Barriers and facilitators to integrate oral health care for older adults in general (basic) care in East Netherlands. Part 1: Normative integration.

OBJECTIVE: to synthesise a framework of barriers and facilitators in the normative integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels. BACKGROUND: Identification of these barriers and facilitators is expected to promote better and more appropriate care. METHODS: For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling, and nursing home patients) in East Netherlands were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined. RESULTS: Two main themes were identified: (1) a compartmentalised care culture in which OHC and general health care are seen as two separate realms, and (2) prioritisation, awareness and attitude regarding OHC integration. Subthemes such as low political attention (macro level); unclear responsibilities, hierarchical relations and the lack of vision of organisations (meso level); and poor awareness and low prioritisation by care providers and patients (micro level) were identified as potential barriers. Subthemes such as leadership (meso level), and the supportive personality of individual caregivers and ownership of patients (micro level) were identified as facilitators. CONCLUSION: Barriers and facilitators in normative OHC integration in The Netherlands are interrelated and apparent at macro-, meso- and micro levels. They are mainly related to (a) a compartmentalised care culture, and (b) related low prioritisation, and poor awareness of and attitude towards (integration of) oral health (care).

Dental status of an institutionalized elderly population of 60 years and over in Qingdao, China.

OBJECTIVES: The aim of this study was to investigate dental status of institutionalized elders and to relate outcomes with background variables and oral functionality. MATERIALS AND METHODS: Dental status of 512 elders (≥60 years) from eight nursing homes in Qingdao were analyzed in terms of prevalence of decayed (D), missing (M), filled (F), and replaced teeth (R). Multivariate logistic regression was applied to determine relationships with the background variables age, gender, and SES. Prevalence of D, M, and F was analyzed also for separate dental regions. For determining oral functionality, prevalence of dentitions with ≥20 teeth without and with tooth replacements was plotted against age. RESULTS: Mean number of D varied from 3.8 at 60 years to 4.6 at 90 years, M from 3.6 at 60 years to 6.7 at 90 years for the lower jaw, and from 3.0 at 60 years to 8.0 at 90 years for the upper. Mean number of F in each jaw was low: 0.2 at 60 years to 0.4 at 90 years. Gender and SES effects were limited. Molars had significantly higher prevalence of D and M than premolar and anterior teeth. Seventy percent of participants of 60 years had ≥20 natural teeth and 12 % at 90 years. Including tooth replacements, 96 % at 60 years, and 84 % at 90 years had ≥20 teeth. CONCLUSIONS: In this sample of institutionalized elders, dental status of the majority of participants did not represent a functional dentition without tooth replacements. CLINICAL RELEVANCE: Institutionalized Chinese elders showed relatively low numbers of decayed teeth but high numbers of missing teeth.

An observational cohort study on shortened dental arches--clinical course during a period of 27-35 years.

OBJECTIVES: The objective of this study was to investigate the clinical course of shortened dental arches ('SDA group') compared to SDAs plus removable denture prosthesis ('SDA plus RDP group') and complete dental arches ('CDA group', controls). MATERIALS AND METHODS: Data (numbers of direct and indirect restorations, endodontic treatments, tooth loss and tooth replacements) were extracted from patient records of subjects attending the Nijmegen Dental School who previously participated in a cohort study on shortened dental arches with three to four posterior occluding pairs (POPs). RESULTS: Records of 35 % of the original cohort were retrievable. At the end of the follow-up (27.4 ± 7.1 years), 20 out of 23 SDA subjects still had SDA with 3-4 POPs compared to 6 out of 13 for SDA plus RDP subjects (follow-up 32.6 ± 7.3 years). Sixteen out of 23 CDA subjects still had CDA; none of them lost more than one POP (follow-up 35.0 ± 5.6 years). SDA group lost 67 teeth: 16 were not replaced, 16 were replaced by FDP and 35 teeth (lost in three subjects) replaced by RDP. Mean number of treatments per year in SDA subjects differed not significantly compared to CDA subjects except for indirect restorations in the upper jaw. CONCLUSION: Shortened dental arches can last for 27 years and over. Clinical course in SDA plus RDP is unfavourable, especially when RDP-related interventions are taken into account. CLINICAL RELEVANCE: The shortened dental arch concept seems to be a relevant approach from a cost-effective point of view. Replacement of absent posterior teeth by free-end RDP cannot be recommended.

Functional dental status and oral health-related quality of life in an over 40 years old Chinese population.

