Alzheimer's disease: psychopathology, medical management and dental implications.

J Am Dent Assoc. 2006 Sep;137(9):1240-51

Authors: Friedlander AH, Norman DC, Mahler ME, Norman KM, Yagiela JA

BACKGROUND: The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with Alzheimer's disease (AD). STUDIES REVIEWED: The authors conducted MEDLINE searches for 2000 through 2005 using the terms "Alzheimer's disease," "geriatric," "epidemiology," "pathophysiology," "treatment" and "dentistry." Reports selected for further review included those published in English in peer-reviewed journals. The authors gave preference to articles reporting randomized, controlled trials. RESULTS: AD is a progressive and fatal neurodegenerative disorder characterized by cognitive dysfunctions, particularly in learning and memory, and the emergence of behavioral abnormalities. Deficiencies in the cells responsible for storage and processing of information underlie the cognitive, functional and behavioral changes seen in patients with the disorder. CLINICAL IMPLICATIONS: As the elderly population grows, increasing numbers of Americans with AD will require dental treatment. The prevalence of dental disease likely will be extensive, because of diminished salivary flow and patients' inability to perform appropriate oral hygiene techniques. Preventive dental education for the caregiver and use of saliva substitutes and anticaries agents by the patient are indicated.

PMID: 16946428 [PubMed - indexed for MEDLINE]

Geriatric alcoholism: pathophysiology and dental implications.

J Am Dent Assoc. 2006 Mar;137(3):330-8

Authors: Friedlander AH, Norman DC

BACKGROUND: The authors reviewed the clinical features, epidemiology, diagnosis, medical treatment, orofacial findings and dental treatment of geriatric patients with alcoholism. TYPES OF STUDIES REVIEWED: The authors conducted MEDLINE searches for the period 1995 through 2004 using the terms "alcoholism," "geriatric," "pathophysiology," "treatment" and "dentistry." They selected reports published in English in peer-reviewed journals for further review. RESULTS: Physiological changes associated with aging permit the harmful effects of drinking alcohol to arise at lower levels of consumption than in younger people. Excessive use of alcohol exacerbates the medical and emotional problems associated with aging and predisposes the person to adverse drug reactions with medications controlling these illnesses. CLINICAL IMPLICATIONS: The incidence of dental disease in this population is extensive because of diminished salivary flow and a disinterest in performing appropriate oral hygiene techniques. Concurrent abuse of tobacco products worsens dental disease and heightens the risk of developing oral cancer. Identification of patients who abuse alcohol, a cancer-screening examination, preventive dental education, and use of saliva substitutes and anticaries agents are indicated. Clinicians must take precautions when performing surgery and when prescribing or administering analgesics, antibiotics or sedative agents that are likely to have an adverse interaction with alcohol.

PMID: 16570466 [PubMed - indexed for MEDLINE]

Insights from students following an educational rotation through dental geriatrics.

J Dent Educ. 2005 Dec;69(12):1368-76

Authors: MacEntee MI, Pruksapong M, Wyatt CC

Little is known about how dental students respond to dental geriatrics. This article describes a qualitative analysis of reflective journals submitted over two years by ninety-two senior students who participated in a brief clinical rotation in long-term care facilities. We used an inductive interpretive approach to analyze the journals. Eight themes emerged from the analysis: 1) complexity of the institutional environment; 2) heterogeneity of the resident population; 3) multidisciplinary environment; 4) record keeping; 5) interactions with residents; 6) the difficulty of oral health care for frail residents; 7) bridging the gap between theory and practice; and 8) the emotional impact of the clinical experiences. Apparently, the students appreciated the opportunity to witness the complexity of care in a multidisciplinary context and to observe a practical program of oral health care. They described the rotations as unique and emotionally challenging but very worthwhile. Overall, they wrote positively about their experiences with the elderly residents, acknowledged the contribution of the rotation as important to their clinical maturation, and reported that the experience enhanced their appreciation of a dentist's professional responsibilities.

PMID: 16352773 [PubMed - indexed for MEDLINE]

The oral health status of nursing home residents: what do we need to know?

