Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study.

BACKGROUND: Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults. METHODS: An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Swietokrzyskie Province in Poland in 2010-2011. The research material included the cross-sectional data of 11,901 individuals aged 40-64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0-2 points), moderate (3-5 points), and severe depressive symptoms (6-8 points). The self-reported number of lost teeth was analysed according to the following categories: 0-4, 5-8, 9-27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption. RESULTS: The likelihood of both moderate (OR = 1.189; 95%CI: 1.028-1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488-2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075-1.609; p < .008) with the occurrence of severe depressive symptoms. CONCLUSIONS: The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.

'It's like being in a tunnel': Understanding the patient journey from tooth loss to life with removable dentures.

INTRODUCTION: The aim of this study was to conceptualise the key stages of the patient journey in the provision of a new denture and examine the factors leading to successful patient-related outcomes. METHODS: Two partially dentate patient samples were included: (i) Denture wearers - patients who had a denture fitted within the previous five years and (ii) New dentures - patients receiving treatment for a new or replacement denture. The methods involved direct targeted participant observations of the denture fitting process, debriefing interviews and a follow-up focus group exploring the patient journey. Data were analysed through the use of phenomenology and grounded theory. RESULTS: Interviews were completed with twenty participants of the denture-wearing sample (11 males and nine females, age range 22 to 86 years). Thirteen participants were included in the treatment journey sample in two primary care settings (six males and seven females, age range 55 to 101 years). Tooth loss and recovery was described as being in an 'emotional tunnel' resulting from 'bodyphonic processes' associated with tooth loss. 'Bodyphonia' subsequently became the context for 'taking control' and 'managing disclosure' when living with a removable denture. Different courses through this process can be readily observed, moderated by different variables (i.e., previous experience, working knowledge, a good fit, the treatment alliance, negotiated compromises and bounded responsibility). CONCLUSIONS: An'integrating framework' that seeks to describe the patient journey from the experience of tooth loss to recovery with a denture is proposed. This framework could be used to aid development of a clinical pathway to guide treatment options. CLINICAL SIGNIFICANCE: This paper conceptualises the patient journey. It stresses the importance of understanding the stages patients go through and highlights that for the dental team, the try-in stage is perhaps the best stage to give information about the denture and plans for continued care.

Does remaining teeth and dental prosthesis associate with social isolation? A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES).

OBJECTIVES: Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6-years follow-up was examined. METHODS: Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms. RESULTS: The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow-up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10-19 teeth and used dental prosthesis, 112 (4.2%) had 10-19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0-9 teeth and used dental prosthesis, and 168 (7.6%) had 0-9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96-1.33) for those with 10-19 teeth and OR = 1.36 (95%CI = 1.17-1.58) for those with 0-9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80-1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0-9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49-2.19] more likely to be socially isolated, whereas participants with 0-9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05-1.45] more likely to be socially isolated. CONCLUSION: Tooth loss was the main predictor for social isolation at follow-up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss.

Perda dentária e suas consequências psicossociais em adultos e idosos / Tooth loss and its psychosocial consequences in adults and older people / La pérdida de dientes y sus consecuencias psicosociales enadultos y ancianos

Introdução: É notório que a perda dentária é um obstáculo a ser lidado na saúde bucal, sendo ainda considerada um problema de saúde pública no Brasil que gera consequências físicas e psicológicas principalmente para adultos e idosos. Objetivo: Descrever as principais consequências psicossociais ocasionadas pela perda dentária em adultos e idosos. Metodologia: Trata-se de uma revisão integrativa da literatura, em que foram realizadas buscas bibliográficas eletrônicas com intervalo de tempo de publicação de seis anos (2016 -2022) nas bases de dados Biblioteca Virtual em Saúde (BVS) e Scientific Electronic Library Online (SciELO). Foram usados os descritores Perda de Dente, Saúde Bucal, Impacto Psicossocial, Adulto e Idoso com o auxílio do operador booleano "and", sendo contemplados artigos em português e inglês no qual o título, o resumo e a leitura na íntegra se relacionassem com o tema, e excluídas publicações do tipo monografias, dissertações, teses, capítulos de livros, livros na íntegra e artigos que não abordaram o tema de estudo. Resultados: Foram utilizados 14 artigos no total para compor o referencial teórico da revisão, sendo que todas essas publicações trouxeram informações relevantes quando se associa a perda dentária com o impacto psicossocial no público alvo. Situações como a vergonha ao sorrir ou falar em público e o comprometimento da fala geram um importante impacto na qualidade de vida dessas pessoas, despertando nelas um sentimento de inferioridade. Conclusão: A perda dentária abala a qualidade de vida das pessoas. Fatores psicológicos como a timidez, a vergonha e alteração de rotinas influenciam na vida social de adultos e idosos (AU).

