'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.

Setting the context for a complex dental intervention of role substitution in care homes: Initial process evaluation findings.

OBJECTIVES: SENIOR (uSing rolE-substitutioN In care homes to improve oRal health) is a randomised controlled trial designed to determine whether role substitution could improve oral health for this population. A parallel process evaluation was undertaken to understand context. This paper reports on the first phase of the process evaluation. BACKGROUND: The oral health and quality-of-life of older adults residing in care homes is poorer than those in the community. Oral health care provision is often unavailable and a concern and challenge for managers. The use of Dental Therapists and Dental Nurses rather than dentists could potentially meet these needs. MATERIALS AND METHODS: Semi-structured interviews were conducted with 21 key stakeholders who either worked or had experience of dependent care settings. Questions were theoretically informed by the: Promoting Action on Research Implementation in Health Services (PAHRIS) framework. The focus was on contextual factors that could influence adoption in practice and the pathway-to-impact. Interviews were fully transcribed and analysed thematically. RESULTS: Three themes (receptive context, culture, and leadership) and 11 codes were generated. Data show the complexity of the setting and contextual factors that may work as barriers and facilitators to intervention delivery. Managers are aware of the issues regarding oral health and seek to provide best care, but face many challenges including staff turnover, time pressures, competing needs, access to services, and financial constraints. Dental professionals recognise the need for improvement and view role substitution as a viable alternative to current practice. CONCLUSION: Although role substitution could potentially meet the needs of this population, an in-depth understanding of contextual factors appeared important in understanding intervention delivery and implementation.

'Whose role is it anyway?' Experiences of community nurses in the delivery and support of oral health care for older people living at home: a grounded theory study.

BACKGROUND: Older people who receive care at home are likely to require support with oral health care. Community nurses, who are also referred to as district or home care nurses, have an important role with this population. This is because they are the healthcare professionals who are most likely to encounter this population, who may also not be receiving regular dental care or oral health promotion. However, few studies have explored community nursing experiences in the delivery and support of oral healthcare for older people living at home. METHODS: A grounded theory approach was used to explore experiences of community nurses in the delivery and support of oral health care for older people living at home. Fifteen practising community nurses from the United Kingdom participated in one-to-one semi-structed interviews from May 2021 to December 2021. These interviews were audio-recorded, transcribed verbatim and analysed using constant comparative analysis. Ethical approval was obtained for this study prior to data collection. RESULTS: Four categories emerged from the data to support development of the core phenomena. These four categories were: (1) Education, in relation to what community nurses knew about oral health, (2) Practice, with regards to how community nurses delivered oral health care to older people in their own home, (3) Confidence, with consideration to the extent to which this supported or impeded community nurses in providing oral healthcare to older people and (4) Motivation, in terms of the extent to which community nurses thought they could or should influence future practice improvement in the area. The core category was (C) Uncertainty as it was both present and central across all four categories and related to community nursing understanding about their specific role, and the role of other professionals, with reference to oral health of their patients. CONCLUSIONS: This study reveals community nurses' uncertainty in providing oral healthcare to older adults at home. Emphasising comprehensive and continuous oral health education can boost nurses' confidence in patient support. Interprofessional collaboration and clear role definitions with oral health professionals are crucial for improving oral health outcomes in this vulnerable population.

Group 4 ITI Consensus Report: Patient benefits following implant treatment in partially and fully edentulous patients.

