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2.
J Dent Educ ; 2020 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-32421870

RESUMEN

Critical thinking is ubiquitous in patient care. One track for critical thinking develops skillsets emulating the thought process of the master clinician using probing questions and has been offered in treatment planning, literature search, and critique, risk assessment in caries and geriatrics, technology decision-making, EBD, and IPP. This paper offers 2 additional critical thinking skillsets following this emulation model in social work and ethics. Conceptualization, another form of critical thinking, is also ubiquitous in health care, yet almost no literature exists to guide learning and assess performance on conceptualization. This paper introduces for discussion 2 examples of conceptualization-"How and how much does this situation differ from the ideal?" and "How does the student/practitioner conceptualize the outcome prior to the imminent procedure?" -used continually by the practitioner in patient care situations. The result is 4 additional critical thinking skillsets at different stages of development in the armamentarium for the teacher.

3.
J Dent Educ ; 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32166746

RESUMEN

PURPOSES/OBJECTIVES: Few tools assess the dental school clinical learning environment from students' perspectives. Considering previous efforts to validate the Dental Education Clinical Learning Instrument (DECLEI) in the United States, the goal of this study was to look for the fewest number of items that accounted for the most amount of variability in responses and/or had the highest correlation to the total DECLEI score using a larger, multi-center sample. METHODS: The DECLEI was distributed to 286 students in two dental schools (University of Iowa and University of Texas at Houston) during the 2017-2018 academic year. Two alternative methods were applied. In the first approach, all 24-items were regressed on the total composite score using a forward conditional method. In the second approach, the item-total correlation for the full scale was calculated and then items with relatively poor coefficients were eliminated. A cutoff of 0.30 or less was used. RESULTS: The first approach, Total R2 by Regression Model, produced a 9-item scale accounting for 90% of the variance in total score and a Cronbach's α coefficient of 0.79. The second approach, Item-Total Correlation, produced a larger scale (20 items), as well as a higher Cronbach's α coefficient of 0.89. The instrument also presented appropriate sensitivity to measure differences between race groups and school of origin. CONCLUSION: DECLEI may have the potential to be used as an instrument to measure clinical learning environments for U.S. dental students using either a smaller, concise scale (Mini DECLEI-USA) or a larger (DECLEI-USA), more thorough scale.

4.
Community Dent Oral Epidemiol ; 48(3): 240-247, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32043281

RESUMEN

OBJECTIVES: Oral health plays an important role in the general well-being of older adults, yet older adults experience unique barriers to dental care. In the United States, almost two-thirds of older adults are dentally uninsured - a reflection of the exclusion of dental benefits from Medicare. The aim of this study was to investigate potential predictors of having a dentist among older adults receiving services funded through the Iowa Department on Aging (IDA). METHODS: This was a cross-sectional analysis on a convenience sample (n = 2692) of adults age 65+ who completed a required survey to determine eligibility to receive services from the IDA. Data from questionnaires completed between March and December 2017 were used to generate multivariable logistic regression models that identified predictors of having a dentist. The dependent variable, having a dentist, was gathered by self-report in the survey. Explanatory variables eligible for inclusion in the models included demographic and geographic factors, indicators of access to dental care, and factors related to activities of daily living. RESULTS: Fewer than half (46.2%) of the respondents reported having a dentist. In the final regression model, individuals with dental insurance were more than twice as likely to have a dentist than those without insurance. Conversely, individuals with a tooth/mouth problem and who need help with housekeeping and with transportation were significantly less likely to have a dentist than their counterparts. CONCLUSIONS: These results align with known insurance-related barriers and identify certain activities of daily living that might influence older adults' ability to access care. The finding that individuals with oral health problems were less likely to have a dentist underscores the need to reduce barriers to care for this population.