Introduction:It is clear that tooth loss is an obstacle to be dealt with in oral health and it is still considered a public health problem in Brazil that brings physical and psychological consequences mainly for adults and older people.Objective:To describe the main psychosocial consequences caused by tooth loss in adults and older people.Methodology:This is an integrative literature review in which an electronic bibliographic search with a publication time interval of six years (2016 -2022) was performed in the Virtual Health Library (BVS) and Scientific Electronic Library Online databases (SciELO). The descriptors Tooth Loss, Oral Health, Psychosocial Impact, Adult and Elderly were used with interposition of the Boolean operator "AND". Articles in Portuguese and Englishwhose title, abstract and full text were related to the theme were selected. Publications such as undergraduate theses, master's dissertations, doctoral theses, book chapters, books, and articles that did not address the topic were excluded. Results: A total of 14 articles were used to compose the theoretical framework of the review and all brought relevant information as to the association between tooth loss and the psychosocial impact on the target audience.Situations such as embarrassment when smiling or speaking in public and speech impairment create animportantimpact on the quality of life of these people, awakening in them a feeling of inferiority. Conclusion:Tooth loss affects people's quality of life. Psychological factors such as shyness, shame, and change in routines influence the social life of adults and older people (AU).

Introducción: Es claro que la pérdida de dientes es un obstáculo a ser abordado en la saludbucal, y aún es considerado un problema de salud pública en Brasil que genera consecuencias físicas y psíquicas principalmente para adultos y ancianos.Objetivo: Describir las principales consecuencias psicosociales provocadas por la pérdida de dientes enadultos y ancianos.Metodología: Se trata de una revisión integradora de la literatura, en la que se realizaron búsquedas bibliográficas electrónicas con un intervalo de tiempo de publicación de seis años (2016 -2022) en las bases de datos Biblioteca Virtual en Salud (BVS) y Scientific Electronic Library Online (SciELO). Se utilizaron los descriptores Pérdida de Dientes, Salud Bucal, Impacto Psicosocial, Adulto y Anciano con la ayuda del operador booleano "y", con artículos en portugués e inglés en los que el título, resumen y lectura completa se relacionaron con el tema; fueron excluidas publicaciones como monografías, disertaciones, tesis, capítulos de libros, libros completos y artículos que no abordaron el tema de estudio.Resultados: Se utilizaron un total de 14 artículos para componer el marco teórico de la revisión, y todas estas publicaciones aportaron información relevante al asociar la pérdida de dientes con el impacto psicosocial en el público objetivo.Situaciones como la vergüenza al sonreír o hablar en público y el deterioro del habla generan un impactoimportanteen la calidad de vida de estas personas, despertando en ellos un sentimiento de inferioridad.Conclusión: La pérdida de dientes afecta la calidad de vida de las personas. Factores psicológicos como la timidez, la vergüenza y el cambio de rutinas influyen en la vida social de adultos y ancianos (AU).

The validity of self-reported number of teeth and edentulousness among Norwegian older adults, the HUNT Study.