OBJECTIVES: The aim of Working Group 4 was to address patient benefits associated with implant dentistry. Focused questions on (a) dental patient-reported outcomes (dPROs), (b) improvement in orofacial function, and (c) preservation of orofacial tissues in partially and fully edentulous patients following provision of implant-retained/supported dental prostheses were addressed. MATERIALS AND METHODS: Three systematic reviews formed the basis for discussion. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary of the 7th ITI Consensus Conference, taking place in 2023 in Lisbon, Portugal. RESULTS: Edentulous patients wearing complete dentures (CD) experience substantial improvements in overall dPROs and orofacial function following treatment with either complete implant-supported fixed dental prostheses (CIFDP) or implant overdentures (IODs). With respect to dPROs, mandibular IODs retained by two implants are superior to IODs retained by one implant. However, increasing the number of implants beyond two, does not further improve dPROs. In fully edentulous patients, rehabilitation with CIFDP or IOD is recommended to benefit the preservation of alveolar bone and masseter muscle thickness. CONCLUSIONS: Completely edentulous patients benefit substantially when at least the mandible is restored using an CIFDP or an IOD compared to CD. In fully edentulous patients, implant prostheses are the best option for tooth replacement. The availability of this treatment modality should be actively promoted in all edentulous communities, including those with limited access and means.

Evaluation of a co-designed educational e-resource about oral health for community nurses: study protocol.

BACKGROUND: Oral health is a crucial aspect of health and wellbeing for older people. Poor oral health has been found to significantly increase the risk of chronic health conditions and poor quality of life for older people. Nurses practicing in the community are well-placed to provide oral health care to older people in their own homes, yet there has been little research in this field to develop accessible support for them to do so. Previous literature, reviewed in an earlier phase of this work, revealed that there has, historically, been a paucity of oral health care education for nurses and very few educational resources have been developed in this field. METHODS: This study will evaluate an educational e-resource which has been co-designed by service users, carers and clinicians. In the first phase of research, evidence of promise will be evaluated by analysing quantitative data on community nurses' oral health attitudes and self-efficacy for oral health assessments of older people. In the second phase of research, facilitators and barriers to community nurses' provision of oral health care to older people and the acceptability of the educational e-resource will be evaluated. DISCUSSION: This research will investigate the potential of an educational e-resource to improve community nurses' capabilities to deliver oral health care to older people in their own homes. This research will inform both future intervention design and understanding of community nurses' knowledge and attitudes about oral health care. Facilitators and barriers to provision of this care for older people will also be explored.

Factors that affect quality of life for older people with head and neck cancer: A systematic review.

PURPOSE: Quality of life is a critical aspect in the management of older head and neck cancer patients. It needs to be considered alongside survival benefit, treatment burden, and longer-term outcomes. The purpose was to undertake a systematic review of empirical peer-reviewed studies with a primary focus on factors impacting quality of life for older head and neck cancer patients. METHODS: A systematic review, searching 5 electronic databases (PsychoINFO, MEDLINE, CINHAL, Embase, and Scopus) using PRISMA methodology was conducted. Data was appraised using the Newcastle-Ottawa scale and a narrative synthesis performed. RESULTS: Only 10 papers fulfilled the inclusion criteria. Two main themes emerged: 1) Impact of head and neck cancer on quality of life domains and 2) quality of life in treatment decision-making. CONCLUSIONS: In an era of progressive personalised care, there is an evident need for more qualitative and quantitative studies focusing on quality of life for older head and neck cancer patients. However, older head and neck cancer patients experience notable differences, especially with poorer physical functioning and greater eating and drinking challenges. Quality of life impacts older patients decision-making, treatment planning and intensifies post-treatment support.

Establishing Healthy Eating 'Habits': A Pilot Randomised Controlled Trial of a Habit-Based Dietary Intervention following Oral Rehabilitation for Older Adults.

