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.     

Do Root Lesions Tend to Develop in the Same People Who Develop Coronal Lesions?

Objectives : The three purposes of this study are to: (1) describe the relationship between the prevalence of coronal caries and root caries; (2) describe the relationship between the three-year incidence of coronal caries and root caries; and (3) if the two conditions are associated, develop a multiple regression model that identifies characteristics distinguishing people who had increments of both root caries and coronal caries from people who had increments of either coronal caries or root caries, or who had no new caries. Methods : Dental examinations and interviews were conducted in the homes of a randomly selected, stratified sample of people over the age of 65 years in five North Carolina counties. The relationships between coronal and root D and DF were analyzed through contingency table analyses, and ordinal logistic regression was used to identify characteristics that differentiated people who had both coronal and root D over the three years from people who had either coronal or root D and people who had no new disease. Results : Evidence of root and coronal caries in whites was much more likely to be in the form of fillings, while for blacks, it was more likely to be in the form of untreated decay. Prevalence rates of coronal and root D and DF were significantly associated for both blacks and whites. Incidence rates based on DF indicated that root and coronal caries were not associated in whites, but were associated in blacks. People more likely to experience both types of caries had more gingival recession at baseline, greater average attachment loss over the three years, and lactobacilli at baseline. In addition, the presence of Porphymonas gingivalis at three years was important for whites. Conclusion : It appears that coronal and root caries do tend to appear together in the same individuals, but fillings attenuate that relationship. The impact of dental treatment on the epidemiology of dental caries appears to be considerable and calls into question whether the F component of the caries index is related to disease as defined by epidemiologic criteria.     

Factors associated with caries incidence in an elderly population

The purpose of this paper was to identify baseline factors associated with future caries development in older adults (age 60) during a 3-year study period. Poisson regression analysis was used to determine the association between potential risk factors and disease incidence. The significant factors associated with high coronal caries incidence rates were high baseline root DMFS ( P < 0.001), high counts of mutans streptococci and lactobacilli ( P =0.036), male geder ( P =0.007), and Asian ethnicity ( P < 0.002). These factors had small to moderate effects on incidence rates, with relative risk values of approximately 1.2 to 2 The significant factors associated with higher disease incidence on root surfaces were baseline coronal DMFS (marginally significant, P =0.078), high bacterial counts ( P =0.002), and Asian ethnicity ( P =0.009). The predictive value of the models was low for both coronal and root caries. This result may be because this population had a higher than usual caries incidence rate, making discrimination among these caries-active individuals difficult. The current study affirmed the value of baseline DMFS and salivary variables to modeling caries incidence and introduced ethnicity as a variable useful for the study of dental caries in older adults.     

Incidence of root caries in an older Canadian population

Abstract This paper reports the results of a longitudinal study of Canadians aged 50 years and over which was designed to estimate the three-year incidence of root caries. At baseline, 699 randomly selected dentate subjects were clinically examined and 493 were examined again after three years. Over this period 27.4% had one or more root DFS increments and the mean DFS increment was 0.6 per person. Because DFS increments overstate root caries incidence DS increments were also calculated. Relatively few baseline variables were associated with either DFS or DS increments. In logistic regression analyses, age was the only variable associated with one or more root DFS increments, while age, dental visiting pattern and wearing a partial denture were associated with one or more root DS increments. In both cases, the predictive power of the models was poor but improved marginally when baseline root caries experience was also entered as an independent variable.     

Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes

BACKGROUND: The complex oral health problems of nursing home residents have been well documented. However, the influences on residents' oral health status, including opinions and experiences of dental professionals and nursing home staff, have not yet been adequately investigated. METHODS: The baseline questionnaire component of this longitudinal study was mailed to all registered dentists practising in Adelaide and Adelaide nursing home directors of nursing (DONs). RESULTS: 413 dentists and 97 DONs indicated that Adelaide dentists' interest and training in nursing home dentistry was low. Dental service provision for nursing home residents was very low and dentists preferred to provide treatment at their dental practices. Few dental hygienists were working in nursing homes and dental professionals provided little educational assistance for nursing home staff. Dentists and DONs held several common and many varying perceptions of the problems associated with dental care provision in nursing homes. Both identified a group of nursing home environmental constraints and a lack of portable dental equipment. DONs further identified a group of resident related problems, and dentists a group of dental practice-related problems. CONCLUSIONS: These study results provide important information concerning problems with nursing home dentistry for dental service providers, educators, policy-makers, administrators and nursing home staff.     