BACKGROUND: Number of teeth is an established indicator of oral health and is commonly self-reported in epidemiological studies due to the costly and labor-intensive nature of clinical examinations. Although previous studies have found self-reported number of teeth to be a reasonably accurate measure, its accuracy among older adults ≥ 70 years is less explored. The aim of this study was to assess the validity of self-reported number of teeth and edentulousness in older adults and to investigate factors that may affect the accuracy of self-reports. METHODS: This study included two different samples of older adults ≥ 70 years drawn from the fourth wave of the Trøndelag Health Study (the HUNT Study), Norway. Sample 1 (n = 586) was used to evaluate the validity of self-reported number of teeth and sample 2 (n = 518) was used to evaluate self-reported edentulousness. Information on number of teeth and background variables (education, smoking, cognitive function, and self-perceived general and oral health) were self-reported in questionnaires, while clinical oral health examinations assessed number of teeth, number of teeth restored or replaced by fixed prosthodontics and edentulousness. Spearman and Pearson correlation coefficients, Bland-Altman plot, chi-square test and kappa statistics were used to assess the agreement between self-reported and clinically recorded number of teeth. RESULTS: The mean difference between self-reported and clinically recorded number of teeth was low (- 0.22 teeth), and more than 70% of the participants reported their number of teeth within an error of two teeth. Correlations between self-reports and clinical examinations were high for the total sample (0.86 (Spearman) and 0.91 (Pearson)). However, a lower correlation was found among participants with dementia (0.74 (Spearman) and 0.85 (Pearson)), participants having ≥ 20 teeth (0.76 (Spearman) and 0.67 (Pearson)), and participants with ≥ 5 teeth restored or replaced by fixed prosthodontics (0.75 (Spearman) and 0.77 (Pearson)). Self-reports of having teeth or being edentulous were correct in 96.3% of the cases (kappa value 0.93, p value < 0.001). CONCLUSIONS: Among older Norwegian adults, self-reported number of teeth agreed closely with clinical tooth counts and nearly all the edentulous participants correctly reported having no teeth.

Association Between Tobacco Smoking, Dental Status and Self-perceived Oral Health in Elderly Adults in Colombia.

Tobacco smoking is responsible for several health problems, including mouth diseases. The aim of the present study was to establish the association between smoking and dental status and self-perceived oral health in a large group of elderly Colombian adults. Analysis of 18,937 survey records of participants aged ≥ 60 years old was conducted. Information regarding age, sex, skin color, socioeconomic level, education, marital status, denture use, partial tooth loss or edentulism, Geriatric Oral Health Assessment Index (GOHAI) and tobacco smoking was retrieved from the database. A descriptive analysis and multivariate logistic regression analysis were performed. Half of the participants were edentulous in the maxilla while mandibular teeth were more frequently retained in more than 60% of the participants. After adjusting for sex and age, smoking consistently increased the odds of partial or complete edentulism in the maxilla (OR 1.05; 95% CI 1.02-1.09) and mandible (OR 1.04; 95% CI 1.00-1.08). Nonetheless, the increase in the odds in the mandible was not statistically significant. The habit of smoking was associated with increased tooth loss that in the long-term may result in poor oral health affecting the quality of life of elderly people.

Association between frequency of laughter and oral health among community-dwelling older adults: a population-based cross-sectional study in Japan.

PURPOSE: Oral health has been reported to have an impact on the activities of daily life such as chewing, eating, and laughing, while psychological factors such as depression and loneliness have been reported to affect oral health. Little is known, however, about the association between laughter and oral health in older adults. This study examined the bidirectional association between the frequency of daily laughter and oral health in community-dwelling older Japanese adults. METHODS: Our cross-sectional study employed data from the 2013 Japan Gerontological Evaluation Study's self-reported survey, which included 11,239 male and 12,799 female community-dwelling independent individuals aged 65 years or older. We defined the oral health status by the number of remaining teeth. The association between the self-reported frequency of laughter (almost every day, 1-5 days per week, 1-3 days per month, or almost never) and oral health was examined using logistic regression analysis. RESULTS: The participants with 10 or more teeth were significantly more likely to laugh compared with the edentulous participants, after adjusting for all covariates. Compared with those who almost never laughed, those who laughed 1-5 days per week were significantly less likely to be edentulous. After stratifying by sex, similar results were found only in the men for both analyses. CONCLUSION: There was a significant bidirectional association between frequency of laughter and oral health that was independent of socioeconomic and lifestyle factors among older adults.

