The minimally important difference for the Xerostomia Inventory among Sjögren's disease patients.

OBJECTIVE: Until now, the clinically relevant improvement for the Xerostomia Inventory (XI) has not been defined. Therefore, our aim was to determine the Minimally Important Difference (MID) of the XI for improvement in dry-mouth symptoms in SjD patients. METHOD: The study recruited 34 SjD patients who underwent sialendoscopy of major salivary glands and 15 SjD patients in a nonintervention control group. XI scores were assessed at several time points. The MID was determined from the mean difference in XI scores between the groups with and without improvement. RESULTS: In the control group, no significant XI score changes were seen. In the sialendoscopy group, a clinically relevant XI score change of four scale points was identified after 1 week. For a prolonged duration (≥16 weeks), a minimum reduction of seven scale points in the XI score was required to indicate clinically relevant improvement. CONCLUSION: In SjD patients, a minimum change of four points in the XI score indicates a clinically relevant improvement for evaluating short-term effects. For prolonged effects, a clinically relevant improvement requires a MID of seven points. The determination of the MID in XI could assist in future studies that evaluate changes in xerostomia.

Dentition and nutritional status of aged New Zealanders living in aged residential care.

BACKGROUND: Previous studies of the nutritional status of older individuals have used measures such as plasma vitamin and mineral levels, which can be difficult to interpret. The relationship between nutrition and dentition has been limited to studying exposures such as the number of posterior occluding pairs of teeth, edentulousness, and the number of natural teeth. OBJECTIVES: To investigate the association between dentition status and nutritional status in a national survey of older New Zealanders living in aged residential care facilities. MATERIAL AND METHODS: Secondary analysis of clinical oral status and nutrition data collected in 2012 in New Zealand's Older People's Oral Health Survey. The validated Mini Nutritional Assessment short format was used to categorize participants as "normal nutritional status," "at risk of malnutrition" or "malnourished." RESULTS: Just under half of older New Zealanders living in aged residential care facilities were classified as either at risk of malnutrition or malnourished (with about one in sixteen in the latter category). The prevalence of malnutrition was higher among those in hospital-level and psychogeriatric-level care, as well as in those of high socioeconomic status. Individuals who were at risk of malnutrition had the most untreated dental caries and untreated coronal caries. Relative to their counterparts in nursing-home-level care, dentate individuals in hospital-level care were 2.4 times-and those in psychogeriatric-level care were 2.8 times-as likely to be malnourished or at risk of it. CONCLUSIONS: Just under half of the New Zealanders living in aged residential care were at risk of malnutrition or were malnourished. Greater experience of untreated dental caries was associated with a higher rate of being malnourished or at risk of it. Poorer cognitive function and greater dependency were important risk indicators for malnutrition.

Patient-related outcomes in Sjögren syndrome treated with stimulants of salivary secretion: Randomized clinical trial.

OBJECTIVES: To investigate the impact of gustatory stimulants of salivary secretion (GSSS) on Sjögren's syndrome patients' self-perception of xerostomia, oral health-related quality of life (OHRQoL) and salivary secretion. METHODS: A total of 110 Sjögren's syndrome patients were randomly allocated to be treated with either a malic acid lozenge or a citric acid mouthwash and then crossed over. Before and after the interventions, the Xerostomia Inventory 5 (SXI-5-PL) and the Oral Health Impact Profile (OHIP-14-PT) questionnaires (both in the Portuguese language) were administered to patients. Unstimulated, mechanical and gustatory-stimulated salivary flows were determined. Repeated measures and between-subject analyses were performed. Statistical significance was set at 5%. RESULTS: After the intervention and within each group, both GSSS elicited a reduction in the SXI-5-PL and OHIP-14-PT scores and an increase in salivary output, significant in the malic acid lozenge group. The malic acid treatment resulted in a greater effect size and percentage improvement than citric acid mouthwash. The malic acid lozenge also produced a significant greater salivary output than the citric acid rising solution. CONCLUSIONS: In Sjögren's syndrome patients, lozenges containing malic acid increased saliva production and xerostomia relief, resulting in improved quality of life.

Long-Term Survival of Enamel-Defect-Affected Teeth.

