Oral health and microflora in an institutionalised elderly population in Canada

A cross-sectional study was undertaken to assess the oral health of a group of elderly, long-term care, institutionalised residents in a facility in Edmonton, Canada. In addition, the oral occurrence of Candida and coliform micro-organisms was evaluated to examine the relationship between oral health status and oral prevalence of these opportunistic pathogens. The mean age of 63 examined individuals was 83.4 (+/- 17.6) years; 28.6 per cent were dentate with a DMF score of 22.4; 4.5 per cent of teeth exhibited root caries. Of the edentate, 55.5 per cent were wearing complete maxillary and mandibular dentures; 59 per cent of the maxillary dentures and 20 per cent of mandibular dentures were found to exhibit good retention and stability while the remaining prostheses were deemed to be poor; 17 per cent of individuals had neither teeth or dentures. Denture stomatitis was the most common mucosal lesion and was found amongst one third of the denture wearers. Three quarters of the residents harboured oral yeasts, 30 per cent coliforms and a significant number exhibited poor oral hygiene and oral pathoses for which remedial treatment was readily available in the form of subsidised dental care.     

Dental treatment needs in Dutch nursing homes offering integrated dental care

The purpose of this study was to determine the dental treatment needs of the residents in nursing homes (NHs) where integrated dental care has been offered without financial barriers. The dental status and surgical, prosthetic, restorative, and periodontal treatment needs were determined for 432 residents (average age 78.8 years) in three Dutch NHs. Although the subjects had no complaints, 72% had dental treatment needs. It was determined that treatment was necessary for 64% of the edentulous subjects (N = 316), 100% of the partially dentate subjects (N = 76), and 87% of the fully dentate subjects (N = 40). We concluded that when residents can no longer carry out oral hygiene independently, it is very difficult for them to maintain a level of oral health where their dental treatment needs have been met, especially for dentate residents.     

Oral health status and practices of dentate Bhil adult tribes of southern Rajasthan,India

Aims : To assess the oral health status of the Bhil tribal population of Southern Rajasthan and to investigate the association of age, oral hygiene and dental visiting practices with oral health status. Design : A cross sectional study of Bhil tribal adults chosen by a multi stage stratified random sampling procedure. Participants : The total sample size was 1,590 male tribal dentate subjects aged 15–54 years. Methods : Clinical recordings of oral hygiene status (OHI ‐ S), caries status (DMFT and DMFS) and treatment needs, and periodontal status (CPI). The Chi square test was applied to discrete data and one way ANOVA for continuous data. Multivariate analyses were carried out to test the association of age, frequency of cleaning teeth, material used for cleaning teeth and dental visiting habits with caries and periodontal status. Results : Debris, calculus and oral hygiene index scores increased with age. The overall mean DMFT and DMFS scores were 5.34±6.48 and 18.94 ± 35.87 respectively. Extraction was the most required treatment (1.74 ± 3.66 teeth) followed by one surface fillings (1.34 ± 1.65 teeth). Shallow periodontal pockets were prevalent (40%) among the 35–44 years age group whereas deep pockets were most common (11.6%) in the oldest age group. More than half the sextants (3.15) were excluded amongst the oldest study group. All the independent variables namely age, frequency of cleaning teeth, substance used for cleaning teeth and visiting habits were statistically significantly related to caries and periodontal status. Conclusions : The study population was characterised by a lack of previous dental care, high treatment needs, high prevalence of periodontal disease and poor oral hygiene. Under these circumstances, the implementation of a basic oral health care programme for the Bhil population is a high priority.     

Oral hygiene and associated factors among frail older assisted living residents

The aim of this study was to determine the associations of older assisted living residents’ tooth brushing habits with health and nutritional status. We assessed the tooth brushing habits, nutritional status, oral health, use of dental services, and morbidity of 1,447 assisted living residents in the Helsinki metropolitan area of Finland. Of the residents, 17% did not clean or had not cleaned their teeth and/or dentures daily. Those not cleaning their teeth and/or dentures daily were more often male, less educated and had a mean length of stay in assisted living longer than those who cleaned their teeth and/or dentures daily. They were more often malnourished and dependent in ADLs. In addition they more often had poorer oral health and used fewer dental services. Poor tooth brushing habits indicate poor oral and subjective health. More attention should focus on the oral hygiene of frail older assisted living residents.     