Depression, periodontitis, caries and missing teeth in the USA, NHANES 2009-2014.

PURPOSE: This study aimed to investigate the association between self-reported depressive symptoms and oral diseases in US adults, including periodontitis, caries, missing teeth and untreated dental caries. DESIGN: This study was designed as a secondary data analysis of a cross-sectional survey. We conducted descriptive, multivariable logistic and Poisson regression analyses on weighted data. SETTING: US National Health and Nutrition Examination Survey 2009-2014 data. PARTICIPANTS: Individuals aged ≥30 years who completed a periodontal examination and depression screening (n=9799). RESULTS: 21.6% (28.9 million) of adults aged ≥30 years reported depressive symptoms, with a higher prevalence among females, current smokers and participants with lower income and education status. More than half of the adults with moderate depressive symptoms had periodontal diseases, and more than one-third had teeth with untreated dental caries. After adjusting for sociodemographics, behavioural factors, having diabetes and psychotherapeutic medication use, depressive symptoms were associated with poorer oral health. Severe depressive symptoms were associated with higher odds of mild periodontitis (2.20; 99% CI 1.03 to 4.66). For those with mild depressive symptoms, the mean number of missing teeth was 1.20 (99% CI 1.06 to 1.37) times the average of non-symptomatic individuals; and 1.38 times (99% CI 1.15 to 1.66) among individuals with moderate depressive symptoms. CONCLUSIONS: Depressive symptoms were associated with mild periodontitis and a greater number of missing teeth, while having teeth with untreated dental caries was attributed to sociodemographic factors. Awareness of oral health status among patients with depressive symptoms can inform both dental and mental health providers to develop tailored treatment and help patients achieve overall wellness.

The Effects of Dental Status and Chewing Efficiency on the Oral-Health-Related Quality of Life of Nursing-Home Residents.

OBJECTIVE: The aim of this study was to evaluate the effects of dental status and chewing efficiency on the oral-health-related quality of life (OHRQoL) of nursing-home residents. MATERIALS AND METHODS: The study was conducted in nine nursing homes. All eligible participants were included, and general and medical data, information about nutritional status and their dental and prosthetic status were collected. Chewing efficiency was assessed by means of a two-colour mixing-ability test. The simple count version of the Geriatric Oral Health Assessment Index (SC-GOHAI) was used to evaluate participants' OHRQoL, and the Mini-Mental State Examination to classify the presence of cognitive impairment. Univariate and multivariate regression models were used to analyse data. RESULTS: The mean age of the participants was 82.1 (± 9.8) years and most participants suffered from at least very mild cognitive impairment. OHRQoL for all participants (n = 143) and denture wearers only (n = 105) was substantially associated with the type of prosthesis, the presence of natural teeth, the number of functional occluding pairs and dental and denture-related (if applicable) treatment needs. Furthermore, in both model's univariate analysis showed that chewing efficiency also affected OHRQoL. In contrast, multivariate analysis of all participants revealed that only a higher number of functional occluding pairs (C: 0.250; p < 0.001), fewer dental treatment needs (C: -1.733; p = 0.019) and a better nutritional status (C: -1.298; p = 0.048) were relevant for better OHRQoL. For denture wearers, a higher number of functional occluding pairs (C: 0.192; p = 0.011), a better denture condition (C: -2.194; p= 0.003) and a higher body mass index (BMI) (C: 0.145; p = 0.006) were the main variables associated with better OHRQoL among participants. CONCLUSION: Good oral health and oral function, including chewing efficiency, are associated with a high OHRQoL of nursing-home residents. However, few dental treatment needs, well-fitting dentures without treatment needs and a high number of functional occluding pairs seem to be the principal variables for an acceptable OHRQoL of nursing-home residents.

Rehabilitation of the completely edentulous young patient with the "Malo Bridge": A case report.