There has been considerable research focussed on the occurrence and aetiology of developmental defects of enamel, but less is known about the extent to which enamel-defect-affected teeth may be at greater risk for dental caries. The Dunedin Multidisciplinary Health and Development Study is a prospective cohort study of 1,037 children born in Dunedin, New Zealand, between April 1, 1972, and March 31, 1973. Participants were examined for the presence of developmental defects of enamel at the age of 9 years and then repeatedly for the occurrence of dental caries through to the age of 45 years. After controlling for confounding variables, incisor teeth affected by demarcated opacities at the age of 9 were 3.4 times more likely to be restored than teeth unaffected by defects. Incisors with diffuse opacities and hypoplasia or combinations of defects were 2.8 times more likely to be restored. Molars with enamel defects of any type did not have any significantly different risk for being subsequently restored or lost due to caries than unaffected molars, except those affected by diffuse opacities, which were at 0.4 times the risk of being lost due to caries. Dental clinicians should be aware that enamel-defect-affected teeth are not necessarily at greater risk for tooth loss due to caries in the long term, but permanent incisors affected by enamel defects are at higher risk of receiving restorative intervention.

Barriers and enablers for dental care among dentate home-based older New Zealanders who receive living support.

OBJECTIVE: To explore the structural, social and individual barriers to, and facilitators for, accessing dental services and remaining dentate, among a purposive sample of dentate home-based older people who receive living support (HBOPWRLS). BACKGROUND: Studies on the oral health of older people have largely been quantitative, while fewer studies have specifically explored the dental service utilisation patterns of dentate HBOPWRLS, especially in New Zealand. MATERIALS AND METHOD: In early 2019, semi-structured interviews were conducted with a purposive sample of 40 dentate HBOPWRLS from one region of New Zealand. A parallel coding and thematic analysis of the interview data was conducted, based on the constant comparative method. RESULTS: Barriers to accessing dental services included the cost of dental treatment, negotiating transport issues, social isolation, traumatic childhood dental experiences, lack of role modelling for good oral health and hygiene, self-ageing and drawing upon discourses of older people, and health conditions impacting on mobility and access to oral health care. Facilitators for accessing dental services included having a support network, parental role models, healthy diet, knowledge of the link between oral and general health, dental clearances for surgery, not wanting dentures and having a strong dislike of them, and agency to resist dentists' advice to have a full extraction. CONCLUSION: The expense of dental care is a major barrier to HBOPWRLS accessing dental services at a life stage of reduced income. Strategies for boosting dental service access among socially isolated older people need further exploration.

When to intervene in the caries process? An expert Delphi consensus statement.

OBJECTIVES: To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions. METHODS: Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference. RESULTS: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds. CONCLUSIONS: Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.

Validity and reliability of a Portuguese version of the Summated Xerostomia Inventory-5.

OBJECTIVES: The aim of this study was to validate and determine the reliability of the Portuguese version of the Summated Xerostomia Inventory. BACKGROUND: Many conditions such as head and neck radiation, autoimmune diseases or polypharmacy are characterised by hyposalivation which can affect oral and systemic quality of life. As such, this condition must be assessed, and the English version of the Xerostomia Inventory has been increasingly used to determine the severity of dry mouth perception. MATERIALS AND METHODS: This was a descriptive cross-sectional study, which employed volunteers suffering from hyposalivation after local ethical committee clearance. Each patient signed an informed consent and responded to the Portuguese version of the questionnaire in the form of an interview. This was repeated again after 2 weeks. A standard single question provided a validity check. Data were analysed using Cronbach's α to test its reliability and total and interitem correlation, and intraclass correlation to determine its internal consistency and test-retest reliability. Significance was set at .05. RESULTS: A sample of 103 volunteers was recruited. Cronbach's α was .84 and .87 for the first and second test administrations, respectively. The intraclass correlation coefficient value for the test-retest reliability was .93, and scores for the individual items ranged from .79 to .90. The correlation between the total score of the questionnaire and standard single dry mouth question was .66, indicating a very good correlation. CONCLUSION: Demonstrating excellent psychometric properties, the Summated Xerostomia Inventory (Portuguese Version) is a valid tool for quantifying Xerostomia in a dry mouth-afflicted population.

Complete tooth loss as status passage.

