Maintaining oral health for a hundred years and more? - An analysis of microbial and salivary factors in a cohort of centenarians.

Aim: To investigate associations between oral health-related conditions and the oral microbiome in a representative study sample of centenarians. Materials and methods: Clinical and microbial parameters from 54 centenarians were assessed in the Heidelberg Dental Centenarian Study. Plaque and salivary samples were collected, and the microbiota was characterized by 16S rRNA gene sequencing. Results: Diversity and structure of the oral microbiome were mainly influenced by the presence of natural teeth and the number of decayed, missing, and filled teeth (0.028 ≤ p ≤ 0.001 in plaque and salivary samples). Centenarians with less caries experience possessed a more diverse oral microbiome. Moreover, the number of dental visits also showed a significant influence on the microbial composition. Most centenarians presented with hyposalivation (mean stimulated flow rate = 0.84 ± 0.55 ml/min), a low buffering capacity, and an acidic pH. The latter was between 5.0 and 5.8 in 46.3% of cases, and we observed that an increased salivary pH correlated with higher alpha-diversity in both salivary and plaque samples. Conclusion: The microbiome diversity correlated significantly with successful oral aging. In addition, regular dental visits were a beneficial factor. However, diversity can be negatively influenced by hyposalivation, associated with pH changes due to aging effects.

Association of Dental and Prosthetic Status with Oral Health-Related Quality of Life in Centenarians.

To date, there is little evidence on centenarians' dental and prosthetic status or their oral-health-related quality of life (OHRQoL). Therefore, the aim of this study was to assess possible associations between sociodemographic and oral health factors, including prosthetic needs in this special age group and their potential influence on OHRQoL. Persons born before 1920 were recruited from population registries in south-western Germany. Fifty-five centenarians participated and underwent a comprehensive oral examination. Cognitive capacity was evaluated using the short Mini-Mental State Examination (S-MMSE, max. 21 points). At an S-MMSE > 10, an analysis of OHRQoL by means of the Geriatric Oral Health Assessment Index (max. ADD-GOHAI score 60 points) was performed (n = 43). Bivariate statistics and a linear regression model were used after variable selection to analyze data. Centenarians presented with a mean (SD) of 22 (7.2) missing teeth. Complete (65.5%) or partial dentures (21.8%) in at least one jaw were most common. One-third of the dentures needed repair/replacement; 16% of the centenarians presented with denture sores. In 60% of cases, OHRQoL was rated unsatisfactory (ADD-GOHAI < 57). Trouble biting or chewing resulted in the lowest levels of OHRQoL. Fewer remaining teeth, reduced functional capacity and removable prostheses correlated with an impaired OHRQoL (rs = -0.36, p = 0.01; rs = -0.34, p = 0.01; rs = -0.29, p = 0.03, respectively). After variable selection, the final linear regression model included only the number of missing teeth, the associated ADD-GOHAI score decreasing by 0.3 points per missing tooth. In conclusion, tooth loss and removable prostheses in need of repair or replacement are highly prevalent in centenarians. These factors seem to modulate OHRQoL negatively, assumedly due to impaired chewing function. Larger confirmatory studies are needed to validate these first results.

Influence of COVID-19 Restrictions on Patients' Self-reported Oral Health Care Needs.

PURPOSE: To assess how current COVID-19 restrictions regarding elective dental procedures influence patients' self-reported oral health care needs at a University Hospital in Germany. MATERIALS AND METHODS: Patients with COVID-19 induced cancellation of elective treatment appointments previously scheduled for the period March 16th to April 30th 2020 were contacted by telephone and questioned about the occurrence of oral health problems, pain, self-reported treatment needs, and the use of emergency dental services. Data were analysed retrospectively. RESULTS: Information on 370 patients aged between 1 and 91 years was included. 16.2% (n = 60) of patients reported having experienced an oral health problem for which they requested timely dental treatment. Within this group, the most frequent complaints were pain or tooth hypersensitivity (42.4%, n = 26), insufficient restorations (28.8%, n = 17) and gingival or periodontal problems (23.7%, n = 14). Associations between the type of treatment pending and the report of an oral health problem were considerable for patients awaiting treatment under full anesthesia, surgical procedures and endodontic treatment (p = 0.001; 0.003 and 0.048, respectively). Problems were reported most frequently in these treatment groups, ranging from 27.7% to 100%, compared to 12.6% among patients scheduled for routine check-ups. Overall, 8.6% (n = 32) were experiencing pain, of whom 5 patients experienced constant pain. However, only 1.9% (n = 7) of patients made use of emergency dental services. CONCLUSIONS: The results suggest that while the postponement of routine check-ups is justifiable during emergency situations, the long-term cancellation of surgical and endodontic therapies must be viewed critically.

