Oral home care and the reasons for seeking dental care by individuals on renal dialysis

A cross-sectional study of 90 patients on renal dialysis was conducted to assess oral home care practices and the reasons for seeking dental care among these patients. Participants were divided into three groups based on the time they have been on renal dialysis. The groups were: (1) dialysis for less than one year, (2) dialysis for 1 to 3 years, and (3) dialysis for more than 3 years. Information regarding oral home care such as frequency of brushing, oral hygiene aids, and reasons for seeking dental care was obtained through a personal interview with the patients. Their oral health status was assessed using a plaque index and a gingival index. The means of plaque index were 1.716 (S.D 0.64), 2.161 (S.D 0.36), and 2.255 (S.D 0.42) respectively for the groups. The means of gingival index were 1.4278 (S.D 0.67), 1.9667 (S.D 0.38), and 2.0556 (S.D 0.35) for the three groups respectively. Tukey's post hoc test showed significant difference in both the indices between first and second groups and between the first and third groups, no significant difference was found between the second and third groups. The results indicate that oral home care practices were inadequate due to the presence of an unacceptable level of oral hygiene among the patients. Miswak (a wooden, Salvadora persica, chewing stick that is popular in the middle east to mechanically clean the teeth) has been found to be popular among the subjects. The primary purpose of dental clinic visits was for treatment of a dental problem rather than for the prevention of dental disease. There is a need for oral health promotion and especially prevention programs among the patients on renal dialysis.     

Oral health status of individuals with cerebral palsy at a nationally recognized rehabilitation center

Cerebral palsy (CP) is a set of nonprogressive neuromuscular disorders caused by defects in the developing fetal brain. The aim of this study is to investigate the prevalence and distribution of various dental conditions including dental caries and periodontitis among individuals with CP who receive care at the Rancho Los Amigos National Rehabilitation Center dental clinic. Medical records of 478 patients between the ages of 3 and 78 years were reviewed. Patients were divided into four age groups: 3–20, 21–35, 36–55, and 56 and above year old. Data related to their dental conditions including caries, periodontitis, and other oral diseases were assessed. Statistical analyses were conducted to evaluate the correlations between these oral diseases and age, gender, ethnicity as well as their living conditions (home or group home). The 36–55‐year‐old age group displayed significantly more caries and periodontitis than any other age groups. Individuals aged 3–20 years showed a significantly lower rate of periodontitis and caries. There was no significant association between gender and race with these outcome variables but there was a correlation between these variables and living conditions. Differences in oral health exist among people with CP from different age groups and living conditions. These findings suggest that there is a dire need for more oral hygiene training and education for the care givers. Dental schools should better prepare their graduates to meet the treatment demands of individuals with special healthcare needs.     

Development of the Geriatric Oral Health Assessment Index

The development of measures for assessing oral health status is essential to the evolution and maturation of a scientific knowledge base in geriatric dentistry. The literature suggests a high prevalence of dental diseases in older adults, yet valid and reliable instruments to assess the impact of oral diseases on older individuals or populations are lacking. This paper describes the rationale for and the development of the Geriatric Oral Health Assessment Index (GOHAI), a self-reported measure designed to assess the oral health problems of older adults. Following a review of the literature and consultation with health care providers and patients, a pilot instrument was developed. The GOHAI was initially tested on a convenience sample of 87 older adults. A revised instrument was then administered to a sample of 1755 Medicare recipients in Los Angeles County. The GOHAI demonstrated a high level of internal consistency and reliability as measured by a Cronbach's alpha of 0.79. Associations of the GOHAI with a single-item rating of dental health and with clinical and sociodemographic supported the construct validity of the index. Having fewer teeth, wearing a removable denture and perceiving the need for dental treatment were significantly related to a worse (lower) GOHAI score. Respondents who were white, well educated, and with a higher annual household income were more likely to have a high GOHAI score, indicating fewer dental problems. Additional applications of the GOHAI are necessary to further evaluate the instrument's validity and reliability, and to establish population norms of oral health in older adult populations as measured by the GOHAI.     