The aim of this article is to add to the literature on the sociology of oral health and dentistry by presenting the relevance of status passage to the study of complete tooth loss. The article reports on an analysis of data taken from participants residing in the Nelson region of New Zealand. In total the data include interviews from 20 participants, all of whom had their remaining natural teeth removed before 1960. In total, 12 women and eight men were interviewed. All were from a European background with an age range of 71 to 101 years. Following a narrative approach, participants were interviewed on the nature of the social factors that resulted in complete tooth loss by starting with their family history and then focusing on the factors and events leading up to their total tooth loss. Data were analysed using the methods and techniques of grounded theory. This article provides an outline of the importance of scheduling, prescribing, social factors, 'compound awareness contexts' and reversibility to the status passage into complete tooth loss. We conclude by arguing that the theory of status passage may enable a detailed analysis of the 'time-space extensionality' of trajectories into complete tooth loss.

'Not on the radar': dentists' perspectives on the oral health care of dependent older people.

OBJECTIVES: We explored the following research questions: (i) what challenges do dentists face when providing oral health care to dependent older adults; and (ii) to overcome those challenges, what recommendations would dentists providing care give those planning and implementing oral health policy and services for dependent older adults? BACKGROUND: The dentate older population is steadily increasing, and about half will end up in residential care, where dental caries rates over time are at least twice as great as those observed elsewhere. MATERIALS AND METHODS: A qualitative study was used, with semi-structured interviews conducted by a single interviewer. Dental examiners in a recent national survey of oral health in dependent older people in New Zealand were interviewed about their experiences and perspectives of that. RESULTS: The challenges participants identified stemmed from three areas - the patient, the care facility and the oral health sector. To address those challenges, the participants recommended actions at the patient, system and sector levels. Each of the challenges and recommendations had a number of subthemes. Overall, the dentists felt that it is a very complex situation urgently requiring policy development, cross-sectoral collaboration and upskilling of the dental profession, carers, the private sector and the State to ensure a care environment which supports achieving and maintaining oral health among frail elders. CONCLUSIONS: Urgent attention to frail older New Zealanders' oral health is needed. Such attention needs to focus on not only the narrow dental clinical preventive and therapeutic implications of those needs, but also on the broader health system and policy development challenges.

Telomere length and periodontal attachment loss: a prospective cohort study.

AIM: The aim of the study was to examine the association between telomere erosion and periodontitis in a long-standing prospective cohort study of New Zealand adults. Specific hypotheses tested were as follows: (i) that exposure to periodontitis at ages 26 and 38 was associated with accelerated leucocyte telomere erosion and (ii) that accelerated leucocyte telomere erosion was associated with higher rates of periodontitis by ages 26 and 38. MATERIALS AND METHODS: Periodontal attachment loss data were collected at ages 26 and 38. Blood samples taken at the same ages were analysed to obtain estimates of leucocyte telomere length and erosion over a 12-year period. RESULTS: Overall, the mean telomere length was reduced by 0.15 T/S ratio (adjusted) from age 26 to 38 among the 661 participants reported on here. During the same period, the mean attachment loss increased by 10%, after adjusting for sex, socio-economic status and smoking. Regression models showed that attachment loss did not predict telomere length, and that telomere erosion did not predict attachment loss. CONCLUSIONS: Although both periodontitis and telomere length are age-dependent, they do not appear to be linked, suggesting that determination of leucocyte telomere length may not be a promising clinical approach at this age for identifying people who are at risk for periodontitis.

Deciduous-dentition malocclusion predicts orthodontic treatment needs later: findings from a population-based birth cohort study.

INTRODUCTION: Estimating orthodontic treatment need in the permanent dentition using information from the deciduous-dentition malocclusion may assist in defining the time for appropriate orthodontic intervention. Our objective was to investigate whether malocclusion in the deciduous teeth predicts orthodontic treatment need in the permanent dentition. METHODS: Two oral health studies nested in a birth cohort were carried out at ages 6 (n = 359) and 12 (n = 339) years. Open bite, crossbite, and canine malocclusion were assessed in the deciduous teeth. Orthodontic treatment need was determined in the permanent dentition using the dental esthetic index. Prevalence ratios were estimated using 2 dental esthetic index cutoff points: highly desirable/mandatory orthodontic treatment and only mandatory orthodontic treatment. We tested all combinations of the deciduous malocclusion and the outcomes, controlling for confounders. RESULTS: Children with only open bite and those with concurrent open bite and canine malocclusion were more likely to have either highly desirable/mandatory orthodontic treatment or only mandatory orthodontic treatment needs by age 12. The combination of crossbite and open bite in the deciduous teeth was associated with the highest risk of need for mandatory orthodontic treatment. CONCLUSIONS: Malocclusion in the deciduous teeth is a risk factor for orthodontic treatment need in the permanent dentition. Children with malocclusion at a young age should be monitored regularly, and caregivers may be able to better prepare for possible orthodontic treatment.