5.
Spec Care Dentist ; 40(1): 49-54, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31912539

RESUMEN

PURPOSE/AIM: To assess self-perception of oral health among institutionalized older adults in Taubate, Brazil. METHOD AND MATERIALS: Demographics, oral, and systemic health data were collected from a sample of 89 institutionalized older adults. The Geriatric Oral Health Assessment Index (GOHAI) was applied to assess their self-perception of oral health. A linear regression model using GOHAI scores and considering age, BMI, gender, race, dry mouth, denture status, number of teeth, number of comorbid conditions, and number of medications as independent variables was generated. RESULTS: Fifty-five percent were male, with an average age of 75.9 years (±9.1), 43.8% identified as mixed race, and 42.7% as white. The average BMI was 23.9 (±3.8), the average number of comorbid condition was 1.8 (±1.4), and the average number of daily medications was 6.2 (±3.6). The average number of teeth was 3.9 (±7.4), and 57.3% of the participants reported dry mouth sensation; 8.9% presented oral lesions, with denture stomatitis as the most common oral lesion (5.6%). The average GOHAI score was 31.1 (±3.7). Regression analysis showed a negative correlation between BMI and GOHAI scores (P = .032, R2  = 7.2%). CONCLUSIONS: Self-perception of oral health was good and negatively correlated with BMI.


Asunto(s)
Salud Bucal , Xerostomía , Anciano , Brasil , Evaluación Geriátrica , Humanos , Masculino , Autoimagen
6.
Gerodontology ; 37(1): 87-92, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31943327

RESUMEN

BACKGROUND AND OBJECTIVE: Ageism is a major barrier for age-appropriate care. The aim of this study was to translate and perform a preliminary validation of an ageism scale for dental students (ASDS) in Brazil (ASDS-Braz). METHODS: The 27-item original ageism scale was translated from English into Brazilian Portuguese. A panel of five Brazilian dental educators revised the scale to establish content validity. The translated version was completed by 156 dental students in the Federal University of Pelotas in Brazil. Principal component analysis, internal consistency reliability and discriminant validity were estimated. RESULTS: All items in the Brazilian Portuguese version received a content validity index score ≥0.80 indicating that they were relevant to the topic. The principal component analysis produced a 12-item scale with three components that accounted for 51% of the overall variance. The first component contained six items associated with a negative view of older adults; the second component contained three items dealing with the complexity of providing care for older adults; and the third component contained three items associated with a positive view of older people. Discriminant validity did not show any differences related to demographic factors, the semester of studies and history of living with older people. CONCLUSIONS: The preliminary validation of the ASDS-Braz produced a 12-item scale with three components with acceptable validity and reliability. Future research in a larger, multi-institutional sample is now warranted.


Asunto(s)
Ageísmo , Estudiantes de Odontología , Anciano , Anciano de 80 o más Años , Brasil , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
7.
Spec Care Dentist ; 40(1): 84-89, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31799710

RESUMEN

AIMS: To assess the prevalence of degenerative bone changes in the temporomandibular joint (TMJ) of older adults using cone-beam computed tomography (CBCT), and to verify possible associations between these findings and patient health history. METHODS: CBCT scans comprising both TMJs were acquired for 137 patients aged 65+, regardless of TMD status. Images were assessed by two oral radiologists and evaluated for the presence of flattening, erosion, sclerosis, subchondral cysts, and osteophytes in the TMJ bony components, and self-reported patient systemic health histories were retrieved from records. RESULTS: There were 59 males, and the mean age was 73.35 ± 6.28. A total of 31.4% had bone changes in both TMJs, and 65.7% had bone changes in at least one side. Bone changes were more prevalent in females, with subchondral cysts (63.3%) and osteophytes (60%) the most common findings. There was a higher prevalence of osteoporosis/osteopenia (38.5%) and connective tissue disorders (39.8%) in patients with TMJ bone changes than in those with normal TMJs. CONCLUSION: Degenerative bone changes of TMJ were prevalent among older adults, and females were more affected. There was a greater prevalence of osteoporosis/osteopenia and connective tissue disorders in patients with TMJ bone changes than in subjects with normal TMJs.


