Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care-dependent older people: An e-Delphi study.

OBJECTIVES: This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels. BACKGROUND: Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet. METHODS: The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1. RESULTS: A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative. CONCLUSIONS: Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people.

The influence of oral health status on speech intelligibility, articulation and quality of life of older community-dwelling people.

OBJECTIVE: To investigate the impact of the oral health status on speech intelligibility, articulation and quality of life of older community-dwelling people. BACKGROUND: To our knowledge, there have been no studies on this topic in patients aged 75 years or older. MATERIAL AND METHODS: Thirty outpatients of a university dental clinic (median [IQR] age of 77.00 [75-82] years) participated. The OHIP-14, a dental examination, a speech intelligibility study and an articulation examination were conducted. RESULTS: Distortions of rhotacisms and sigmatisms were most common, followed by distortions of labiodentals and apicoalveolars. Seven participants (23%) required dental treatment. Distortions of rhotacisms were lowest in participants with loss of teeth in the posterior part of the maxilla and equal in participants with edentulous maxilla and loss of teeth in the anterior part of the maxilla (P = 0.014). Labiodental distortions were lowest in participants with loss of teeth in the posterior part of the maxilla, but were higher in participants with loss of teeth in the anterior part of the maxilla and highest in participants with an edentulous maxilla (P = 0.035). People with normal mouth opening had lower percentage of labiodental distortions than people with a reduced mouth opening (P = 0.05). The proportion of participants with inadequate denture hygiene and distortions of bilabials was 71.4% compared to 10.5% for participants with adequate denture hygiene (P = 0.005). CONCLUSION: Dentists must consider the impact of a denture on speech, but also should be aware of other oral health factors that influence the speech and quality of life of elders.

Appropriate use of antibiotics for oral/dental conditions in older adults: a narrative review.

OBJECTIVES: Considering the high rates in the use of antibiotics for oral/dental conditions in older patients and the rise in antimicrobial resistance, appropriate antibiotic prescription is important. This narrative review aimed to discuss the challenges and special considerations when prescribing antibiotics to older patients for oral/dental conditions. METHODS: PubMed/MEDLINE, Scopus, Web of Science, and articles' reference lists were searched for antibiotics use for oral conditions by older patients. Moreover, scientific and professional organisations' official websites were searched for guidelines on antibiotic use in dentistry. RESULTS: Despite several guidelines about the use of antibiotics in dentistry, specific information on their administration to older patients is missing. Relevant challenges include age-related changes in pharmacokinetics and pharmacodynamics, comorbidities and polypharmacy associated with low adherence, contraindications, adverse reactions, and drug-drug interactions. In unfit and frail older patients some antibiotics should be avoided, or doses should be adjusted, according to medical conditions or medications received. Amoxicillin, with doses adapted to renal function, is one of the safest options, while other antibiotics should be chosen with caution upon indications and individual patient characteristics. CONCLUSIONS: Healthcare providers should prescribe antibiotics to unfit and frail older adults with caution, given the multitude of comorbidities and potential interactions with medications received. Further research is needed on the safe and effective use of antibiotics in older patients.

The impact of a preventive and curative oral healthcare program on the prevalence and incidence of oral health problems in nursing home residents.

AIMS: To assess the impact of an oral healthcare program in nursing homes on the initial treatment backlog and residents' oral health stability. MATERIALS AND METHODS: The study is a longitudinal cohort study in nursing home residents in Flanders, Belgium, to evaluate the oral healthcare programme Gerodent. The program consisted of: (1) the introduction of an oral healthcare team, (2) oral health education, (3) the implementation of oral health guidelines and protocols, and (4) regular visits of a mobile dental team. Data were extracted from the oral health records of 381 residents from 21 nursing homes who received treatments from the mobile dental team between October 2010 and March 2014 (mean follow-up period of 22.5 months). Oral health and treatment need between baseline and follow-up were compared. RESULTS: The mean age at baseline was 82.4 years and the mean number of consultations per resident was 3.61 during the follow-up period. The proportion of residents with an oral treatment need was reduced from 65.9% to 31.3%. Among residents with natural teeth, there was significantly lower prevalence of caries (from 70.5% at baseline to 36.5% at follow-up; p<0.001), residual roots (from 54.2% to 25.1%; p<0.001), and need for fillings (from 31.9% to 17.1%; p<0.001) or extractions (from 64.3% to 31.6%; p<0.001). In the group with partial or full dentures (n = 223), 38.1% needed a repair, rebasing or renewal of their existing dentures at baseline and the respective figure at follow-up was 9.0% (p<0.001). In terms of oral health stability, 53% of the residents had no incident restorative and prosthetic treatment need throughout the follow-up period. A lower number of natural teeth at baseline (p<0.001) and a shorter follow-up period (p = 0.002) were associated with higher chances of oral health stability. CONCLUSION: The oral healthcare program Gerodent significantly reduced the treatment backlog and contributed to a considerable proportion of residents being stable in terms of oral health without any incident treatment needs.

An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults.

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care-dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture-related conditions, hyposalivation, and oral pre- and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person-related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non-dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.

Practical Guidelines for Physicians in Promoting Oral Health in Frail Older Adults.

