Outreach dental care programme for older adults using long-term care services in Hong Kong: A qualitative study.

OBJECTIVES: To explore the effects and improvement needs of an outreach dental care programme (ODCP) for older adults using residential care or daycare services from the perspectives of the caregivers, the dentists and administrative staff involved in the implementation of the ODCP. METHODS: A qualitative study was conducted through semi-structured interviews with three stakeholders, long-term care (LTC) facility caregivers, administrative staff and dentists working for the ODCP. Combined maximum variation and snowball sampling strategies were adopted, and 22, 9 and 7 participants were interviewed from each stakeholder, respectively. The interviews were conducted via telephone, which were audio-recorded and transcribed verbatim for analysis. NVivo software was used for storing and analysing the data. Data analysis was conducted continuously during the study. RESULTS: Most participants opined that the ODCP benefited older adults by raising their oral health conditions and awareness. However, they complained of the complicated administrative procedures, unmet dental treatment needs, inefficient coordination, unclear work guidelines and shortage of dental manpower. More advanced dental treatment options, better coordination among different parties, simpler administrative processes and better incentives for dentists were proposed to further improve the programme. CONCLUSIONS: According to the stakeholders, ODCP seems beneficial to older adults using LTC services. Further improvements in the scope of dental treatments, cooperation between the outreach dental teams and caregivers, and streamlining of the administrative process are needed for the provision of effective outreach dental care to satisfy the unmet treatment needs of older adults who use LTC services. Better incentives are needed to attract and retain dentists.

Outreach dental care program for older adults using residential care or day care services in Hong Kong: A cohort study.

AIM: To evaluate the effects of an outreach dental care program (ODCP) on the oral health status and oral health-related quality of life (OHRQoL) of older adults who used residential or day care services in Hong Kong. METHODS: Older adults who had received dental treatments provided in the ODCP were recruited. Clinical examinations were performed by one calibrated examiner (SXY) at baseline and 1-year follow-up in the residential homes or day care centres. Face-to-face interviews were conducted using the transition scale of the Oral Health Impacts on Daily Living (OHIDL) questionnaire to investigate the perceived change in OHRQoL at baseline, 2-month and 1-year follow-ups. The Wilcoxon matched-pair signed-rank test or McNemar/McNemar-Bowker test was used to explore the change in oral health status after dental treatments. Factors associated with the perceived change in OHRQoL were explored with binary logistic regression. RESULTS: Four hundred and thirteen older adults (mean age = 83.8 years) participated in the study at baseline, and 377 (91.3%) and 359 (86.9%) were successfully followed 2 months and 1 year after receiving the outreach dental service, respectively. At the 1-year follow-up, the number of decayed teeth and functional tooth units, and the prevalence of poor denture hygiene decreased while there was more dental plaque deposition and a higher proportion of participants with gingival bleeding upon probing. More than 50% of the participants perceived no change or an improvement in OHRQoL in all domains at both follow-ups. Older adults who perceived their oral health status as 'healthy or fair' and those who suffered from toothache at baseline had a higher chance to perceive having a better or at least the same OHRQoL at the 2-month and 1-year follow-ups, respectively. CONCLUSIONS: The ODCP in Hong Kong can solve some of the dental problems of older adults using long-term care services and keep most of them from deterioration in OHRQoL, especially those suffering from toothache.

Risk indicators for root caries in older adults using long-term social care facilities in Hong Kong.