Asunto(s)
Osteoartritis , Osteofito , Trastornos de la Articulación Temporomandibular , Anciano , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Articulación Temporomandibular
8.
J Am Dent Assoc ; 151(2): 108-117, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31882123

RESUMEN

BACKGROUND: The integration of dentistry into comprehensive and long-term care has occurred infrequently and with limited success. The authors aim to describe how the Program of All-Inclusive Care for the Elderly (PACE) has the potential for such incorporation for the growing population of nursing home-appropriate older adults preferring to age in place. METHODS: The authors used a 56-item online survey to explore aspects of oral health care within PACE, including organizational structure, availability and provision of care, preventive protocols, and provider reimbursement. The survey was distributed to all 124 programs nationally. Data analyses included descriptive statistics for each of the variables of interest. RESULTS: Thirty-five programs completed the survey (28%) in 23 states (74%) where PACE is available. Most programs covered comprehensive dental services and predominantly provided care off-site. Most programs reimbursed dentists at Medicaid fee-for-service rates and some at commercial rates. Dentistry was most frequently ranked the second-highest specialty focus behind mental health. CONCLUSIONS: PACE is a comprehensive interdisciplinary model of care and an underused opportunity for furthering medical-dental integration. It uses local dental resources in order to accommodate the oral health care needs of the growing population of older adults preferring to age in place. PRACTICAL IMPLICATIONS: PACE is an opportunity for the dental profession to further medical-dental integration and ensure that newer models of long-term care include comprehensive and coordinated oral health care programs. It is also an opportunity to promote an integrated model of care with policy makers to support integrated oral health care for the nursing home-eligible population.


Asunto(s)
Anciano Frágil , Servicios de Salud para Ancianos , Anciano , Humanos , Medicaid , Estados Unidos
9.
Dent Clin North Am ; 63(4): 631-651, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31470918

RESUMEN

Frail older adults and persons with special needs are at higher risk of oral diseases including dental caries. Considering the diverse background of the population, a personalized approach for each patient is mandatory to successfully manage their oral health needs. This article describes a succinct way to assess and categorize the risk of rapid oral health deterioration (ROHD) among this group. The procedures for assessing ROHD risk examine the ROHD risk categories, how risk factors impact treatment strategies, what techniques and materials exist for caries prevention and treatment, and how one effectively communicates caries management plans for this population.


Asunto(s)
Caries Dental , Enfermedades de la Boca , Anciano , Anciano Frágil , Humanos , Salud Bucal
10.
Dent Clin North Am ; 63(4): 663-668, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31470920

RESUMEN

This article explores psychosocial barriers to dental care and implications for caries management. At-risk populations experience an increased potential for stressors and obstacles that interrupt oral health care and lessen the potential for these groups to pursue dental treatment. These impediments may include financial restrictions, lack of reliable transportation, or inappropriate informed consent. Involving a social worker in dental caries management can help patients to overcome the barriers that hinder oral health care. An increased awareness of these barriers, along with the resources that are available, may help dental providers to better reach their patients and manage dental caries.


Asunto(s)
Caries Dental , Atención Odontológica , Humanos , Salud Bucal , Trabajadores Sociales
11.
J Dent Educ ; 83(11): 1339-1344, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31406005

RESUMEN

The aims of this study were to assess the perceptions of dental students, faculty members, and patients about the benefits and pitfalls of intraoral camera use and to compare the completion rate of treatment planned posterior crowns with and without intraoral camera use in a predoctoral dental clinic. From July 2016 to June 2017, all 60 fourth-year dental students at one U.S. dental school were encouraged to use the intraoral camera in treatment planning with patients in the school clinic. Perceptions of the students, their patients, and the faculty members supervising the treatment planning were assessed with a survey at the end of the treatment planning appointment. The completion rate of treatment planned posterior crowns was determined by recalling all posterior teeth that were treatment planned for a single unit crown at a specific period of time compared to the number of the same crowns completed for the same patients at a specific period of time, using the electronic health record, with and without camera use. Of the 60 students, 51 completed 198 surveys (85% response rate); 35 faculty members completed 64 surveys, and 202 patients completed one survey each (response rates for those groups could not be calculated). The survey results suggested that the students, faculty, and patients viewed intraoral camera use in a positive way. However, faculty perceptions were a little lower than those of patients and students, and a significant number of faculty members were neutral. The completion rate of posterior planned crowns was significantly higher (p=0.0005) when intraoral cameras were used to present images to patients than when cameras were not used. In this study, intraoral camera use in a predoctoral clinic was perceived positively by students and patients but more neutrally by faculty, and it increased the completion rate of planned posterior crowns.