Dry mouth - An overview.

This paper presents an overview of dry mouth, an important condition in the older population. Dry mouth will first be defined, followed by consideration of its occurrence. There will then be an overview of the leading causes of dry mouth. Next, the impact of dry mouth will be discussed in order to explain why it is a significant condition. Lastly, there will be a brief description of the diagnosis and management of dry mouth.

An ageing population poses dental challenges.

In this narrative review paper, we summarise what is known about the oral health of older people, with a specific focus on the most common oral conditions in that age group. After that, the implications for older people׳s oral care are considered, along with ways of developing and maintaining a gerodontologically capable and responsive workforce and oral care delivery system.

A bibliometric analysis of Community Dentistry and Oral Epidemiology: Fifty years of publications.

OBJECTIVES: In celebration of the journal's 50th anniversary, the aim of the study was to review the whole collection of Community Dentistry and Oral Epidemiology (CDOE) publications from 1973 to 2022 and provide a complete overview of the main publication characteristics. METHODS: The study used bibliometric techniques such as performance and science mapping analysis of 3428 articles extracted from the Scopus database. The data were analysed using the 'Bibliometrix' package in R. The journal's scientific production was examined, along with the yearly citation count, the distribution of publications based on authors, the corresponding author's country and affiliation and citation count, citing source and keywords. Bibliometric network maps were constructed to determine the conceptual, intellectual and social collaborative structure over the past 50 years. The trending research topics and themes were identified. RESULTS: The total number of articles and average citations has increased over the years. D Locker, AJ Spencer, A Sheiham and WM Thomson were the most frequently published authors, and PE Petersen, GD Slade and AI Ismail published papers with the highest citations. The most published countries were the United States, United Kingdom, Brazil and Canada, frequently engaging in collaborative efforts. The most common keywords used were 'dental caries', 'oral epidemiology' and 'oral health'. The trending topics were healthcare and health disparities, social determinants of health, systematic review and health inequalities. Epidemiology, oral health and disparities were highly researched areas. CONCLUSION: This bibliometric study reviews CDOE's significant contribution to dental public health by identifying key research trends, themes, influential authors and collaborations. The findings provide insights into the need to increase publications from developing countries, improve gender diversity in authorship and broaden the scope of research themes.

The oral health status and treatment needs of adults with intellectual disabilities in Auckland.

AIMS: Adults with intellectual disabilities (ID) are known to have poor oral health and complex dental needs requiring treatment under general anesthesia (GA). This retrospective chart review aimed to provide information on the oral health status and treatment needs of adults with ID in Auckland. METHODS AND RESULTS: Data on 1075 adult patients with ID seen through the Auckland public dental service during the period June 2016 to April 2020 were drawn from electronic notes. Analyses focused on age group differences and the characteristics associated with the use of GA for dental treatment. More cumulative caries experience, poorer oral hygiene, and more missing teeth were observed among those who were older. About half (50.8%) of the patients used GA for dental treatment. This proportion was higher among those who were younger, less independent, non-verbal, with poorer oral hygiene, or who had active decay. CONCLUSION: Adults with ID are a heterogeneous population with unmet dental treatment needs. Different age groups require consideration of distinct characteristics for dental care provision. It is important to be for public sector service provision to be developed to consider predictors for GA service use in patients who are younger, less independent, non-verbal, or have active decay.

Influence of case definitions on epidemiological estimates of periodontitis prevalence and its associations with smoking and OHRQoL.

OBJECTIVES: To compare periodontitis prevalence estimates obtained using the new classification system with those generated using other case definitions from the literature, examine the strength of the association between tobacco smoking and periodontitis (and that between periodontitis and its impact on oral-health-related quality of life; OHRQoL) using those definitions. METHODS: We conducted a secondary analysis of data from the 2009 New Zealand Oral Health Survey, a cross-sectional dental examination survey of a representative sample of people aged 18 or over. We identified cases using 10 different periodontitis case definitions and then compared weighted prevalence estimates across those. The associations between smoking and periodontitis, and between periodontitis and short-form Oral Health Impact Profile (OHIP-14) scores, were then compared across the various case definitions. RESULTS: There was considerable variation in periodontitis prevalence estimates (range 3% to 59%). All definitions (but one) showed a higher prevalence of periodontitis in smokers than in non-smokers. The new classification stage III definition showed the strongest association, with an adjusted prevalence ratio of 1.99 (95%CI: 1.35, 2.91). All case definitions (but one) had a higher mean OHIP-14 score among people with periodontitis. CONCLUSIONS: Periodontitis prevalence estimates are greatly influenced by case definition choice. The new classification system may be more accurate than any other used to date, but questions remain about its utility for periodontal epidemiology.