Good oral health in old age is particularly important for maintaining adequate oral function, preventing pain and discomfort, controlling localized or systemic inflammation, sustaining social interaction, and preserving quality of life. Given that oral health is an integral part of general health and well-being, and that major chronic systemic and oral diseases share common risk factors, oral health prevention and promotion should be embedded within routine medical assessment and care provision. The role of medical physicians, particularly primary care physicians, geriatricians, and elderly care physicians, in community and long-term care facilities in assessing and promoting oral health in frail older adults is critical and has been emphasized in recent European recommendations. All physicians should appreciate the importance of oral health and incorporate an initial oral health screening into routine medical assessment and care. A short interview with patients and carers on current oral health practices may help to assess the risk for rapid oral health deterioration. The interview should be followed by an oral health assessment, using validated tools, for nondental health care providers. Based on these findings, the physician should decide on necessary follow-up procedures, which may include oral health counseling and/or dental referral. Oral health counseling should include advice on daily oral, mucosal, and denture hygiene; denture maintenance; dietary advice; smoking cessation; limitation of harmful alcohol consumption; management of xerostomia; and frequent dental review. To enable physicians to perform the tasks recommended in this publication, appropriate teaching at both undergraduate and postgraduate levels must be delivered in addition to provision of appropriate continuing education courses.

Medication Use and Its Potential Impact on the Oral Health Status of Nursing Home Residents in Flanders (Belgium).

BACKGROUND: Polypharmacy is considered the most important etiologic factor of hyposalivation, which in turn can initiate oral health problems. OBJECTIVES: To describe the medication use of nursing home residents, to identify the medications related to hyposalivation and to find possible associations between the different classes of medication, the number of medications, and the oral health status of the residents. DESIGN: A cross-sectional study. PARTICIPANTS: The study population consisted of the residents of a nonrandom sample of 23 nursing homes from 2 Belgian provinces, belonging to the oral health care network Gerodent. All residents of the sample visited the Gerodent mobile dental clinic between October 2010 and April 2012. MEASUREMENTS: For each resident, oral health data, demographic data, and an overview of the total medication intake were collected. RESULTS: The study sample consisted of 1226 nursing home residents with a mean age of 83.9 years [standard deviation (SD) 8.5]. The mean number of medications per person was 9.0 (SD 3.6, range 0-23, median 9.0). Of all prescribed medication, 49.6% had a potential hyposalivatory effect with a mean number per person of 4.5 (SD 2.2, range 0-15, median 4.0). In the bivariate analyses, associations were found between medication use and oral health of residents with natural teeth: the higher the number of medications (with risk of dry mouth) and the overall risk of medication-related dry mouth, the lower the number of natural teeth (P = .022, P = .005, and P = .017, respectively). In contrast, the total treatment need tended to decrease with rising medication intake, resulting in a clear increase of the treatment index with rising medication intake (P = .003, P < .001 and P = .002). The logistic regression model analysis confirmed that the proportion of carious teeth diminished and the treatment index increased in case of rising medication intake, especially when considering the number of medications with a risk of dry mouth and the overall risk of medication-related dry mouth. A possible explanation for this trend might be the finding that in the group with a high medication use, the teeth most sensitive to caries and plaque retention could already have been extracted at the moment of screening for the study, because of a lifelong history of caries pathology. CONCLUSIONS: This study shows a high level of medication use, including the substantial intake of medication with a possible hyposalivatory effect. Moreover, clear associations were found between the medication intake and the oral status of the residents.

Older People's Preferences for Side Effects Associated with Antimuscarinic Treatments of Overactive Bladder: A Discrete-Choice Experiment.

INTRODUCTION: Understanding the importance older people attribute to the different side effects associated with oral antimuscarinic treatments for overactive bladder (OAB) could help inform prescribers, healthcare policy makers and the drug industry. OBJECTIVE: Our objective was to quantify the importance of the most prevalent cognitive and side effects of oral antimuscarinic treatments for OAB in older people. METHODS: We conducted a discrete-choice experiment (DCE) with the assistance of an interviewer with community-dwelling and hospitalized older people aged >65 years. The DCE involved two hypothetical drugs for imaginary OAB, with three levels of four side effects for each drug, and the International Consultation on Incontinence Questionnaire-Overactive Bladder and EuroQol 5-Dimensions (EQ-5D) questionnaire were also administered. Data were analysed using a conditional logit model. RESULTS: In total, 276 older people participated in the study. The median age was 75 years (interquartile range [IQR] 69-80), 63% were women and 21% had OAB syndrome. The most unwanted side effect in the choice of antimuscarinics for OAB was severe cognitive effects, followed by severe constipation, severe blurred vision, severe dry mouth, moderate cognitive effects and moderate constipation. Severe cognitive effects were at least 1.7 times as important as severe constipation. Exploratory subgroup analysis showed that none of the attributes was found to be significant in people who scored as anxious or depressed on the EQ-5D, and preferences about cognitive effects, constipation and blurred vision were equal in people with and without OAB. CONCLUSION: Older people attribute more importance to loss of cognitive function as a possible side effect of antimuscarinic treatment than to the three most prevalent possible side effects of this treatment.