Age-related knowledge deficit and attitudes towards oral implants: Survey-based examination of the correlation between patient age and implant therapy awareness.

BACKGROUND: Implantology, as a recognized therapeutic approach, is gaining prominence. The decision-making process and success of implant therapy are closely linked to patient knowledge and expectations. This study aims to explore the association between age and knowledge regarding oral implants. METHODS: Participants were categorized into three age groups (ag): ag 1 (35-44 years), ag 2 (65-74 years), and ag 3 (75 years and older). A total of 400 participants per age group were randomly selected using data from the residents' registration office of Berlin, Germany. Structured telephone interviews were conducted between 2016 and 2017, employing a 67-item questionnaire covering awareness, information level, cost estimation, attitudes, and experiences with oral implants. RESULTS: Despite a low overall knowledge level across all age groups, there was no significant correlation between age and knowledge about oral implants. Awareness increased with age. Information sources varied, with friends, acquaintances, and dentists playing key roles. Participants expressed diverse opinions on implants, with durability and stability identified as crucial characteristics. Significant differences in knowledge were observed between age groups regarding awareness, information sources, and perceptions of dentists offering implants. CONCLUSIONS: The study suggests a need for targeted educational programs, emphasizing age-appropriate information sources to enhance health literacy in oral implantology, particularly among older individuals. Educating physicians on oral implant basics is also crucial. Implementing these measures could empower individuals to make informed decisions about oral implant treatment, thereby contributing to improved oral health outcomes.

DENTAL PATIENT-REPORTED OUTCOMES IN GERIATRIC DENTISTRY : A call for clinical translation.

As the proportion of older adults in the world population increases, there is an increasing need to provide adequate dental care for this very heterogeneous group of individuals. The relationship between oral and systemic health, the impact of medication on oral health, and the influence of accessibility to dental care and other social and environmental factors shape the provision of dental care for older adults more than in children, younger, and middle-aged adults. However, while dental care for older adults is shaped by these factors and is often different from the care for other adults, what matters to older dental patients does not differ from what matters to dental patients in general. The four dimensions of oral health-related quality of life (OHRQoL)-Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-capture dental patients' suffering from oral disorders. OHRQoL questionnaires can be used to assess this impact and to achieve results that are compatible with adults in general. More than in other age groups, cognitive impairments or dementia limit the usefulness of questionnaires or interviews for oral health impact assessment. In these situations, family members or caregivers can assess the patient's oral health impact, and oral health care providers need to rely more on physical oral health characteristics for clinical decision-making than in other dental patients. While the tools to measure oral health impact change, the targets for dental care stay the same. Prevention and reduction of functional, painful, aesthetical, and broader psychosocial impact related to oral disorders are the central tasks for geriatric dentistry as they are for dentistry in general. The aim of the manuscript is to highlight the importance of patient-reported outcome measures in geriatric dentistry, addressing challenges and opportunities for their application.

Influence of visual acuity, manual dexterity and handgrip strength on oral and denture hygiene ability of non-frail older people: Development of the Gerostomatological Assessment Battery.

BACKGROUND: Due to the heterogeneity of older people, it is difficult to identify reliable factors influencing oral health. OBJECTIVE: The aim was to illustrate the influence of visual acuity, manual dexterity, and handgrip strength on the oral and denture hygiene ability of older non-frail people. METHODS: In a cross-sectional study, conducted at a specialized dental clinic, at baseline, all participants received professional prophylaxis and instruction on daily oral and denture hygiene regimes for a 6-week intervention period. Data on the Quigley and Hein modified plaque index (QHI), respectively, the Denture Hygiene Index (DHI), visual acuity, manual dexterity and handgrip strength in non-frail participants (≥ 65 years) were collected. Recruitment was done within the clinic's patient clientele and within the staff (control cohort). RESULTS: Women showed significantly better manual dexterity than men (Mann-Whitney U, p = .01), while women's mean handgrip strength was significantly lower (Mann-Whitney U, p < .01). Manual dexterity (Mann-Whitney U, p = .003) and handgrip strength (Mann-Whitney U, p = .052) were associated with age. However, visual acuity, manual dexterity and handgrip strength had no influence on oral or denture hygiene. CONCLUSION: Visual acuity, manual dexterity and handgrip strength have no influence on oral and denture hygiene ability in older non-frail people. Further studies should investigate whether these factors also have no influence on oral and denture hygiene in vulnerable older patients. Therefore, an assessment tool for the evaluation of potential influencing factors of oral and denture hygiene is proposed in a dental context. This Gerostomatological Assessment Battery (G-AB) can be used as a helpful tool to check the individual cognitive function and comprehension, dental therapy approaches and their individual adaption.

