Dental status of the institutionalized elderly population of Edinburgh

ABSTRACT A randomly selected population of 442 persons in Edinburgh was interviewed and examined. Although 71 % of the sample required treatment, only 52 % were physically and mentally able to benefit from treatment. Thirty percent of the sample were able to use public transport to attend a dentist, 66 % would require cars and ambulance transport and 4 % were bedridden and would require domiciliary dental services. Twenty-one percent of the sample had thought about seeking dental treatment, while only 25 % had heard how to claim exemption from or help towards dental charges. Edentulousness was present in 91 % of the sample, only 41 persons having remaining natural teeth. Seventy-three percent were wearing dentures which required adjustment or replacement, but only 39 % thought their dentures were unsatisfactory. In 58 % of the patients the oral tissues were so deformed or resorbed that the prosthodontic treatment needed would be complex and require special skills. Half of the sample had some form of denture-induced pathology which required either conservative or surgical treatment.     

The oral health of the elderly in Melbourne

A survey of 303 subjects over the age of 60 years collected demographic and oral health status data for analysis. The majority of the sample (64.2 per cent) were edentulous. Over 90 per cent of the dentate subjects required scaling and the removal of plaque (CPITN score of TN2); however, just less than half of the sextants examined were excluded because they contained fewer than two functional teeth. About one-third of the dentate subjects required no treatment for dental caries. Of those who required treatment, most needed only one restoration of any particular type. Total tooth loss was associated with gender, level of education, previous occupation, and birthplace. The need for complex periodontal treatment (TN3) was not high, nor was there a high prevalence of root or cervical dental caries.     

A study to determine oral health needs of institutionalised elderly patients by non dental health care workers

In this survey normative need as assessed by an examining dentist and the subject's own perceived need are compared with need assessed by untrained care workers. A method for simple assessment of elderly people on admission to day centres or elderly peoples' residential homes is described and its efficiency in use assessed during a survey of 41 subjects. Results suggest that use of a simple questionnaire can alert carers to problems requiring dental care--oral hygiene regimens can then be improved, dentures named and dentists called to provide treatment. Too often this type of initial assessment is neglected.     

Improving oral health to enhance general health in elderly people in Uruguay

A review of ways in which the oral health and general health of elderly people in Uruguay is presented. The dental profession has not yet understood the real dimension an ageing population brings with it, nor its responsibility for general and psychosocial health of older adults. Generally, Uruguay as a developing country, is increasing its social policies, therefore there is much to be done. Specifically, dentists and specialists in gerodontology are not sufficiently conscious of the role they play in this process. However, to be successful in this endeavour, dental professionals really need the support of their country, without which no changes can take place. An accurate management of gerodontology is not enough, some aspects of older adult's lifestyles must be studied such as the psychological and social profile. The objective is not to work in several specialties but to work properly as a team co‐ordinated by the national authorities.     

The Brisbane Statistical Division Survey of Adult Dental Health 1984. 3. Dental health status and treatment needs

Dental status and treatment requirements were investigated in 1504 subjects. Mean numbers of decayed, missing and filled (DMF) teeth for the various age groups were: 15–19 years, 6.2; 20–24 years, 10.6; 25–29 years, 15.8; 30–34 years, 18.1; 35–44 years, 20.4; 45–54 years, 23.0; 55–64 years, 26.2; and 65 years and older, 28.7. Total tooth loss did not occur in the 15–19 years or 20–24 years groups. In the 25–29 years group 2.6 per cent of subjects had lost all their teeth, 4.2 per cent in the 30–34 year group and 5.0 per cent in the 35–44 year group. The figures for the older age groups rose dramatically with almost 60 per cent of the 65 year and older age group having lost all their natural teeth. Treatment requirements for all age groups were low. In the 15–19 year age group 62.4 per cent of subjects had no treatment requirements. In other age groups the proportion was lower, ranging from 43.2 to 55.9 per cent. The periodontal condition of subjects was relatively good with only 3.3 per cent requiring complex treatment for severe forms of periodontal disease. A high proportion (over 50 per cent in all but the 15–19 year age group) required scaling and improved personal oral hygiene.     