Incidence of Coronal and Root Caries in an Older Adult Population

Incidence rates for new root caries and new coronal caries in noninstitutionalized older adults are unknown. In this study, a representative sample of 451 elderly Iowans received dental examinations at the start of the study and again after 18 months. This dentate cohort had a mean of 0.87 new surfaces of coronal decay per person per year and a mean of 0.57 new surfaces of root decay per person per year. Coronal caries occurred at an annual rate of 1.4 surfaces per 100 susceptible coronal surfaces. Root caries occurred at an annual rate of 2.6 surfaces per 100 susceptible root surfaces. This study shows that both coronal and root caries were active in this older population, indicating a need for emphasis on the prevention and treatment of dental caries in older adults.     

Dental caries experience in older people over time: what can the large cohort studies tell us?

BACKGROUND: Little was known of the natural history of dental caries among older adults until recently, but reports from a number of large cohort studies have now enabled better understanding of the nature and determinants of dental caries in older people. The aim of this review is to examine and compare findings from established population-based longitudinal studies of older adults in order to determine their preventive implications. METHODS: The dental literature was reviewed in order to identify reports on dental caries incidence from large, population-based dental longitudinal studies of older adults (age 50+) with at least 3 years of follow-up. RESULTS: Reports were identified from four studies (in Iowa, North Carolina, Ontario and South Australia) which met the criteria; four reports dealt with coronal caries, and five with root surface caries. When annualised, coronal and root surface caries increments were combined and compared with those reported for adolescents, the caries experience of older people over time (between 0.8 and 1.2 new surfaces affected per year) exceeded that reported from cohort studies of adolescents (between 0.4 and 1.2 surfaces per year). The only caries risk factor common to all four studies was the wearing of a partial denture (for root surface caries only). CONCLUSIONS: Older people are a caries-active group, experiencing new disease at a rate which is at least as great as that of adolescents. PRACTICE IMPLICATIONS: Dentate older people should be the target of intensive monitoring and preventive efforts at both the clinical practice and public health levels. There is no easily identifiable 'magic bullet' for preventing caries in that age group, but the use of evidence-based preventive interventions (such as fluoride) should suffice.     

Eighteen-month Coronal Caries Incidence in North Carolina Older Adults

In this longitudinal study of a random sample of North Carolinians over the age of 65 and living in their homes, 325 blacks and 280 whites were examined and interviewed 18 months after baseline examinations. Coronal caries incidence was greater among whites than blacks. The increment due to teeth becoming root fragments were similar for both races; however, there were more newly crowned teeth among whites. Newly crowned surfaces were not used as part of the caries increment in logistic regression models to investigate potential risk predictors. For blacks, caries development over the 18-month period was associated with a higher lactobacillus score and more coronal caries at baseline, more previously filled coronal surfaces, and lack of active membership in clubs or other groups. For whites, having no self-reported tooth sensitivity, having a lower socioeconomic index score, taking antihistamine medications at baseline, and having the perception of more problems after the age of 40 than before were all associated with the development of coronal caries.     

Root Caries Prevalence in Black and White North Carolina Adults over Age 65

The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.     

Effect of Residence in a Fluoridated Community on the Incidence of Coronal and Root Caries in an Older Adult Population

Eighteen-month caries incidence among older adult residents of fluoridated and nonfluoridated communities was compared. Rates for both coronal and root caries were consistently lower among long-term residents of the fluoridated communities than among life-long residents of nonfluoridated communities. Coronal caries incidence was significantly lower for people who had resided in fluoridated communities for more than 30 years (1.95 vs 1.33 surfaces). Root caries incidence was significantly less among residents for more than 40 years (0.56 vs 1.11 surfaces). Fluoridation appeared to be beneficial for the older adults examined, even though the exposure to fluoridated water began in adulthood.     

Reduction in caries rate among patients with xerostomia using a power toothbrush

The purpose of this study was to evaluate whether the use of a Sonicare*** toothbrush could be beneficiai in reducing coronal and/or root caries among patients with medication-induced xerostomia.
Eighty subjects with drug-induced xerostomia using either a Sonicare toothbrush (SC) or a manual toothbrush (MTB) were included in the study. Control subjects using a MTB were frequency-matched to 40 subjects using a SC, based on age, gender, number of teeth at baseline, and salivary flow rates. Subjects were individually matched according to the type of xerostomic medication they were taking. Caries were assessed at baseline, and subjects were instructed to have carious teeth restored. Summary statistics were assessed and computed by treatment group for incipient and frank coronal and root caries after one year. Statistical comparisons of the number of frank and incipient coronal and root caries between treatment groups were conducted using paired t -tests.
After one year of use, the numbers of incipient and frank root caries were significantly lower among subjects using SC compared to subjects using MTB. Subjects using SC also exhibited somewhat lower incipient and frank coronal caries than subjects using MTB, although their differences were not statistically significant.
The authors concluded that the Sonicare toothbrush may be beneficial in reducing root caries among older adults with medication-induced xerostomia.     