Validation of a New Measuring Instrument for the Assessment of Bite Force.

BACKGROUND: this study aims to validate two occlusal-force-measuring devices by comparing them to a universal testing machine and assessing their reliability across various dental and prosthetic groups. The research comprised two parts: part 1 assessed the measurement accuracy of the Occlusal Force Meter GM 10® (OFM) (Morita, Nagano Keiki, Higashimagome, Ohta-ku, Tokyo, Japan) and a prototype (PRO) by comparing them to a calibrated universal testing machine (ZWICK). Part 2 involved analyzing the devices' reliability based on clinical bite force measurements from study participants. RESULTS: both devices become more accurate and reliable compared to the ZWICK over time of usage. Additionally, higher deviation from the ZWICK can be observed for higher values of forces applied and vice versa for both devices. The PRO's intraoral alignment influences its mean values compared to the OFM in different dental and prosthetic groups. CONCLUSION: both devices had limitations and required quadratic function calibration, making them suitable only for progression measurements. The study concludes that both the OFM and PRO devices can measure occlusal forces with improved accuracy over time. Intraoral alignment should be considered. Their easy-to-use clinical application would allow a more widespread use of masticatory function diagnosis, which could indicate the need for treatment and improve treatment planning.

Use of handgrip strength measurement as an alternative for assessing chewing function in people with dementia.

BACKGROUND: Chewing ability and handgrip strength can be independent explanatory factors of physical fitness. The usability of measurement procedures for assessing chewing function in people with dementia seems to be limited. This study aimed to show an association between handgrip strength and chewing function to enable the use of handgrip strength measurement as an alternative for determining chewing parameters in people with dementia.  METHODS: The data analysed here are part of the OrBiD (Oral Health, Bite Force and Dementia) pilot study. A total of 120 participants were assigned to five evaluation groups based on their cognitive abilities using the Mini-Mental State Examination (MMSE). The MMSE groups in this data analysis were "no dementia" (noDem, MMSE 28-30), "mild cognitive impairment" (mCI, MMSE 25-27), and "mild dementia" (mDem, MMSE 18-24). Handgrip strength, maximum occlusal force, and chewing efficiency were measured.  RESULTS: The Mini-Mental State Examination scores among all participants (n = 71) resulted in a median of 27 and a range of 18-30. An association between maximum handgrip strength and the cognitive impairment of the participants was shown. Nevertheless, the use of handgrip strength measurement as an alternative for determining chewing function was not verified in this study. CONCLUSIONS: The feasibility and reliability of chewing function measurements in people with dementia should be investigated. Existing measurement procedures may need to be adapted or new assessments may need to be developed to be usable in people with dementia. TRIAL REGISTRATION: ClinicalTrials.gov NCT03775772.

What Counts for the Old and Oldest Old?-An Analysis of Patient Criteria for Choosing a Dentist-Part I: Awareness and Selection Criteria, Infrastructure, and Dental Office Equipment.