J Dent Educ. 2005 Sep;69(9):1015-7

Authors: Guay AH

PMID: 16141087 [PubMed - indexed for MEDLINE]

Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany.

J Dent Educ. 2005 Sep;69(9):987-97

Authors: Holm-Pedersen P, Vigild M, Nitschke I, Berkey DB

This article reviews access to and financing of dental care for aging populations in selected nations in Europe. Old age per se does not seem to be a major factor in determining the use of dental services. Dentition status, on the other hand, is a major determinant of dental attendance. In addition to perceived need, a variety of social and behavioral factors as well as general health factors have been identified as determinants of dental service use. Frail and functionally dependent elderly have special difficulties in accessing dental care; private dental practitioners are hesitant to provide dental care to these patients. One reason may be that the fee for treating these patients is too low, considering high dental office expenses. Another reason may be problems related to management of medically compromised patients. This raises an important question: does inadequate training in geriatric dentistry discourage dentists from seeking opportunities to treat geriatric patients? Overall, the availability of dental services, the organization of the dental health care delivery system, and price subsidy for dental treatment are important factors influencing access to dental care among older people in Europe as well as in the United States.

PMID: 16141084 [PubMed - indexed for MEDLINE]

Access to dental care among older adults in the United States.

J Dent Educ. 2005 Sep;69(9):961-74

Authors: Dolan TA, Atchison K, Huynh TN

Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.

PMID: 16141082 [PubMed - indexed for MEDLINE]

[Self-perception and oral health conditions in an elderly population]

Cad Saude Publica. 2005 Jul-Aug;21(4):1251-9

Authors: Silva DD, de Sousa Mda L, Wada RS

This study assessed oral health conditions through clinical examination and self-perception. The sample consisted of 112 subjects 60 years of age or older in Rio Claro, São Paulo, Brazil, divided into two groups: G1, with dental insurance (n = 55) and G2, without dental insurance (n = 57). Clinical examinations were conducted according to WHO guidelines. Data on self-perceived oral health were collected using the GOHAI (Geriatric Oral Health Assessment Index). DMFT was 29.13, higher in G1 (p = 0.0091). Mean number of teeth currently present in both groups was 7.63, higher in G2 (p = 0.0131). Periodontal conditions showed a high percentage of null sextants (70.3%), where CPI revealed higher prevalence for calculus and PIP for pockets up to 3mm. The percentage of edentulous subjects was 45.5%, higher in G1 (p = 0.0142). Among edentulous subjects, 69.6% wore complete upper dentures and 42.9% complete lower dentures. Mean GOHAI was 33.61, qualifying self-perceived oral health status as positive, and the only difference was in the physical dimension, where G2 showed higher values (p = 0.0154). Self-perceived oral health was considered satisfactory, but this was not confirmed by clinical data from the two groups.

PMID: 16021263 [PubMed - indexed for MEDLINE]

Understanding dental students' knowledge and perceptions of older people: toward a new model of geriatric dental education.

J Dent Educ. 2005 Apr;69(4):419-33

Authors: Fabiano JA, Waldrop DP, Nochajski TH, Davis EL, Goldberg LJ

Increasing numbers of older people and the decreasing rates of edentulism highlight the importance of dental education that focuses on oral health and aging. This evaluation study assessed dental students' knowledge and beliefs about older people as well as their awareness of the biopsychosocial concerns that are potential barriers to oral health care. Dental students' (N=202) knowledge and perceptions of older people were evaluated before and after the first year of a new educational program. Students completed the Palmore Facts on Aging Quiz II (FAQ II) and answered questions about health problems and social concerns that may influence patient care. The intervention was twofold: 1) the CARES (Counseling, Advocacy, Referral, Education, and Service) Program, a clinical collaboration between the schools of Dental Medicine and Social Work, was initiated; and 2) all students were exposed to geriatric educational interventions. FAQ II scores did not significantly change, but dental students' awareness of mental health, independence, and social concerns increased between Times 1 and 2. The results of the study suggest that positive interactions with older adults by health care providers may depend more on positive perceptions toward older people than increased knowledge about aging. Future research will focus on positive experiences with older adults and attitudes of dental students toward the elderly.