Validation of an oral health quality of life index (GOHAI) in France

Oral health has traditionally been defined in terms of disease. Today, health is seen in a wider context: taking into account its impact on everyday living. Several indices attempt to capture this dimension. The Geriatric Oral Health Assessment Index (GOHAI) has been adapted for general use and tested on adult samples, mainly in North America. Language, cultural norms and the health care system in France are different and this raises the need to validate the GOHAI in France before it receives widespread use. OBJECTIVES: The purpose of this study was to test the validity of a French version of the GOHAI. METHODS: The GOHAI is based on responses to a 12-item self-administered questionnaire. The items were translated into French, back-translated and compared with the original. After pilot testing and minor modifications, the French version was administered to a group of low-income persons benefiting from the national health insurance system (n = 260, 18-45 years). Measures for stability and internal consistency were calculated. Concurrent and discriminant validity were assessed. RESULTS: Cronbach's alpha (0.86) showed a high internal consistency and homogeneity between items. Item-scale correlations varied between 0.40 and 0.78. Repeat administration of the GOHAI to 32 participants gave weighted kappa coefficients from 0.51 to 0.87 and a Pearson's correlation coefficient of 0.87. Low GOHAI scores were associated with perceptions of poor oral and general health, low satisfaction with oral health and a perceived need for dental care. There were significant relationships between the GOHAI score and most objective measures of dental status except FT. Younger, well-educated and higher income respondents were more likely to have a high GOHAI score. CONCLUSION: The French version of the GOHAI exhibits satisfactory psychometric properties but two items (one about swallowing, the other with complex sentence structure) had poor stability.     

Translation and validation of the Chinese version of GOHAI

OBJECTIVE: To translate and validate the Chinese version of General Oral Health Assessment Index (GOHAI) for elderly in Hong Kong and to investigate factors that possibly may influence the GOHAI scores. METHODS: The English version of GOHAI was translated into Chinese. Persons aged 60-80 years were interviewed by two trained interviewers and clinically examined by a dentist. Information on subjects' demographic background and oral health conditions was collected. RESULTS: Altogether 1,023 elderly were interviewed and clinically examined. The mean GOHAI score was 48.9 (SD = 7.2). Cronbach's alpha of the translated GOHAI was 0.81; item-scale correlation ranged from 0.28-0.61. It was found that the mean GOHAI scores were lower for subjects with poorer perceived oral health (rs = 0.57, P < .001). Elderly who had perceived dental treatment need had a lower mean GOHAI score than those who did not (P < .001). It was also found that elderly who lived in elderly homes, those who received social welfare assistance, those who had recent dental visits, and those with higher DMFT scores had higher mean GOHAI scores. CONCLUSION: The translated Chinese version of GOHAI demonstrated acceptable reliability and validity. It is available for use by researchers in oral health-related quality of life studies on Chinese elderly population.     

Validation of the Geriatric Oral Health Assessment Index (GOHAI) in the Malay language

OBJECTIVE: To translate and validate the Geriatric Oral Health Assessment Index (GOHAI into the Malay language for use in Malaysia. METHODOLOGY: The 6-Likert scale GOHAI was translated into the Malay language and self-administered on 189 subjects aged 60+. All subjects underwent oral status assessment. The measure was assessed for construct and discriminant validity, for test-retest reliability and principal component factor. FINDINGS: Mean GOHAI score was 46.2 (SD 9.7, range 17-60). The Cronbach's alpha was 0.79. Mean GOHAI scores increased with more positive self-rated oral health and general health. The elderly with no perceived dental treatment need had higher mean GOHAI scores than those with perceived needs. There were slightly stronger inverse correlations between GOHAI scores and caries experience, number of teeth present, and number of pathologically mobile teeth. The measure demonstrated strong test-retest reliability. Eight of the 12 items had Spearman's r3 0.7. Only one principal factor was found at eigenvalue > 1. Using ANCOVA, self-rated perception of oral health and perceived need for dental treatment had the most significant impact on the GOHAI score. CONCLUSION: AND RECOMMENDATIONS: The Malay language version of the GOHAI demonstrated acceptable validity and reliability and will be an important instrument to measure oral health-related quality of life among Malay-speaking Malaysians. Use of the Malay language version GOHAI should also be pursued among diverse adult age groups.     