Utilization of a dentist is influenced by many factors. The aim of this study is to present the factors relating to how patients become aware of a dentist, according to which criteria they select the dentist, and which factors in the infrastructure, equipment of dental offices, and human interactions are important for patients. A telephone survey with 466 participants (female 59.9%) in three age groups (ag 1: 35−50 years, ag 2: 70−84 years, ag 3: >85 years) in three German cities was conducted. Data were analyzed with respect to age, gender, and place of residence. Hardly any differences in the selection of the dentist and the selection criteria applied were found between the sexes, the age groups, or the places of residence. Recommendation seems to be the major aspect regarding how patients become aware of or select their dentist (n = 278, 65.6%), while modern technologies, e.g., the internet, play a subordinate role (n = 31, 7.3%). The unimportance of modern technologies increases significantly with the increase in age. As age increases, factors such as infrastructure (e.g., elevator available (ANOVA p < 0.001; Bonferoni correction: significant differences between ag 1 and ag 2 p < 0.001, ag 1 and ag 3 p < 0.001, and ag 2 and ag 3 p = 0.009); accessibility by wheelchair (ANOVA p < 0.001; Bonferoni correction: significant differences between ag 1 and ag 2 p = 0.006; and ag 1 and ag 3 p < 0.001); etc.) and dental office equipment become significantly important and influence the choice of dentist, while the importance of good parking facilities significantly decreased with age (ANOVA p = 0.003; Bonferoni correction: significant differences between ag 1 and ag 3 p = 0.004, and ag 2 and ag 3 p = 0.023). With increasing age, e.g., the importance of a television in the waiting room (ANOVA p = 0.012; Bonferoni correction: significant differences between ag 1 and ag 3 p = 0.014; and ag 2 and ag 3 p = 0.011), a modern waiting room (ANOVA p < 0.001; Bonferoni correction: significant differences between ag 1 and ag 3 p < 0.001; and ag 2 and ag 3 p < 0.001) or the possibility to visualize the oral situation on a screen decreases significantly (ANOVA p < 0.001; Bonferoni correction: significant differences between ag 1 and ag 2 p < 0.001; ag 1 and ag 3 p < 0.001, and ag 2 and ag 3 p < 0.001). If dentists want to welcome and treat older people, they should adapt the accessibility, infrastructure and equipment of their practice to the needs of older people in order to be able to guarantee continuous lifelong dental care regardless of the need for assistance or care.

What Counts for the Old and Oldest Old?-An Analysis of Patient Criteria for Choosing a Dentist-Part II: Personal Characteristics and Soft Skills.

Soft skills include communication skills and personality traits that are important when choosing a dentist, but other factors within the dental office also seem to be important for patients. The aim of this study is to evaluate factors that are important to people in a dentist as well as characteristics of the ideal dentist and to evaluate possible age-, gender-, and residence of living specific differences. A telephone survey with participants aged 35 years or older (ag­age group: ag 1: 35−50 years, ag 2: 70−84 years, ag 3: >85 years) in three German cities was conducted. Data were analyzed with respect to gender and age. Most of the participants (n = 298, 64.2%), regardless of their own gender, age, or place of residence did not care about the gender of the dentist. In general, the price of the treatment does not play a role in choosing the ideal dentist. Women differ significantly from men in their choice of dentist (ANOVA p < 0.001 (preference of non-smoker), ANOVA p < 0.001 (preference, that the dentist does not smell of smoke, importance of appearance (ANOVA p < 0.001) and psycho-social skills, etc.). As age increases, professional experience and psycho-social competencies are rated as important. With the increase in age, the mean value of the desired years of professional experience increases without significant differences between age groups. The importance of advanced training (ANOVA p < 0.001; Bonferoni correction: significant difference between ag 1 and ag 2 p < 0.001, and ag 1 and ag 3 p < 0.001) decreases with age. Especially for participants aged 70 to 84 years, a relationship of trust is important. Between the places of residence, statistical differences for almost all surveyed items were found (e.g., importance that the dentist speaks the patients' native language ANOVA p < 0.001, Bonferoni correction: significant difference between Berlin and Leipzig, Berlin and Mainz, and Leipzig and Mainz (each p < 0.001), dentist has a specialization ANOVA p < 0.001, Bonferoni correction: significant difference between Berlin and Leipzig and Berlin and Mainz (each p < 0.001), etc.). Dentists should be trained to develop psycho-social skills to meet the special demands of the increasing older population.