OBJECTIVES: This study aimed to assess oral health-related quality of life (OHRQoL) related to dental status. MATERIAL AND METHODS: One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. OHIP-14CN scores were used to assess OHRQoL and analyzed using multivariable logistic regression including five dental conditions ('≥10 teeth in each jaw'; 'complete anterior regions'; 'sufficient premolar regions' (≥3 posterior occluding pairs (POPs)); 'sufficient molar regions' (bilaterally ≥1 POP); and tooth replacement) after adjustment for five background variables. Likelihood ratios for impaired OHRQoL (OHIP total score ≥5) were assessed at each level of the classification system. RESULTS: In the hierarchical scheme, OHIP-14CN total scores were highest in branch '<10 teeth in each jaw' (8.5 ± 9.5 to 12.3 ± 13.2). In branch '≥10 teeth' scores ranged from 6.2 ± 7.7 to 8.3 ± 9.3. The most important dental condition discriminating for impact on OHRQoL was '≥10 teeth in each jaw' (Likelihood ratio 1.59). In this branch subsequent levels were discriminative for impaired OHRQoL (Likelihoods 1.29-1.69), in the branch '<10 teeth in each jaw' they were not (Likelihoods 0.99-1.04). Tooth replacements were perceived poorer as their natural counterparts (odd ratios, 1.30 for fixed and 1.47 for removable appliances). CONCLUSIONS: OHRQoL was strongly associated with the presence of at least 10 teeth in each jaw. The hierarchical classification system predicted approximately 60 % of subjects correctly with respect to impaired OHRQoL. CLINICAL RELEVANCE: From an OHRQoL perspective, natural teeth were preferred over artificial teeth.

Tooth loss and oral health-related quality of life: a systematic review and meta-analysis.

BACKGROUND: It is increasingly recognized that the impact of disease on quality of life should be taken into account when assessing health status. It is likely that tooth loss, in most cases being a consequence of oral diseases, affects Oral Health-Related Quality of Life (OHRQoL). The aim of the present study is to systematically review the literature and to analyse the relationship between the number and location of missing teeth and oral health-related quality of life (OHRQoL). It was hypothesized that tooth loss is associated with an impairment of OHRQoL. Secondly, it was hypothesized that location and distribution of remaining teeth play an important role in this. METHODS: Relevant databases were searched for papers in English, published from 1990 to July 2009 following a broad search strategy. Relevant papers were selected by two independent readers using predefined exclusion criteria, firstly on the basis of abstracts, secondly by assessing full-text papers. Selected studies were grouped on the basis of OHRQoL instruments used and assessed for feasibility for quantitative synthesis. Comparable outcomes were subjected to meta-analysis; remaining outcomes were subjected to a qualitative synthesis only. RESULTS: From a total of 924 references, 35 were eligible for synthesis (inter-reader agreement abstracts κ = 0.84 ± 0.03; full-texts: κ = 0.68 ± 0.06). Meta-analysis was feasible for 10 studies reporting on 13 different samples, resulting in 6 separate analyses. All studies showed that tooth loss is associated with unfavourable OHRQoL scores, independent of study location and OHRQoL instrument used. Qualitative synthesis showed that all 9 studies investigating a possible relationship between number of occluding pairs of teeth present and OHRQoL reported significant positive correlations. Five studies presented separate data regarding OHRQoL and location of tooth loss (anterior tooth loss vs. posterior tooth loss). Four of these reported highest impact for anterior tooth loss; one study indicated a similar impact for both locations of tooth loss. CONCLUSIONS: This study provides fairly strong evidence that tooth loss is associated with impairment of OHRQoL and location and distribution of tooth loss affect the severity of the impairment. This association seems to be independent from the OHRQoL instrument used and context of the included samples.

Long-term follow-up indicates unimpaired oral health-related quality of life for people having shortened dental arches.

OBJECTIVES: To assess and analyse OHRQoL of people with shortened dental arches (SDA) in a long-term cohort study. METHODS: All participants of a long-term cohort study on SDA who were still attending the university dental clinic and still had an SDA (SDA group) with 3-5 posterior occluding pairs and intact anterior areas, an SDA plus removable dental prosthesis (SDA plus PRDP group) or complete dental arch (CDA group) completed the Dutch version of the Oral Health Impact Profile (OHIP-49NL) and additional questions on satisfaction with their dental status (yes/no). Mann-Whitney tests were performed for OHIP total scores and OHIP domain scores. The chance that the difference in median OHIP scores between the groups was larger than 6 OHIP units, was calculated by a bootstrapping procedure. RESULTS: 10 participants were eligible for SDA group and 11 for CDA group. The SDA plus PRDP group (n=1) was excluded from analyses. Mean follow-up period was 29.3±5.5 for SDA group and 36.7±5.5years for CDA group. Mean OHIP-49NL score was 13.9±10.9 for SDA group and 11.3±8.6 for CDA group. Differences in mean total scores and mean scores per domain were not statistically different. The probability that a difference in median OHIP total scores between groups was larger than 6 OHIP units was 0.25. Both groups showed high percentages of satisfaction with dental condition, except for dental appearance. CONCLUSION: OHRQoL of people with a long-term SDA condition was similar to that of people with CDA. CLINICAL SIGNIFICANCE: People having SDA for long periods are expected to report similar OHRQoL and satisfaction levels/oral comfort as people with CDA.