Asunto(s)
Clínicas Odontológicas , Facultades de Odontología , Actitud del Personal de Salud , Educación en Odontología , Docentes de Odontología , Humanos , Estudiantes de Odontología
12.
Clin Exp Dent Res ; 5(4): 406-412, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31452951

RESUMEN

Abstract: Interprofessional education (IPE) and interprofessional practice (IPP) are essential for the comprehensive care of patients. A goal of this paper is to articulate learning outcomes likely to improve patient outcomes. Yet learning outcomes in IPE are "systematically lacking" in consistency. Objective: An approach offered here and the main purpose of this paper is to develop and implement an IPE learning outcome by applying emulation concepts from the education literature. In dental situations, emulation has been used to derive the thought process of the expert succinctly enough for the novice to apply to the next patient. Methods: The expert's thought process thus becomes the learning outcome, the learning guide, and the assessment instrument. In IPE/IPP, several experts make up the team. The resulting learning outcome is the collection of key questions from respective health care team members. Team members are primary care, pharmacy, nursing, social work, nutrition, and dentistry. The resulting list of questions has not been reported and was applied to patient planning in a geriatric/special needs clinic. Results: Students were more likely to apply questions from disciplines that were preceded by didactic instruction-primary care, pharmacy, nutrition, and dentistry-and less likely to apply questions from nursing and social work. Conclusions: Although still in the early stages, the model is viable to guide learning and assess performance to a level of grasping the concept. The exercise is student led. For the practitioner, the learning outcome becomes the performance outcome. Further model development is ongoing with limited models for comparison.

13.
J Oral Implantol ; 45(4): 327-333, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31216256

RESUMEN

The aim of this study was to evaluate the characteristics of randomized controlled trials (RCTs) regarding implant-supported single tooth or fixed partial dentures. We performed searches (PubMed/MEDLINE and Web of Science) to identify all RCTs published from 1996 to 2016 and assessed publication details, study characteristics, international collaboration networks, and characteristics related to the implant-supported treatment. Two reviewers independently screened the titles/abstracts and selected full texts. A total of 122 RCTs were included, and most of the authors were from Europe (72%). Most trials did not report a trial registering number (89.9%) or sample size calculation (58.2%). The use of the CONSORT Statement increased over the past 9 years. Trials were mostly conducted at universities (54.9%), and only 13.1% compared 2 or more implant brands. Loading protocol was the most prevalent main comparison among the included studies, and most of the RCTs did not clearly report whether they excluded patients with known risk factors. The studies reviewed here presented different methodological and publication characteristics, and many did not show aspects aligned with current research practices.


Asunto(s)
Implantación Dental Endoósea , Implantes Dentales , Ensayos Clínicos Controlados Aleatorios como Asunto , Odontología , Humanos , Metaanálisis en Red
14.
Spec Care Dentist ; 39(3): 262-273, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30964560

RESUMEN

Alzheimer's disease and related disorders (ADRD) are among the age-associated chronic conditions that are most challenging to health care systems around the globe, as patients with dementia require full-time, intensive care for multiple years. Oral health care is negatively impacted by cognitive decline, and consequently poor oral health is common among people with ADRD. Poor oral health status is linked with many undesirable consequences for the well-being of people with ADRD, from excruciating local pain to life-threatening conditions, as aspiration pneumonia. In this paper, the authors provide an update on the most current concepts about Alzheimer's disease epidemiology, etiology, and management, current oral health care for patients with Alzheimer's disease, oral health promotion strategies for this population, as well as current research and future direction for improving oral health care for patients with Alzheimer's disease. It concludes that oral health care should be included in the patient's routine health care as early as possible in the progression of Alzheimer's disease for preventing rapid oral health deterioration. Establishing oral hygiene routines and providing dental treatment that is customized to the patients' individual needs and disease stage are important to achieve good oral health outcomes and prevent quality of life decline.