PMID: 15800255 [PubMed - indexed for MEDLINE]

[Domiciliary assistance dental programs: a current demand]

Aten Primaria. 2004 Oct 31;34(7):368-73

Authors: Gil Montoya JA, Subirá Pifarré C

INTRODUCTION: The growing demand of dental treatment by institutionalised and community-dwelling older adults has made necessary to develop and to evaluate domiciliary dental care programmes. OBJECTIVE: Delivering and economic evaluation of comprehensive oral health care treatment to older adults living at home or in geriatric centres, with problems of transportation. PROGRAM: A domiciliary dental care program in a nursing home and in a group of people receiving domiciliary care has been develop. During a 10 and 5 month period and working with 210 and 47 patients respectively, a dentist and hygienist treated the basic dental needs with portable instruments. DISCUSSION: In spite of the advantages of those programmes, they have a lot of problems such as the economic costs (25,000 Euros in the nursing home and 16,700 in their own house), the dental treatment limitations and the few patients you can visit in one day. The development of domiciliary dental care treatment programmes suppose high economics cost that we must pay attention.

PMID: 15511359 [PubMed - indexed for MEDLINE]

Daily oral care and cough reflex sensitivity in elderly nursing home patients.

Chest. 2004 Oct;126(4):1066-70

Authors: Watando A, Ebihara S, Ebihara T, Okazaki T, Takahashi H, Asada M, Sasaki H

BACKGROUND: Intensive oral care can reduce the incidence of pneumonia in elderly nursing home patients, but the mechanism is unknown. OBJECTIVE: To explore the effects of intensive oral care on impaired cough reflex sensitivity, which is a known risk factor of aspiration pneumonia. METHODS: Cough reflex sensitivity to citric acid was measured in elderly nursing home patients, who were randomly assigned to the intervention group (n = 30) and the control group (n = 29). The patients in the intervention group had their teeth and gingiva cleaned by caregivers after every meal for 1 month. The patients in the control group performed their own oral care during the same period. Serum substance P (SP) concentration, cognitive function, and activities of daily living (ADL) were also assessed. RESULTS: In the intervention group, cough reflex sensitivity at 30 days showed significantly higher sensitivity than baseline (p < 0.01). At 30 days, the cough reflex sensitivities in the intervention group were significantly higher than that of the control group (p < 0.05). Compared with the control group, the odds ratio of improvement of cough reflex sensitivity was 5.3 (95% confidence interval, 1.7 to 16.0; p < 0.005) for the intervention group. One month of intensive oral care did not have a significant effect on serum SP concentration, cognitive function, and ADL. CONCLUSION: Intensive oral care may reduce the incidence of pneumonia by improving cough reflex sensitivity in elderly nursing home patients.

PMID: 15486365 [PubMed - indexed for MEDLINE]

Oral health care services for older adults: a looming crisis.

Am J Public Health. 2004 May;94(5):699-702

Authors: Lamster IB

PMID: 15117682 [PubMed - indexed for MEDLINE]

Oral health care for the elderly: more than just dentures.

Am J Public Health. 2004 May;94(5):698

Authors: Ahluwalia K

PMID: 15117681 [PubMed - indexed for MEDLINE]

A predoctoral clinical geriatric dentistry rotation at the University of the Pacific School of Dentistry.

J Dent Educ. 2004 Apr;68(4):454-9

Authors: Ch&#xE1;vez EM, LaBarre EE

Predoctoral dental students from University of the Pacific School of Dentistry provide initial and yearly dental evaluations for participants of On Lok Senior Health Services on site at On Lok centers. Student dentists also complete some dental procedures including denture fabrication, adjustments and repairs, hard and soft relines, scaling/root planing, polishing, and limited restorative treatments. A wide range of age-prevalent oral conditions such as candidiasis and xerostomia are identified and treated or managed. Students may also be called upon to present patient needs weekly to a member of the interdisciplinary team for discussion. Students periodically review instructions and devices for oral health care with the On Lok staff. The program is intended to be mutually beneficial to the participants of On Lok and Pacific student dentists. While the majority of comprehensive and emergency services are provided by On Lok staff dentists and contract specialists, the student dentist program has broadened the scope of the oral health program at On Lok and has been well integrated with the other day services. Meanwhile, Pacific students gain experience identifying and managing the complex social, economic, and health needs of frail elders in San Francisco.