An ageing population presents significant nutritional challenges, particularly for partially dentate adults. This two-armed pilot randomised controlled trial (RCT) compared habit formation (automaticity) for healthy eating behaviours between control and intervention groups after participation in a habit-based dietary intervention for older adults, following oral rehabilitation in the United Kingdom (UK). n = 54 participants were randomised to receive a habit-based dietary intervention (intervention group n = 27, IG) or standard dietary advice in a leaflet (control group n = 27, CG). The IG attended three sessions over six weeks, which focused on habit formation for three healthy eating behaviours (increasing fruit and vegetables, wholegrains, and healthy proteins). Participants were assessed for habit strength (using the Self-Report Behavioural Automaticity Index (SRBAI)) alongside health and nutrition outcomes at six weeks, four months and eight months. Forty-nine participants completed all follow-up visits. The IG compared to the CG had significant increases in automaticity at six weeks, four months (primary outcome) and eight months for eating ≥3 portions of fruit and vegetables; choosing wholegrain sources over white alternatives, and choosing healthy protein sources over red/processed meat. The mean change in the Mini Nutritional Assessment total score was greater in the IG compared with the CG at six weeks only (p = 0.03). A habit-based dietary intervention following oral rehabilitation increased automaticity for healthy dietary behaviours, which could translate into clinically meaningful benefits in this cohort of older adults.

Combined effect of eating speed instructions and food texture modification on eating rate, appetite and later food intake.

Modifying food texture and eating slowly each reduce appetite and energy intake. No study has evaluated the effect of combining these measures to slow eating speed and determine the effect on appetite. The aim of this study was to investigate whether there is a combined effect of manipulating oral processing behaviours (OPBs) in this manner on self-reported satiety and subsequent food intake. A 2 × 2 design was used with four breakfast conditions in total. Twenty-four participants attended four study visits where they were asked to consume one of two isocaloric fixed-portion breakfasts differing in texture: 1) granola with milk and 2) yogurt with muesli and conserve. Participants consumed each breakfast twice, with verbal instructions to chew slowly at one visit and at a normal rate at another. Consumption was video-recorded to behaviourally code OPBs. Participants completed visual analogue scales of self-reported appetite measures at the beginning of the test session, immediately prior to and immediately after breakfast consumption. They also completed a food diary documenting food intake for the remainder of the day. The breakfast designed to be eaten slowest (the harder-textured meal with instructions to eat slowly) was eaten at a slower rate, with a greater number of chews per bite and a slower bite rate (p < 0.001) compared to the other meals. No differences were observed between the breakfast conditions on subjective measures of post-prandial satiety, or subsequent energy or macronutrient consumption. Results of this study highlight that combined effects of texture and instructions are most effective at reducing eating rate, though eating slower was not shown to enhance post-meal satiety. Reduced eating speed has previously been shown to reduce ad-libitum energy intake. Future research should consider combined approaches to reduce eating speed, to mitigate the risk of overconsumption within meals.

A comparative examination of the role of need in the relationship between dental service use and socio-economic status across respondents with distinct needs using data from the Scottish Health Survey.

BACKGROUND: Disparities in oral health and distinct patterns in service use related to socio-economic status have been shown to exist in the United Kingdom. A number of studies have used the Andersen behavioural model to better understand the factors that influence utilization and thereby inform policies aimed at improving service uptake. As the nature of need may differ across distinct types of patients, however, so too may the distribution of enabling and pre-disposing factors and observed relationships between need, other factors and service use. In this study we compare samples with distinct self-assessed needs in terms of their characteristics and patterns of service use to compare application of the Andersen model to dental services among respondents to a population based survey. MATERIALS AND METHODS: Data were taken from the Scottish Health Survey, for 2019. Data on service use, oral hygiene habits, perceived treatment need, and socio-demographic characteristics were extracted. Data were analysed using descriptive statistics, t-tests and ordered logistic regression analyses. RESULTS: Two thousand one hundred forty-eight usable responses were obtained from the survey, 74.95% of the sample had visited the dentist less than a year ago, 11.82% between 1 year and up to 2 years ago, 7.12% between 2 and 5 years ago and 6.10% more than 5 years. Descriptive statistics, t-tests and ordered logistic regression analyses revealed distinct patterns of service use when the sample was partitioned based on perceived treatment need. Specifically those with self-assessed treatment need were older, more likely to smoke, be male and be less likely to have a degree than those who did not. While service use was positively related to age (predisposing) among those who did not have self-assessed treatment need, it was negatively related for those with perceived treatment need. Distinct patterns were also evident with respect to sugar exposure (need) and ease with which time off work could be organised (enabling). DISCUSSION: The study shows common and distinct patterns of service use related to enabling and predisposing factors across groups differentiated by self-perceived treatment need. If inequalities in health and healthcare use are to be addressed, it is important to understand their origins. Conflation of distinct types of need that may correlate with predisposing and enabling factors complicates this. CONCLUSION: In applying the Andersen model, it is important to take account of potential differences in the types of need expressed where possible to understand the role of other variables in service use.

