[A lifetime of proper chewing: oral health and quality of life]. / Een leven lang goed kauwen: mondgezondheid en levenskwaliteit.

Being able to chew properly is crucial to a good quality of life. This, in turn, is based on good oral health. This not only applies to healthy people, but also to those who are vulnerable. To achieve this good oral health, the authors of this opinion paper argue for more integration of medical and dental education, in order to promote shared expertise and, thus, interprofessional collaboration. It is expected this will ultimately benefit both general health and oral health for everyone.

[Education and the dentist in 2025. An inventory of the gerodontology-programme for 5 Dutch and Flemish dental schools]. / Serie: Tandheelkundig onderwijs anno 2025. Een inventarisatie van het gerodontologie-onderwijs bij 5 Nederlandse en Vlaamse opleidingen tandheelkunde.

In a consensus meeting (September 2019) of the three Dutch and the two Flemish dental schools their current education programmes on gerodontology were presented and discussed. The aim was to examine if these programmes were in line with the most recent (inter)national guidelines, such as those of the European College of Gerodontology and the recently introduced Dutch framework Oral Health Care (2020). Therefore, the competences regarding the domain of gerodontology were analysed to assess if students were prepared adequately to meet the oral health care needs of the ageing population. In the consensus meeting a new set of competences was formulated together with a new outline for the gerodontology-programme applicable for the Dutch and Flemish dental schools.

[Acute respiratory distress in a frail older patient: spontaneous tooth aspiration]. / Acute ademnood bij een kwetsbare oudere: spontane aspiratie van een gebitselement.

A 68-year-old man presented at the emergency room with acute difficulty breathing. On account of recent subarachnoidal haemorrhage the patient was a resident of a care facility, and was also being treated for acute bronchitis there. Radiographic imaging of the lungs revealed a tooth with crown and pontic to have been inhaled. The tooth was surgically removed. After 3 weeks in the intensive care unit, the patient died of aspiration pneumonia. Spontaneous tooth aspiration is rare, yet it can have fatal consequences in vulnerable older patients. Aspiration of a foreign body may lead to injury and infection of the trachea and lungs. In order to determine the correct diagnosis in patients with acute respiratory distress, adequate and targeted diagnostics is essential; especially in older patients with multimorbidity and polypharmacy. Sarcopenia, dysphagia, a decrease in functional chewing units and decreased sensation of the palate increase the risk of choking in patients. In addition, dysphagia and poor oral health are known to be strongly associated with aspiration pneumonia. Healthcare providers should pay more attention to oral health in frail older patients.

[Ruinous dentition as consequence of root caries]. / Desolate dentitie als gevolg van wortelcariës.

An 88-year-old patient was referred to a geriatric dentist because of seriously neglected dentition and with the desire to look decent again. The deterioration of the dentition turned out to be the result of cognitive and physical decline and polypharmacy. The Clinical Practice Guideline (KPR) 'Root caries in (frail and care-dependent) older people provides recommendations to prevent deterioration of the dentition caused by root caries in older people. The timely recognition of risk factors, the use of additional fluoride measures and the intensification of professional oral care are the central points. In short: not to lose sight of an older patient. It can prevent the destruction of the teeth that the older patient has taken good care of until then.

[Research agenda oral care for older people in the Netherlands and Flanders (Belgium)]. / Wetenschapsagenda 'Mondzorg voor ouderen' in Nederland en Vlaanderen.

Oral care for older people is an underexposed topic in dentistry as well as in general healthcare, while oral care professionals are increasingly confronted with frail and multimorbid older people with complex care needs. The research agenda 'Oral care for the elderly' was developed to encourage the collaboration of researchers in the Netherlands and Flanders (Belgium) to do more research in this area and in this way, to achieve an expansion and implementation of knowledge. This will make possible the provision of a socially responsible and robust basis for sustainable oral care for frail older people. The focus of the agenda is on 3 themes, namely oral health and oral function for older people; multi/interdisciplinary collaboration within primary care and the costs, benefits and long-term effect(s) of oral care throughout the entire course of life. This article provides an overview of this research agenda and the way in which it has been established.