Using the GOHAI to assess oral health status of frail homebound elders: reliability, sensitivity, and specificity

A pilot study assessed the clinically determined and self-reported oral health status of 50 randomly selected homebound patients served by Boston's Home Medical Service. The sample was largely female, low-income, and edentulous. The median age of the patients was 81 years (range, 64–101). While 76% deemed themselves to be in good to excellent oral health, 80% of the patients had not seen a dentist within the last two years, and 80% were found to be in need of routine dental care. To assess whether the Geriatric Oral Health Assessment Index (Atchison and Dolan, 1990) could be used by non-dental health professionals to determine the need for requesting dental consultation, the study physician repeated the administration of the GOHAI for 23 of the 50 subjects within eight weeks of the initial examination. For the 23 subjects having both dentist- and physician-administered GOHAI scores, the intraclass correlation coefficient was r = 0.61 (p = 0.002), indicating good agreement between the dentist's and physician's administrations of the GOHAI. However, given the high prevalence of need for care, the GOHAI appears to be of less value than an examination for identifying persons who need dental care in this population. Future research is needed to examine the GOHAI's sensitivity and specificity in populations with low to moderate prevalence of treatment need .     

Dental hygienists as providers in long-term care facilities

The authors surveyed all practicing dental hygienists (n = 870, response rate = 69%) in Kansas about providing preventive dental care to elderly residents of long‐term care (LTC) facilities. Maximum likelihood estimates stepwise logistic regressions were used to predict the likelihood of dental hygienists filling the need for a specialty workforce. Few respondents wanted to work exclusively with elderly patients. Lack of interest in LTC practice was related to the number of children living at home or discomfort with patients who had limited abilities to communicate. Interest in part‐time geriatric practice was related to motivation to help older patients and unhappiness with current role limitations. Implications for reimbursement and educational offerings are discussed. While dental hygienists could fill a need in preventive oral health for elderly patients, it remains to be seen if subsequent policy changes result in that outcome.     

Dental treatment and demand for services in a Veterans Administration Nursing Home Care Unit

Planning the provision of dental care in nursing homes requires evaluation of both dental needs and demand for services. Dental treatment needs have been documented for residents of longterm care facilities. This paper examines the actual dental care provided to institutionalized persons demanding care. Dental records of 144 patients at a Veterans Administration Nursing Home Care Unit (NHCU) were reviewed to evaluate needs and treatment demands. About 20 percent of the NHCU patients were currently receiving dental treatment; the remainder were on recall (closed cases). Of the total services needed, slightly over half were denture related services, about a quarter were oral surgical services, and 16 percent were operative procedures. Almost a third refused some or all of the proposed dental treatment; seven percent were unable to be examined or treated. No statistically significant difference was found between the age and the level of nursing home care needed for those receiving treatment and those refusing treatment. Once the backlog of need was met, this NHCU dental program consisted primarily of recall exams, and prosthetic and oral surgical treatment. The case mix and refusal rate may change, however, as future cohorts of elders retain more teeth and have experienced preventive dental services during their lifetimes.     

