Effectiveness of the lay health advisor program on oral function and quality of life in aboriginal older adults: A randomized controlled trial.

BACKGROUND: Aboriginal older adults residing in remote areas have poor oral function due to inadequate access to healthcare services. Lay health advisor (LHA) strategies can fill capacity shortages of healthcare professionals in rural communities and increase population acceptance of health care or healthy behaviours. OBJECTIVE(S): To evaluate the effectiveness the LHA program on oral function and oral health-related quality of life (OHRQoL) among older adults in aboriginal community. METHODS: Participants were randomly assigned to an experimental group (EG; n = 122) and a control group (CG; n = 118). All participants performed oral exercises, and the EG received additional one-on-one 30-min lessons by an LHA over 4 weeks. Data were collected through face-to-face interview and oral examination. The generalized estimating equation model was used to analyse changes in outcomes over time. RESULTS: The EG exhibited significantly greater improvement in swallowing (ß = .63) at the 6-month follow-up and in masticatory performance (ß = .52) and pronunciation of the syllable/pa/ (ß = 2.65) at the 2-week follow-up than the CG did. The EG had a significantly lower plaque control record (ß = -.14) and plaque index (ß = -.30) at the 3-month follow-up than the CG did. Moreover, the OHRQoL was significantly increased at 6-months follow-up in the EG (p = .010). CONCLUSION: The LHA program had positive effects on chewing, swallowing and plaque control in aboriginal older adults. LHA group also experienced positive long-term effect on OHRQoL after intervention.

Combining augmented and virtual reality simulation training to improve geriatric oral care performance in healthcare assistants: A randomized controlled trial.

Objective: Healthcare assistants (HCAs) are frontline caregivers for older adults. This study evaluated the effectiveness of combining augmented reality (AR) and virtual reality (VR) to implement oral healthcare simulation training for HCAs. Methods: An experimental design was adopted. HCAs were recruited and randomly assigned to an AR/VR group (n = 40) or a control group (n = 40). The AR/VR group received 2.5 h of AR/VR training. Participants were trained on the Bass brushing technique through AR and on scenario-based oral care procedures for various physical and oral health conditions in older adults through VR. A self-administered questionnaire was employed to collect data before and after the training. Generalized estimating equations were used to analyze the differences between pretest and posttest results. Results: After the training, the HCAs in the AR/VR group achieved a significantly greater increase in their level of oral care-related knowledge (ß = 2.55, effect size [ES] = 1.62), self-efficacy (ß = 4.23, ES = 0.75), and behavioral intention (ß = 2.10, ES = 0.55) relative to the control group. Conclusion: This study revealed that the application of an AR/VR simulation system can effectively improve the geriatric oral care performance of HCAs.

Clinical investigation of use of Episil® oral solution in oral mucositis during radiotherapy for head and neck cancer.

Objective: Episil® is a bio adhesive barrier-forming oral liquid gel that has been used in recent years to relieve pain of oral mucositis (OM) with radiotherapy (RT) or chemoradiotherapy (CRT) in head and neck cancer (HNC) patients. We conducted a retrospective analysis of the clinical effects of Episil® on OM in these patients. Study design: Between June 2018 and May 2020, 65 patients with HNC were treated with RT or CRT at our hospital. Results: The median total RT dose was 50 Gy (range, 30-70 Gy) and the completion rate was 63/65 (97%). The median time to OM resolution was 47 (6-90) days and was significantly longer (53 [27-90] days) when the total RT dose was ≥51 Gy (P < 0.001). Episil® was used in 26 patients. Among them, 10 discontinued its use due to ineffective pain relief, usage difficulties, and taste intolerance. The median duration of use was 30 days and was significantly longer (34.5 days) (P < 0.001) when patients experienced pain relief at treatment initiation. Conclusion: Although Episil® has been shown to be effective in improving the pain of OM caused by RT for HNC patients, and medical professionals are required to give careful attention to each patient.

A Case of Oral Health Management for a Patient with Extensive Ulceration of the Oral Mucosa Due to Herpes Zoster.