Oral health of Singapore adults

In a study conducted by the Dental Division of the Ministry of Health in 1992, 3157 Singapore adults aged 20 to 65 years and over were interviewed on their knowledge, attitude and practice of dental care and given an examination. About 66% indicated they required dental treatment. Utilisation of dental services was low with 39% visiting the dentist at least once in 2 years. About 72% brushed their teeth morning and night. The dental examination showed that 79.2% had calculus, 92% needed prophylaxis and oral hygiene instruction and only 0.2% needed complex periodontal treatment. A large proportion (96.6%) of the sample was dentate. The mean DMFT was 10.7 and the mean number of decayed root for the dentate population was 0.2. The age-group 65 years and over had the highest percentage (63.6%) of persons wearing dentures and the age group 50-54 years had the highest percentage (54.2%) requiring dentures. This study has shown that oral health promotion for home and professional care should be stressed to the adult population, particularly the older age groups.     

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.     

Oral health status of a long-term-care, veteran population

Abstract – The Department of Veterans Affairs (VA) operates the largest, integrated health care system in the United States of America. The projected need for long-term-care in the VA health care system parallels an expected increase in need for care in the United States, but precedes the need for care in the general population by 25–30 yr. The VA's Office of Dentistry, in an effort to estimate the resource requirements of this swelling group of veterans, initiated in 1986–7 an oral health survey of long-term care patients. The overall goals were to describe the oral health status of VA nursing home care units (NHCU) residents and to develop a methodology for estimating future dental health services utilization. This study describes the oral health status of the study population. Demographic and oral health data were collected for 650 long-term care residents of six VA NHCUs between October 1986 and July 1987. Data were collected on sociodemographic status, medical history, dental caries, periodontal diseases, oral soft tissue pathology, and the presence of dental prostheses. Caries and periodontal disease were evaluated using the United States National Institute of Dental Research Survey of Employed Adults and Seniors protocols. The oral health status of the population is described using DMF and ESI indices, the prevalence of oral lesions, levels of tooth loss, oral hygiene scores, and the status of existing dentures. Findings show moderate levels of untreated dental caries and periodontal disease and significant tooth loss which increased with age. A need for preventive therapy, restorative dentistry, conservative periodontal therapy, and prosthodontic care was evident. Soft tissue oral pathologies were rare and frequently related to prostheses use. The subject's overall willingness for care was high. Subjects were found to have a high number of medical comorbidities, and one third of all subjects had to be excluded from the periodontal examination for medical reasons or non-cooperation.     

A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population

Prosthesis function and dental conditions were observed for 5 years in 27 elderly patients treated with mandibular cantilevered fixed partial dentures (FPDs) and in 26 elderly patients treated with distal-extension removal partial dentures (RPDs). All patients were treated with a complete upper denture. The patients were assigned randomly into two treatment groups that had the same composition with regard to sex, age, and distribution of teeth. The patients were under supervised oral hygiene and prosthodontic care. Clinical examination of prostheses, masticatory system, periodontal status, and caries was carried out yearly. Oral hygiene was good, and the periodontal status was maintained in both groups. Caries was observed six times more frequently in the RPD group than in the group with fixed restorations, however. Occlusal and functional conditions deteriorated in the RPD group only. Eight of 42 fixed partial dentures (19%) failed; of these, six were recemented with composite resin. Generally the need for dental and prosthetic follow-up treatment was more pronounced in the RPD group than in the FPD group.     

Oral health of a Brazilian population on renal dialysis

The purpose of this study was to assess the oral health of patients with chronic renal failure (CRF) undergoing hemodialysis in Brazil. A dentist examined 160 subjects aged 40 to 85 years of age. Data was collected on dental caries, use of and need for dentures, oral mucosa, periodontal disease and temporomandibular joint status. All subjects were interviewed about their socioeconomic status, dental and medical history, and oral hygiene habits. Most subjects had hypertension (49.4%); used the public service for their medical care (69.4%); had a middle school educational level (83.1%); and did not complain of xerostomia (60.0%). The majority used private oral healthcare services and used a toothbrush only for oral hygiene. The mean DMFT was 26.0 (standard deviation 7.7). Moat individuals did not wear dentures, but needed some type of prosthesis. Lesions of the oral mucosa (3.1 %), signs (2.5%) and symptoms (3.8%) of temporomandibular dysfunction could be observed in only a few patients. The oral health of the subjects examined was poor. These persons needed their oral condition monitored by a dentist and their oral disease treated as well as receiving instruction on oral hygiene.     