OBJECTIVE: To investigate risk indicators associated with root caries among the Hong Kong older adults who attended long-term care facilities regularly. METHODS: Nonfrail older adults with at least six natural teeth from 10 long-term social or residential care facilities were examined. The clinical examinations were conducted by two calibrated dentists in the institutions. Portal dental chairs, intra-oral LED lights, disposable mouth mirrors, periodontal probes and CPI probes were used in the examinations. Negative binomial regression analyses were performed to identify the risk indicators associated with root caries. Multilevel logistic regression analyses were conducted to detect the associations between DF-root and D-root, and selected person-level and tooth surface-level factors. RESULTS: A total of 353 older adults (mean age 74.9 years) were examined. The prevalence of DF-root and D-root was 43.1% and 30.0%, respectively. The mean DF-root and D-root scores were 1.3 and 0.7, respectively. Relative to participants without DF-root, those with root caries experience were older and had more exposed root surfaces, and a higher proportion were partial denture wearers. There was a positive correlation between the DF-root score and the age of the participant, and with the numbers of exposed root surfaces, missing teeth and teeth with coronal caries. Higher prevalence of DF-root was observed among the older participants, and caries experience of root surfaces with greater gingival recession and visible plaque was higher. Lingual root surfaces and roots in the mandibular anterior region had the lowest rates of DF-root. CONCLUSIONS: People who are older have a higher prevalence and severity of root caries. Coronal caries experience, maxillary teeth, buccal root surfaces, gingival recession and plaque on the root surface are positively associated with root caries in older adults.

Risk predictors of dental root caries: A systematic review.

OBJECTIVES: To identify the risk predictors of root caries and to describe their relationship with the incidence and increment of root caries. DATA: Observational longitudinal studies. SOURCES: Four electronic databases (PubMed, MEDLINE, EMBASE, and Scopus) (From 1 January 1990 to 31 January 2019). STUDY SELECTION: Information on the factors associated with the incidence or increment of decayed and filled root surfaces (DF-root) and/or decayed root surfaces (D-root) were extracted by two reviewers independently. The factors were put into six categories, namely social-demographic background, general health, health behaviors, fluoride exposure, oral health habits and oral health condition. From the 440 potential papers identified, 19 papers reporting on 16 cohort studies were finally included. The total sample size was 7340 participants from different countries worldwide, with age ranging from 20 to 100 years. Positive correlations between new root caries and age, baseline root caries experience, gingival recession and use of tobacco were reported while negative correlations were found for socio-economic status, good oral hygiene and use of fluorides. Mixed findings were detected for the association between new root caries and the number of natural teeth. CONCLUSION: This systematic review discovered a number of root caries risk predictors in different categories. People who are older, in lower socio-economic status or tobacco users, and those with more root caries experience, gingival recession and poor oral hygiene have higher risk of developing new root caries. CLINICAL SIGNIFICANCE: This systematic review provides support that improvement of oral hygiene, prevention of gingival recession, and use of fluoride would be useful strategy for prevention of new root caries.

Systematic review of literature: functional outcomes of implant-prosthetic treatment in patients with surgical resection for oral cavity tumors.

The current systematic review was performed to assess the functional outcomes of implant-prosthetic treatment on patients who have had surgical resection of oral cavity tumors. The assessment of function, satisfaction, or quality of life (QoL) were the major outcomes that evaluated preoperative and/or before and after implant-prosthetic treatment. Only eight published studies fulfilled the inclusion criteria. Three publications evaluated chewing ability, masticatory performance, and neuromuscular function, and the other five publications used questionnaire as a method of assessment. These publications mainly reported on implant-prosthetic treatment in mandibulectomy patients. It was found that implant-retained prosthesis had a beneficial effect on masticatory performance and masseter muscle activity on the defect side, but not on the non-defect side. Swallowing threshold performance and jaw movement parameters showed no significant differences between non-implant-retained prosthesis and implant-retained prosthesis. Significant improvement in prosthesis and patients' satisfaction with implant-retained prosthesis compared to non-implant-retained prosthesis was observed. However, general improvement in patients' QoL was not observed after implant-prosthetic treatment. Patients with intraoral resection might benefit from implant-retained prosthesis with regard to masticatory function and satisfaction. However, future clinical trials with an adequate sample size are needed to identify the group of patients who are likely to benefit from the implant-prosthetic treatment modality.

Proximal contact loss between implant-supported prostheses and adjacent natural teeth: a retrospective study.