Determinants of change in oral health‐related quality of life over 7 years among older Japanese

Because there are more elderly people than ever before and because they are living for longer periods of time, it is essential to understand the determinants of healthy ageing. This study examined changes in oral health‐related quality of life (OHRQoL) among Japanese elderly over a 7‐year period. A sample of independently living individuals (aged 60+ years) underwent a questionnaire and dental examination at baseline and 7 years afterwards. The Geriatric Oral Health Assessment Index (GOHAI) was used to assess the impact of oral conditions. Occlusal force and salivary flow were also assessed. Of the 411 participants assessed at baseline, 130 (31·6%) accepted to participate after 7 years. There were no significant differences between those lost to follow‐up and those assessed at 7 years, except that a higher proportion of the latter rated their baseline general health as good. Among the latter, the overall mean GOHAI score did not change significantly (11·8 at baseline and 11·1 at follow‐up; P = 0·16). However, after controlling for age, gender and baseline GOHAI score, participants who had lost teeth or experienced a decline in occlusal force after 7 years had higher follow‐up GOHAI scores (indicating poorer OHRQoL). Unfavourable changes in clinical oral status over time are reflected in poorer self‐rated oral health.     

Arthritis and use of dental services: a population based study

BACKGROUND: Rheumatoid arthritis (RA) and osteoarthritis (OA) are chronic systemic conditions that can have a profound effect on oral health as the result of physical disability, immunosuppressant and other medications and autoimmune disease. However, there is insufficient information available on the use of dental services by the people suffering from RA or OA. The purpose of this study was to investigate dental visits and factors associated with dental attendance in those with RA and OA in order to improve access to dental care in these groups. METHODS: The study used population based data from the 1995 National Health Survey (total n=53828). The main variables of interest were reported RA (n=1193) and OA (n=3091) and the main outcome variable was having visited a dental professional in the previous 12 months. Chi-square analysis was performed using SAS software. RESULTS: The proportion of people visiting a dental professional in previous 12 months was significantly less in both RA and OA respondents compared to non-arthritic respondents. Both males and females with RA and OA were found to be less likely to have visited a dental professional when compared to general population (p=0.001 in each case). Furthermore, the findings have revealed that RA and OA patients living in metropolitan centres were more likely to have a dental visit than those living in rural or remote areas (p=0.001 in each case). CONCLUSIONS: When compared to non-arthritic subjects, all patients with RA and OA were less likely to receive dental care, in particular preventive care. This is especially important in patients with Sjogren's Syndrome and those who are immunosuppressed.     

Dental status and oral health quality of life in economically disadvantaged French adults

Expansion of French health insurance coverage has increased funding for dental care for economically disadvantaged adults. This study aimed to measure clinical and self-perceived oral health, behaviors, and use of dental services by adults who were eligible for such coverage. The regional agency that gives administrative services for the health insurance funds provided a sample of 900 adults aged 35–44 years, insured through this program. We reached 805 of these adults by mail; of these 18% were surveyed and clinically examined. Self-perceived oral health was measured by the Global Oral Health Assessment Index (GOHAI) and participants' attitudes to dental health, by questionnaire. Decayed and Missing teeth constituted 40% of the DMFT. Participants reported poor oral health (63%), and 79% perceived a need for care, although they used dental services infrequently and had poor knowledge of available services. Cost of care and number of carious teeth were important predictors of the GOHAI.     

Components of Self-reported Oral Health and General Health in Racial and Ethnic Groups

OBJECTIVE: The objective of this study is to investigate the validity of the General Oral Health Assessment Index (GOHAI), a self-reported oral health measure, when used in an all-age adult sample of Hispanics and African-Americans. METHODS: The study groups were 506 disadvantaged Hispanic and African-American adults who were recruited at low-cost medical and dental clinics. To explore the validity of the GOHAI in an all-age, ethnically diverse sample, principal component and principal factor analyses were conducted on the 12 items of the GOHAI and the 14 items constituting the MOS physical/social and mental health components. RESULTS: Four factors accounted for 40 percent of the total variance of health as measured by the MOS and GOHAI items: general health, physical/worry oral health, mental health, and social oral health. An association between socioeconomic variables and each subscale was found to be significant except for the physical/worry oral health subscale. CONCLUSIONS: This study confirms that the GOHAI is valid when used in younger and ethnically diverse samples. The findings also emphasize that oral health is distinct from general health and that the use of generic self-reported measures of health may miss important aspects of oral health that are valuable for dental health professionals.     

