[Barriers for visiting a dental clinic among (frail) older individuals; the momentum of the influenza vaccination as finding place]. / Barrières bij (kwetsbare) ouderen voor bezoek tandartspraktijk; griepprikmomentum als vindplaats.

As age increases, the proportion of older people visiting a dental practice decreases. The aim of this survey was to gain insight into the extent to which frailty and/or dental status are related to visiting a dental practice and what barriers older (frail) people experience in this respect. A questionnaire was distributed among people eligible for the annual flu vaccination in Winschoten, The Netherlands. In total, 1027 people aged 60 and over completed the questionnaire. 60-80% of them had recently visited a dental practice depending on their frailty. Dental status was the decisive factor for not visiting a dental practice. Edentulous individuals were more likely not to visit than (partially) dentate individuals. Barriers to visiting a dental practice were related to making an appointment, costs, and/or the services provided. The flu vaccination seems to be an interesting momentum to identify people who do not, or no longer, visit a dental practice.

Health and quality of life differ between community living older people with and without remaining teeth who recently received formal home care: a cross sectional study.

OBJECTIVE: To assess oral health, health, and quality of life (QoL) of care-dependent community-living older people with and without remaining teeth who recently received formal home care. MATERIALS AND METHODS: For this cross-sectional observational study, community-living older people (≥ 65 years), who recently (< 6 months) received formal home care, were interviewed with validated questionnaires and underwent an oral examination. Oral health, general health, medicines usage, frailty (Groningen Frailty Indicator), cognition (Minimal Mental State Examination), QoL (RAND 36), and oral health-related QoL (Oral Health Impact Profile-14) were assessed. RESULTS: One hundred three out of 275 consecutive eligible older people (median age 79 [IQR (Inter Quartile Range) 72-85 years] participated in the study. Thirty-nine patients had remaining teeth and 64 were edentulous. Compared with edentulous older people, older people with remaining teeth scored significantly better on frailty, QoL, physical functioning, and general health. No significant differences were seen in cognition. Dental and periodontal problems were seen in more than half of the patients with remaining teeth. Two third of the edentulous patients did not visit their dentist regularly or at all. CONCLUSIONS: Care-dependent home-dwelling older people with remaining teeth generally were less frail, scored better on physical functioning and general health and had better QoL than edentulous older people. Dental and periodontal problems were seen in approximately 50% of the elderly. CLINICAL RELEVANCE: Notwithstanding their common dental problems, frailty, health, and QoL are better in home-dwelling older people with remaining teeth. To maintain this status, we advise not only dentists, but also health care workers and governments, to encourage people to maintain good oral health.

Elderly with remaining teeth report less frailty and better quality of life than edentulous elderly: a cross-sectional study.

OBJECTIVE: To assess oral status and self-reported oral health in community-living elderly and to determine differences between relevant subgroups of oral status (remaining teeth, edentulous, implant-retained overdentures) and case complexity (robust, frail, complex care needs). SUBJECTS AND METHODS: In this cross-sectional descriptive study, 1325 Dutch community-living elderly (≥75 years of age) were asked to complete validated questionnaires on frailty, activities of daily living (ADL), complexity of care needs, and QoL. Data on oral status, self-reported oral health, dental care, general health, and medication use were assessed. Differences between relevant subgroups were determined. RESULTS: Data of 1026 (77%) elderly (median 80 years, IQR 77-84) were analyzed: 39% had remaining teeth, 51% were edentulous, and 10% had implant-supported overdentures. Elderly with complex care needs (n = 225, 22%) and frail elderly (n = 217, 21%) were more often edentulous and reported more oral problems than robust elderly (n = 584, 57%). Elderly persons with remaining teeth were less frail, had better QoL and ADL, and used fewer medicines than edentulous elderly. Elderly with implant-supported overdentures performed better on frailty and QoL than edentulous elderly with conventional dentures. CONCLUSION: Community-living elderly commonly suffer from oral health problems, in particular elderly with complex care needs. QoL, ADL, and general health are higher among community-living elderly with remaining teeth and implant-supported overdentures than in edentulous elderly.