OBJECTIVES: To determine the prevalence of proximal contact loss between posterior implant-supported prostheses and the adjacent anterior natural tooth and to identify potential contributing factors. MATERIALS AND METHODS: Forty-five consecutive patients, who had received either implant-supported fixed partial denture (FPD) or implant-supported single crown (SC) in the posterior region and were under regular review, were recruited. Interproximal space was assessed by the number of matrix bands that could be placed, and tooth mobility was assessed by Periotest®. A self-reported questionnaire was administered. Effects of various patient and prosthesis parameters on interproximal space were analyzed by Kruskal-Wallis test or Mann-Whitney U test. Correlations were tested by Spearman's rank correlation coefficient. Differences were considered significant if P < 0.05. RESULTS: Forty-three of 66 (65%) prostheses showed proximal contact loss. Frequent food packing was reported in 40% of the prostheses. The mean interproximal space was 167 (SD = 125) µm, and it was positively correlated with patients' age (P = 0.031) and time since prostheses delivery (P = 0.002). The interproximal space in the FPD group was significantly larger than the SC group (P = 0.008). CONCLUSION: Proximal contact loss is not uncommon in posterior implant-supported prostheses. In this study, age of the patient, prosthesis type and time since delivery of prosthesis were found to be contributing factors.

Proximal contact loss between implant-supported prostheses and adjacent natural teeth: a clinical report.

There is limited knowledge about the changes that proximal contacts between implant-supported prostheses and adjacent teeth undergo over time. This report describes the management of a clinical situation with the loss of proximal contact between implant-supported prostheses and adjacent natural teeth in a partially edentulous patient.

Willingness to pay for implant therapy: a study of patient preference.

AIMS: This study determined the amount of willingness to pay (WTP) for implant treatment and identified the factors affecting WTP. METHODS: Subjects attending a university dental hospital were recruited (n=59). They were presented with two hypothetical clinical scenarios: missing one anterior/posterior tooth. The clinical procedures, outcome and plausible complications of various replacement options (fixed and removable partial dentures, implants) and sequelae of no treatment were presented. They were then asked how much they were willing to pay for tooth replacement under the two situations using a bidding method, with a starting bid of Hong Kong (HK)$20,000 in HK$1000 increment/decrement if they were willing/unwilling to pay that amount (1 USD=7.8 HKD). The amount was recorded at which the subject chose the opposite option or it reached HK$0. Demographic data were also collected. WTP values were compared between anterior and posterior replacements, and among various demographic subgroups. Spearman's correlations and linear regression analysis were also conducted. RESULTS: Ninety-four percent and 84% of the subjects chose implant treatment to replace missing anterior and posterior teeth, respectively. The mean WTP amounts for anterior/posterior tooth replacement were HK$11,000/HK$10,000 (P>0.05). Higher WTP amounts were obtained from females, subjects without missing teeth or restorative need, and had attained higher level of education (P<0.05). Gender (P<0.05), level of education (P=0.042), and the presence of missing teeth (P=0.001) were independent predictors of WTP. CONCLUSIONS: The estimated WTP value for a single tooth replacement using dental implants was HK$10,000. Gender, level of education and presence of missing teeth were independent predictors that influenced WTP.

A retrospective clinical evaluation of two-unit cantilevered resin-bonded fixed partial dentures.

BACKGROUND: The authors conducted a study to examine the clinical performance of two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) that were inserted at The Prince Philip Dental Hospital, University of Hong Kong. METHODS: The authors recalled patients who had received two-unit cantilevered RBFPDs at least 24 months before the recall examination. The authors recorded the following data: patient's sex and age, operator's experience, prosthesis cementation date, endodontic treatment if performed, bone support, tooth mobility, the presence of shim-stock contacts on the abutment or pontic in intercuspal position, and the presence of aproximal axial contacts adjacent to the prosthesis. They also recorded the date of any debonding with subsequent treatment. They asked the patients qualitative questions about their prostheses. RESULTS: A total of 269 prostheses were placed in 214 patients and had a mean service life of 51.7 months +/- 19.5 months standard deviation, with a range of 13.2 to 141.6 months. Of 14 failed prostheses, 12 debonded, resulting in a success rate of 94.8 percent and clinical retention rate of 95.5 percent. No discernable rotation or drifting of the abutments was apparent in any of the prostheses. Overall patient satisfaction with RBFPDs was good, with an average assessment score of 8.5. CONCLUSIONS: The authors observed a 95.5 percent clinical retention rate of 269 two-unit RBFPDs, with no apparent drifting of the abutments. Longer-term follow-up studies are required. CLINICAL IMPLICATIONS: Two-unit RBFPDs are conservative and clinically retentive prostheses in the short to medium term.