An oral health survey of Western Samoans

abstract Internationally accepted criteria established by the World Health Organization were used to obtain estimations of dental parameters in Western Samoa. A total of 1,680 subjects were presetected with the aid of a table of random digits from a sampling frame prepared by the World Health Organization's Filariasis Control Project, and a stratified multi-stage design was adopted. The Dental Health Unit of the World Health Organization, Geneva supplied the basic data forms, prepared the computer program and processed the results. Dental caries indices in Western Samoa were shown to be very low, as were point prevalence rates for oral mucosal diseases, dentofacial anomalies and conditions needing immediate attention. Intense gingivitis among adolescents and destructive periodontal disease in adulthood were widespread and there was an unmet need for dentures in older age groups.     

Comparison of oral and general health development among institutionalized elderly people

This investigation comprises a longitudinal (2 yr) study of development in oral and general health among 100 institutionalized elderly people in Gothenburg. The aim of the study was to photographically document variations in oral health in relation to variation in the general health of these individuals during the period of the project. Changes noted from one examination to the next were limited to a judgment of an "unchanged", "deteriorated", or "improved" status. Medical analyses were based upon information collected from medical charts and the subjective impressions of the care staff, and odontological analyses were based upon photographic screening according to a set of given criteria. Results demonstrated a relation between developments in oral and general health among older people. The strongest relationships were registered between changes on the tongue and general health. The project has shown that a standardized photographic follow-up of health developments in oral tissues can be a valuable aid in cooperative efforts between medical physicians and dentists regarding health supervision of the elderly.     

Oral health care needs among the middle-aged and the elderly in Hong Kong

Abstract A sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35–44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.     

Survey of the dental health and denture status of institutionalized elderly patients in Ireland

An investigation was conducted to establish the dental status of 368 elderly patients in two geriatric hospitals in Limerick, Ireland, in terms of denture status and the number of teeth present. Seventy eight percent of those examined were edentulous, but only 27% of edentulous patients were wearing maxillary and mandibular dentures. A further 18% wore a maxillary denture only, 21% had dentures made but no longer wore them, and 33% had never had dentures. Forty-four patients had some maxillary and mandibular teeth present and 20 of these had sufficient teeth for masticatory purposes. Very few patients, edentulous or dentate, complained of any problems, although 27 were felt to require extraction of one or more teeth.     

Oral health promotion for institutionalised elderly

Abstract – The purpose of the present study was to develop and evaluate educational approaches specifically for improvement of oral hygiene behaviour amongst institutionalised elderly. A sample of 201 residents, 48–99 yr of age (mean age 82 yr), was selected from four different institutions in Lothian, Scotland. A clinical examination and a structured interview were conducted immediately before and 2 months after the termination of the programme. The four institutions were blind to the examiner and randomly allocated to a control group or one of the three programmes; 1) active involvement of staff only; 2) active involvement of residents only; 3) active involvement of both residents and staff. The programme comprised three 1-h sessions at monthly intervals in groups of five to six residents or members of staff. The analysis of the results showed poor oral health and oral hygiene, high objective need for oral care but low perceived need. The programme had little impact on most of the included variables and only about half of the participants remembered the programme 2 months after its termination. The implications of the study arc that groups of elderly need to be differentiated further so that only well and not confused elderly participate in programmes such as this and less well and confused elderly receive regular professional support with oral hygiene.     

Survey of the dental state and needs of a group of elderly army pensioners in England

375 army pensioners (89% of the population of the Royal Hospital Chelsea) were interviewed and given a dental inspection. The quality of any denture was assessed by KAPUR's method. Of the 318 men with dentures 254 (85%) had not been back to the dentist since and 60% of the dentures were over 10 years old. 244 denture wearers claimed they were satisfied although only 11 dentures could be rated 'good' and 67% of complete dentures were 'poor'. 25% of those interviewed actually wanted treatment, 10% did not know but the majority simply 'couldn't be bothered'. The overwhelming need is for skilled prosthetic treatment. A plea is made for educating patients to appreciate that dentures should be changed and that regular dental inspections are necessary throughout life.     