Asunto(s)
Enfermedad de Alzheimer , Humanos , Salud Bucal , Higiene Bucal , Calidad de Vida
15.
Gerodontology ; 36(3): 251-257, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30957278

RESUMEN

OBJECTIVES: To describe the validation of a new 27-item ageism scale for dental students in Greece. BACKGROUND: A new ageism scale for dental students has been developed by American and European Gerodontology educators and was preliminary validated in the United States. METHODS: The scale was translated into Greek and administered to 8th- and 10th-semester dental students in Athens. Principal components analysis was used to explore the internal structure of the measure; internal consistency reliability was assessed using Cronbach's α coefficient; corrected item-total correlations were calculated to decide which low contributing items should be removed from the scale; and discriminant validity was tested investigating variation in relation to demographic and educational factors. RESULTS: A total of 152 students responded to the questionnaire. The Principal component analysis offered a 15-item scale distributed into four factors that accounted for 56.4%, of the total variance, produced stronger factor loadings, a comparable amount of overall component variance and logical sets of components. The four factors produced were values/ethics about older people (four items, α = 0.71), patient compliance (four items, α = 0.72), barriers to dental care (four items, α = 0.57) and dentist-older patient interaction (three items, α = 0.64). Discriminant validity revealed statistically significant differences in factors and items related to semester of studies, gender and family's permanent residence. CONCLUSION: The preliminary validation of the Greek version of the ageing scale for dental students revealed a 15-item questionnaire that demonstrated acceptable validity and reliability and could be further tested in larger samples.


Asunto(s)
Ageísmo , Estudiantes de Odontología , Anciano , Anciano de 80 o más Años , Grecia , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Traducciones
16.
J Prosthodont ; 28(3): 264-270, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30375110

RESUMEN

PURPOSE: To investigate the relationships between gender, age, patients' perceptions about the dentists' conduct, number of adjustments, treatment type, and expectation prior to prosthetic treatment and patient satisfaction with their treatments. MATERIALS AND METHODS: Data were integrated from four studies that measured patient expectations before treatment and satisfaction after treatment using a visual analog scale (VAS) from 0 to 10. These scores were given for each of four aspects of the therapeutic outcomes: chewing, esthetics, phonetics, and comfort. Patients' perceptions about the dentists' conduct was also assessed using a Likert-scale questionnaire. The total sample size, after combining the data from all four studies, was 223 subjects. Bivariate and multivariable analyses were performed. The covariates entertained were gender, age, treatment type, patients' perceptions about the dentists' conduct, number of adjustments, and expectation prior to denture fabrication. RESULTS: In the entire sample, 115 (51.57%) patients were females and 108 (48.43%) were males. They ranged in age from 28 to 81 years old; the mean age was 53.2 years (SD = 11.5). Combining four treatments together, there was no significant difference between patients' expectation and satisfaction scores for all four items. There were no significant differences between expectation and satisfaction for different genders. Multivariable analysis showed that patient expectation, satisfaction and the difference (satisfaction score-expectation score) scores for all four aspects were associated with treatment type (implant treatments were favored), and expectation prior to prosthetic treatment (the higher the expectation, the higher the satisfaction) was associated with satisfaction and difference scores. Satisfaction and difference scores for chewing were associated with number of adjustments and satisfaction, and satisfaction and difference scores for phonetics and comfort were associated with how well the dentist explained the intended treatment before performing it. CONCLUSIONS: Patient satisfaction was associated with treatment type (implant treatments were favored), expectations prior to prosthetic treatment (the higher the expectation, the higher the satisfaction), and how well the dentist explained the intended treatment before performing it.