Predictors of root caries in the elderly

In an attempt to determine the association between overall health status, medication history, and oral hygiene status and root caries, 24 older persons residing independently in the community and 23 residents of a nursing home were interviewed and received oral examinations, using the Oral Hygiene Index and the Root Caries Index. The mean age of this population was 80 yr, with the nursing home subjects somewhat older than community-dwelling subjects. Only six persons had no root surface caries; three subjects had caries on all tooth surfaces with gingival recession. Mandibular teeth, particularly molars and premolars, showed the greatest attack rate. The best predictors of root caries were number of teeth remaining, calculus, plaque, and the use of medications with xerostomic effects. Medications were most predictive of maxillary root caries. The results point to the need to provide interceptive dental therapeutics for high risk geriatric populations such as those using multiple medications and with a poor history of oral care.     

The incidence of dental caries in children and adolescents who have cerebral palsy and are participating in a dental program in Brazil

The aim of this study was to describe the incidence of caries among children and adolescents who have cerebral palsy. The authors conducted baseline and follow‐up dental examinations of 118 children and adolescents with cerebral palsy in a specialized healthcare unit in São Paulo, Brazil. Family care‐givers completed a questionnaire that provided socioeconomic and behavioral information. The analysis used multivari‐ate Poisson regression models adjusted for age. More than half (52.5%) of the subjects had at least one permanent or deciduous tooth affected by new caries during the longitudinal assessment (2004–2008). The incidence of caries was associated with the baseline prevalence of caries (incidence ratio = 1.92), a higher frequency of sugar intake (IR = 1.56), and having at least one sibling (IR = 1.64). Participants whose family care‐givers had more education had a significantly lower incidence (IR = 0.68). The factors associated with a higher incidence of caries are similar to those in the general population. This evidence can potentially be used to develop an effective oral health promotion program for these patients.     

Distribution of coronal and root caries experience among persons aged 60+ in South Australia

This report provides epidemiological data describing caries experience among the population of noninstitutionalized older adults in Adelaide and Mt Gambier. Subjects were selected in a stratified random sample of persons aged 60+ who were listed on the South Australian Electoral Database. Oral examinations were conducted by four calibrated dentists among 853 dentate persons aged 60 years and over. There was an average of 14.7 missing teeth, 8.3 filled teeth and 0.3 decayed teeth, and a further 0.2 teeth were present as retained roots. The mean number of missing teeth was higher (p<0.05) in older compared with younger age groups, and in Mt Gambier compared with Adelaide. The mean DFS of 22.1 was significantly higher (p<0.05) among younger persons, females and in Adelaide. Root surface caries affected an average of 3.1 surfaces, and was greater (p<0.05) among persons aged 70–79 years, males and Adelaide residents. However, when root caries was expressed as an attack rate per 100 exposed surfaces, differences were statistically significant only among age groups. Analysis of specific teeth revealed that no more than 40 per cent of molars were retained, and between 30 and 58 per cent of retained molars had coronal fillings.     

Twenty-four month coronal caries incidence: the role of dental care and race

OBJECTIVES: To describe for a diverse sample of dentate middle-aged and older adults: (1) the 24-month incidence of coronal caries, and (2) its association with a broad range of clinical, behavioral, financial, attitudinal, and sociodemographic factors. METHODS: The Florida Dental Care Study is a prospective observational longitudinal cohort study of 873 persons who at baseline had at least 1 tooth and were 45 years or older. In-person interviews and clinical examinations were conducted at baseline and 24 months, with 6-monthly telephone interviews between those times. A multinomial logistic regression was done to predict whether a participant was in one of four mutually exclusive groups at the 24-month examination (new decay only [NDO]; new filling(s) only [NFO]; both new decay and filling(s) [BOTH]; or neither [NONE]). RESULTS: Only 33% of the 24-month participants were in the NONE group. There was no significant difference in caries incidence between regular attenders and problem-oriented attenders, regardless of whether teeth crowned at baseline, incident crowns, or incident root fragments were excluded. However, once differences in incident tooth loss and baseline clinical, behavioral, financial, and attitudinal differences were taken into account, regular attenders did appear to benefit by developing fewer coronal lesions and fewer dental symptoms than problem-oriented attenders. Baseline carious surfaces, filled surfaces, number of teeth, and bulk restoration fractures predicted caries incidence, but baseline cusp fractures did not. Persons with negative dental attitudes were more likely to be in the NDO and BOTH groups, and negative attitude toward brushing and flossing (but not their frequency) also predicted caries incidence. CONCLUSION: Certain baseline clinical conditions, approach to dental care, ability to pay for dental care, dental attitudes, race, and age group were predictive of coronal caries incidence, and regular attenders appeared to benefit from regular attendance.     

