Oral health care for patients with Alzheimer's disease: An update

Alzheimer's disease and related disorders (ADRD) are among the age‐associated chronic conditions that are most challenging to health care systems around the globe, as patients with dementia require full‐time, intensive care for multiple years. Oral health care is negatively impacted by cognitive decline, and consequently poor oral health is common among people with ADRD. Poor oral health status is linked with many undesirable consequences for the well‐being of people with ADRD, from excruciating local pain to life‐threatening conditions, as aspiration pneumonia. In this paper, the authors provide an update on the most current concepts about Alzheimer's disease epidemiology, etiology, and management, current oral health care for patients with Alzheimer's disease, oral health promotion strategies for this population, as well as current research and future direction for improving oral health care for patients with Alzheimer's disease. It concludes that oral health care should be included in the patient's routine health care as early as possible in the progression of Alzheimer's disease for preventing rapid oral health deterioration. Establishing oral hygiene routines and providing dental treatment that is customized to the patients’ individual needs and disease stage are important to achieve good oral health outcomes and prevent quality of life decline.     

The prevalence and experience of oral diseases in Adelaide nursing home residents

BACKGROUND: The twenty-first century will see the evolution of a population of dentate older Australians with dental needs very different from those of older adults in past years. This study provided comprehensive information concerning oral disease prevalence in older South Australian nursing home residents. METHODS: This paper presents cross-sectional baseline results. RESULTS: Most of the 224 residents, from seven randomly selected nursing homes, were functionally dependent, medically compromised, cognitively impaired and behaviourally difficult older adults who presented many complex challenges to carers and to dental professionals. Two-thirds (66 per cent) were edentulous with many dental problems and treatment needs. Dentate residents had a mean of 11.9 teeth present, higher than previously reported. The prevalence and experience of coronal and root caries and plaque accumulation was very high in dentate residents; especially males, those admitted more than three years previously, those who ate fewer food types and those who were severely cognitively impaired. These residents had more retained roots, decayed teeth and missing teeth, and fewer filled teeth when compared with data for community-dwelling older adults. CONCLUSIONS: This study highlighted the poor oral health status of these nursing home residents and the great impact of dementia on their high levels of oral diseases.     

Oral health care for nursing home residents in The Netherlands – a national survey

Abstract – In order to be able to develop adequate oral health care programs for nursing home residents in The Netherlands, currently available arrangements and problems experienced by dentists participating in this field of dentistry were evaluated in a national survey. One questionnaire was mailed to the managements of all nursing homes and a second to all dentists known to be involved in nursing home dentistry. The response rates were very high. The study indicated that, in almost every nursing home, dental care for residents was available, at least in cases of dental emergency. On average the dentists were spending only limited time on nursing home dentistry. The majority of dentists examined or treated the residents only when either the patients or others experienced or discovered an oral health problem. In delivering this kind of care the dentists experienced a lot of problems. These findings suggest that the oral health care for nursing home residents in The Netherlands must be evolved by research, special training of dentists, and through development of special care programs.     

株州市老干部口腔健康状况初步调查

目的：了解株州地区老干部群体口腔卫生及健康状况。方法：在株州地区对487名老干部进行口腔卫生知识问卷及口腔健康调查。结果：患龋率54．4％，龋均2．9；龈萎缩和牙松动的患病率分别是72．8％和29．3％；牙缺失率72．9％，缺牙均数7．1；义齿修复率47．9％，义齿修复不合格率23．5％。结论：提高老年人口腔卫生保健意识，重视老年人牙病的防治，应作为开展社区口腔预防工作的一个重要内容。     

太原市养老机构老年人口腔健康状况的调查分析

目的了解太原市养老机构老年人的口腔保健意识及其健康状况,以针对性地开展口腔疾病的防治,提高养老机构老年人的生活质量。方法随机抽取太原市6个行政区48所养老机构内的359名老人,分别对口腔保健意识、态度及行为设计问卷调查,并进行口腔检查,所得数据通过SPSS 20.0软件进行统计分析。结果太原市养老机构老年人口腔保健意识欠缺,保健行为不规范,口腔健康状况除受刷牙习惯及口腔不良习惯的显著影响,尚与年龄、受教育程度等因素相关,55～64、65～74岁年龄组每日刷牙、曾有过口腔就诊经历的比例均低于第四次全国口腔流行病学调查数据,而无牙颌比率、缺牙未修复比率均高于同年龄组全国平均水平。结论太原市养老机构内老年人自我口腔保健意识及口腔健康状况较差,应有计划、有目的地对其开展口腔卫生宣教,帮助其养成良好的口腔卫生行为习惯,养老机构应定期开展口腔卫生检查诊疗服务,以改善老年人口腔健康状况,提高生活质量。     