Asunto(s)
Motivación , Satisfacción Personal , Adulto , Anciano , Anciano de 80 o más Años , Estética Dental , Femenino , Humanos , Masculino , Masticación , Persona de Mediana Edad , Satisfacción del Paciente , Encuestas y Cuestionarios
17.
Spec Care Dentist ; 39(1): 28-33, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30427556

RESUMEN

PURPOSE/AIM: Ageism negatively affects health care. This paper presents an extended validation of a novel scale assessing ageism among dental students. METHOD AND MATERIALS: A previously pilot-tested 27-question scale applied to a larger sample (n = 315) from two U.S. dental schools with Principal Component Analysis used to assess internal structure of the measure. Questions whose deletion increased the overall α loading on >1 factor or those unexpectedly grouped in another factor were thoroughly examined. RESULTS: The scale resulted in five statements (grouped in two factors), which explained 63% of the overall variance with a substantially higher reliability value than other solutions (0.76). Two factors highly correlated were grouped together in a single scale. The five statements are "Elderly people do not take good care of their teeth" (0.62), "Elderly patients do not usually comply with dental advice" (0.93), "The Elderly patient does not live long enough to make it worthwhile to invest time and effort in complex dental treatment" (0.81), "The elderly patient does not live long enough to make it worthwhile to invest money in expensive dental treatment" (0.95), and "Dental treatment of elderly patients is too time-consuming" (0.57). CONCLUSIONS: Five items achieved high reliability toward the validity of this scale.


Asunto(s)
Ageísmo , Cuidado Dental para Ancianos/psicología , Estudiantes de Odontología/psicología , Adulto , Femenino , Humanos , Iowa , Kansas , Masculino , Análisis de Componente Principal , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
18.
Dent Traumatol ; 35(2): 109-114, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30548143

RESUMEN

BACKGROUND/AIMS: The prevalence of facial fractures among older adults has increased in recent years, and nationwide studies about the epidemiological profile and outcomes of hospital-based ED visits for facial fractures among older adults are scarce. The aim of this study was to provide USA-wide data of hospital-based Emergency Department (ED) visits for facial fractures among older adults, and to investigate the outcomes associated with these visits. MATERIAL AND METHODS: The Nationwide Emergency Department Sample (NEDS) for the years 2008-2014 was used for the present study. All ED visits with a diagnosis of facial fractures in any of the diagnoses fields and only patients aged 65 years and above were included. RESULTS: A total of 540 748 ED visits matched the criteria (62.7% were females). Public insurance-Medicare-(85.2%) was the most common payer. The three most frequent facial fractures included fractures of the nasal bones (61.3%), fractures of "other" facial bones (16.7%), and fractures of the orbital floor (15.0%). Falls were the most common causes of facial fractures (81.8%). Following ED visits, 64.1% were treated and released, and 30.6% were admitted into the hospital. The mean ED charge per visit was US$5507. Total ED charges across the entire United States was US$2 518 289 555. CONCLUSIONS: Among older adults, nasal bone fractures are the most common type of facial fracture. Facial fractures are mainly caused by falls. There was no significant trend in mortality rates over the study period, and there was a significant financial burden associated with the facial fracture-related ED visits.


Asunto(s)
Accidentes por Caídas , Traumatismos Faciales , Fracturas Craneales , Anciano , Servicio de Urgencia en Hospital , Traumatismos Faciales/epidemiología , Femenino , Hospitalización/economía , Humanos , Masculino , Medicare , Estudios Retrospectivos , Fracturas Craneales/economía , Fracturas Craneales/epidemiología , Estados Unidos
19.
Braz. dent. sci ; 22(1): 103-110, 2019. tab
Artículo en Inglés | LILACS, BBO - Odontología | ID: biblio-986920