PMID: 15112923 [PubMed - indexed for MEDLINE]

Medical health and medication use in elderly dental patients.

J Contemp Dent Pract. 2004 Feb 15;5(1):31-41

Authors: Jainkittivong A, Aneksuk V, Langlais RP

The objectives of this study were to obtain information on the medical conditions and medications used among elderly Thai dental patients and to investigate the relationship between the findings in relation to age and sex. The information regarding medical conditions and medication use was obtained from interviews of 510 dental patients aged 60 years and older. The incidence of medical conditions was 82.5%; women had a significantly higher incidence of medical conditions (86.5%) than men (76.5%). The incidence of medical conditions did not differ among the three age groups. Overall, cardiovascular disease was the leading problem (33.7%) with hypertension being the major component (26.1%). The prevalent problems were bone/joint disorders (32.4%), allergies (18.2%), diabetes mellitus (14.5%), and eye and ear problems (14.3%). In our sample, 65.5% reported taking medications, with an average of 1.5 drug groups per person. The average number of medications taken increased as age increased. Women took medications more frequently than men (70% vs. 58.5%). The four most prevalent drugs were cardiovascular agents (32%), endocrinologic drugs (14.5%), nutritional therapeutics (12.9%), and drugs acting on the musculoskeletal system (11.4%). The present study supports the findings of previous reports in that the presence of medical conditions is high in the elderly and the incidence of medication use increases with advancing age.

PMID: 14973558 [PubMed - indexed for MEDLINE]

Oral health disparities among the elderly: interdisciplinary challenges for the future.

J Dent Educ. 2003 Dec;67(12):1327-36

Authors: Pyle MA, Stoller EP

The elderly, like other population groups, have experienced varying levels of oral health among their diverse demographic subgroups. For those in poverty, experiencing social isolation, residing in long-term care institutions, and with complex medical illness, oral health care may be unreachable. Various models of training, education, and community, public, and professional collaboration have been proposed, yet few strategies have been implemented. Interdisciplinary approaches that bring interested partners together as equal stakeholders may create faster tracks in improving access to health care for those geriatric patients who lack it. This article explores past and present recommendations for interdisciplinary collaborations, reviews the current and future needs of the geriatric population, discusses educational models and content, and expresses the need for leadership to address oral health disparities in the elderly. Finally, strategies for making improvements in the existing oral health disparities are discussed.

PMID: 14733265 [PubMed - indexed for MEDLINE]

Current status of predoctoral geriatric education in U.S. dental schools.

J Dent Educ. 2003 May;67(5):509-14

Authors: Mohammad AR, Preshaw PM, Ettinger RL

The elderly constitute the fastest growing segment of the U.S. population. Dental schools must educate dental students so that they are competent and confident in managing the treatment needs of elderly patients. Programs in geriatric dentistry have been developed in response to the changing oral health needs of growing numbers of older adults. The purpose of this online survey was to identify the current status of predoctoral geriatric dental education in U.S. dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the World Wide Web, and fifty-four US. dental schools were invited to complete the form. Data from completed questionnaires were submitted to the investigators via email. Following repeated phone calls and emails to urge school administrators to respond to the electronic questionnaire, a 100 percent response rate was achieved. All schools reported teaching at least some aspects of geriatric dentistry, and 98 percent had curricula that contain required didactic material. Sixty-seven percent of schools reported having a clinical component to geriatric dental teaching. Of these schools, the clinical content was required in 77 percent and elective in the rest. Thirty percent of schools reported a specific geriatric dentistry clinic within the school, and 11 percent had a remote clinical site. Sixty-three percent of schools have a geriatric program director or a chairman of a geriatric section. Over a third of schools indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has continued to expand over the last twenty years and has established itself in the U.S. predoctoral dental curriculum. The format of teaching the subject varies considerably among the dental schools. Although didactic teaching of geriatric dentistry has increased markedly in the last two decades, clinical experience, both intramurally and extramurally, did not keep pace.