Factors influencing the likelihood of dental service checkup: results from a survey in Saudi Arabia.

Background: The funding and delivery of healthcare including dental care in the Kingdom of Saudi Arabia (KSA, or Saudi Arabia) is undergoing a process of reform. To inform this process, it is important that policymakers are aware of the relationships between service use, specific types of use, and the factors that influence this. Currently, there is a paucity of research in this area in KSA that examines dental service use for checkups at a national level and none that examines differences in this use across regions or that examines explicitly the role of income. Aims: This study uses the most recent version of the Saudi Health Interview Survey (SHIS) to examine the relationships between the use of dental services for a checkup and socio-demographic characteristics of respondents. Particular focus is given to the differences between regions in service use and the role of socio-demographics within regions. Methods: Data were taken from SHIS 2013. Descriptive statistics (means and standard errors) were used to characterize the sample. Logistic regression analyses were used to examine the relationship between checkups in the past 12 months and a range of covariates including income and region. The analysis was repeated for sub-samples based on specific regions. No attempt was made to impute missing values. Results: A sample of 7603 respondents provided complete data for analysis. Fifty-one per cent of the respondents were male, 29% were educated at least to degree level, 25% reported that they floss at least once per day, 69% reported that they brushed their teeth at least once per day, and 11% reported that they had visited the dentist for a checkup in the preceding 12 months. Logistic regression analyses revealed income, region, and oral hygiene habits to be among the significant determinants of the likelihood of dental checkup in the preceding 12 months. In logistic regression analyses at the regional level, different relationships were evident between checkups and socio-demographic characteristics across regions. Conclusion: Region and income are significant determinants of dental service use for checkups. Differences exist between regions in the relationship between socio-demographic characteristics and the likelihood of getting checkups. Policy changes should reflect the potential differences they might have across regions for which the role of socio-demographic characteristics varies.

Interventions supporting community nurses in the provision of Oral healthcare to people living at home: a scoping review.

BACKGROUND: Oral health is a critical issue for public health and poor oral health is associated with significant chronic health conditions and lower quality of life. There has been little focus on providing oral health care to people who receive care in their own homes, despite the high risk of poor oral health in older people. Nurses practicing in the community are well placed to deliver this care, but little is known about how to build this capability through education or training interventions. METHODS: A scoping review methodology was employed to find and review studies of oral health interventions involving populations of people receiving care in their own home or those nurses who deliver this care. The research question asked what previous research tells us about oral health interventions delivered by nurses in the community. Data was extracted for four areas: setting and type of intervention, patient outcomes, changes to nursing practice and implementation and process evaluations of interventions. RESULTS: Two thousand eighty papers were found from the searches, and only nine were ultimately deemed eligible for inclusion in the review. Included studies spanned community nursing for older people (n = 3) and health visiting or community nursing for children and infants (n = 6). Patient outcomes were generally positive, but this is based on a low level of evidence. Changes to practice including increased oral health care administered by nurses were found, but this required professional support to be sustainable. CONCLUSIONS: This review has found that there is a clear gap in the research around interventions designed to be used by community nurses to improve oral health care for people receiving care in their own homes. The results also suggest that any future intervention must make use of a participatory, co-design approach and consider the complex setting of nursing practice in the community and the barriers to delivering this care, such as time pressure and lack of prior experience.