Risks, consequences, and prevention of falls of older people in oral healthcare centers.

One-third of community-dwelling people older than 65 years of age fall each year, and half of them fall at least twice a year. Older care home residents are approximately three times more likely to fall when compared to community-dwelling older people. Risk indicators for falls are related to the older people's body, environment, behavior, and activities. An important health risk indicator is (orthostatic or postprandial) hypotension, which may induce cerebral hypoperfusion. Although the majority of falls remain without major consequences, 10% to 25% of falls in care homes result in bodily trauma. Prevalent fall-related injuries are brain injury, lower extremity fracture including hip fracture and forearm/wrist fracture, facial fracture, humeral fracture, and rib/scapular fracture. As fall accidents by older people can have severe consequences, prevention of falls is of paramount importance. Healthcare providers, including oral healthcare providers, should inform older people on risks of falling and draw attention to potentially hazardous arrangements.

Missing Teeth and Prosthodontic Replacement in an Institutionalized Dentate Population of 60 Years and Older in Qingdao, China.

PURPOSE: The aim of this study was to investigate missing teeth and prosthodontic replacements in an institutionalized elderly population in China, and to assess dental functionality before and after the prosthodontic replacements based on a hierarchical dental functional classification (HDFC) system. MATERIALS AND METHODS: A sample of 512 participants (9% aged 60-69 years; 29% aged 70-79 years; 62% aged ≥ 80 years) living in eight nursing homes in Qingdao were categorized by the HDFC with and without tooth replacements. A functional dentition in the HDFC meets all the following criteria: ≥ 10 natural teeth in each jaw; a complete anterior region; 3 or 4 posterior occluding pairs (POPs) in the premolar regions; and ≥ 1 POP bilaterally in the molar region. Participants with tooth replacements were reclassified. The score for effectiveness of replacements were as follows: 4 for ≥ 10 teeth in each jaw; 3 for a complete anterior region; 2 for 3 or 4 POPs in premolar regions; and 1 for ≥ 1 molar POP bilaterally. RESULTS: Twenty percent of the participants had functional dentitions, but 42% met none of the functional criteria. In the branch '≥ 10 teeth in each jaw' the mean number of teeth present was 26.3 ± 2.9, and the mean number of POPs was 6.2 ± 2.0. In the branch '< 10 teeth in each jaw,' there were 13.4 ± 5.5 teeth and 1.1 ± 1.5 POPs. Of the 384 participants with natural teeth in each jaw, 44% had no replacements and 56% had fixed dental prostheses (FDPs), partial removable dental prostheses (PRDPs), or both. FDPs usually replaced 1 or 2 teeth, and PRDPs 3 or more teeth. On the basis of natural teeth plus artificial teeth (214 participants with replacements), 46% had functional dentitions while 18% met none of the functional criteria. In the promoted participants, the mean number of teeth added by FDPs was 3.6 ± 2.5, and for PRDPs it was 11.9 ± 6.5. FDPs had a significantly higher mean promotion value per tooth added than PRDPs. CONCLUSION: Approximately half the tooth replacements effectively met all criteria for a functional dentition.

Increased risk for premolar tooth loss in shortened dental arches.

OBJECTIVES: To assess sustainability of shortened dental arches (SDA) by determining time to 'first restorative intervention' of teeth and time to 'tooth loss' and comparing these outcomes with complete dental arches (CDA) and SDA plus removable dental prostheses (RDP). METHODS: Data (follow-up time ranged from 27.4 (SD 7.1) to 35.0 (SD 5.6) years; max. follow up: 45.8 years) from patient records of 59 subjects (23 SDA, 23 CDA, and 13 SDA plus RDP) participating in a prospective cohort study on shortened dental arches (SDA) were analysed. Group effects on survival were analysed using Cox regression models; where appropriate Kaplan-Meier analyses were done. RESULTS: Compared to SDA subjects, CDA subjects had a lower risk to receive a first restorative intervention in anterior teeth (HR=0.377; 95% CI [0.205-0.695]) and premolars (HR=0.470; 95% CI [0.226-0.977]). CDA subjects had a lower risk to lose premolars compared to SDA subjects (HR=0.130; 95% CI [0.053-0.319]). Risk for 'first restorative intervention' and for 'tooth loss' did not significantly differ between SDA with and without RDP. CONCLUSIONS: SDA subjects had an increased risk to lose premolars and to receive a first time restoration in anterior teeth and premolars compared to CDA subjects. SDA subjects with RDP had no increased risk to receive a first restorative intervention or for tooth loss compared to SDA without RDP. CLINICAL RELEVANCE: Subjects with shortened dental arches can be discerned as enduring at-risk patients. It is therefore recommended that shortened dental arch subjects receive intensive and continuous care to prevent further tooth loss.