Oral health status in individuals with dementia living in special facilities

Abstract:  Aim:  The aim of this review was to retrieve data describing the oral health status of individuals with dementia living in special facilities. Materials and methods:  A literature search on the MEDLINE database (Entrez PubMed) was performed. The literature search yielded 208 papers, of which seven publications were selected for evaluation. Results:  From the available studies poorer oral hygiene, decreased saliva flow rates and a higher caries incidence were reported in individuals with dementia living in special facilities when compared with healthy individuals. Oral health problems were more pronounced in the severe stage of the disease. Conclusions:  There is limited scientific data describing the oral health status of individuals with dementia living in special facilities. However, available data indicate that individuals with dementia living in special facilities have more oral health problems than individuals without dementia.     

Molecular and immunological evidence of oral Treponema in the human brain and their association with Alzheimer's disease

The purpose of this investigation was to use molecular and immunological techniques to determine whether oral Treponema infected the human brain. Pieces of frontal lobe cortex from 34 subjects were analyzed with species-specific PCR and monoclonal antibodies. PCR detected Treponema in 14/16 Alzheimer's disease (AD) and 4/18 non-AD donors (P < 0.001), and AD specimens had more Treponema species than controls (P < 0.001). PCR also detected Treponema in trigeminal ganglia from three AD and two control donors. Cortex from 15/16 AD subjects and 6/18 controls contained Treponema pectinovorum and/or Treponema socranskii species-specific antigens (P < 0.01). T. pectinovorum and/or T. socranskii antigens were also found in trigeminal ganglia and pons from four embalmed cadavers, and 2/4 cadavers also had Treponema in the hippocampus. These findings suggest that oral Treponema may infect the brain via branches of the trigeminal nerve.     

Evaluation of the implementation of an 'oral hygiene protocol' in nursing homes: a 5-year longitudinal study

De Visschere L, de Baat C, Schols JMGA, Deschepper E, Vanobbergen J. Evaluation of the implementation of an ‘oral hygiene protocol’ in nursing homes: a 5‐year longitudinal study. Community Dent Oral Epidemiol 2011; 39: 416–425. © 2011 John Wiley & Sons A/S Abstract – Objectives: To explore the long‐term effects of the implementation of an oral hygiene protocol in nursing homes. Methods: Out of 14 nursing homes (Flanders) seven nursing homes were randomly allocated to the intervention group and confirmed to implement an ‘oral hygiene protocol’. The remaining nursing homes (the control group) continued to perform oral hygiene as usual. Oral hygiene levels were scored and factors related to plaque levels were recorded. Mixed model analysis with random institution effect, were performed to explore differences in oral hygiene levels owing to the intervention, and the predictive value of explanatory variables. Results: At baseline, no significant differences were found between plaque levels in both study groups. In an unadjusted analysis, different effects were observed on denture and dental plaque. The lowest denture plaque levels were found 2 years after the start of the study, while the lowest dental plaque levels were found at the end of the study. The effect of the intervention could not be confirmed in an adjusted mixed model, where significant indicators for dental plaque were resident’s dependency (P < 0.01) and presence of mouth rinse (P < 0.01). Capacity of the nursing home (P < 0.05) and the presence of toothpaste (P < 0.01) were dominant influencing factors for denture plaque. Conclusions: After 5 years of implementation obtained plaque levels were unsatisfactory. A lot of uncertainties remained on the impact of characteristics of individual nursing homes. Obtaining adequate oral hygiene levels in nursing homes remain an important ongoing challenge and needs further research.     

天津市部分老年干部口腔健康状况调查报告

目的：了解分析天津市部分老年干部的口腔健康状况，并评价全身因素对其的影响。方法：对参加2004年体检的769名大干60岁的天津市老年干部的121腔状况及全身情况进行调查，结果用SPSS10．0软件处理。结果：该人群患龋率为71．78％，人均失牙6．38颗，牙龈炎患病率为52．27％，牙周炎患病率为27．18％，全口失牙的人群占5．33％。年龄是失牙和龋患的危险因素，而年龄和吸烟程度是牙周病和全口失牙的危险因素，全身疾病种类数对该人群口腔状况的影响不大。结论：该人群口腔健康状况不容乐观，我们应大力普及口腔健康教育。     

Accessibility to oral health care for people on social assistance: a survey of social service providers from Public Welfare Centers in Flanders