Push-Out Bond Strength Assessment of Different Post Systems at Different Radicular Levels of Endodontically Treated Teeth.

This study assessed the bond strength of prefabricated post systems at different root levels of endodontically treated teeth. One-rooted human premolars (N = 70; n = 10) were cut to 2 mm above the cement-enamel junction. Root canals were treated and randomly assigned to one of the seven post systems: T: Titanium (Mooser), ZrO: Zirconia (Cosmopost), G: Fiber (FRC Postec Plus), E1: Fiber (Direct) (Everstick post), E2: Fiber (Indirect) (Everstick post), PP: Fiber (PinPost), and LP: Injectable Resin/Fiber composite (EverX Posterior). All posts were luted using a resin cement (Variolink II), and the roots were sectioned at the coronal, middle, and apical root levels. Push-out tests were performed in the Universal Testing Machine (0.5 mm/min). Data (MPa) were analyzed using two-way ANOVA and Tukey's tests (α = 0.05). The results showed that the bond strength (mean ± SD) of E2 posts were highest (5.3 ± 2.7) followed by PP (4.1 ± 2.0); G (4.0 ± 1.6); LP (2.6 ± 1.9): T (2.2 ± 1.5) and ZrO (1.9 ± 1.0) posts systems. No significant differences were found in bond strength of all post systems. The bond strength in the coronal root level was the highest with 3.6 ± 2.2 MPa. The bond strength of FRC post systems was significantly higher than those of rigid posts of titanium or ZrO2. Bond strength results were the highest in the coronal root level for all tested post systems but did not differ significantly from the other two root levels.

Student Perceptions of Age and Ageing-An Evaluation of Swiss Dental Students Receiving Education in Gerodontology.

Society is ageing and the higher number of senior citizens in the total population is a challenge for society and often perceived as a burden. Negative images of old age can lead to ageism and poorer healthcare for older people. The younger generation will have to master these demographic challenges. Therefore, their attitude towards and their perception of the older generation has to be monitored. The aim of this study is to present the images of ageing held by dental students who received education in gerodontology and to assess possible changes between different generations of students over time and separated by gender. An annual, anonymous questionnaire survey was conducted among dental students at the end of the 10th semester each year between 2008 and 2021. The questionnaire surveyed personal attitudes towards ageing, the assessment of seniors, and personal experience with seniors (images of ageing, "Aging Semantic Differential"). In addition to confirming Friedan's phenomenon regarding the assessment of age limits, the present study was able to demonstrate a positive image of ageing in dental students, which has remained almost constant over the years. An education in gerodontology might positively influence student perceptions of age and aging.

On the Necessity of a Geriatric Oral Health Care Transition Model: Towards an Inclusive and Resource-Oriented Transition Process.

People in need of care also require support within the framework of structured dental care in their different life situations. Nowadays, deteriorations in oral health tend to be noticed by chance, usually when complaints or pain are present. Information on dental care is also lost when life situations change. An older person may rely on family members having oral health skills. This competence is often not available, and a lot of oral health is lost. When someone, e.g., a dentist, physician, caregiver, or family member notices a dental care gap, a structured transition to ensure oral health should be established. The dental gap can be detected by, e.g., the occurrence of bad breath in a conversation with the relatives, as well as in the absence of previously regular sessions with the dental hygienist. The aim of the article is to present a model for a structured geriatric oral health care transition. Due to non-existing literature on this topic, a literature review was not possible. Therefore, a geriatric oral health care transition model (GOHCT) on the basis of the experiences and opinions of an expert panel was developed. The GOHCT model on the one hand creates the political, economic, and legal conditions for a transition process as a basis in a population-relevant approach within the framework of a transition arena with the representatives of various organizations. On the other hand, the tasks in the patient-centered approach of the transition stakeholders, e.g., patient, dentist, caregivers and relatives, and the transition manager in the transition process and the subsequent quality assurance are shown.