It is possible to rehabilitate fully edentulous patients with implantsupported fixed or removable prostheses; however, implantsupported fixed prostheses are the gold standard for patients who not prefer to use removable dentures. This case report, prosthetic rehabilitation of a completely edentulous young patient with an implantsupported fixed hybrid prosthesis using the "Malo Bridge" technique is described. A 18 years old male patient was referred to the clinic with complaints of tooth loss, aesthetics, function, and phonetic. A total of 5 implants were placed in both the jaws. Considering that screw holes may cause aesthetic problems due to the Class III occlusion, these problems have been solved with the implant-supported hybrid prosthesis called Malo bridge. With the Malo Bridge design, the patient's aesthetic, functional and phonetic loss was eliminated, patient comfort and quality of life were improved, and patient expectations were met. It is a viable treatment option to rehabilitate completely edentulous jaws with a cross relationship and increase interarch distance using Malo Bridge to support a fixed prosthesis.

Oral health status and oral health-related quality of life among patients with type 2 diabetes mellitus in the United Arab Emirates: a matched case-control study.

BACKGROUND: Nearly a quarter of the population in the UAE has type 2 diabetes mellitus (T2DM), and this medical condition is associated with poorer oral health. The effects on oral health-related quality of life (OHRQoL), however, have not been examined in this population. Therefore, the objective of this study was to assess the impact of oral health problems, such as caries and periodontitis, on OHRQoL among Arab patients with and without T2DM. METHODS: This matched case-control study included 88 diabetic and 88 non-diabetic participants recruited from University Dental Hospital Sharjah and University Hospital Sharjah, UAE. Participants completed a sociodemographic questionnaire as well as the Oral Health Impact Profile short form (OHIP-14), which measures OHRQoL. Clinical examinations were conducted to assess participants' dental caries status, using the Decayed Missing Filled Teeth (DMFT) Index, and periodontal condition, via clinical attachment loss (CAL) dichotomized to CAL < 3 mm and CAL ≥3 mm. Linear regression models were used to identify the association among OHIP domains, clinical attachment loss, DMFT scores, and diabetes status. RESULTS: The mean age of participants was 43.0 years. A significantly (p = 0.01) higher proportion of diabetic patients (23%) had a CAL ≥3 mm than non-diabetic patients (10%). No significant differences in OHIP scores were observed between diabetic and non-diabetic patients. The results of the linear regression suggested that irrespective of diabetic status, DMFT scores were significantly associated with physical disability, physical pain, psychological discomfort, and psychological disability, as well as total OHIP scores. CAL was significantly associated with the handicap domain. Among non-diabetic patients, OHIP scores were significantly associated with DMFT scores in five OHIP domains (functional limitation, physical disability, physical pain, psychological discomfort, psychological disability), as well as total OHIP scores. Among diabetic patients, CAL was significantly associated with both the social disability and handicap domains, while only the handicap domain reached statistical significance among non-diabetic patients. CONCLUSIONS: Participants who had decayed teeth, irrespective of their diabetic status, reported substantial physical and psychological impacts on OHRQoL. CAL also had a significant impact on OHRQoL, being primarily associated with the OHIP handicap domain in both diabetic and non-diabetic patients.

Validation of a modified version of the Spanish Geriatric Oral Health Assessment Index (GOHAI-SP) for adults and elder people.

