of older adults do not have access to practical education about dental care; the majority of older Australians are eligible to use public‐funded dental services, but barriers limit their access to these services; few Australian public or private dental services are designed with a geriatric focus; geriatric dental education does not have a high profile in Australian dental schools; no specialty exists in Australia for geriatric dentistry, nor is there a national geriatric dentistry association.     

Professional monopoly, social covenant, and access to oral health care in the United States

Lack of access to oral care is a severe problem in the United States with over one-third of the population lacking dental insurance. In this group, 32 million people lack dental insurance and access to public dental services (Medicaid or Medicare), and 7 million of them need dental care. In some high-risk populations, such as Native Americans, two-thirds have unmet dental needs. Only 1 percent of Medicaid-eligible babies have a dental examination before twelve months of age. In this paper the social covenant of the dental profession is examined and suggestions made for improving access to care through improved efficiency. It is proposed that 1) private dentists should accept 5 percent per annum of their patients for indigent care funded by improved efficiency from utilizing allied dental providers (ADP) in new roles, and 2) ADP should have their own independent state boards. If dentists refuse to honor their social covenant, then ADP should be allowed to practice independently, breaking the professional monopoly.     

Tooth loss, denture wearing and oral health-related quality of life in elderly Chinese people

OBJECTIVES: To investigate the relationship between tooth loss, denture wearing and oral health-related quality of life (OHQoL) among community-dwelling elderly people in Hong Kong. METHODS: A questionnaire study of elderly people aged 60-80 years who were recruited at neighborhood social centres for the elderly. The Chinese version of the General Oral Health Assessment Index (GOHAI) was used and information about natural tooth number and denture wearing were obtained. RESULTS: 233 elderly subjects were recruited and interviewed. Around 20% of the partially dentate subjects had their last tooth loss within the previous year and a quarter within the last five years. Significantly fewer edentulous subjects had their last tooth loss within the previous year (3%) and within the last five years (12%, p < 0.001). Twenty two percent of the subjects had difficulty in accepting tooth loss. More edentulous subjects (69%) were satisfied with their dentures than partially dentate denture wearers (37%, p < 0.001). Edentulous elderly subjects had a higher mean GOHAI score (53.0) than partially dentate denture wearers (49.1, p < 0.001). Results from a multiple factor ANOVA revealed that elderly subjects who had loose teeth, difficulty in accepting tooth loss and were not satisfied with their removable dentures had a lower mean GOHAI score. CONCLUSIONS: In general, tooth loss and denture wearing did not have a major impact on OHQoL in elderly Chinese people. However, partially dentate denture wearers experienced a greater adverse impact on OHQoL than edentulous subjects most probably due to less satisfaction with their dentures and discomfort associated with loose teeth.     

Effectiveness of oral health care--some Danish experiences.

The paper presents an overview of the oral health situation in Denmark with consideration to the effectiveness of dental health care services to children, adolescents, and adults. According to the Act on Dental Health consolidated in 1986, the Municipal Dental Service provides systematic preventive and curative care free of charge to the child population and adolescents. The adults are responsible for a substantial part of the payments at the private dental practitioners but some of the payments, in particular the curative services, are covered by the National Health Insurance Scheme. The Municipal Dental Service is attended by nearly 100%. In order to plan and evaluate the service, a standardized recording system has been established. Thereby, national oral epidemiological data have been provided since 1972. Partly due to the preventive approach, a general decrease over-time in the prevalence of dental caries has been documented for children and adolescents. For example, in 1972 children in first class had a mean caries experience of 12.4 def-s against 3.9 def-s in 1990. Moreover, the distribution of dental caries has become even more skewed which means that an increasing number of the children are free of caries while a limited number of the children still show a significant caries experience. According to interview data from 1987, 72% of the adult population 16 years of age and above reported regular dental visits at least once a year. The proportion of regular dental visitors were high in 16-24-years-old (92%) but lower in the age group 65-74 (35%). In 1982, clinical epidemiological data were collected as part of a national oral health survey. The results indicated that the amount of untreated dental caries and the number of missing teeth were significantly lower among regular dental visitors than irregulars. As to periodontal health, treatment needs were also prominent among regular dental visitors. In a longitudinal survey, over-time changes in the occurrence of denture wearers have been observed. In 1976, 30% of the 35-44-year-olds were denture wearers against 11% in 1986. One important finding from this survey was that social inequality in oral health seems to be reduced in younger adults. Finally, experiences from implementation of health education and preventive dental care in industrial settings are discussed, and the health outcome of a comprehensive public dental health care programme for old-age pensioners is reviewed.