Oral Health and Successful Ageing - The PROS and dPROS: A Scoping Review.

OBJECTIVES: This review aimed to determine how successful aging is operationalized in the oral heath context, and to determine the use of Patient Reported Outcomes (PROs) and Dental Patient Reported Outcomes (dPROs). METHODS: A scoping review was conducted and was registered with PROSPERO (CRD42021232668). The reporting of the review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. RESULTS: Five databases were searched and 1288 potentially relevant publications were identified. A total of 263 'effective' studies informed this review. Most studies were observational in nature (94.3%, 250) and the majority were cross-sectional (52.5%, 139). Most studies (89.4%, 235) were unidimensional in their operationalization of successful aging. Successful aging was mainly operationalized in terms of the 'biomedical model' (81.4%, 214) with limited consideration of psychological and social dimensions/models. Regarding biological health, commonly considered components were 'nutrition' (33.6%, 72/214) and 'longevity' (28.9%, 62/214). PROs were most frequently employed in the assessment of nutrition (88.8%, 64/72), albeit in response to standardized assessments. Regarding the psychological dimension (28.9%, 76), 'cognition' was most frequently assessed (69.7%, 53/76) - typically by the use of PROs (83.0%, 44/53). Social dimensions were only rarely considered (1.5%, 4). In terms of oral health - a range of aspects were considered including: 'number of teeth' (58.2%, 153 - dPROs (31.6%, 49/155)); and prosthesis use (30.4%, 80 - dPROS (31.3%, 25/80)). CONCLUSION: The operationalization of successful aging in oral health is typically unidimensional and focuses primarily on the 'biomedical model'. PROs and dPROS are both widely used in the assessment of successful aging in the oral health context.

Prevention of Oral Functional Decline.

OBJECTIVES: The oral cavity functions in eating, speaking, socializing, and serving as a natural barrier to external pathogens. In the prevention of oral function decline in older people, oral health conditions should be maintained through public health actions. METHODS: This article discusses public health actions to prevent oral functional decline through addressing three major issues among older people: tooth loss, hyposalivation, and oral cancer. Negative impacts of tooth loss, hyposalivation, and oral cancer will be described, followed by describing public health approaches to prevent these problems RESULTS: Tooth loss, commonly caused by dental caries and periodontal diseases, affects one's ability to eat, speak, and socialize freely. Prevention of tooth loss can be done in clinical settings, community settings, and through national policies. Saliva plays an important role in eating, swallowing, and protecting oral mucosa from pathogens. The major causes of dry mouth are polypharmacy and the use of anticholinergic medications among older people. Public health actions to promote collaboration between dentists and doctors in the adjustment of drug prescriptions are warranted. Oral cancer can affect oral function largely both from the disease itself and from cancer treatments due to the destruction of oral structures and salivary gland function. Tobacco use and alcohol consumption are major risk factors for oral cancer; they also contribute to various systemic diseases and cancers of other organs. CONCLUSIONS: Public health policies and interventions using the common risk factor approaches to tackle tobacco and alcohol consumption should be encouraged. Rather than focusing on older people, the prevention of oral function decline should be planned through a life-course perspective.

Satisfaction with dental care services in Great Britain 1998-2019.