Professional education to meet the oral health needs of older adults and persons with disabilities

A well‐prepared dental workforce is critical to improving the oral health of special needs patients. This paper, originally presented at the National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and Persons with Disabilities, reviews and suggests opportunities to enhance the professional education of the dental workforce, including enhanced faculty training in gerontology, geriatrics and special patient care, and opportunities for improved curricula and team training both within the dental team and among the diverse group of health professional that often collaborate in the care of special needs patients. Other considerations include the creation of a specialty of Special Care Dentistry, and the effective use of dental team members in the care of special needs patients.     

Differences between Racial Groups in the Impact of Oral Disorders among Older Adults in North Carolina

Objectives : This study investigated variations in impact of oral disorders between older black adults and older white adults living in North Carolina. Methods : Using the Oral Health Impact Profile (OHIP) questionnaire, 440 participants aged 70 and older provided data on their perceptions of the impact of oral disease on aspects of their lives during the previous 12 months. Results : For 22 of the 49 items queried in the OHIP questionnaire, older blacks reported more frequent impact than older whites (P<. 05). For none of the OHIP items did whites report more frequent impact. The impacts reported were diverse and included items reflecting pain, physical disability, psychological disability, and social disability. When the number of items occurring fairly often or very often were summed for dentate participants, blacks reported more items than did whites (3.7 vs 1.1 , P<. 0001). This difference decreased to 2.7 vs 2.0 (P<. 346) after controlling statistically for greater mean periodontal pocket depth, more unreplaced missing teeth, and more episodic dental visits among blacks. Conclusions : Older dentate blacks reported more impact from oral problems than older dentate whites. The differences in reported impact likely are linked to differences in oral status and dental visit history between these two racial groups in North Carolina.     

Differences in oral health status between institutionalized and non-institutionalized older adults

Differences in oral health status between independent and institutionalized adults have been difficult to interpret because the latter population is typically older and has a higher proportion of women, confounding any association between institutionalization and disease levels. We undertook an analysis of oral disease amongst institutionalized (n = 149) and non-institutionalized (n = 246) samples of older adults randomly selected from the population in East York, Ontario. When the confounding effects of age and gender were controlled by constructing 67 matched pairs, institutionalized people were more than twice as likely to be edentulous (OR = 2.17, 95% CI = 1.09-4.29). This association was confirmed using data from all subjects in a logistic regression model. Analysis of covariance of data from dentate subjects revealed that the institutionalized seniors had fewer filled teeth (P less than 0.05, controlling for age and sex), but there were no statistically significant differences in the number of teeth which were missing, decayed, or requiring extraction. These findings suggest that antecedent, sociodemographic factors prior to institutionalization are responsible for the higher probability of oral disease in this group of older adults.     

Pre-school child oral health in rural Western Australia

BACKGROUND: In light of the various challenges faced by public dental health services, especially when large geographical areas and isolated communities are concerned, targeting of high risk groups within these populations needs to be investigated. This study aimed to assess caries experience, dental health behaviour and dental service utilization among a sample of pre-school children in a rural community in Western Australia. METHODS: The study was a cross-sectional oral health survey of pre-school children between the ages of 2 and 5 in Carnarvon, Western Australia. RESULTS: In total, 70 pre-school children (representing approximately 15 per cent of the total 2-5 year old population of Carnarvon) were examined. Less than half of the children were caries free. Both caries prevalence and severity (mean dmft) were significantly higher among Aboriginal children than non-Aboriginal children. Caries prevalence and severity were also significantly higher among children who often consumed carbonated drinks. CONCLUSIONS: This survey indicates that some pre-school children in rural areas, and especially Aboriginal pre-school children, are at high risk of developing dental caries. Effective oral health programmes commencing well before the usual first contact with dental services at age 5 are needed for young children at high risk of dental caries.     