Oral ulcers caused by herpes zoster virus infection are commonly encountered in daily clinical practice. However, in rare cases, sepsis or viremia can occur with serious outcomes; hence, these must be managed effectively. Here, we report a case of a patient with extensive ulceration caused by varicella zoster virus infection. Antiviral treatment was started early, and oral health management was started simultaneously, with oral hygiene instructions for pain control. As a result, the patient was able to resume oral food intake and was discharged from the hospital within a week. This case suggested that oral health management comprising supportive care, with the assistance of dentists and dental hygienists, as well as antiviral therapy, are important in the treatment of oral ulcers associated with herpes zoster virus infection.

Clinical-based oral rehabilitation programme improved the oral diadochokinesis and swallowing function of older patients with dementia: A randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of a clinical-based oral function intervention on oral function and care behaviours in older patients with mild dementia. METHOD: Participants were randomly assigned to the experimental group (EG) and control group (CG). Both groups received a leaflet on oral health-related knowledge, and the EG also received an oral function intervention, which was a brief one-on-one lesson concerning oral exercise and preventive oral care. Oral exercise included turning the head, pouting lips, bulging cheeks, stretching tongue, articulation exercise and salivary gland massages. A reminder phone call was made every 2 weeks. Perceived xerostomia and dysphagia, plaque index (PI), Winkel tongue-coating index (WTCI), repetitive saliva-swallowing test (RSST), oral diadochokinesis (DDK) and oral care behaviours were recorded at baseline and at 3-month follow-up. Generalised Estimating Equations (GEE) were used to analyse the indicated effects. RESULTS: The EG (n = 59) exhibited greater improvement to the CG (n = 55) in RSST [ß = 0.7; effect size (ES) = 0.45], the syllables /pa/ (ß = 3.1; ES = 0.37) and /ka/ (ß = 2.7; ES = 0.40) in oral DDK, PI (ß = -0.2; ES = 0.52) and WTCI (ß = -0.8; ES = 0.38). Moreover, the EG exhibited better preventive behaviours in regular dental visits [adjusted odds ratio (aOR) = 2.2], daily mouth cleaning frequency (aOR = 1.6) and mouth cleaning before sleep (aOR = 1.3). CONCLUSION: The brief clinical-based intervention was effective in improving the swallowing function, oral DDK and plaque control of older patients with mild dementia at 3-month follow-up.

Burden of Oral Diseases and Access to Oral Care in an Ageing Society.

OBJECTIVE: The total years lived with disability among older people, and the concomitant burden of tooth loss in ageing societies have increased. This study is an overview of the burden of oral diseases and access to oral care in an ageing society. METHODS: We selected key issues related to the burden of oral diseases and access to oral care and reviewed the relevant literature. RESULTS: The rising number of older people with teeth increases their oral health care needs. To improve access to oral care, affordability of care is a great concern with respect to universal health coverage. In addition, accessibility is a crucial issue, particularly for vulnerable older adults. To improve oral care access, attempts to integrate oral health care into general care are being made in ageing countries. For this purpose, provision of professional oral care at home through domiciliary visits and provision of daily oral health care by non-dental professional caregivers are important. Oral health care for older people reduces general diseases such as pneumonia and malnutrition, which in turn could reduce further healthcare costs. CONCLUSIONS: To address the growing burden of oral care in ageing societies, special provision of oral health care to vulnerable older people, and integration of oral care with primary care will be required.

Effects of artificial intelligence-assisted dental monitoring intervention in patients with periodontitis: A randomized controlled trial.

AIM: To evaluate the effects of an at-home artificial intelligence (AI)-assisted dental monitoring application on treatment outcomes in patients with periodontitis. MATERIALS AND METHODS: Participants with periodontitis were recruited and randomly assigned to an AI (n = 16), AI and human counselling (AIHC; n = 17), or control (CG; n = 20) group. All participants received non-surgical periodontal treatment. We employed an AI-assisted tool called DENTAL MONITORING® (DM) intervention, a new technological AI monitoring product that utilizes smartphone cameras for intra-oral scanning and assessment. Patients in the AI and AIHC groups received additional (a) DM or (b) DM, respectively, with real-person counselling over 3 months. Periodontal parameters were collected at baseline and follow-ups. A mixed-design model analysed the follow-up effects over time. RESULTS: The AI and AIHC groups, respectively, exhibited greater improvement in probing pocket depth (PPD) (mean diff = -0.9 ± 0.4 and -1.4 ± 0.3, effect size [ES] = 0.76 and 1.98), clinical attachment level (mean diff = -0.8 ± 0.3 and -1.4 ± 0.3, ES = 0.84 and 1.77), and plaque index (mean diff = -0.5 ± 0.2 and - 0.7 ± 0.2, ES = 0.93 and 1.81) at 3-month follow-up than the CG did. The AIHC group had a greater reduction in PPD (ES = 0.46) and clinical attachment level (ES = 0.64) at the 3-month follow-up compared with the AI group. CONCLUSIONS: Using AI monitoring at home had a positive effect on treatment outcomes for patients with periodontitis. Patients who received AI-assisted health counselling exhibited better treatment outcomes than did patients who received AI monitoring alone.