BACKGROUND: Satisfaction with dental services can provide valuable insights into aspects of quality including access as well as changes in this over time. In the UK publicly funded dental services are ostensibly delivered by private sector general dental practitioners for whom private patients represent an opportunity cost to the provision of care to public patients. This study examined changes in satisfaction as economic circumstances and policy changed in Britain between 1998 and 2019. METHODS: Data were taken from successive waves of the British Social Attitudes Survey a representative cross-sectional survey of the population between 1998 and 2019. Descriptive statistics and a series of logistic regression analyses were used to examine the relationships between satisfaction and a range of socio-demographic characteristics over time. RESULTS: 37,328 usable responses were extracted from the survey spanning 21 years of data. Over the course of the survey approximately 71% of the sample was very satisfied, satisfied or neither satisfied nor dissatisfied with publicly funded dental services. Satisfaction fell at the outset of the study period but rose following the economic downturn from 2008 which coincided with increased use of publicly funded services. Differences were evident in satisfaction between older versus younger respondents, more affluent versus less affluent respondents and better educated versus less well-educated respondents. Satisfaction did not appear to change in response to policy changes. CONCLUSION: Satisfaction is an important outcome of service provision. Policies aiming to improve satisfaction with publicly funded dental care in the UK must take account of the competing demands on dentists' time from private patients. At times of economic expansion or when supply has been disrupted, these may be particularly acute and require specific interventions to improve access for those who depend on public services.

Undergraduate teaching and assessment methods in prosthodontics curriculum: An international Delphi survey.

OBJECTIVES: To achieve consensus amongst an expert panel of prosthodontics/restorative dentistry academics on the best undergraduate teaching and assessments, and to develop recommendations regarding teaching and assessment of undergraduate prosthodontics. METHODS: Semi-structured electronic questionnaires were used to collect data from senior clinical academics involved in the teaching of prosthodontics on three consecutive occasions (Delphi method). The questionnaires asked the experts' opinion on best teaching and assessment methods in the undergraduate prosthodontics curriculum. Invitation emails, with a hyperlink to the Round 1 questionnaire, were sent to 36 international dental academic experts. In later rounds, panellists were invited to consider their previous responses in light of the overall group response in attempt to bring the panel to a consensus. The group response was summarized using simple descriptive statistics, and the target level of consensus for each question was set at ≥ 70%. A response rate of at least 70% between rounds was deemed appropriate to maintain rigour. RESULTS: Twenty-three senior academic experts from eleven countries agreed to participate. Eighteen (representing nine different countries) completed the questionnaires in its entirety (response rate 78.3%). The number of statements that attained consensus agreement was much higher than the number of non-consensus statements-92.6%, 175 statements out of 189 over three iterative rounds. Only 14 statements did not obtain a consensus during this Delphi study. CONCLUSIONS: A total of 175 consensus statements represent the agreement expert views of participated senior academics in prosthodontics from nine different countries and across four continents. These consensus statements could be considered detailed guidelines and recommendations to improve future undergraduates' curriculum in prosthodontics. CLINICAL SIGNIFICANCE: This Delphi study achieved a high consensus among a panel of senior academics in the teaching and assessment of undergraduate prosthodontics. This consensus could help minimise the current international and national divergence in dental schools' prosthodontics curricula, which could benefit future dentists and, subsequently, the patients.

Appropriateness of tooth replacement strategies for adult patients in the United Kingdom with reduced dentitions - a modified Delphi analysis.

OBJECTIVE: To develop consensus from experts in Restorative Dentistry based in the United Kingdom (UK) on the most appropriate tooth replacement strategies in adult patients with reduced dentitions using a modified Delphi analysis. METHODS: An expert panel of UK specialists (n=20) in Restorative Dentistry or Prosthodontics were asked to answer the following question: using available evidence and your clinical experience, how appropriate is each tooth replacement strategy for each clinical scenario of tooth loss in the mandible presented? Five specific clinical patterns of tooth loss were presented to panellists using clinical photographs, and using a 9-point Likert scale, they were asked to rate the appropriateness of listed tooth replacement strategies during two Delphi rounds. The target level of consensus for each statement was 70%. RESULTS: Consensus was reached on the appropriateness of thirty-seven tooth replacement strategies (37%) across ten clinical scenarios. Of these, thirteen were considered appropriate (13%) and twenty-four were considered inappropriate (24%). CONCLUSION: The results from this Delphi process represent the consensus professional views of an expert panel of UK specialists in Restorative Dentistry and Prosthodontics. CLINICAL SIGNIFICANCE: Tooth replacement for partially dentate patients is a common clinical consideration. This study provides evidence from a Delphi process to help clinicians and patients make informed choices about appropriate and inappropriate treatment options.