PMID: 12809185 [PubMed - indexed for MEDLINE]

Optimism and life satisfaction as determinants for dental and general health behavior-oral health habits linked to cardiovascular risk factors.

J Dent Res. 2003 Mar;82(3):194-9

Authors: Yl&#xF6;stalo PV, Ek E, Laitinen J, Knuuttila ML

Oral infections and cardiovascular diseases share common biological and behavioral risk factors. Psychosocial determinants could act as a link between general health behavior and dental health behavior. Our objective was to study optimism and life satisfaction as determinants of general and dental health behavior and to evaluate whether these are connected with cardiovascular risk factors and dental diseases. The 1966 Northern Finland Birth Cohort (N = 12,058) is a general population birth cohort. In a postal questionnaire, respondents (N = 8690) were asked about their health behavior and dental status. Cardiovascular risk factors were assessed in health examinations (N = 6033). Generalized linear regression models were used in analysis. The results showed that health orientation increases with strengthening life satisfaction and optimism. Dental health behavior and general health behavior were associated with both cardiovascular risk factors and self-reported dental diseases, which support the assumption that they share a common behavioral background.

PMID: 12598548 [PubMed - indexed for MEDLINE]

Endodontic status in older U.S. adults. Report of a survey.

J Am Dent Assoc. 2001 Nov;132(11):1525-30; quiz 1595-6

Authors: Goodis HE, Rossall JC, Kahn AJ

BACKGROUND: Aging people experience a number of changes in the root canal systems of teeth that, while they are normal, have the potential to compromise the pulp's response to injury. METHODS: To better understand the dental perspective on these changes, the authors mailed a questionnaire to diplomates of the American Board of Endodontics. The questions dealt with the respondents' experiences, ages of their patient population and their perception of root canal changes in aging patients. The authors analyzed the data in terms of number of diplomates providing a response and stratified them on the basis of the respondents' number of years in practice. RESULTS: Respondents indicated that the number of patients aged 65 years and older in their practices is increasing. Virtually all of the diplomates agreed that the root canal gets smaller with age, but that this diminution does not contribute to the failure of treatment of affected teeth. Most respondents indicated that aging patients' teeth are in poorer condition than those of younger patients. CONCLUSIONS: As the U.S. population ages, clinicians need to have a better understanding of the physiological changes occurring in older patients' teeth that may influence the treatment required to help patients retain their natural dentition. Further studies are needed to determine the impact of aging on dental disease and treatment modalities. CLINICAL IMPLICATIONS: Recognition of changes in the dentition of aging patients will lead to more successful treatment, retention of functional natural dentition and better maintenance of general health.

PMID: 11806066 [PubMed - indexed for MEDLINE]

[The role of dentistry in the interdisciplinary team: contributing to comprehensive health care for the elderly]

Cad Saude Publica. 2000 Oct-Dec;16(4):1099-109

Authors: Shinkai RS, Del Bel Cury AA

This literature review focuses on dentistry's role in comprehensive health care for the elderly. The authors discuss the need for an interdisciplinary approach. They begin by analyzing the current situation in geriatric dentistry and related problems in Brazil, relating primarily to the lack of specific studies and human resources with training in geriatrics and gerontology. The authors emphasize interactions between dentistry and other health professions for health promotion, specific prevention, and rehabilitation of elderly patients, with special attention to the importance of communication and information exchange.

PMID: 11175533 [PubMed - indexed for MEDLINE]

Oral care of elderly patients: nurses' knowledge and views.