BACKGROUND: The Geriatric Oral Health Assessment Index (GOHAI) was developed and validated in 1990 and translated into Spanish in 1999. Since then, the original version has been used in numerous studies, but it has not been re-evaluated in terms of language in the new generations of older adults. The purpose of this study is to confirm the validity of the Spanish version of the Geriatric Oral Health Assessment Index (GOHAI-SP) after three decades to be used as part of an ongoing field trial. METHODS: The GOHAI-SP was pilot tested in a focus group to confirm linguistic comprehension. A version with minor language changes was administered to individuals with metabolic syndrome aged 55-75 years from one health care district in southern Spain as part of an ongoing field trial (PREDIMED-Plus). Clinical evaluation included assessment of dental and periodontal status. The psychometric properties of the GOHAI-SP were evaluated through stability and internal consistency measures, and concurrent and discriminant validity were assessed. RESULTS: The new version of the GOHAI-SP was administered to 100 individuals. The application time was reduced by 7 min. The alpha value for reliability was 0.87. The item-scale correlation coefficients ranged from 0.54 to 0.75, and the test-re-test correlation for the total score was 0.75. There were inverse correlations between GOHAI-SP scores and the number of lost teeth and the decayed-missing-filled teeth index (p < 0.001). CONCLUSIONS: The GOHAI-SP questionnaire remains a valid and useful tool to assess oral health-related quality of life in primary health care settings. A linguistic update of the questionnaire brought improvements to the instrument application. TRIAL REGISTRATION: The PREDIMED-Plus trial is registered in the ISRCTN registry with reference number ISRCTN89898870. Registration date: 4th July 2014.

Impact of Seniors Centers on oral health-related quality of life of older adults.

OBJECTIVE: This study evaluated the oral health-related quality of life (OHRQoL) of older adults participating or not in Seniors Centers (SC). METHODS: Two independent samples were compared: older adults who participate in SC (n = 124) and older adults who visited Primary Healthcare Centers (PHC) and do not participate in SC (n = 164). The data collected consisted of sociodemographic (sex, age, educational level, marital status, family income) and psychosocial characteristics-Sense of Coherence (SOC), anxiety and depression using HADS, happiness-, and oral clinical evaluation-use and need of dental prosthesis and decayed (D), missing (M), or filled (F) teeth. The resulting OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14). The Mann-Whitney test was used to assess the associations between the independent variables and the OHIP-14. Poisson regression models were also used in the analyses (α=0.05). RESULTS: In the PHC, of the 270 individuals invited to participate in the study, 164 (60.7%) were interviewed and clinically examined; while in the SC, of the 166 individuals invited to participate in the study, 124 (74.7%) were interviewed and clinically examined. After adjustments for sociodemographic, psychosocial and clinical factors, we found that the impact on OHRQoL was 2.8 times higher (95%CI 2.0-4.2) for older adults who did not participate in SC. CONCLUSION: Older adults who participated in SC showed better perception on OHRQoL, independently of sociodemographic, psychosocial and clinical factors.

Loss of Functional Dentition is Associated with Cognitive Impairment.

BACKGROUND: Although tooth loss is known to increase the risk of cognitive impairment and dementia, few studies have investigated the association between functional teeth including rehabilitated lost teeth and cognitive functionObjective:We investigated the associations of the numbers of functional teeth and functional occlusal units with cognitive impairment and cognitive function in late life. METHODS: The current study was conducted as a part of the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD), a community-based elderly cohort study. We analyzed 411 participants who have agreed with the additional dental exam. Geriatric psychiatrists and neuropsychologists administered the Consortium to Establish a Registry for Alzheimer's disease Assessment Packet Clinical and Neuropsychological Assessment Battery to all participants, and dentists examined their dental status. RESULTS: Higher number of functional teeth (OR = 0.955, 95% CI = 0.914-0.997, p = 0.037) and higher number of functional occlusal units (OR = 0.900, 95% CI = 0.813-0.996, p = 0.042) were associated with lower odds of cognitive impairment. When we analyzed these relationships separated by the location of teeth, only the numbers of functional teeth (OR = 0.566, 95% CI = 0.373-0.857, p = 0.007) and functional occlusal units (OR = 0.399, 95% CI = 0.213-0.748, p = 0.004) in the premolar area were associated with lower odds of cognitive impairment. CONCLUSION: Loss of functional teeth and functional occlusal units (especially in the premolar region) were associated with increased cognitive impairment.

Can chronic oral inflammation and masticatory dysfunction contribute to cognitive impairment?