[A view on collective oral care for frail older people: united we stand]. / Visie op de collectieve mondzorg voor kwetsbare ouderen: eendracht maakt macht.

Oral health in frail older people is often poor. There are a number of reasons for this, such as increased morbity and decreased motivation for (self) care. Good oral health is, however, very important. Studies have revealed poor oral health to cause or aggravate several medical and psychological problems. Illness and medication can, in turn, damage oral health. Oral health among the elderly should therefore be carefully monitored and maintained. This requires multidisciplinary and interprofessional collaboration on the part of healthcare professionals and others involved. Such collaboration is now still very limited; hardly anything has been written about how such collaboration in the area of oral care for frail older people should or could be organised. This article provides an overview of the possibilities and the relevant factors in the area of oral care for the elderly in promoting collaboration among healthcare professionals and others involved. All of this is under the banner of 'united we stand'.

[Autonomy in the individual oral care programme of the care-dependent cognitively impaired older patient]. / Autonomie in het mondzorgplan van de zorgafhankelijke, cognitief beperkte oudere patiënt.

The decision-making process on oral healthcare issues concerning caredependent, frail older people living in nursing homes may be complex if patients are incapable of (adequately) expressing consent or are legally incapacitated. Therefore, oral healthcare professionals providing care to cognitively impaired patients in nursing homes need background knowledge of healthcare legislation and healthcare ethics, concerning the aspects relevant to developing an individual oral care programme. In this article, attention is given to these aspects of healthcare legislation and ethics, and the guideline 'Mondzorg en verzet bij wilsonbekwaamheid ter zake' (oral healthcare and resistance of the legally incapacitated) is described. This can be applied in comparable cases.

[Active oxygen in the treatment of (root) caries and its suitability for frail older people]. / Actieve zuurstof bij de behandeling van (wortel)cariës en de toepasbaarheid ervan bij kwetsbare ouderen.

In 2000 it was suggested that there was a new, fast and simple way to treat dental caries based on the outcomes of an in vitro study of the antimicrobial effect of ozone, a form of active oxygen, on caries lesions in dental roots. The aim of the review of literature described in this article was to determine the effectiveness of active oxygen in the treatment of dental (root) caries as demonstrated by in vivo research of frail older people'. From the results it became clear that the quality of the various trials is not very high and that there is, at least at the present time, an insufficient solid scientific evidence base that the use of ozone is an effective treatment for dental (root) caries. It is, however, still too early to conclude that active oxygen, in whatever form, cannot contribute positively to the fight against caries.

[Preventive dentistry 6. Prevention of caries in frail older people]. / Preventieve tandheelkunde 6. Preventie van cariës bij kwetsbare ouderen.

Many older people have a bad oral health, with (root) caries a prevalent cause. Alarming results of research projects raise the question whether sufficient preventive measures are being taken to prevent the development and progress of (root) caries in frail older people. A review of the recent literature revealed that in frail older people and physically or cognitively impaired adults, daily use of a 5,000 ppm fluoride toothpaste and quarterly application of chlorhexidine or sodium fluoride can decrease by half the risk of root caries. In the Netherlands, toothpaste containing 5,000 ppm fluoride is not (yet) on the market. At the present time, only the advice brochure 'Prevention of root caries' is available. Another measure to prevent deterioration of oral health among frail older people is paying attention to frail older people who do not visit their dentist on a regular basis due to physical limitations and care dependency. When this is the case, it is necessary to intensify professional oral healthcare with instructions to personal caregivers and professional care providers in order to fight (root) caries.

[Dissertations 25 year after date 41. Older people's adaptability]. / Proefschriften 25 jaar na dato 41. Aanpassingsvermogen van ouderen.