A longitudinal study of the oral health condition of elderly stroke survivors on hospital discharge into the community.

AIM: To investigate the oral health of elderly stroke survivors on discharge from hospital into the community after rehabilitation and six months later compared with community dwelling elderly people without stroke. METHOD: The study took place in the rehabilitation unit of a general medical hospital in Hong Kong. It was a longitudinal study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. Verified clinical examination techniques and measures were used to assess dental caries, periodontal disease, oral hygiene, oral candidiasis, prosthetic status/need and functional disability (Barthel Index [BI]). Socio-demographic information was also collected. RESULTS: Stroke survivors had significantly higher plaque and bleeding scores on hospital discharge and after six months compared with the control group (p<0.01). On hospital discharge, the stroke group also had a poorer periodontal condition with more 4-5mm pockets. The mean BI on hospital admission was 71 and 91 on discharge. Stroke survivors with a higher BI on discharge had lower plaque scores after six months. The tooth condition, number of functional tooth pairs, prosthetic status, presence of oral candidiasis and oral yeast carriage were similar between stroke and comparison groups. CONCLUSIONS: Despite significant objective improvement in functional ability after stroke, elderly survivors returning to the community had significantly poorer periodontal health compared with community dwelling elderly without stroke, and the situation did not improve dramatically over six months. The protracted recovery of hand, arm and oral sensori-motor function is the most likely cause.

A preliminary report on patient acceptance of a novel intra-oral lubricating device for the management of radiotherapy-related xerostomia.

Management of radiotherapy-related xerostomia is difficult. Saliva substitutes are helpful but the effects are short-lived. The purpose of the study was to develop a prototype intra-oral lubricating device for the management of radiotherapy-related xerostomia and to evaluate patient acceptance. An intra-oral lubricating device was fabricated that incorporated a reservoir in the palatal vault and permitted slow release of saliva substitute by the patient. Preliminary clinical testing was done in five patients with radiotherapy-related xerostomia. A measure incorporating seven questions was used to explore patient acceptance. The device was simple to fabricate using materials available in a technical laboratory. All patients were able to wear the device for at least 4 h per day throughout the test period. The device was considered easy to use and clean. Some impairment of speech and chewing was noted although this appeared to be related to the bulkiness of the reservoir. General oral comfort was improved due to the lubricating effect. The bulk of the reservoir was reduced as a consequence of patient feedback. The design addressed key problems associated with previous lubricating systems. Patient reports on oral functioning with the device in situ provided pivotal information on the device's utility.

Oral health condition and saliva flow in southern Chinese with Sjögren's syndrome.

OBJECTIVE: To investigate the oral health condition and saliva flow of southern Chinese patients with Sjögren's syndrome (SS). METHOD: 51 SS patients (26 primary and 25 secondary cases) and 29 controls took part in this cross-sectional study. Stimulated whole and parotid saliva flow rates, pH, and buffer capacity, and xerostomia, oral mucosal lesions, oral hygiene status, dental and periodontal conditions, prosthetic status were assessed and compared between groups. RESULTS: Stimulated whole saliva (SWS) flow was reduced in primary and secondary SS cases (p<0.001), pH and buffer capacity were also reduced in the primary SS group (p<0.05). SS patients had a greater prevalence of xerostomia than controls (p<0.001). Primary SS patients had a higher mean DMFT, more missing teeth, and more prostheses than secondary SS cases and controls (p<0.05). SWS flow correlated negatively with the number of filled teeth in both SS groups (p<0.05) and the number of decayed teeth in the primary SS group (p<0.05). CONCLUSION: Despite good oral hygiene and regular dental check-ups, the oral health of southern Chinese with primary SS was significantly compromised compared with secondary SS cases and controls, most probably due to the combined effect of impaired salivary gland function and poorer saliva buffer capacity.