Oral Health-Related Quality of Life in institutionalized elderly in Barcelona (Spain).

OBJECTIVE: The objective of this study is to describe the oral health status and the factors associated with oral health-related quality of life (OHRQoL) in people aged 65 and older institutionalized in Barcelona in 2009. STUDY DESIGN: [corrected] Cross sectional study in 194 elderly. The dependent variable was poor OHRQoL, according to the Geriatric Oral Health Assessment Index (GOHAI). The independent variables were socio-demographic data, last dental visit, subjective and objective oral health status. Robust Poisson regression analysis was used to determine the factors associated with OHRQoL as well as the strengths of association (Prevalence Ratios with respective confidence intervals at 95%). RESULTS: According to GOHAI, 94 women (68.1%) and 36 men (64.3%) had poor OHRQoL. The average DMFT index (number of decayed, missing and filled teeth) was 22.8, with mean 10.2 remaining teeth. According to the Community Periodontal Index only 1.9% were healthy. 33.8% of the sample (35.5% of women and 30.4% of men) presented edentulism, 54.2% needed upper dental prostheses (51.1% of women and 60.7% of men) and 64.7% needed lower ones (61.6% of women and 71.4% of men). Only 7.2% had visited a dentist in the past year (8.8% of women and 3.6% of men). After fitting several multivariate adjusted robust Poisson regression models, poor OHRQoL was found to be associated to self-reporting problems with teeth or gums, self-reporting poor opinion about teeth/gums/denture and also associated to functional edentulism, needing upper denture, but not to socio-demographic factors or time since last dental visit. CONCLUSIONS: The study population has poor objective oral health. A high percentage has poor OHRQoL associated to subjective and objective oral health conditions. Dental care is required and these services should be included in the Spanish National Health System.

Oral health care activities performed by caregivers for institutionalized elderly in Barcelona-Spain.

OBJECTIVES: To describe the frequency of brushing teeth and cleaning of dentures, performed by caregivers, for institutionalized elderly people. METHODS: A cross-sectional study in a sample of 196 caregivers of 31 health centers in Barcelona. The dependent variables were frequency of dental brushing and frequency of cleaning of dentures of the elderly by caregivers. The independent variables were characteristics of caregivers and institutions. We performed bivariate and multivariate descriptive analyses. Robust Poisson regression models were fitted to determine factors associated with the dependent variables and to assess the strength of the association. RESULTS: 83% of caregivers were women, 79% worked on more than one shift, 42% worked only out of necessity, 92% were trained to care for elderly persons, 67% were trained in oral hygiene care for the elderly, and 73% recognized the existence of institutional protocols on oral health among residents. The variables explaining the lower frequency of brushing teeth by caregivers for the elderly, adjusted for the workload, were: no training in the care of elderly persons (PRa 1.7 CI95%: 1.6-1.8), not fully agreeing with the importance of oral health care of the elderly (PRa 2.5 CI95%: 1.5-4.1) and not knowing of the existence of oral health protocols (PRa 1.8 CI95% 1.2-2.6). The variables that explain the lower frequency of cleaning dentures, adjusted for the workload, were lack of training in elderly care (PRa 1.7 CI95%: 1.3-1.9) and not knowing of the existence of protocols (PRa 3.7 CI95%: 1.6-8.7). CONCLUSION: The majority of caregivers perform activities of oral health care for the elderly at least once per day. The frequency of this care depends mainly on whether caregivers are trained to perform these activities, the importance given to oral health, the workload of caregivers and the existence of institutional protocols on oral health of institutionalized elderly persons.

Oral health risks of tobacco use and effects of cessation.

The purpose of this paper is to review the epidemiologic evidence for the effects of tobacco use and tobacco use cessation on a variety of oral diseases and conditions. Exposures considered include cigarette and bidi smoking, pipe and cigar smoking, and smokeless tobacco use. Oral diseases and disorders considered include oral cancer and precancer, periodontal disease, caries and tooth loss, gingival recession and other benign mucosal disorders as well as implant failure. Particular attention is given to the impact of tobacco use cessation on oral health outcomes. We conclude that robust epidemiologic evidence exists for adverse oral health effects of tobacco smoking and other types of tobacco use. In addition, there is compelling evidence to support significant benefits of tobacco use cessation with regard to various oral health outcomes. Substantial oral health benefits can be expected from abstention and successful smoking cessation in a variety of populations across all ages.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals.

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Prevalence of smoking among dentists in Catalonia--Spain (2006) . Literature review of smoking cessation practices in the dental office.

OBJECTIVE: The objective of this study was to collect data on the prevalence of smokers among Catalonian dentists (by age and sex) and compare them with existing data on the general population, doctors, registered nurses and pharmacists. The overall prevalence of smokers in Catalonia (2006) was 34.5% of men and 24.3% of women. Data available on the prevalence of smoking among doctors (26.3% men and 22.1% women), pharmacists (19.8% men and 20.6% women) and registered nurses (34.1% men and 35.3% women) relates to the year 2002. STUDY DESIGN: In September 2006, Catalonian dentists (n=3,799) were asked about their habits in relation to tobacco in a self-administered questionnaire, on use and opinions with respect to dental amalgam. Five hundred and seventy-nine questionnaires were received, of which 538 answered the question on smoking (14.2% of the sample universe). RESULTS: The prevalence of smokers among dentists is lower (24.9% of men and 18.4% of women) than in the general population and other healthcare professionals. In dentists in the age group between 25 and 34 years, the prevalence was 26.1% in men and 14.9% in women, while the prevalence in this age group in the general population was 43.6% and 37.1%, respectively. CONCLUSION: Catalonian dentists have a much lower prevalence of tobacco use than the general population and lower even than other healthcare professionals. Given that non-smoking healthcare professionals have better awareness for providing recommendations for smoking prevention and cessation, Catalonian dentists may be a valid group for performing this task for which there is scientific evidence.