Global Perspectives of Oral Health Policies and Oral Healthcare Schemes for Older Adult Populations.

The aim of this study was to present a concise summary of the oral health policies and oral healthcare schemes for older adult populations in a number of selected countries around the world. In this paper, the current and planned national/regional oral health policies and oral healthcare schemes of nine countries (Australia, Brazil, China including Hong Kong, India, Japan, Switzerland, Thailand, the United Kingdom, and the United States) are reported. Barriers and challenges in oral health promotion in terms of devising oral health policies, implementing oral health schemes, and educating the future dental workforce are discussed. In response to the aging of population, individual countries have initiated or reformed their healthcare systems and developed innovative approaches to deliver oral health services for older adults. There is a global shortage of dentists trained in geriatric dentistry. In many countries, geriatric dentistry is not formally recognized as a specialty. Education and training in geriatric dentistry is needed to produce responsive and competent dental professionals to serve the increasing number of older adults. It is expected that oral health policies and oral healthcare services will be changing and reforming in the coming decades to tackle the enduring oral health challenges of aging societies worldwide.

Functionally Orientated Tooth Replacement for Older Patients.

Across the globe the population is ageing. In addition, older patients are retaining increasing numbers of natural teeth into old age. Therefore, clinicians are faced with the challenges of managing chronic dental diseases, including caries and periodontal disease, alongside replacing missing units. A number of treatment options are available to replace missing teeth for such patients with large numbers currently receiving removable partial dentures. Alternative approaches to treatment should be considered for this population group, including functionally orientated tooth replacement according to the principles of the shortened dental arch concept. In correctly chosen cases, this approach can provide patients with an acceptable, functional and aesthetic reduced dentition. Additionally, evidence suggests that such an approach can significantly reduce the maintenance burden for patients and clinicians which can ultimately deliver a more cost effective solution compared to removable alternatives.

Association between diet and periodontitis: a cross-sectional study of 10,000 NHANES participants.

BACKGROUND: Periodontitis is a major cause of tooth loss globally. Risk factors include age, smoking, and diabetes. Intake of specific nutrients has been associated with periodontitis risk but there has been little research into the influence of overall diet, potentially more relevant when formulating dietary recommendations. OBJECTIVES: We aimed to investigate potential associations between diet and periodontitis using novel statistical techniques for dietary pattern analysis. METHODS: Two 24-h dietary recalls and periodontal examination data from the cross-sectional US NHANES, 2009-2014 (n = 10,010), were used. Dietary patterns were extracted using treelet transformation, a data-driven hierarchical clustering and dimension reduction technique. Associations between each pattern [treelet component (TC)] and extent of periodontitis [proportion of sites with clinical attachment loss (CAL) ≥ 3 mm] were estimated using robust logistic quantile regression, adjusting for age, sex, ethnicity, education level, smoking, BMI, and diabetes. RESULTS: Eight TCs explained 21% of the variation in diet, 1 of which (TC1) was associated with CAL extent. High TC1 scores represented a diet rich in salad, fruit, vegetables, poultry and seafood, and plain water or tea to drink. There was a substantial negative gradient in CAL extent from the lowest to the highest decile of TC1 (median proportion of sites with CAL ≥ 3 mm: decile 1 = 19.1%, decile 10 = 8.1%; OR, decile 10 compared with decile 1: 0.67; 95% CI: 0.46, 0.99). CONCLUSIONS: Most dietary patterns identified were not associated with periodontitis extent. One pattern, however, rich in salad, fruit, and vegetables and with plain water or tea to drink, was associated with lower CAL extent. Treelet transformation may be a useful approach for calculating dietary patterns in nutrition research.