Cross-cultural adaptation of the Thai Xerostomia Inventory and Summated Xerostomia Inventory.

OBJECTIVE: To cross-culturally adapt and validate the Thai version of the Xerostomia Inventory (XI) and Summated Xerostomia Inventory (SXI) for subjective evaluation of oral dryness in Thai middle-aged and older adults. METHODS: The original English versions of the XI and SXI were cross-culturally translated into Thai. Content validity was examined by the expert panel and 30 pilot subjects. The XI/SXI-Thai were then administered to 200 Thai adults (aged 50 years or older) for further assessment of psychometric properties. The standard question, the Bother Index, and the Xerostomia Questionnaire were used as comparator instruments for the evaluation of criterion and construct validity, respectively. Internal consistency reliability was assessed using Cronbach's alpha. RESULTS: The final XI/SXI-Thai were found to have good content validity. Both scales were able to distinguish between xerostomia and non-xerostomia groups. We observed moderate to strong correlation between the XI/SXI-Thai and other comparator instruments, reflecting good criterion and construct validity. Cronbach's alpha values were 0.875 and 0.847 for the XI-Thai and SXI-Thai, respectively. CONCLUSIONS: The XI-Thai and SXI-Thai were found to be valid, reliable, and easily administrable instruments for xerostomia assessment in Thai middle-aged and older individuals in both clinical and research settings.

Cross-cultural translation and modification of the revised oral assessment guide for oral health assessment by non-dentists.

OBJECTIVES: This study aimed to conduct a cross-cultural translation of the revised oral assessment guide (ROAG) into Thai language and to modify the tool to increase its validity and reliability. MATERIALS AND METHODS: The present study was a cross-sectional design conducted in dental and hospitalized patients, and community-dwelling people. The original English-version of the ROAG was translated into Thai, which was evaluated for validity and reliability. The tool was then revised to develop the modified ROAG for non-dentist (ndROAG) comprising 9 oral assessment categories with a three-level response; healthy, mild, and severe alteration. The criterion validity of the ndROAG was tested in 82 adult and older participants, and 46 non-dentists comprising dental assistants, dental hygienists, community health volunteers, and nurses, using a calibrated dentist as the reference standard. The ndROAG was translated back into an English version. The criterion validity was evaluated using weighted Kappa (Kw) and intraclass correlation coefficient (ICC). Internal consistency was determined using Cronbach alpha. The three-level response was dichotomized into healthy and changed to determine the sensitivity and specificity. RESULTS: The Kw values, ICC, and Cronbach alpha values of the ndROAG were higher than those of the pre-test ROAG. The sensitivity of the ndROAG in identifying the healthy and changed state ranged from 57.1 to 100.0% with the lowest value in the saliva category, whereas the specificity ranged from 90.9-100.0%. CONCLUSION: The original ROAG was translated and revised into the ndROAG with improved validity and reliability. The ndROAG can be used by non-dentists to assess the oral health of adult and older individuals to detect oral changes, which includes self-care instructions and patient referral guidance.

Association between oral hypofunction and general health: a systematic review.

BACKGROUND: Oral hypofunction comprises 7 oral function conditions, including mastication, swallowing, pronouncing, oral hygiene, and oral dryness. However, it remains unresolved whether having oral hypofunction and each individual condition adversely affect general health. This study aimed to investigate the association between oral hypofunction and general health, encompassing physical, psychological, and social dimensions. METHODS: Oral hypofunction was diagnosed following the criteria proposed by the 2016 Japan Society of Gerodontology, comprising 7 oral function conditions. Oral hypofunction was diagnosed when at least 3 conditions presented. The selected studies eligible for reviewing were based on the PI(E)CO criteria: P (population), adult and older adults; I/E (intervention/exposure), having oral hypofunction by considering overall and individual 7 oral function conditions; C (comparator), not having oral hypofunction; O (outcome), the general health status, encompassing physical, psychological, and social dimensions. Electronic search limited to English articles was performed through PubMed, Scopus, and Cochrane Database of Systematic Reviews databases from January 2016 to June 2023. The included studies were assessed for quaility and risk of bias using the modified Newcastle-Ottawa scale. Qualitative analyses were performed on the general outcome, and having oral hypofunction considering overall and individual oral function conditions. RESULTS: Ten studies were included in the final syntheses. One was a prospective cohort, one was a case-control, and the others were cross-sectional studies. All included studies were high quality. General health outcomes were mostly frailty, sarcopenia, and malnutrition, whereas mild cognitive impairment,social withdrawal, and gastric cancer prognosis were identified in one of the included studies. The association between general health and having oral hypofunction was stronger than when considering an individual condition. The health outcomes were predominantly associated with mastication and swallowing, whereas their relationships with oral hygiene and dryness were less likely to be reported. CONCLUSIONS: The present review found an association between the presence of oral hypofunction and impaired general health. However, the specific impact on individual physical, psychological, and social dimensions cannot be distinctly delineated. Further prospective studies are required to clarify the causal-effect relationship between oral and general health.