The Effect of a Masticatory Muscle Training Program on Chewing Efficiency and Bite Force in People with Dementia.

Until now, no study has investigated the effects of masticatory muscle training on chewing function in people with dementia. This study aimed to investigate whether physiotherapeutic exercises for the masticatory muscles have an influence on chewing efficiency and bite force in people with dementia. In a clinical trial with stratified randomization subjects were assigned to three groups based on the Mini Mental State Examination (MMSE: group 1-28-30, group 2-25-27, group 3-18-24). Each group was divided into an experimental (ExpG, intervention) and control group (ConG, no intervention). As intervention a Masticatory Muscle Training (MaMuT) (part 1: three physiotherapeutic treatments and daily home exercises, part 2: daily home exercises only) was carried out. Chewing efficiency and bite force were recorded. The MaMuT influenced the masticatory performance regardless of the cognitive state. Bite force increased in ExpG 1 and 2. Without further training, however, the effect disappeared. Chewing efficiency increased in all ExpG. After completion of the training, the ExpG 2 and 3 showed a decrease to initial values. Subjects of ExpG 1 showed a training effect at the final examination, but a tendency toward the initial values was observed. ExpG 3 seemed to benefit most from the physiotherapeutic exercises in terms of improving chewing efficiency by the end of the intervention phase. ExpG 1 showed the greatest gain in bite force. The MaMuT program is a potential method of improving masticatory performance in people with cognitive impairment or dementia when used on a daily basis.

Impact of an Oral Hygiene Intervention in People with and without Dementia on Oral Health Parameters-Results from the Oral Health, Bite Force, and Dementia (OrBiD) Pilot Study.

This study aimed to assess the influence of an oral hygiene intervention on oral health, depending on the degree of dementia. A clinical evaluation of oral health parameters (index of decayed, missing, and filled teeth (DMFT-index), periodontal screening index (PSI), oral hygiene index (OHI), and bleeding on probing (BOP)) was performed in 120 subjects assigned to five groups, based on the mini mental state examination (MMSE) at baseline and after 12 months. Each MMSE group (no dementia (noDem, MMSE 28-30), mild cognitive impairment (mCI, MMSE 25-27), mild dementia (mDem, MMSE 18-24), moderate dementia (modDem, MMSE 10-17), and severe dementia (sDem, MMSE ≤ 9)) was split into control (no intervention) and experimental groups (intervention on oral hygiene: increased frequency, daily usage of high-fluoride toothpaste). In total, 99 out of 120 subjects were included in the analysis. The dropout rate was high in subjects with modDem and sDem due to death. In subjects with noDem, mCI, and mDem, no changes in the DMFT were found, but improvements in the OHI, BOP, and PSI were observed. Subjects with modDem or sDem demonstrated a deterioration in DMFT; however, in these patients, OHI improved in all control and experimental groups, BOP improved in the experimental group only, and PSI did not improve at all. The scope of improving oral health parameters by increasing the recall frequency and by continuously using high fluoride toothpaste is at its limits in people with severe dementia. Multidimensional approaches should be sought to improve the oral health of vulnerable older patients.

The OrBiD (Oral Health, Bite Force and Dementia) Pilot Study: A Study Protocol for New Approaches to Masticatory Muscle Training and Efficient Recruitment for Longitudinal Studies in People with Dementia.