National survey of oral health care in Finnish municipal old people''s homes

As oral health is especially important for physically, mentally and socially handicapped old people, the aim of this study was to investigate the dental services provided for people living in municipal old people's homes in Finland. The study involved all the 431 municipal old people's homes in Finland in 1989. The directors of the old people's homes were asked to fill in a questionnaire. The response rate was 99.5%. The study showed that the dental services provided for the elderly vary greatly in different old people's homes. As a whole, however, dental care arrangements are inadequate: oral examinations on admission are performed always in 11% and never in 47% of the old people's homes, and oral examinations for residents are carried out annually in 23% and never in 21%. In 56% of the homes the need for treatment comes to light only when the old people themselves complain about a dental problem. Comprehensive dental care is available in 16% of the homes. One notable feature is that, although all the homes are publicly owned, the system of charging for the dental care of the elderly varies considerably between different homes. Comparing the results of this study with those from earlier investigations shows that, although there has been some progress in dental service arrangements in the 1980s, the oral care provided for these old people is still far from satisfactory. It is obvious that the value of oral health as an important component of human well-being is not yet widely recognized. To rectify the situation uniform regulations governing dental services for the elderly in institutions are required for the whole of the country.     

The Oral Health Status, Treatment Needs, and Dental Utilization Patterns of Native American Elders

The purpose of this study was to evaluate the oral health status, treatment needs, and dental care utilization patterns of a Native American population aged 65-74 years. A random sample of 688 individuals was chosen and approached regarding participation in the study. Data were gathered through an interviewer-administered questionnaire and an oral examination. A total of 204 individuals completed all aspects of the study. Only one participant had all 28 natural teeth, while 58.3 percent were totally endentulous. Of the 85 dentate participants, almost 53 percent required at least one extraction. The average number of required extractions in the dentate subjects was three. Although 94 percent of the sample stated they had a usual source of dental care, 40.7 percent had not visited a dentist within the last five years. Multiple regression analyses were used to determine the factors associated with total number of teeth present among the dentate participants. Years of education and time since last dental visit were the two significant predictors (P less than .05) of number of teeth present. The higher the level of education, the greater the number of teeth in later life. The number of teeth present was inversely related to years since dental treatment. Compared to the results of the National Survey of Oral Health in US Employed Adults and Seniors, this Native American sample had a higher prevalence of endentulism and utilized dental services less often than a comparable age group in the US population as a whole.     

Geriatric oral health issues in the United Kingdom

The current status of geriatric oral health in the United Kingdom is influenced by an historical pattern of care prevalent during the early years of the National Health Service in 1948, when inexpensive oral health care became available to all. At that time, tooth extraction was perceived as an acceptable, and among some people a preferred, approach to oral care. This has left a legacy of edentulism among senior citizens, which affects both oral and general health, in addition to an attitude that places oral health as a low priority. This legacy is now beginning to unwind as cohorts of adults, who have benefited from low‐cost dental care for the majority of their lives, are entering their senior years. Many of these young‐old retain their natural teeth and have more positive attitudes towards oral health. This paper discusses the impact of this history as well the effect of income on access to care, the influence of the ageing process on adequate oral hygiene and the availability of dentists trained to treat both dentate and edentulous geriatric patients. A brief outlook for the future is also provided.     

Medical considerations relating to the oral health of older adults

This review paper was written in conjunction with the 2010 National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and Persons with Disabilities. It provides an overview of specific medical considerations involved with dental diagnosis and treatment of this “at risk population.” The role of oral inflammation is referenced within the context of the oral/systemic paradigm (e.g., diabetes, cardiovascular disease/stroke, respiratory diseases, and cognition). Oral manifestations associated with multi‐organ diseases, tobacco/alcohol use, and medications are additionally discussed. Finally, the paper encourages development of interdisciplinary approaches to positively influence health outcomes.