Oral health status of patients seeking emergency dental care in Transkei

The oral health status of a rural Black population seeking dental treatment was determined at three separate locations in Transkei. Of the patients who presented for treatment 92 per cent were suffering from acute or chronic pain. The main reason for seeking care was pain resulting from dental caries (84 per cent). Inadequate oral hygiene practice was uniformly evident in all the patients at the three locations, as well as within all the age groups. The pattern of gingival bleeding was also comparable by age and location and its distribution closely parallelled the oral debris scores. The mean DMFT for the total population (n = 290) was 5,7 (s.d. 6,1); and 17,0 per cent were caries-free. Caries was more widespread and severe in the patients at the military base in Port St Johns where the mean DMFT of 10,6 differed greatly from the mean DMFT scores of patients at Port St. Johns (3,6) and Elliotdale (4,5). Untreated dental decay accounted for a large percentage of the DMFT at all three sites but in the military group, the untreated decay component, (60,4 per cent of the DMFT), was the highest. With the stratification of the data by age, the average DMFT (8,4), was highest in the 31-50 age group.     

Delivery and financing of oral health care in long-term services and supports: A scoping review

BackgroundThe oral health of older adults requiring long-term services and supports is reported to be poor as there is no national standard of care for the provision of oral health care. The purpose of this scoping review was to understand the breadth of models of delivery and financing of oral health care in the full spectrum of long-term services and supports.Types of Studies ReviewedA literature search was performed in 4 electronic databases: MEDLINE via PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Included articles were those that were regarding a nursing home population or dependent older adults living in the community, included a delivery or financing model for oral health care, and included an outcome measurement.ResultsSixteen articles were included in the review. Delivery mechanisms included onsite mobile oral health care at nursing homes and adult day health care centers for those living in the community or home visits for those who were homebound. Other mechanisms included teledentistry or using alternative workforce models such as certified public health dental hygienists. Numerous studies reported positive oral health outcomes when comprehensive care was provided in a variety of settings. Other reported outcomes included oral health stability, caries indexes, cost, and oral health–related quality of life.Conclusions and Practical ImplicationsIf providing onsite oral health care is not possible at facilities, programs can consider home visits, teledentistry, and alternative workforce models.     

Ability to estimate oral health status and treatment need in elderly receiving home nursing--a comparison between a dental hygienist and a dentist

The aim of this study was to compare the estimation ability of a dental hygienist to that of a dentist when, independently, recording the oral health status and treatment need in a population of elderly, receiving home nursing. Seventy-three persons, enrolled in a home nursing long-time care programme, were recruited. For the oral examination a newly developed protocol with comparatively blunt measurement variables was used. The oral examination protocol was tested for construct validity and for internal consistency reliability. Statistical analyses were performed using Wilcoxon matched pairs signed rank sum test for testing differences, while inter-examiner agreement was estimated by calculating the kappa-values. Comparing the two examiners, good agreement was demonstrated for all mucosal recordings, colour, form, wounds, blisters, mucosal index, and for the palatal but not the lingual mucosa. For the latter, the dental hygienist recorded significantly more changes. The dental hygienist also recorded significantly higher plaque index values. Also regarding treatment intention and treatment need, the dental hygienist's estimation was somewhat higher. In conclusion, when comparing the dental hygienist's and the dentist's ability to estimate oral health status, treatment intention, and treatment need, some differences were observed, the dental hygienist tending to register "on the safe side", calling attention to the importance of inter-examiner calibration. However, for practical purpose the inter-examiner agreement was acceptable, constituting a promising basis for future out-reach activities.     

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.