In 1990, the thesis 'Removable complete dentures in older people, an issue dealing with adaptability?' was published. Among other things, this thesis aimed at finding a method of measuring older people's adaptability to removable complete dentures. Its conclusion was that a subscale of the "Beoordelingsschaal voor Oudere Patiënten" (Rating scale for older patients) had predictive value. Subsequently, only a few research projects on this topic have been carried out. They dealt with demonstrated adaptation achieved after treatment, the realised adaptation. The results were disappointing. Ever since the availability of endosseous oral implants, research into adaptability to conventional removable complete dentures seems less relevant. During the last decades, inquiries into a method of measuring treatment effectiveness has focused on older people's quality of life and general health condition. However, to assess with respect to oral health care an older person's general health condition and load-taking capacity adequately, some experience is indispensable.

[Aftercare for durability and profitability of single-unit and multi-unit fixed dental prostheses]. / Nazorg voor dutrzaamheid en profijtelijkheid van kronen en bruggen.

An important aim ofa treatment with single-unit and multi-unit fixed dental prostheses is a durable and profitable treatment outcome. That requires aftercare, too. First, the frequency of routine oral examinations should be assessed, using an individual risk profile. The objectives of the routine oral examinations are the prevention and, when necessary, the treatment of pathological conditions and complications. With regard to prevention, attention should be paid to information and instruction, oral biofilm and calculus, non-functional activities, hard tooth tissues, periodontal and peri-implant tissues, and saliva. Subsequently, it can be determined whether the intended durability and profitability have been achieved or can still be achieved, whether or not through indicated adjustments. Special attention should be paid to endodontically treated teeth. Restorative, repair or replacement treatments may be indicated in case ofcomplications, such as loose single- or multi-unitfixed dental prosthesis, fracture of a fixed dental prosthesis unit, lost tooth pulp vitality, tooth root fracture, and implant or implant abutment problems.

[The role of single- and multiple-unit fixed dental prostheses in the strength distribution of the occlusal and orofacial system]. / Het krachtenspel van kronen en bruggen in het occlusiesystem, mede in relatie tot het orofaciale systeem.

An occlusal system that does not function well, has a negative impact on the functional level of the oral system and the orofacial system. In purely mechanical terms, a limited anatomical reduction of the occlusal system has limited implications for the functional level since the occlusal system has several forms of adaptation, reserve, and compensation. However, following the loss of (parts of) teeth, an occlusal system may be anatomically reduced to such an extent that restoration of the functional level is required, for instance by the use of implant-supported single- and multiple-unit fixed dental prostheses. The mechanical strength of a tooth and a single-tooth fixed dental prosthesis on a similar tooth type is not essentially different. But the same cannot be said of the mechanical strength of a multiple-unit fixed dental prosthesis, because the strength is controlled by the mechanoreceptors in the periodontal ligaments of the abutment teeth. This control system is disturbed by the insufficiency of or, when oral implants are involved, the absence of mechano-receptors. It is unknown whether this is causing noticeable problems.

Meta-analysis of dysphagia and aspiration pneumonia in frail elders.

As part of a systematic literature review, a comprehensive literature search was carried out to identify risk factors for aspiration pneumonia in frail older people. A prominent risk factor found was dysphagia with evidence level 2a, according to the Oxford Centre for Evidence-based Medicine Levels of Evidence. Subsequently, a meta-analysis of 4 cohort, 1 case-cohort, and 1 case-control study on dysphagia as a risk factor of aspiration pneumonia in frail older people was performed. Using a random effects model, we found a positive correlation between dysphagia and aspiration pneumonia: OR = 9.84; 95%CI = 4.15 - 23.33 (test for statistical homogeneity: p < 0.001). Then, a subgroup meta-analysis was performed with 4 cohort studies, all including patients with a cerebrovascular disease. Once again, a positive correlation was found between dysphagia and aspiration pneumonia: OR = 12.93; 95%CI = 8.61 - 19.44. The test for statistical homogeneity revealed no statistically significant result (p = 0.15). It was concluded that dysphagia is a serious risk factor for aspiration pneumonia in frail older people, particularly in those suffering from a cerebrovascular disease.