Association between oral health and advisability of oral feeding in advanced cancer patients receiving palliative care: a cross-sectional study.

PURPOSE: Maintenance of oral feeding is important in terms of maintaining and improving the quality of life in terminal cancer patients receiving palliative care. Although adequate oral health status is essential for oral feeding in hospitalized patients, the relationship between oral health and oral feeding in patients receiving palliative care remains unclear. This cross-sectional study aimed to examine how the general condition and oral health status of these patients relate to decisions regarding their nutritional intake methods. METHODS: This retrospective cross-sectional study included 103 terminal cancer patients (59 men and 44 women; mean age, 73.8 ± 10.9 years) who received palliative care between April 2017 and August 2019. The nutritional method was assessed using the Functional Oral Intake Scale (FOIS). We assessed two types of nutritional methods: (1) the method advised by the attending physician until the initial dental examination (FOIS-I) and (2) the recommended method based on consultation with a palliative care doctor and dentist after the initial oral examination (FOIS-R). Furthermore, the participants' basic information and Dysphagia Severity Scale (DSS) and Oral Health Assessment Tool (OHAT) scores were assessed. RESULTS: There was a divergence between FOIS-I and FOIS-R. FOIS-R was significantly higher than FOIS-I (p < 0.001). Multiple regression analysis revealed that the time until death, DSS score, and OHAT score had a significant impact on determining the food form for oral feeding. CONCLUSIONS: Appropriate oral health assessment is important in determining the food form and indication for oral feeding among patients receiving palliative care.

Physical Frailty and Oral Frailty Associated with Late-Life Depression in Community-Dwelling Older Adults.

Late-life depression is a major mental health problem and constitutes a heavy public health burden. Frailty, an aging-related syndrome, is reciprocally related to depressive symptoms. This study investigated the associations of physical frailty and oral frailty with depression in older adults. This large-scale cross-sectional study included 1100 community-dwelling older adults in Taiwan. The participants completed a dental examination and questionnaires answered during personal interviews. The 15-item Geriatric Depression Scale was used to assess depression, and information on physical conditions and oral conditions was collected. Multivariable logistical regression analysis was conducted to examine associations of interest. Significant factors associated with depression were pre-physical frailty (adjusted odds ratio (aOR) = 3.61), physical frailty (aOR = 53.74), sarcopenia (aOR = 4.25), insomnia (aOR = 2.56), pre-oral frailty (aOR = 2.56), oral frailty (aOR = 4.89), dysphagia (aOR = 2.85), and xerostomia (aOR = 1.10). Depression exerted a combined effect on physical frailty and oral frailty (aOR = 36.81). Physical frailty and oral frailty were significantly associated with late-life depression in community-dwelling older adults in a dose-response manner. Developing physical and oral function interventions to prevent depression among older adults is essential.

Effectiveness of Virtual Reality-Based Training on Oral Healthcare for Disabled Elderly Persons: A Randomized Controlled Trial.

(1) Background: Virtual reality (VR) technology is a widely used training tool in medical education. The present study aimed to evaluate the effectiveness of VR training of oral hygiene students on providing oral healthcare to disabled elderly persons. (2) Methods: A randomized controlled trial was conducted. In 2021, oral hygiene students were randomly assigned to a VR experimental group (EG; n = 11) and a control group (CG; n = 12). The EG received two-hour, thrice-repeated VR-based training interventions at 2-week, 4-week, and 6-week follow-ups. The CG received no VR-based interventions. Data were collected using a self-administered questionnaire before and immediately after each intervention. We performed generalized estimating equations to compare the responses. (3) Results: The EG exhibited a more significant improvement in oral care-related knowledge, attitude, self-efficacy, and intention at the 6-week follow-up than the CG. The students' intention to assist the elderly in using interdental brushes (ß = 0.91), with soft tissue cleaning (ß = 0.53), and with oral desensitization (ß = 0.53), and to have regular dental visits (ß = 0.61) improved significantly at the 6-week follow-up. (4) Conclusions: VR training positively affected students' knowledge, attitude, self-efficacy, and intentions on providing oral healthcare to disabled elderly persons.