Oral exercises significantly improve oral functions in people with mild and moderate dementia: A randomised controlled study.

BACKGROUND: There have been no standard protocols of oral exercises for maintaining and improving oral function for people with dementia. OBJECTIVE: This study aimed to determine the effects of home-based oral exercises on the oral function of people with mild to moderate dementia. METHODS: Twenty-two participants at King Chulalongkorn Memorial Hospital were randomly assigned to the exercise group (n = 11) or control group (n = 11). The exercise group was instructed to do three home-based oral exercises, consisting of tongue-strengthening, oral diadochokinesis (ODK) and mouth-opening exercises, for 3 months, while the control group received advice on oral health care. The maximum tongue pressure (MTP) was the primary outcome. MTP, ODK rates of /pa/, /ta/, /ka/, modified water swallowing test (MWST) and oral moisture were measured at baseline, and after 1, 2 and 3 months of training. The generalised estimating equation analysis was used to evaluate the effects of oral exercises on the oral function. RESULTS: The MTP and all ODK rates in the exercise group were significantly increased after 3 months of training. There were significant interaction effects between time and intervention in MTP and all ODK rates. No significant interaction effects between time and intervention in oral moisture were found. The MWST scores in both groups did not change through the end of study, and no adverse effects were reported. CONCLUSION: Home-based oral exercises were found to be effective for improving tongue strength and tongue-lip motor function in people with mild to moderate dementia.

A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults.

OBJECTIVES: The aim of this pilot study was to develop a Thai-version of a simple swallowing questionnaire, called the T-SSQ, and to evaluate the association between malnutrition risk and swallowing ability, determined objectively by tongue strength and subjectively by the T-SSQ. Sensitivity analysis was also performed to determine which swallowing indices better estimate malnutrition in older adults. METHODS: This cross-sectional study comprised two phases: Phase I, development and cross-cultural translation of the T-SSQ; and Phase II, application of the T-SSQ in 60 older adults. In Phase I, content and face validity of the T-SSQ was evaluated by 10 experts and 15 older adults. In Phase II, the convergent validity of the T-SSQ was evaluated by determining its association with objective tongue strength. Nutritional status was evaluated using the Thai-version of the Mini-Nutritional Assessment. Covariates included sociodemographic characteristics, and oral and health-related status. Adjusting for covariates, the associations between the two swallowing indices and malnutrition risk were determined using multivariable regression analyses. A cut-off value for low tongue strength was determined using a receiver operating characteristic (ROC) curve, and sensitivity analysis between the swallowing indices and malnutrition risk was performed. RESULTS: The T-SSQ comprised 4-items of common signs and symptoms of a swallowing problem. Its content and face validity were verified. Older adults were considered as having a swallowing problem when at least one item was reported. Convergent validity of the subjective index was shown by significantly different tongue strength values between the participants with and without a swallowing problem (p for independent t-test = 0.014). Based on the highest area under the ROC curve, an 18-kPa cut-off value was chosen to classify low tongue strength. Having a swallowing problem and low tongue strength was significantly associated with malnutrition risk. The positive predictive value of the subjective swallowing index was 1.8-fold higher than objective tongue strength. CONCLUSIONS: Self-reported swallowing problems determined by the T-SSQ can be used as a subjective index for evaluating swallowing ability in older adults. Subjective swallowing problems and objective tongue strength were associated with malnutrition risk. However, the T-SSQ estimated malnutrition risk better than the objective index.

Moving toward a competency-based curriculum: Analyzing patients' information and students' evaluation in geriatric dentistry.