RESUMEN

Objective: To describe and compare potential differences in systemic health characteristics and xerostomia among residents in American and Brazilian nursing facilities (NF). Material and Methods: This secondary analysis used data from a study in NF located in Iowa-USA (n=81) and Sao Paulo (SP)-Brazil (n=119). Recorded data included demographics, medications, comorbid conditions, and self-reported xerostomia. Results: The Iowa group mean age was 82.1 years (±12.9), 60.5% were females, and 100% were white, whereas the SP group mean age was 76.4 years (±8.7), 47.9% females, most participants identified as either white (42.0%) or as more than one race (45.4%). The median number of comorbid conditions and medications in the Iowa were 9 and 12, respectively, as compared to 2 and 6 in SP. Most common comorbidities in Iowa were hypertension, dementia (including Alzheimer), and depression. In SP, they were hypertension, unspecified diabetes mellitus (including type 2), and Parkinson. Most common prescription medications in Iowa were acetaminophen, acetylsalicylic acid, and magnesium hydroxide, while in SP, they were omeprazole, acetylsalicylic acid, and losartan. Xerostomia was reported by 32.1% (Iowa) and 59.7% (SP) of the participants. There was no association between age and dry mouth sensation in either Iowa (p=0.480) or SP (p=0.130) samples. However, there was an association between total medications and dry mouth sensation in Iowa (p=0.040), but not in SP (p=0.075) Conclusions: Iowans presented with higher numbers of comorbidities and prescription medications, however xerostomia was reported in a greater percentage in SP. Xerostomia was associated to higher number of medications in Iowa, but not in SP.(AU)


Objetivo: Descrever e comparar possíveis diferenças nas características de saúde sistêmica e xerostomia entre residentes em instituições de longa permanência (ILP) americanas e brasileiras. Materiais e Métodos: Esta análise utilizou dados de um estudo em ILPs localizadas em Iowa/EUA (n = 81) e São Paulo/Brasil (n = 119). Os dados avaliados incluíram dados demográficos, medicamentos, comorbidades e xerostomia autoreportada. Resultados: A idade média do grupo de Iowa foi de 82,1 anos (± 12,9), 60,5% eram do sexo feminino e 100% eram brancos, enquanto a idade média do grupo SP foi de 76,4 anos (± 8,7), 47,9% do sexo feminino, a maioria dos participantes identificados como brancos ( 42,0%) ou como mais de uma raça (45,4%). A média do número de comorbidades e medicamentos em Iowa foi de 9 e 12, respectivamente, em comparação com 2 e 6 em SP. Comorbidades mais comuns em Iowa foram hipertensão, demência (incluindo Alzheimer) e depressão. Em SP, foram hipertensão, diabetes mellitus (incluindo o tipo 2) e Parkinson. Os medicamentos de prescrição mais comuns em Iowa eram acetaminofeno, ácido acetilsalicílico e hidróxido de magnésio, enquanto em SP, foram omeprazol, ácido acetilsalicílico e losartana. A xerostomia foi reportada por 32,1% dos participantes em Iowa e 59,7% em SP. Não houve associação entre idade e sensação de boca seca nas amostras de Iowa (p = 0,480) ou SP (p = 0,130). No entanto, houve associação entre o total de medicamentos e a sensação de boca seca em Iowa (p= 0,040), mas não em SP (p = 0,075). Conclusões: Os residentes de Iowa apresentaram maior número de comorbidades e prescrição de medicamentos, porém a xerostomia foi relatada em maior percentual em SP. A xerostomia foi associada ao maior número de medicamentos em Iowa, mas não em SP.(AU)


Asunto(s)
Xerostomía , Envejecimiento , Anciano Frágil , Hogares para Ancianos
20.
J Am Med Dir Assoc ; 19(12): 1039-1046, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30471798

RESUMEN

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


Asunto(s)
Cuidado Dental para Ancianos , Anciano Frágil , Promoción de la Salud , Enfermedades de la Boca/diagnóstico , Salud Bucal , Rol del Médico , Anciano , Consejo , Femenino , Humanos , Masculino , Enfermedades de la Boca/prevención & control , Medición de Riesgo
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