Evaluating e-learning on an international scale: An audit of computer simulation learning materials in the field of dentistry.

BACKGROUND/PURPOSE: Global networking and e-learning courses are an effective strategy for sharing educational content and there is potential scope to use e-learning technology in dental education. Therefore, this study aimed to explicate the challenges encountered in international e-learning use and decipher optimum solutions for disseminating course/systems on an international scale. MATERIALS AND METHODS: An e-learning course with four computer-assisted simulation materials developed among international faculties was provided to dental undergraduates at dental schools in Japan and Vietnam in 2020. A post-questionnaire survey plus pre- and post-tests were conducted to obtain learners' feedback and assess the success of the course's implementation. RESULTS: Altogether, 41 students participated, with a response rate of 78.8%. The mean post-test score was significantly higher than that of the pre-test (p < 0.001). Students from both groups felt that e-learning was beneficial, useful for their future, and should be continued. CONCLUSION: This study showed that e-learning/course provision could be achieved at an international level by using a common online system, which is beneficial for students to gain a wider perspective and global dental education. Learners indicated that they learned without any major problems in learning operations. This type of educational material creation and course implementation is extremely important in global networking and dental education in the present era; and communication and cooperation between the faculties was important for course provision. More countries should be included in future studies to ensure that it has global application.

Factors affecting the oral health of inpatients with advanced cancer in palliative care.

PURPOSE: Patients with terminal cancer undergoing multidisciplinary palliative care often have oral health problems, but these details are still unclear. This cross-sectional study aimed to elucidate the oral health of patients with terminal-stage cancer who are inpatient recipients of acute-phase palliative care, and to unveil the factors affecting their oral health. METHODS: Participants were 121 patients with terminal-stage cancer (68 males, 53 females, mean age: 73.6 ± 11.1 years) and oral health complaints. They received palliative care at Tokyo Medical and Dental University Medical Hospital between April 2017 and August 2019. Their demographic and medical details were extracted, retrospectively, from their medical records, and their oral health status, such as the number of natural teeth, removable denture usage, Oral Health Assessment Tool (OHAT), and Dysphagia Severity Scale, were evaluated. All outcomes were assessed by a dentist from the palliative care team. RESULTS: The problems with soft tissue, saliva, and oral cleanliness were observed. The absence of posterior occlusal support was common, and the use of removable dentures was often inadequate. In contrast, swallowing function was relatively well-conserved and 46.3% of the participants were capable of nutrition intake solely by mouth. Multiple regression analysis revealed a significant association between total OHAT score and age, consciousness level, prognostic level, and method of nutritional intake. CONCLUSION: The results revealed that the oral health of terminal cancer patients under palliative care declined despite receiving routine oral care from nurses, and suggest the importance of including dental professionals in multidisciplinary palliative care.

Clinical Outcomes and Oral Health-Related Quality of Life after Periodontal Treatment with Community Health Worker Strategy in Patients with Type 2 Diabetes: A Randomized Controlled Study.

Interventions engaging community health workers (CHW) for diabetes management aim to improve diabetes care and self-management behaviors among patients. We evaluated the effects of nonsurgical periodontal treatment (NSPT) with the CHW strategy on oral self-care behaviors, periodontal status and oral health-related quality of life (OHQoL) in patients with type 2 diabetes mellitus (T2DM). The participants were randomly assigned to experimental (EG; n = 35) and control (CG; n = 33) groups. All participants received NSPT, whereas the patients in the EG also received one-on-one 30 min lessons from a CHW over 4 weeks. The EG exhibited greater improvement in the probing pocket depth (ß = -0.2, effect size [ES] = 0.61) and clinical attachment level (ß = -0.2, ES = 0.59) at 1-month follow-up than the CG did. The ES increased over the 1-, 3- and 6-month follow-ups, indicating an increase in OHQoL (ES = 0.19, 0.60, and 0.62, respectively) in the EG. The patients in the EG were more likely to change their oral self-care behaviors than patients in the CG were. The NSPT with CHW strategy had a positive effect on 1-month periodontal treatment outcomes, long-term OHQoL and oral self-care behaviors in patients with T2DM.