OBJECTIVE: There is no core competency for geriatric dentistry and special patient care (GSP) in Thailand. Therefore, GSP program was developed as a knowledge-based curriculum. This study aimed to describe the development and architecture of the GSP curriculum by analyzing patients' information and students' evaluation to move toward a competency-based curriculum. Comparisons with the original GSP curriculum and future direction are discussed. METHODS: Development and architecture of the GSP curriculum were described. Information of 130 patients attending the GSP clinic, and those who participated in a maintenance recall was analyzed. Students' evaluation was performed using a 21-item questionnaire within seven domains based on the ASEAN University Network-Quality Assurance (AUN-QA) checklist. The responses were made using a five-point ordinal scale ranging from totally agree to totally disagree. RESULTS: Only 50% of the patients attended a maintenance recall. Among the recalled patients, 74.2% reported emerging problems. The AUN-QA questionnaire responses indicated that students mostly agreed with the program specification, teaching and learning approach, students' assessment methods, student quality, and support domains. The modified curriculum was developed based on the patients' information and students' evaluation. The original and modified GSP curricula were compared. CONCLUSIONS: Information analysis of the patients and students' evaluation are essential to move a knowledge-based curriculum for geriatric and special patient care dentistry toward a competency-based curriculum that is appropriate for patients' condition and serves students' requirements. Oral health care in elderly and special care patients requires a multidisciplinary approach, and should encompass oral disease problems, behavior, and social context.

The Patient's Denture Assessment (Thai version) is a valid and reliable tool for evaluating the outcome of treatment with complete denture.

BACKGROUND: Complete tooth losses are still being major problems which resulted in lesser quality of life especially for elderly patients. However, there are still lack of questionnaire to evaluate the treatment outcome from the patient's aspect. The objective of this study is to evaluate the reliability and validity of the Patient's Denture Assessment-Thai version (PDA-T), then use this questionnaire to assess patient satisfaction with complete denture treatment outcome also investigates the factors involving their satisfaction. METHODS: The subjects comprised 120 edentulous adult patients (49 men/71 women; average age 70 years-old) from the Prosthodontic and the Geriatric Dentistry and Special Patients Care Clinic at the Faculty of Dentistry, Chulalongkorn University during 2019 March‒2020 March. The patients were divided into two groups: the group experienced (Exper) (n = 54) with wearing complete dentures, and the non-experienced (NonExper) group (n = 66). The patients used the validated PDA-T to self-assess their treatment at different times. The Exper group completed the questionnaire at t0 (during treatment), t0.5 (2‒8-weeks after t0), and t1 (final follow-up). The NonExper group completed the questionnaire only at t1. RESULTS: In the Exper group, Cronbach's α and average inter-item correlation was 0.95 (range 0.76‒0.95) and 0.47 (range 0.57‒0.83), respectively. The intraclass correlation coefficients (n = 18, 95% confidence interval) were 0.98 overall. The paired t-test (p < 0.05) between t0 and t1 indicated a significant difference between t0 and t1 in every PDA-T topic, and the effect size was 1.71. In the NonExper group, the Pearson correlation analysis indicated no significant correlation between the patients' demographics and masticatory function. CONCLUSION: The reliability and validity of the PDA-T indicate it is a valuable tool for evaluating complete denture treatment. Treatment success affected the patients' satisfaction but was not associated with the type of doctors, genders, ages, or educational level.

Hyposalivation, oral health, and Candida colonization in independent dentate elders.

Hyposalivation is an important problem in elders and could interfere with several oral functions and microbial ecology. While the number of independent elders who retain more natural teeth increases worldwide, few studies examined hyposalivation in this population. Thus, this study aims to examine relationships between hyposalivation, oral health conditions and oral Candida colonization in independent dentate elders and evaluate factors associated with salivary flow and Candida carriage. We conducted a cross-sectional study in fifty-three dentate elders (≥65 years old with at least 4 pairs of posterior occlusal contacts) with no, or well-controlled, systemic conditions. Participants were interviewed for medical history, subjective dry mouth symptoms, oral hygiene practices and denture information. Unstimulated and stimulated salivary flow rates, objective dry mouth signs, gingival, tongue-coating, and root-caries indices were recorded. Stimulated saliva was cultured on Sabouraud-dextrose agar for Candida counts. Candida species were identified using chromogenic Candida agar and polymerase chain reaction. Statistical significance level was set at p<0.05. The results showed that hyposalivation was associated with higher gingival and tongue-coating indices (p = 0.003 and 0.015, respectively), but not root-caries index. Hyposalivation was also associated with higher prevalence of oral Candida colonization (p = 0.010; adjusted OR = 4.36, 95% confidence interval = 1.29-14.72). These two indices and Candida load were negatively correlated with unstimulated and stimulated salivary flow rates. Interestingly, non-albicans Candida species were more prevalent in denture wearers (p = 0.017). Hence, hyposalivation is a risk factor for poorer oral health and oral Candida colonization in independent dentate elders. Because of its potential adverse effects on oral and systemic health, hyposalivation should be carefully monitored in elders.