Postgrad Med J. 2000 Feb;76(892):89-91

Authors: Preston AJ, Punekar S, Gosney MA

It is important that healthcare professionals caring for the elderly in hospitals have a core knowledge of the orodental care requirements of their patients. The aim of this study was to determine the knowledge and views of nurses working on acute and rehabilitation care of the elderly wards about orodental care. One hundred nurses and healthcare assistants took part in this questionnaire study of which 58 were qualified nurses and 70 had been employed on care of the elderly wards for two or more years. Although the majority of the respondents were registered with a dentist and attended regularly, 40 did have 'some anxiety' about visiting their dentist. Approximately half of the study population regularly gave advice to their patients about dental care but their knowledge of and reasons for providing oral care and advice was often incorrect. The group's understanding of the availability of dental treatment provided by the National Health Service was also often inaccurate. It was concluded that a better core knowledge of the orodental care of older patients is required by all healthcare professionals who care for this group. It is also important that individuals in whom anxiety is associated with their own dental experience do not neglect to give orodental health advice to their patients.

PMID: 10644385 [PubMed - indexed for MEDLINE]

Depressed taste and smell in geriatric patients.

J Am Dent Assoc. 1999 Dec;130(12):1759-65

Authors: Winkler S, Garg AK, Mekayarajjananonth T, Bakaeen LG, Khan E

BACKGROUND: Geriatric patients have a number of dental care problems that younger patients do not encounter. The oral changes associated with aging can have a significant effect on the efficacy of dental treatment. TYPES OF STUDIES REVIEWED: The authors reviewed studies dealing with the causes of depressed sense of taste and smell; the causes included aging, disease, medications and dental problems. Based on their findings, the authors described the location and anatomy of taste buds and receptor cells for smell and explored appetite, saliva, food seasonings, nutrition and dietary recommendations. They also discussed the relationship of smoking and tongue cleaning to taste sensations. RESULTS: The authors found that considerable differences exist between elderly people and young people in regards to sensory perception and pleasantness of food flavors. Salt and bitter taste acuity declines with age, but sweet and sour perceptivity does not. Olfactory acuity also declines with age. The authors found that most of the studies reviewed suggested that the sense of smell is more impaired by aging compared with the sense of taste. Smoking diminishes the taste of food and makes flavorful foods taste flat, while tongue brushing can increase taste sensation for geriatric patients. CLINICAL IMPLICATIONS: Food can become tasteless and unappetizing for geriatric patients as the result of declining taste and smell perception. Geriatric patients should be encouraged to add seasonings to their food instead of relying on excessive consumption of salt and sugar to give their food flavor. Adequate nutrition, tongue cleaning and smoking cessation are recommended for geriatric dental patients.

PMID: 10599179 [PubMed - indexed for MEDLINE]

Oral health and nutrition.

Age Ageing. 1999 Sep;28(5):419-20

Authors: Walls AW

PMID: 10529032 [PubMed - indexed for MEDLINE]

An impression technique for severely resorbed mandibles in geriatric patients.

J Am Dent Assoc. 1999 Feb;130(2):255-6

Authors: Pyle MA

PMID: 10036849 [PubMed - indexed for MEDLINE]

Three-year changes in self-perceived oral health status in an older Canadian population.

J Dent Res. 1997 Jun;76(6):1292-7

Authors: Locker D, Jokovic A

Although change is a central goal of oral health care interventions, little attention has yet been paid to change in self-perceptions of oral health status. This is an important omission, given the current emphasis on assessing health outcomes. This paper reports the results of a study which examined changes over a period of three years in self-perceived oral health among 611 community-dwelling Canadians aged 50 years and over. Change in self-perceptions was measured by means of a global transition item and change scores derived from repeat administrations of four subjective oral health status indicators. Overall, 20.5% reported that their oral health had deteriorated over the three-year observation period, 68.5% that it had remained the same, and 10.5% that it had improved. There was a significant association between these global change categories and change scores for the four subjective indicators. Because of the small number of edentulous subjects, the analysis of baseline characteristics predicting change was confined to dentate subjects. Bivariate and logistic regression analyses were used to compare the two groups reporting change with those whose oral health status remained stable over the observation period. The results suggest that, when compared with this reference group, those who deteriorated and those who improved were similar in some respects but distinct in others. Those who improved appeared to have specific oral conditions at baseline causing pain. Those who deteriorated had poor oral health in general and came from more disadvantaged backgrounds. However, the explanatory power of logistic regression models predicting change in self-perceived oral health was poor when judged in terms of model sensitivities. This was to be expected, given that the models did not include variables documenting the incidence of disease, receipt of dental care, or changes in social and personal circumstances over the observation period.