Chewing ability and dental functional status.

PURPOSE: The aim of this research was to explore the relationship between chewing ability and dental functional status, perceived oral health-related quality of life, and a number of background variables in a Vietnamese population. MATERIALS AND METHODS: The cluster stratified sample consisted of 2,805 dentate subjects aged ⋝ 20 years from urban and rural areas in Southern Vietnam. Chewing ability was assessed using a questionnaire that included questions on perceived difficulty with respect to eight foods and three questions of the Oral Health Impact Profile that were considered relevant. RESULTS: Only a minority reported serious problems with chewing ability (reporting difficult or very difficult to chew). The logistic regression analysis on chewing ability outcomes showed significant relationships between chewing ability and having ⋝ 10 teeth in each arch, having sufficient molar regions (⋝ 1 molar posterior occlusal pair [POP] bilaterally) for hard and soft foods, and having sufficient premolar regions (⋝ 3 POPs), especially for hard foods. In the hierarchical functional classification system, likelihood to report complaints on chewing ability appeared to discriminate in the branch "⋝ 10 teeth in each arch." Likelihood at subsequent levels ranged from approximately 1.5 to 3. In the branch "< 10 teeth in each arch," likelihood did not discriminate because the groups lacked sufficient homogeneity. CONCLUSIONS: Chewing ability and oral health-related quality of life were positively correlated. Among all dental and other variables, decreased chewing ability was strongest when correlated with older age categories and not correlated or weakly correlated with sex, socioeconomic status, and residence.

Dental laboratory production of prosthetic restorations in a population in sofia, bulgaria: a descriptive study.

Objective. To describe prosthodontic production related to mutilated dentitions in Sofia, Bulgaria. Methods. Prosthodontic production from 5 dental laboratories was recorded during a 14-day period. Production was related to dentitions as noted from casts. Dentitions were classified as edentulous, interrupted/reduced, slightly interrupted, shortened, and complete. The representativeness of the laboratory sample was verified trough comparison with a Sofia population sample using proportions of crowned or replaced teeth per dental region. Results. The total production consisted of 243 crowns, 16 post and cores, 82 fixed dental prostheses, and 41 removable dentures. Proportions of crowned teeth were significantly different between the samples; proportions of replaced teeth were not. Of the 58 incomplete dentitions analyzed, 19 were restored to the level of completeness, 15 resulted in slightly interrupted, and 24 in shortened dentitions. Conclusions. Predominantly fixed restorations were provided to restore mutilated dentitions to a functional level and not necessarily to complete dentitions.

Esthetic perception of missing teeth among a group of Tanzanian adults.

PURPOSE: To assess esthetic perceptions among Tanzanian adults regarding missing teeth using a cross-sectional clinical study of a convenience sample of 5,532 subjects in the Northern coastal zone of Tanzania. MATERIALS AND METHODS: The dental status of urban and rural Tanzanian adults (5,532 subjects, ages between 20 and 80 years) was recorded. A structured interview was used to assess esthetic perception (yes/no complaint) considering the location and number of missing teeth. Logistic regression analysis was applied to determine the effects of the variables age (2 groups: < or = 45 years vs > 45 years), gender, socioeconomic status (high/middle vs low), and residence (urban vs rural) on the number of complaints. RESULTS: Of the subjects with 1 or more missing maxillary anterior teeth, 54% reported a complaint. Dissatisfaction was reported by significantly more subjects < or = 45 years of age and subjects with high/middle socioeconomic status. Gender and residence had no significant influence. Of the subjects with missing maxillary premolar(s) (no missing anterior teeth), 25% reported esthetic complaints (missing first premolar: 24%; missing second premolar: 11%; missing first and second premolar on the same side: 44%). Dissatisfaction was significantly greater in women, subjects < or = 45 years of age, and subjects with high/middle socioeconomic status. Residence had no significant influence. Fewer than 1% of the subjects were dissatisfied with missing maxillary molars. CONCLUSION: Among this group of Tanzanian adults, absence of teeth played a considerable role in the esthetic appreciation of their dentition. Complaints were associated with both number and location of missing teeth.