Research with people with dementia is a great challenge in terms of recruitment, study participation and adherence to interventions resulting in less research activity and higher financial, organizational and personnel efforts. As dementia progresses, there is a deterioration in general and oral health and chewing function. Oral treatment options often focus on healthy patients. Interventions for people with dementia are needed. The aims of the paper were to describe the study protocol of the OrBiD (Oral Health, Bite Force and Dementia) pilot study as well as the description of two new methodological approaches. These are (A) an efficient recruitment process of people with dementia, simultaneous double study participation and (B) a novel approach to train the masticatory muscles by using physiotherapy. A novel methodology for the recruitment process (A) and, in particular, for the assignment of subjects to the experimental and control groups was developed and successfully tested. Additionally, a physiotherapy program (B) to train strength and coordination of the masticatory muscles was newly developed with the challenge to ensure that this training could also be carried out with people with cognitive impairments and dementia, if necessary, in cooperation with their relatives or caregivers. This was also successfully implemented. Recommendations for a feasibility assessment of a study involving people with dementia were made considering the organizational effort, the required personnel, structural and financial resources, the required number of subjects and the type of study design. When planning crossed studies, it must be ensured that the content, the interventions or their possible results of the study arms do not influence each other. The overall aim of this paper is to demonstrate the sustainable and efficient feasibility of studies with people with dementia.

Undergraduate Dental Education in Gerodontology in Germany between 2004 and 2019-A case for compulsory teaching?

INTRODUCTION: The study surveys the present state of undergraduate dental education in gerodontology in Germany and highlights changes between 2004 and 2019. MATERIALS AND METHODS: In 2019, questionnaires were emailed to the department heads of all German dental schools. Data were analysed descriptively and compared to existing data from 2004, 2009 and 2014. RESULTS: Thirty-nine (86.7%) out of forty-five responding department heads stated to teach aspects of gerodontology in traditional core subject lecture series. Overall, 15 (55.6%) out of 27 responding dental university schools are offering special education in gerodontology (dedicated lecture series and/or practical training). A stronger focus on non-dental topics has been observed over the years. DISCUSSION: The 15-year observation period in Germany shows that teaching gerodontology should be mandatory. There is a lack of specialists in gerodontology at the dental schools, although specialisation has been possible for many years in the German professional association. Students should be sure that, as in other subjects, they are well trained for the very heterogeneous patient group of seniors. The financial and personnel prerequisites for the universities need to be established. CONCLUSION: Inclusion of gerodontology in the national syllabus is a decisive factor for the integration of the subject into undergraduate courses. The recommendations of the European College of Gerodontology (2009) and of the German Association of Gerodontology (DGAZ) regarding didactical and practical teaching should be implemented in the respective compulsory syllabus to prepare current undergraduate dental students for the demographic challenges of tomorrow.

Influence of cognitive impairment and dementia on oral health and the utilization of dental services : Findings of the Oral Health, Bite force and Dementia Study (OrBiD).

BACKGROUND: The aim of this study was to show the influence of cognitive impairment and dementia on oral health and on the utilization of dental services. METHODS: A cross-sectional analyzation of data of the OrBiD (Oral Health, Bite Force and Dementia) pilot study was conducted. 137 subjects were stratified into five dementia groups on the basis of the Mini Mental State Examination (MMSE) (1-no dementia (MMSE 28-30), 2-mild cognitive impairment (MMSE 25-27), 3-mild dementia (MMSE 18-24), 4-moderate dementia (MMSE 10-17), and 5-severe dementia (MMSE < 10)). Information on the utilization of dental services and oral health parameters (DMFT index, degree of restoration, Periodontal Screening Index, Bleeding on Probing, Oral Hygiene Index, Denture Hygiene Index) were collected. RESULTS: An increase in dementia resulted in significant reduction in utilization. Moreover, with increasing cognitive impairment/dementia there was a significant difference in the number of teeth that were decayed, but not in the number of filled or missing teeth or the DMF/T index itself. With increasing dementia, the degree of restoration decreased and oral/denture hygiene deteriorated significantly. Nevertheless, periodontal therapy was required for all subjects independent of their degree of dementia while bleeding on probing was increasing with increasing dementia. CONCLUSIONS: An influence of cognitive impairment and dementia on oral health and on the utilization of dental services was shown. However, no conclusions about the influence of the utilization behavior of people with dementia on oral health parameters can be drawn. Further longitudinal studies are needed. Trial registration ClinicalTrials.gov NCT03775772. Registered 14th December 2018, https://clinicaltrials.gov/ct2/show/NCT03775772 .