Oral health and functional capacity of centenarians.

The number of very old individuals, namely centenarians, is growing fast. In dentistry, the increasing number of older adults retaining natural teeth present new challenges for preventive and restorative dental care. However, there is a considerable lack of knowledge on the oral health status and needs in this exceptional age group. The aim of this population-based study was to identify the prevalence of oral diseases, therapeutic needs and functional capacity (evaluating centenarians' autonomy and their capabilities regarding treatment and oral hygiene) in centenarians. Subjects born before 1920 were recruited from population registries in South-Western Germany, providing information on dental health experiences, oral health behaviors and undergoing dental examination. 55 centenarians participated in the study (mean age ± SD = 101.2 ± 1.6, 83.6% females). Results were compared to epidemiological data on adults aged 75-100 years examined in the Fifth German Oral Health Study. Adherence to recommended dental behaviors and dental check-ups was lower in the centenarian population. Moreover, with the exception of a lower Root Caries Index, centenarians showed a higher caries experience, and presented with a mean DMFT of 25.2 ± 3.9, a DMFS of 111.0 ± 21.8, a root caries prevalence of 34.5% and a Restorative Index of 54.0%. Centenarians' functional capacity was also considerably lower. Non-existent or greatly reduced treatment capabilities and oral hygiene capabilities were registered in 63.7% and 43.6% of cases, respectively. Centenarians with a lower educational level (p = 0.018), in a care facility (p = 0.045) or in need of nursing care (p = 0.001) were more likely to have a low functional capacity. 98.2% of centenarians received help in their daily activities but only 12.7% in their oral hygiene. In conclusion, although most still have natural teeth, a decline of oral health can be perceived. As compliance with recommended behaviors is limited and most centenarians can no longer undergo dental treatment, the lack of assistance in daily oral health care is problematic.

Periodontal and peri-implant diseases in centenarians.

AIMS: To report the prevalence of periodontal and peri-implant diseases in centenarians in South-Western Germany, examine associations with sociodemographic factors and explore age-related trends. MATERIAL AND METHODS: Eligible persons born before 1920 were identified from population registries in South-Western Germany. A total of 55 centenarians were visited at home or in nursing care facilities. Of them, 35 were dentate, 33 of which underwent periodontal examination. Implants in 2 edentulous patients were also registered. RESULTS: The mean number of teeth was 9.5 ± 7.1; centenarians in need of nursing care had considerably less teeth than others (8.5 versus. 17.0 teeth, p = .03). Mean probing depth was 2.7 ± 0.8mm; mean clinical attachment loss was 4.2 ± 1.7 mm. Severe tooth mobility (degree 2 or 3) and furcation involvement were present in approximately 3% of eligible teeth. According to CDC/AAP classification, 25.8% of centenarians had no or mild periodontitis, 54.8% of centenarians had moderate periodontitis, and only 19.4% were severely affected. Of 27 implants examined in 5 centenarians, 59.3% were classified as healthy, 29.6% had peri-implant mucositis, and 11.1% had peri-implantitis. CONCLUSIONS: This study reveals the predominance of moderately severe disease in centenarians. While there were high levels of moderate periodontitis and peri-implant mucositis, signs of severe periodontitis, severe furcation involvement, tooth mobility or peri-implantitis were less frequent.