Presentation and subsequent care of dental injuries sustained by New Zealand adults.

BACKGROUND/AIMS: Injuries to permanent teeth are common and can have lasting effects, but knowledge of their consequences is deficient because there is a lack of information from longitudinal follow-up studies of adult populations. The aim of this study was to use routinely collected adult dental trauma data from New Zealand's no-fault, Government-run social insurance scheme-the Accident Compensation Corporation-to investigate the presentation and subsequent care of dental injuries sustained by adults. METHODS: Cross-sectional analysis of all new dental injuries recorded during 2008 was followed by prospective analysis of all treatment claimed in the following five years for all new injuries recorded in June 2008 for adults aged 18+ years. Those injuries were categorised into five clinically meaningful, ordinal groups of dental injuries, ranging from least severe (Minor injury) to most severe (Severe displacement). The prospective post-injury treatment information was summarised as (1) restorations; (2) crowns and veneers; (3) completed root canal treatment (preparation and obturation of root canal[s]); (4) extraction (extraction; surgical removal); and (5) implant placement. RESULTS: Orofacial trauma details were recorded for 32 110 individuals (of all ages) in 2008; males predominated in all age groups, except for those aged 65+ years. Of the 68 890 separate injuries to permanent teeth recorded, 74.9% involved maxillary teeth, with almost 50% involving teeth 21 and 11. Some 66.9% of the dental injuries were classified as Minor; 21.7% involved Fractures or loosening, and 8.2% were Severe fractures. Displacement and Severe displacement injuries comprised 1.8% and 2.5% respectively. During June 2008, dental injuries were recorded for 1325 adults. More than 80% of those dental injuries underwent treatment during the subsequent five years, and more severe initial trauma required more complicated treatment. Minor injuries accounted for 33.5%, fractures/loosening for 50.8%, severe fractures for 1.2%, displacements for 8.8%, and severe displacements for 5.8% of the total cost of treatment provided over that five-year period. CONCLUSIONS: Although most injuries sustained were minor, their subsequent treatment burden is not only high but also greater with more severe initial trauma. The ongoing societal cost of orofacial trauma appears to be high.

Can clozapine be used by dental practitioners to increase salivary flow in patients with dry mouth? A scoping review.

OBJECTIVES: Clozapine, an atypical antipsychotic used to treat people with schizophrenia, has been proposed as a possible treatment for salivary gland hypofunction. This scoping review investigated the available literature on clozapine's impact on salivary flow, in order to determine whether it could be used by dental practitioners in low doses as a treatment for dry mouth. DATA SOURCES: An electronic search was completed using Ovid MEDLINE (1996 to Nov 2021). Key MeSH search terms included "clozapine," "Clozaril," "salivation," "salivary flow rate," "sialorrhea," "hypersalivation," and "drooling." Two reviewers independently reviewed eligible articles and extracted the data based on the inclusion and exclusion criteria. RESULTS: The initial search identified 129 studies, six of which were included in this review. Four of them (one cross-sectional and three interventional) described salivary flow rates in schizophrenic patients taking clozapine, while one of those and two others focused on the mechanism of clozapine-induced sialorrhea, with one study covering both. There were mixed findings, with one study observing a moderate association between clozapine dose and salivary flow, and the others reporting no differences. Findings on the putative mechanisms for clozapine-induced sialorrhea (CIS) were inconclusive. CONCLUSION: There is insufficient high-quality information to justify using low-dose clozapine to increase salivary flow in dental patients with salivary gland hypofunction. Well-designed interventional studies and randomized control trials are required.

Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders.

BACKGROUND: Most research on older people's oral health has been quantitative. A need for more in-depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. OBJECTIVE: To explore experiences and perceptions of oral health and oral health care among an ethnically-mixed sample of older New Zealanders. METHODS: In-depth interviews were conducted with 24 older people in two communities in New Zealand's South Island. Thematic analysis of transcribed data was undertaken. RESULTS: Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. CONCLUSIONS: We identified a number of shared experiences which affect older people's ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received.