Chewing function and related parameters as a function of the degree of dementia: Is there a link between the brain and the mouth?

BACKGROUND: To date, no study has investigated the association between chewing function and related parameters as a function of the degree of dementia using a finer subdivision of the values of the Mini-Mental State Examination (MMSE). OBJECTIVE: This study aimed to investigate the differences in chewing function and related parameters as a function of the degree of dementia. METHODS: An analysis of cross-sectional data obtained from the OrBiD (Oral Health, Bite Force, and Dementia) pilot study was performed. The participants were stratified into five groups based on the outcomes of the MMSE (no dementia, MMSE 28-30; mild cognitive impairment, MMSE 25-27; mild dementia, MMSE 18-24; moderate dementia, MMSE 10-17; severe dementia, MMSE <10). The chewing efficiency, maximum occlusal force and related parameters (number of supporting zones, number of teeth, Eichner index, tooth/denture status, denture quality, and dental treatment needs) were recorded. RESULTS: The MMSE groups showed significantly different chewing efficiencies (p = .003, Jonckheere-Terpstra test) and maximum occlusal forces (p = .003, Jonckheere-Terpstra test), but the number of supporting zones (p = .055, chi-square test) and the number of natural teeth (p = .126, chi-square test) were not different. The Eichner index, tooth/denture status, denture quality and dental treatment need showed no significant associations with the degree of dementia. CONCLUSION: An improvement in the usability of the measurement methods for assessing chewing function in people with dementia is needed. Research involving people with dementia is necessary because the nutritional situation often deteriorates rapidly within a multifactorial system, which includes chewing ability and oral health.

Health-Related Social and Ethical Considerations towards the Utilization of Dental Medical Services by Seniors: Influencing and Protective Factors, Vulnerability, Resilience and Sense of Coherence.

The aim is to analyze protective and modifying factors (e.g., vulnerability, resilience, sense of coherence) in relation to the utilization of dental services by seniors at different levels of the healthcare system. Terminological imprecision in the use and transfer of existing terms (sense of coherence, resilience, salutogenesis) to gerodontology is clarified. Factors influencing a reduced utilization (static/dynamic factors) can occur isolated or in combination and, thus, model the risk of a reduced utilization of dental services (influencing-factor mechanism). Protective factors of utilization include patient-specific factors for self-motivation and factors that promote oral-health-related resilience. Resistance forces that counteract can be identified as oral-health-related resilience factors. Achieving social and individual appreciation and establishing a prevention-oriented approach to utilization will be increasingly challenging, since the population is becoming older and access is not equal in terms of opportunity. Resistance forces need to be strengthened in an ethical context. Studies should increasingly present resilience processes, determinants and modes of action at the various interfaces in the healthcare system, which can ensure sustainable medical care in old age. The concepts conveyed here are generally valid and able to point out inequalities and ageism in access to dental services.

Considerations for the Prosthetic Dental Treatment of Geriatric Patients in Germany.

Demographic changes in the industrialized countries require that dentists adapt to the growing and heterogeneous group of elderly patients and develop concepts for the dental care of fit, frail, and dependent old and very old people. In general, dental care for old and very old people should be based on their individual everyday life. As a result of demographic changes, improved oral hygiene at home, and the establishment of professional teeth and denture cleaning, tooth loss occurs increasingly in higher ages, which implies that first extensive prosthetic rehabilitation with fixed or/and removable dental prostheses is shifting to a higher average age than ever before. This phenomenon requires that the individual diseases, potential multimorbidity and polypharmacy, and associated limitations are taken into consideration. Against this background, the current survey aims to summarize epidemiological trends associated with tooth loss, using Germany as a highly representative country for demographic changes as an example. Furthermore, the current narrative summary outlines general principles that should be followed in dental care, treatment of geriatric patients, and outlines current therapeutic options in prosthetic dentistry.