PMID: 9168863 [PubMed - indexed for MEDLINE]

Oral infections in home-living elderly patients admitted to an acute geriatric ward.

J Dent Res. 1997 Jun;76(6):1271-6

Authors: Meurman JH, Pajukoski H, Snellman S, Zeiler S, Sulkava R

Little is known about the oral health of the frail and home-living elderly. The effects of dentogenic infections on the general condition of the elderly are also unknown. We therefore set out to investigate 191 elderly patients referred to an acute geriatric hospital due to sudden worsening of their general health. The patients' mean age was 81.2 +/- 6.4 years (range, 67 to 96 years), and they had lived at home before hospitalization. The patients were examined and their diagnoses set by a team of physicians. The dentist's examination was also made bedside. Panoramic x-rays were taken for those who were able to stand (n = 148). Particular attention was paid to the occurrence of dental infection foci and systemic infection parameters of blood. Only patients free from other than dental infections were included in the statistical analyses (n = 184). Panoramic x-rays revealed dentogenic infection foci in 71.1% of the dentate patients. Periodontal condition was poor in 96.2% of the patients (CPI score, 2 to 4). All infection parameters were high in patients with high periodontal treatment need, but the differences were not statistically significant. Neither were there statistically significant correlations between the number of dentogenic infection foci recorded from the radiographs and infection parameters of blood. More of the edentulous patients had positive salivary yeast counts than did the dentate patients (84.4% vs. 66.1%; P < 0.05). No correlation was found between the main systemic diagnoses and dental infections. Since the prevalence of dentogenic infection foci in our subjects was high, and they did not cause marked increase in the hematological infection parameters investigated, it seems clear that geriatricians should refer their patients for dental examinations. Although our patients represent the home-living elderly population in a Nordic country with a high standard of living and good medical care, dental care had been neglected regardless of the patients' systemic disease.

PMID: 9168860 [PubMed - indexed for MEDLINE]

The effects of simple interventions on tooth mortality: findings in one trial and implications for future studies.

J Dent Res. 1997 Apr;76(4):867-74

Authors: Hujoel PP, Powell LV, Kiyak HA

The purpose of this report was to use a particular clinical trial, the Preventive Geriatric Trial (PGT), as a starting point to discuss whether treatment efficacy can be evaluated by means of tooth mortality. In the PGT, 296 subjects were recruited and randomly assigned to five treatment groups: (1) usual procedures (UP); (2) UP + a cognitive-behavioral intervention (CB); (3) UP + CB + weekly chlorhexidine rinse (CHX); (4) UP + CB + CHX + semi-annual fluoride varnish (F); and (5) UP + CB + CHX + F + semi-annual prophylaxis, including scaling (P). Exploratory analyses revealed that tooth mortality after the 1st year was lower in treatment groups 3, 4, and 5 than in groups 1 and 2. A one-year exposure resulted in a 45% reduction in tooth mortality (p < 0.05); a two-year exposure resulted in a 59% reduction (p-value < 0.04). The PGT findings suggested that it is possible to design trials based on clinically relevant endpoints, such as tooth mortality. For the detection of moderate treatment effects, such trials could take the form of Large, Simple Trials (LST), where many subjects are recruited with minimally restrictive entry criteria, and data are collected only on essential baseline characteristics and tooth mortality. LSTs have provided "reliable answers to important clinical questions" for other chronic diseases, and several arguments suggest that they could play a similar critical role in dental research: (1) Periodontitis and caries are among the most common and costly chronic diseases affecting humans, and the identification of even moderately effective treatments by LSTs can have a large socio-economic impact; (2) the identification of low-cost widely practicable treatments that lend themselves to be investigated in LSTs is likely to benefit more people than the identification of high-cost complex treatments; and (3) tooth mortality is simple to assess and more relevant than the unvalidated surrogate endpoints that have largely failed for more than 20 years to provide reliable answers to certain controversial issues regarding treatment efficacy. The cost of not reliably establishing the safety and the efficacy of treatments may be far greater than the cost of conducting LSTs.