Dental needs of the elderly in residential care in Newcastle-upon-Tyne and the role of formal carers

Interviews were carried out on 61 formal carers from 41 residential homes and 379 elderly residents from 35 homes. Formal carers were questioned about their own dental health and arrangements made to maintain the dental health of the residents. Only 46% of carers attended a dentist regularly although the majority knew that teeth and dentures should be examined regularly. Carers arranged most of the dental treatment received by residents. The percentage of residents from each home receiving treatment ranged from 0% to 52%. Residents judged by formal carers to be capable of participation were interviewed and a 40% stratified random sub-sample was examined. 96% of residents stated that they would only attend a dentist if they were experiencing problems. However, among residents reporting problems (25% of the sample), only a third wished to see a dentist. This proportion rose to half when treatment was offered. The reported barriers to seeking dental treatment included the resident's belief that he or she was coping satisfactorily, transport difficulties and ill health. Denture and oral hygiene were poor and dentures cleaned by staff were no cleaner than those cleaned by residents. A random sample of residents judged by formal carers to be confused were also examined. The condition of their teeth and dentures was similar to that of non-confused residents.     

The oral health status of dentate patients with chronic renal failure undergoing dialysis therapy

OBJECTIVE: The aim of this study was to compare the oral health status of chronic renal failure (CRF) patients on renal replacement therapy with a matched reference population. DESIGN: Cross-sectional study. SUBJECTS: Forty-two dentate CRF patients--aged 25-52 years old--were matched with a reference group of 808 dentate subjects. METHODS: The oral health was assessed using decayed missing filled (DMF) indices, simplified oral hygiene index and periodontal status. An oral health questionnaire was used to assess self-reported dental problems. Student t-tests and chi-square tests were performed to compare the CRF patients with the controls. RESULTS: All index-scores in the CRF patients were comparable with the controls except for number of teeth covered with calculus that was significantly higher (P < 0.05) in CRF patients (4.1 +/- 2.6) than in controls (3.0 +/- 2.9). The self-reported oral health questionnaire revealed a trend for increased temporomandibular complaints in CRF patients (16.7%vs 5.7% in controls; P = 0.06) as well as bad taste (31.0%vs 6.8% in controls, P = 0.08). CONCLUSIONS: For most dental aspects, the oral health of CRF patients is comparable with controls.     

Oral health in Florida nursing homes

Abstract:  Objectives:  The purpose of this study was to measure the oral health and hygiene status among 265 South Florida nursing home residents aged between 45 and 98 years. Methods:  The oral health and hygiene status of the residents were assessed by noting the presence of calculus, caries, gingivitis, cheilitis, apthous ulcer, dry mouth and red or white lesions. Results:  The incidence of nursing home residents with calculus was 79.6% and the remaining 20.4% were edentulous. More than half of residents had oral problems (50.6%) the commonest was gingivitis (36.6%), followed by caries (26%) and tooth fracture (15.9%). Almost half the residents wore dentures (47.2%). Statistical analysis was conducted using analysis of variance ( P -values). Ageing of the residents was statistically correlated to a worsening of oral hygiene status ( P  < 0.0066), absence and presence of one or two dentures ( P  < 0.0034) and a loss of teeth ( P  < 0.0001). Conclusions:  The ageing of residents is correlated to increasing oral health problems and the loss of teeth. Oral health neglect affects almost all of the nursing home residents. Care providers should receive education and training from dental hygienists to improve the standard of oral hygiene and health of the elderly.     

Perceived Need for Dental Care Among Dentate Older Individuals in Sri Lanka

The authors assessed the perceived need for dental care among 585 older individuals, of whom 235 received a clinical oral examination. Of the 235 participants, only 171 were dentate. The present analysis is limited to this group. Of these 171 dentate adults, 43 percent perceived a need for dental care. Of this sample section, 53 percent perceived a need for dentures. Age, perceived oral health status, presence of mobile teeth, three impact items of the Oral Health Impact Profile‐14 (OHIP‐14) scale—namely “had a painful aching in the mouth, had difficulty in eating and that the diet had been unsatisfactory due problems with teeth, mouth or dentures”–and the total OHIP‐14 score showed significant associations with perceived need for dental care in bi‐vartate analysis. Poor perceived oral health status emerged as the strongest predictor of perceived need for dental care in logistic regression.     

Dental needs related to primary cause for institutionalization

One hundred and forty-seven dentate residents of a long-term care facility were examined to determine oral status and need for treatment. The assessment included dental caries (NIDR criteria), oral hygiene index-simplified, and missing teeth. Caries was further divided into "restorable" and "nonrestorable." Also, the primary cause for institutionalization was determined .     