[An evaluation of the implementation of the 'Guidelines for oral care for patients dependent on care']. / Een evaluatie van de implementatie van de 'Richtlijn mondzorg voor zorgafhankelijke cliënten in verpleeghuizen'.

75% of older people being admitted to a nursing home are found to have oral care problems that have not been treated. Moreover, the Healthcare Inspectorate [in the Netherlands] reports that oral care for patients who depend on care in nursing homes is inadequate. The 'Guidelines for oral care for patients dependent on care in nursing homes', developed in 2007, appears to have been inadequately implemented. The goal of this research was to gain insight into the implementation of these guidelines in healthcare organisations. To that end, a questionnaire was distributed among the staff of 74 nursing homes. An analysis of the data revealed that people are -familiar with the guidelines and that oral care providers are often available. Oral care providers, however, often do not have access to reasonable dental care facilities. Patients are, moreover, generally not screened and/or monitored in accordance with the guidelines. Finally, it seems that the instruction of nurses and care-providers is insufficient. Research supports the conclusion that the nursing home staff is well-acquainted with the 'Guidelines for oral care for patients dependent on care' but that implementation of the guidelines in daily practice leaves much to be desired.

[Peri-implant health in people aged 75 and over with an implant-retained overdenture in the mandibula]. / Peri-implantaire gezondheid bij 75-plussers met een overkappingsprothese op implantaten in de onderkaak.

The number of elderly patients with an implant-retained overdenture in the mandibula is increasing. There is, however, insufficient information on how these elderly people are functioning with their overdenture and on their peri--implant health. Therefore, a study was carried out among a group of people aged 75 and over who had been provided with an implant-retained overdenture in a general dental office, measuring their ability to manage independently, their general health and peri-implant health. The study revealed a high degree of ability to manage independently, despite the health problems affecting many over 75. The patients rated their prosthetic overdentures with an average grade of 8.9 ± 1.1. Plaque around the implant (73%) and bleeding on probing (68%) were frequently seen. However, progressive peri-implant bone loss was seldom seen. No relationship was evident between plaque-scores and the ability to manage independently. Except for oral hygiene instruction and/or professional cleaning of peri-implants, no serious interventions were necessary. It was concluded that this group of elderly people, provided with an implant-retained mandibular overdenture, are functioning well. Plaque around the implant and bleeding on probing are often present but progressive peri-implant bone loss is rare.

[Oral health in care-dependent elderly: an inventory in a nursing home in the north of the Netherlands]. / Mondgezondheid van kwetsbare ouderen: een inventarisatie in een verpleeghuis in Noord-Nederland.

When people grow old and dependent on care, it usually becomes increasingly difficult to maintain oral health. The aim of this study was to assess what changes have taken place during the last ten years in oral health and the need for dental care among patients who were admitted to a nursing home between 2002 and 2012. Results revealed that the number of patients with remaining teeth increased significantly, from 7.9% to 28.7%, and that the number of patients with implants increased from 0.0% to 3.2%. More than 80% of the patients had moderate to poor oral health upon arrival. Moreover, almost half of the patients were revealed to be non-cooperative for evaluation and/or treatment, especially those who had remaining teeth. The expectation is that as a result of the increasing number of care-dependent elderly with remaining teeth in combination with poor oral health, the demand for dental care for care-dependent elderly in nursing homes will increase harply in the coming years.

[Treatment and subsequent care of oral implants for care-dependent patients]. / Zorg en nazorg voor implantaten bij zorgafhankelijke patiënten.

Care-dependent people may experience problems with their dentures for which treatment with an implant-supported denture is an effective option. Furthermore, patients treated with an implant-supported denture previously, may have become dependent on care, with the result that their daily oral self-care becomes problematic. These conditions demand an individual approach. In the process of deciding about treatment, the dentist has to ask himself 6 questions. The questions have to do with the benefits and effectiveness of any treatment, the individual oral healthcare programme, the cooperative abilities of the patient, the availability of voluntary and/or professional care providers, and the accessibility of good and quick professional oral healthcare service. Depending on the outcome of these considerations, the treatment may be either removing the superstructure and 'burying' the implants, improving an existing implant-supported denture or inserting implants and fabricating a new implant-supported denture.