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.     

Oral health in older adults with dementia living in different environments: a propensity analysis

This study was to compare oral health in dementia patients living in different environments. One hundred two dementia patients living in the community, assisted living facilities and nursing homes (NH) were retrospectively selected from a community‐based dental clinic. Participants’ sociodemographics, medical, dental, functional, and cognitive assessment were documented at arrival. Poisson and negative‐binomial regressions were developed to assess impacts of residential status on the number of missing teeth and number of caries/retained roots, respectively. Oral health was poor in study participants, regardless of their residential status. Nearly 30% of NH residents were edentulous, about two times higher than those in the community. Dentate participants averaged about 5.9 caries/retained roots at arrival. Forty‐four percent of community‐dwelling participants and 54% of NH residents presented with five or more caries/retained roots. Holding other factors constant, living environment was not associated with oral health measures, indicating oral health had declined in dementia patients before they were placed into NH.     

Prospective study of 5-year caries increment among children receiving comprehensive dental care in the New England children's amalgam trial

Abstract – Objective: To measure the 5‐year caries increment among high‐risk children during their participation in the New England Children’s Amalgam Trial (NECAT), and to evaluate sociodemographic factors that may account for any observed disparities. Methods: NECAT recruited 534 children aged 6–10 with at least two decayed posterior occlusal surfaces from urban Boston and rural Maine. After restoration of baseline caries and application of sealants to sound surfaces, NECAT continued to provide free comprehensive semiannual dental care to participants. The net caries increment of children who completed the 5‐year follow‐up (n = 429) was calculated and predictors of caries increment were investigated using multivariate negative binomial models. Results: The majority of children (89%) experienced new caries by the end of the 5‐year follow‐up. Almost half (45%) had at least one newly decayed surface by the first annual visit. At year 5, the mean number of new decayed teeth was 4.5 ± 3.6 (range 0–25) and surfaces was 6.9 ± 6.5 (range 0–48). Time trends showed a noticeably higher increment rate among older children and young teenagers. Multivariate models showed that age (P < 0.001), number of baseline carious surfaces (P < 0.001), and toothbrushing frequency (<1/day versus ≥2/day, P = 0.04) were associated with caries increment. Only 48 children (11%) did not develop new caries. Conclusions: Despite the receipt of comprehensive semiannual dental care, the vast majority of these high‐risk children continued to develop new caries within 5 years. While disparities were observed by age, extent of prior decay, and toothbrushing frequency, no other sociodemographic factors were associated with caries increment, suggesting that the dental care provided during the trial reduced sociodemographic disparities in prior caries experience that were observed at baseline.     

Monitoring time-related trends in dental caries in permanent teeth in Japanese national surveys

Objectives: According to dental examinations of 3‐ and 12‐year‐old children conducted throughout Japan, the prevalence of dental caries in children is decreasing. However, little is known about changes in the prevalence of dental caries in adults. This study analysed past and present prevalences of dental caries in permanent teeth and predicted future trends in dental caries in adults. Methods: Data were sourced from nine national dental surveys conducted in Japan at 6‐year intervals from 1957 to 2005. Data from oral examinations were recorded as indices of decayed, missing and filled teeth. Results: The mean number of filled teeth increased markedly, whereas mean numbers of decayed teeth and missing teeth decreased substantially in people aged ≥ 40 years. By contrast, the mean number of filled teeth first increased and then decreased in groups aged 5–39 years. Conclusions: Among Japanese respondents sampled in a series of cross‐sectional studies between 1957 and 2005, the incidence of dental caries in young adults decreased, suggesting a decrease in prevalences of dental caries in future generations. However, this tendency was not observed in respondents aged ≥ 40 years. The results suggest adults will experience less dental caries in the near future.