Oral health profile in an institutionalized population of Italian adults with mental retardation

The oral health of 219 residents with mental retardation living in a long-term-care institution near Milan was assessed. The dental and periodontal status, daily habits, oral hygiene, and oral mucosal status were evaluated. Of the sample, 179 (81.7%) were males. The mean age of the residents was 61.3 years, and the degree of cooperation was evaluated as good for 131 subjects (59.8%), fair for 79 (36.1%), and poor for nine (4.1%). The percentage of residents who were edentulous was 21.5% (47 subjects), of whom 28 subjects (59.6%) were without dentures. Evaluation showed an overall DMFT of 23.1, and the average number of missing teeth was 20.5. All subjects had periodontal disease: Forty-five subjects had calculus and/or shallow pockets (4–5 mm); 61 had deep pockets (≥ 6 mm). The most common mucosal lesion was oral stomatitis (49.3%). These findings underline the need for special programs aimed at institutionalized subjects with mental retardation.     

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.     

Could a national oral health promotion program improve the oral hygiene of persons attending special care establishments in France? Evaluation of a pilot program

This study aimed to investigate the effectiveness of an oral health promotion intervention implemented in special care establishments by dentists trained online. Twenty‐six dentists intervening in 27 French special care establishments undertook a standardised oral health promotion intervention, including a conference presentation for care staff and hands‐on toothbrushing workshops. Oral hygiene status of the residents was performed at baseline and at 6 months, and were compared using the McNemar test. Mixed logistic regression was performed to identify the factors associated with an improvement of dental plaque removal. The oral health intervention was completed by 890 residents: 445 children, 373 adults and 72 elderly adults. At baseline, dental plaque was observed for 79.8% of the 797 dentate residents. Among the 691 dentate residents included in the final analysis, dental plaque removal was improved for 34%. Improvement in dental plaque removal was recorded more often for the group of 13 to 20‐year‐old residents (OR = 1.97; 95% CI = 1.15–3.38). The results indicate that this programme failed to significantly improve the dental plaque removal of the residents. More research is needed to understand the limiting factors of such interventions.     

Oral disorders and treatment implications in people over 75 years

The oral health of subjects over 75 yr and living independently in the southwest of Britain was assessed. The majority (80%) of the sample were edentulous, and a large proportion of both edentate and dentate subjects were using dentures. More than half of the denture wearers were using loose, very unhygienic, or structurally defective dentures. Mucosal pathoses were quite common, although most of the lesions were denture-induced stomatitis found in association with unhygienic dentures. The dentate subjects had, on average, 11 natural teeth, frequently with evidence of root caries and deep periodontal pockets or extreme bone loss. The oral health problems suggest that there is a significant need to develop effective methods of improving oral hygiene in this age group. The prosthetic treatment is related principally to denture repairs while there is a need to control root caries among the growing population of elderly dentate people.     

Oral health conditions and denture treatment needs in institutionalized elderly people in Japan

Oral health conditions, including dental conditions, temporomandibular joint (TMJ) conditions, denture status, and oral hygiene status, were assessed on 1908 institutionalized elderly people 65 yr of age and older at 29 of the 30 existing institutions in the city of Kitakyushu, Japan. The percentage of edentulous people was 27% in the 65-74-yr-old group, and increased with age to 56% in the 85 yr and older group. In dentate persons, the mean number of remaining teeth and DF teeth were 13.4 and 8.6, 9.5 and 6.8, and 8.4 and 6.5 in the groups aged 65-74 yr old, 75-84 yr old, and 85 yr and older, respectively. 81% of all the persons examined had no unusual symptoms in their TMJ. A clicking sound was the most frequent symptom (17%). Hygiene of both their teeth and dentures was very poor. Of all the subjects, 36% needed new full and/or partial denture(s), and 41% needed only repair. When the institutionalized elderly people were compared according to their general health condition, no clear differences were observed in percentage of edentulousness, mean number of remaining teeth and DF teeth, and TMJ conditions. However, a higher level of both untreated teeth and denture treatment needs, and poorer oral hygiene, was found in elderly people having poor general health than was observed in those with better health.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of the oral health condition of nursing home residents by primary care nurses

We interviewed 36 primary care nurses in three Dutch nursing homes regarding the functional oral health and dental treatment needs of 331 care‐dependent residents (average age 77.8 years). The nurses assessed the residents’ oral health condition as good (8.3 on a scale of 0 to 10). Edentulous residents wearing dentures were considered to have better functional oral health than dentate residents wearing partial dentures and edentulous residents not wearing dentures. According to the nurses, only 9% of the residents required dental treatment. This finding is in contrast with an intraoral study of the same population, in which dentists determined that 73% of the residents needed dental treatment.