PMID: 9126183 [PubMed - indexed for MEDLINE]

The old-old dental patient: the challenge of clinical decision-making.

J Am Dent Assoc. 1996 Mar;127(3):321-32

Authors: Berkey DB, Berg RG, Ettinger RL, Mersel A, Mann J

As the U.S. geriatric population grows older, dentists should recognize the need to carefully consider age-related concerns that influence clinical decision-making. The authors discuss several prevalent problems typically found in "old-old" patients and propose a model for determining the appropriate extent of dental care for them.

PMID: 8819779 [PubMed - indexed for MEDLINE]

Geriatric dentistry and prevention: research and public policy (reaction paper).

Adv Dent Res. 1991 Dec;5:74-7

Authors: Meyerowitz C

The population of older adults is heterogeneous and can be divided into many subgroups: the young-old, the old-old, the healthy, the sick, the frail, the mentally and physically handicapped, the ambulatory, the chair-bound, house-bound or institution-bound, and the economically advantaged and disadvantaged. This diversity is extremely important to the discussion of the oral health needs, preventive health strategies, and research agenda for the elderly. As life expectancy increases, more attention is being paid to disease prevention so that the quality of life in old age can be improved. However, the link among oral health, systemic disease, and quality of life in the elderly needs to be better-defined. There is some evidence in the literature that indicates that coronal and root caries appear to be major health problems for the elderly. This needs to be corroborated in longitudinal studies. Although periodontal disease prevalence and severity are high in some subgroups of the elderly, these appear to be in decline in the general population. Dental health-care workers must be cognizant of the oral conditions associated with systemic disease and the use of medication, a major concern in older adults. Prevention of oral disease in the elderly requires early intervention, education of the dental health team, and innovative uses of well-established preventive agents such as fluoride. An extensive research effort is needed to answer basic and applied questions regarding the oral health needs of the elderly. Federal and private funding will be necessary. The dental profession will have to demonstrate and be persuasive that money spent on research and care for the elderly is money well spent.

PMID: 1819288 [PubMed - indexed for MEDLINE]

Geriatric dentistry and prevention: research and public policy.

Adv Dent Res. 1991 Dec;5:69-73

Authors: Gershen JA

Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. The elderly are at greater risk for oral disease, since gains in longevity result in more medically compromising conditions or systemic disease with oral manifestations. Also, as edentulism decreases and as more teeth are retained by the elderly, the pattern of oral diseases and the treatment of dental conditions will be altered. Barriers to self-care and professional care must be removed, and prevention and early intervention strategies must be formulated to reduce the risk of oral disease. Risk factors for oral diseases in the elderly can be reduced by personal home-care regimens, professionally provided preventive, diagnostic, and therapeutic care, changes in high-risk behavior, and a supportive environment. Generating new information about the prevention of oral diseases and conditions that have an impact on the elderly requires a substantial research effort. A research agenda for the elderly should include: epidemiologic studies of relevant oral diseases and related risk factors; investigations of patient and provider attitudes and behavior related to oral health; studies of the relationship between general health and oral health; development and testing of preventive and treatment strategies for conditions such as xerostomia, root caries, secondary caries, and gingival recession; and studies for the evaluation of the impact of the aging population on the dental delivery system. Public policy options to support geriatric oral health care and research are limited by the Government's pre-occupation with cost containment and the lack of visibility for dental programs.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 1819287 [PubMed - indexed for MEDLINE]

Geriatric dentistry: a pressing need.

J Dent Res. 1989 Nov;68(11):1550

Authors: Massler M

PMID: 2584523 [PubMed - indexed for MEDLINE]

Dental care for nursing home patients.

Public Health Rep. 1978 Jan-Feb;93(1):90-2

Authors: Latt B, Stowell BS

PMID: 622452 [PubMed - indexed for MEDLINE]

Dental care for the shut-in patient: a workable solution.

Am J Public Health Nations Health. 1966 Nov;56(11):1921-6

Authors: Waldman HB, Stein M

PMID: 5951034 [PubMed - indexed for MEDLINE]