PURPOSE OF REVIEW: This article provides an overview of current literature focused on oral health and cognitive impairment in older adulthood, focusing in particular on whether oral inflammation, tooth loss and masticatory dysfunction might increase the risk of cognitive impairment in this age group. RECENT FINDINGS: There is now general acceptance that cognitive impairment contributes to poor oral health, largely through detrimental changes in behaviours related to maintaining good oral hygiene. There is more limited evidence for the reverse causal direction, but at least some studies now suggest that inflammatory mechanisms, tooth loss and masticatory dysfunction each have the potential to contribute to cognitive decline. SUMMARY: Poorer oral health significantly correlates with cognitive dysfunction, and at least some studies suggest that there may be a bi-directional causal relationship. Randomized controlled trials assessing cognitive abilities in relation to oral hygiene or oral health interventions, or provision of removable or fixed (implant-supported) dentures, are encouraged.

Quality of life related to tooth loss and prosthetic replacements among persons with dependency and functional limitations.

Objectives: To examine if tooth loss or treatment with different prosthetic replacements are associated with oral health-related or health-related quality of life (OHRQoL or HRQoL) among persons with dependency and functional limitations.Material and Methods: Comparisons between results of questionnaires and clinical data (number of teeth, Eichner index, presence, type, and condition of prosthetic replacements) from a population of 180 individuals with dependency and functional limitations sampled from the register of increased financial support in Norrbotten County, Sweden.Results: The associations between clinical variables and the questionnaire responses were weak overall, e.g. Spearman's rho was 0.162 (p = .033) for correlation between number of teeth and GOHAI, 0.094 (p = .249) for number of teeth and OHIP, -0.070 (p = .356) for complete dentures and GOHAI, and -0.108 (p = .185) for complete dentures and OHIP.Conclusions: The weak associations between clinical variables and questionnaire results in the present study suggest that good results on measured QoL do not necessarily indicate good oral health. As we cannot expect this specific population to report oral disorders by themselves, regular check-ups are necessary.

Impact of seniors centers on oral health-related quality of life of older adults

ABSTRACT OBJECTIVE This study evaluated the oral health-related quality of life (OHRQoL) of older adults participating or not in Seniors Centers (SC). METHODS Two independent samples were compared: older adults who participate in SC (n = 124) and older adults who visited Primary Healthcare Centers (PHC) and do not participate in SC (n = 164). The data collected consisted of sociodemographic (sex, age, educational level, marital status, family income) and psychosocial characteristics—Sense of Coherence (SOC), anxiety and depression using HADS, happiness—, and oral clinical evaluation—use and need of dental prosthesis and decayed (D), missing (M), or filled (F) teeth. The resulting OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14). The Mann-Whitney test was used to assess the associations between the independent variables and the OHIP-14. Poisson regression models were also used in the analyses (α=0.05). RESULTS In the PHC, of the 270 individuals invited to participate in the study, 164 (60.7%) were interviewed and clinically examined; while in the SC, of the 166 individuals invited to participate in the study, 124 (74.7%) were interviewed and clinically examined. After adjustments for sociodemographic, psychosocial and clinical factors, we found that the impact on OHRQoL was 2.8 times higher (95%CI 2.0-4.2) for older adults who did not participate in SC. CONCLUSION Older adults who participated in SC showed better perception on OHRQoL, independently of sociodemographic, psychosocial and clinical factors.

Relationship between tooth loss, low masticatory ability, and nutritional indices in the elderly: a cross-sectional study.