Objectives: The goals of the present study were as follows: (i) to explore the characteristics of the Flemish Public Centers for Social Welfare (PCSW) concerning oral health care; (ii) to explore possible barriers experienced by people on social assistance and oral health-care providers; and (iii) to explore the accessibility of general and oral health care for people on social assistance. Methods: The data of this cross-sectional study were obtained by a survey of social service providers working in a PCSW. For this purpose, a new questionnaire was developed. The survey was validated by means of a pilot study. All 306 PCSWs in Flanders were invited to participate in this survey, of which 192 (62.7%) responded. Results: The findings demonstrate that for people on social assistance, financial limitations and low prioritisation of oral health are the main barriers to good oral health care. The study reveals that such individuals experience greater financial barriers and poorer access to a dentist than to a general medical practitioner. The study also reveals that dentists report financial concerns and administrative burdens as the main barriers in treating this subgroup. The responses of PCSWs demonstrate that local dentists are reluctant to treat this subgroup. Conclusion: Additional efforts are needed to improve the accessibility of oral health care for people on social assistance. Recommended improvements at the organisational level could improve increased education to target the population on the importance of oral health care. Administrative burden and financial concerns of the providers also need to be addressed to decrease their reluctance to work with those on social assistance.Key words: Oral health care for people on social assistance, oral health care for asylum seekers, oral health care for undocumented immigrants     

广西65-74岁人群口腔健康行为抽样调查

目的：了解广西65-74岁城乡人群口腔卫生行为、口腔卫生服务利用等情况,为广西口腔卫生保健工作提供信息支持。方法：对广西壮族自治区65-74岁城乡常住人口430人进行口腔健康问卷抽样调查。结果：广西87.21%的65-74岁老年人每天刷牙,城市为95.33%,农村为79.17%,城市好于农村（P〈0.001）。近半数（48.84%）认为自己牙齿健康状况不好,但绝大部分（88.84%）不愿意主动就医。有46.28%的老人从未看过牙,城、乡分别为17.76%、74.54%,农村高于城市（P〈0.05）。结论：广西部分65-74岁老年人未建立口腔健康行为,大部分老人对自身口腔疾病及危害认识不足,未能充分利用现有的口腔卫生资源,城乡差别较大。     

An intervention to reduce care‐resistant behavior in persons with dementia during oral hygiene: a pilot study

The primary purpose of this pilot study was to test the feasibility of an intervention designed to reduce care‐resistant behaviors (CRBs) in persons with moderate‐to‐severe dementia during oral hygiene activities. The intervention, Managing Oral Hygiene Using Threat Reduction (MOUTh), combined best oral hygiene practices with CRB reduction techniques. Oral health was operationalized as the total score obtained from the Oral Health Assessment Tool (OHAT). CRB was measured using a refinement of the Resistiveness to Care Scale. Seven nursing home residents with dementia received twice daily mouth care for 14 days. The baseline OHAT mean score of 7.29 (SD = 1.25) improved to 1.00 (SD = 1.26, p < .001); CRB improved from 2.43 CRBs/minute (SD = 4.26) to 1.09 CRBs/minute (SD = 1.56, t = 1.97, df 41, p= .06). The findings from this pilot study suggest that the MOUTh intervention is feasible and reduced CRBs, thus allowing more effective oral care.     

Status of oral healthcare in long-term care facilities

Oral health is a fundamental component in the overall well-being and quality of life for elders living in long-term care facilities. Effective oral care interventions must not only involve recognising the importance of oral health in this population, but giving oral hygiene the same priority as other care practices in long-term care settings.     

Oral health problems and needs of nursing home residents

Kiyak HA, Grayston MM, Crinean CL: Oral health problems and needs of nursing home residents.
Abstract – The problem of dental neglect and high levels of unmet dental needs among elderly residents of long term care facilities has been widely documented in literature. A survey was conducted of 1063 residents in 31 nursing homes throughout Washington (representing 11% of all facilities in the slate). The greatest single need among dentate elderly was for routine oral hygiene (72%), while for denture wearers adjustment of loose dentures was the primary need (46.4%). Periodontal problems were slightly more prevalent than root caries (43%) and 36% respectively) among dentate elderly. Dry mouth was found in 10% of residents. Oral conditions were worse in larger facilities located in rural and moderate size communities, and those under a proprietary corporation. These results suggest that daily oral hygiene and regular check-ups by a dental professional are most needed by frail elderly, especially in large, proprietary homes in rural and moderate size communities. Education of nursing home staff and the elderly themselves in the importance and methods of home care are also critical needs.