Outpatient, dental care of adult vulnerable patients under general anaesthesia-a retrospective evaluation of need for treatment and dental follow-up care.

OBJECTIVES: To analyse the treatment needs of patients who had received dental treatment under GA and the effectiveness of the treatment provided. MATERIALS AND METHODS: Retrospective chart analysis of adult at risk and vulnerable patients requiring dental treatment under GA (2007-2017). Outcome variables were indications for GA, DMF/T, and type of treatment, failure rates of treated teeth, emergencies and recall intervals after GA. RESULTS: Four hundred fourteen subjects (median age 42 years, range 18-93 years) were assigned to four groups (people with disabilities (pwdis), dementias (pwd), dental phobias (pwph), and addictions/psychosocial disorders (pwapd)) and attended the pre-GA assessment. Of these, 247 subjects (median 37 years, range 18-93 years) were treated under GA, mostly pwdis (n = 154, 69.7%). The main indication for treatment under GA was suspicion of pain (n = 178, 72.1%). Pwd had the highest degree of restoration (46.7%), DMF/T value (23.8), and most missing teeth (5.8). Pwapd had the most decayed teeth (12.9). There was a 12-month recall augmented by 2-4 oral hygiene sessions depending on compliance. The failure rate of all treated teeth was 4%. Two dental emergencies were reported for patients who received a GA. CONCLUSIONS: Dental treatment need was high for adult vulnerable people. The diagnostic groups differed mainly in their subjective reason for need of a GA, their DMF/T, treatment needs and type of treatments performed. Failure and dental emergency rates after GA were low in spite of a recall interval of 12 months. CLINICAL RELEVANCE: Regular annual recalls could avoid dental emergencies in patients requiring treatment under GA.

Interrater reliability and concurrent validity of oral/dental items in the resident assessment instrument minimum data set 2.0.

OBJECTIVE: To examine interrater reliability and concurrent validity of oral/dental items in the Resident Assessment Instrument Minimum Data Set (RAI-MDS) 2.0. BACKGROUND: RAI-MDS is a standardised instrument used in nursing to determine health status and nursing needs. The extent to which oral/dental items in the RAI-MDS describe dental treatment needs concerning oral health has been questioned. MATERIALS AND METHODS: This study evaluated the interrater reliability (dentist vs. nurse) and validity of oral/dental items in the Swiss version of RAI-MDS 2.0 (areas: K-nutritional status, L-oral/dental status) using professional oral examinations as a benchmark. Data of 168 residents of five long-term care facilities in the canton of Zurich, Switzerland, were collected within 1 year between October 2017 and December 2018. The statistical evaluation used descriptive statistics and Cohen's kappa (95% CI). RESULTS: RAI-MDS items K1a, chewing (κ 0.098, 95% CI: 0.004-0.19); K1c, pain (κ 0.039, 95% CI: -0.03 to 0.11); L1a, debris (κ 0.117, 95% CI: 0.02-0.21); L1c, dental status (κ 0.229, 95% CI: 0.12-0.34); L1d, dental disease (κ 0.129, 95% CI: 0.02-0.24); L1e, periodontal diseases (κ -0.005, 95% CI: -0.07 to -0.03); and L1f, daily cleaning (κ -0.031, 95% CI: -0.05 to -0.01) showed weak or no agreement, whereas L1b, denture status (κ 0.634, 95% CI: 0.52-0.75), showed substantial agreement. CONCLUSION: Oral/dental items in RAI-MDS lack reliability and validity. Recognition of oral health situation/treatment needs by nursing staff does not seem to be possible with the current version of this tool.