BACKGROUND: Low masticatory ability and the resulting decrease in intake of masticable foods can result in undernutrition. The present study investigated the relationship between tooth loss, low masticatory ability, and nutritional indices in the elderly. METHODS: The data analyzed in this study were retrieved from the baseline data of the 2007 Fujiwara-kyo study, a prospective cohort study of community-dwelling elderly individuals. Subjects included 1591 men and 1543 women, both with a median age of 71 years. The maximum occlusal force was measured as an objective index of masticatory ability. Foods were divided into five groups based on hardness: Group 1 (bananas, etc.), 0.53 kg; Group 2 (boiled rice, etc.), 1.22 kg; Group 3 (raisins, etc.), 2.93 kg; Group 4 (raw carrots, etc.), 4.38 kg; and Group 5 (beef jerky), 6.56 kg. To obtain a subjective index of masticatory ability, a questionnaire-based survey was conducted to determine whether subjects could masticate foods within each group. As nutritional indices, serum albumin levels and body mass index (BMI) data were used. RESULTS: The median number of teeth was 21. The proportion of subjects for whom all five food groups were masticable showed a significant decrease in the number of teeth in both males and females. Logistic regression analysis showed that, after adjustment for confounders, no significant relationships were observed between the number of teeth and the masticatory ability with nutritional indices in males. In females, a maximum occlusal force of 100 to 300 N (OR = 1.65; 95% CI = 1.06-2.55) or less than 100 N (OR = 1.95; 95% CI = 1.15-3.31) showed a significant correlation with serum albumin levels below 4.4 g/dL (reference: 500 N or more). In addition, the masticability of all five food groups showed a significant correlation with BMI < 21.0 kg/m2 (OR = 0.62; 95% CI = 0.46-0.85) in females. CONCLUSIONS: A low number of teeth was associated with low masticatory ability in both males and females. Low masticatory ability was associated with low plasma albumin levels and low BMI in females. Not smoking, maintaining grip strength, preventing cancer, and masticatory ability are important for preventing undernutrition.

Prospective cohort of adult oral health in Piracicaba, SP, Brazil.

OBJECTIVE: To describe the methodological aspects of a Prospective Cohort Study of adult oral health in Piracicaba, Brazil. RESULTS: This Prospective Cohort Study evaluated adults (20-64 years old) between the years of 2011 and 2015, in Piracicaba, São Paulo, Brazil. The main objective was to evaluate the risk factors for tooth loss in adults. Data were collected at households and selected via probabilistic sampling, through clinical examination of caries, considering as variables the decayed, missing and filled permanent teeth index, need for caries treatment, periodontal disease (Community Periodontal Index and Periodontal Attachment Loss), use and need for dental prosthesis, and presence of visible biofilm. A questionnaire about demographic, socioeconomic and health habits, use of dental services, self-perceived quality of life (Oral Health Impact Profile-14) and health literacy (14-item Health Literacy Scale) was also employed. In 2011, 248 adults participated, and in 2015, 143 (follow-up rate = 57.7%). Despite the follow-up sample loss, most sociodemographic characteristics remained in the participant sample: for example, women (72.0%) (p = 0.534), family income between R$545,00 and R$1090,00 (63.9%) (p = 0.920), above 11 years of education (53.1%) (p = 0.200) and belonging to middle class (67.1%) (p = 0.909).

The experience among patients with multiple dental loss as a consequence of treatment for head and neck cancer: A qualitative study.

OBJECTIVES: To explore the experience among patients with multiple dental loss as a consequence of treatment for head and neck cancer. METHODS: Semi-structured qualitative interviews were conducted with a purposive sample of fifteen people with head and neck cancer, who had multiple teeth removed as part of their tumour resection or extracted pre-radiotherapy. The interviews were digitally recorded and transcribed for analysis by two researchers, independently. RESULTS: The interview data were categorised into four themes: 1. Pretreatment experience of being informed that teeth had to be removed, 2. Impact of dental loss post-treatment, 3. Coping with dental loss, and 4. Getting dentures and implants. Patients receiving primary radiotherapy felt the time between being informed of requirement for dental extractions and actual extractions was short. Dental loss was detrimental to all patients in terms of eating, speaking, socially and their intimate lives. CONCLUSIONS: Patients whose primary treatment was surgery, appeared more accepting of dental loss. Whereas, those having primary radiotherapy, there seemed to be a focus on prevention of radiotherapy-induced complications, with limited choices and recognition on post-treatment dental functionality. This study showed the negative impact of dental loss on patients' quality of life. CLINICAL SIGNIFICANCE: Dentists should be aware of the post-treatment implications of dental loss on patients' lives; presenting this, as well as the clinical advantages for extractions, to aid decision-making. Patients should be informed of the lack of conclusive research evidence regarding pre-radiotherapy dental extraction. There should also be clear pathways regarding post-treatment dental-related rehabilitation.