Association between the dental occlusion and perceived ability to eat foods of Taiwanese older adults.

Tooth loss is a common problem among older adults that affects masticatory function (MF) and food selection. Financial burden is a reason that some older adults in Taiwan with this condition forgo dental restoration. To identify the number of posterior occlusal support areas (POSAs) associated with MF. Large-scale cross-sectional study included 1100 community-dwelling participants of Taiwan aged ≥65 years. Participants completed dental examination and questionnaires through personal interviews. Masticatory performance was evaluated using a colour-changeable chewing gum. Masticatory ability was evaluated on the basis of how many of 14 common foods the participants were able to eat. Participants were grouped into 10 categories (A1-A3, B1-B4 and C1-C3) according to the Eichner index (EI) of posterior occlusal contacts. Multivariable regression models were used to analyse the association between the EI groups and MF. More than 80% of the participants with two or more POSAs (those in groups A1-B2) could easily eat various foods. Compared with those in groups A1-B2, those in groups in B3, B4, C1, C2 and C3 exhibited a significantly different masticatory performance (all P < .001) and significantly higher difficulty in eating fruits and vegetables. A dose-response effect between POSAs and perceived masticatory ability to eat fruits and vegetables was observed (P < .05 for both trends). Preservation of at least two POSAs is essential for MF. Older adults with tooth loss can undergo the restoration of two POSAs to improve MF and increase food intake.

What Factors Affect Changes in Body Composition and Swallowing Function in Patients Hospitalized for Oral Cancer Surgery?

PURPOSE: There are few studies about sarcopenia before and after surgery for oral cancer. Therefore, we examined body composition during hospitalization and factors affecting weight loss, skeletal muscle mass index (SMI) reduction, and swallowing function at discharge in this patient group. PATIENTS AND METHODS: A prospective survey was conducted at Tokyo Medical and Dental University Dental Hospital for patients who underwent primary surgery for oral cancer and reconstruction using free flaps. We compared body weight, SMI, grip strength, and walking speed at admission and discharge. We also examined factors affecting weight loss and SMI reduction and the functional oral intake scale (FOIS) score at discharge. RESULTS: There were 26 patients that we could survey during the period. As a result of Wilcoxon's signed-rank test, body weight, SMI, and grip strength were significantly reduced during hospitalization, but no reduction was noted for sarcopenia. As a result of multiple regression analysis, postoperative chemoradiotherapy was a risk factor for weight loss, reduced SMI, and low FOIS score at discharge. CONCLUSION: Postoperative chemoradiotherapy is a risk factor for weight loss, muscle mass loss, and dysphagia at discharge, and chemoradiotherapy may affect rather than an invasion of surgery. After surgery, besides follow-ups for cancer, oral cancer patients should be followed up to assess dysphagia, undernutrition, and sarcopenia.

Imaging findings of intraosseous traumatic neuroma of the mandible.

A traumatic neuroma is an uncommon pseudotumor associated with peripheral nerves and occurs following surgery or trauma. It mostly occurs in the extraosseous soft tissue; traumatic neuromas of intraosseous origin are extremely rare. We herein report an unusual case of an intraosseous traumatic neuroma associated with the inferior alveolar nerve that was incidentally found on a panoramic image. In this report, we place special emphasis on the imaging features of traumatic neuroma, including the computed tomography and magnetic resonance imaging findings.

Association of Temporomandibular Joint Pain According to Magnetic Resonance Imaging Findings in Temporomandibular Disorder Patients.

PURPOSE: This study investigated the associations between magnetic resonance imaging (MRI) findings and pain in the temporomandibular joint (TMJ). MATERIALS AND METHODS: The study included 646 TMJs of 323 consecutive patients with temporomandibular disorders; of these, 222 (34.4%) had TMJ pain whereas 424 (65.6%) had no TMJ pain. MRIs were used to evaluate disc position, osteoarthritis, joint fluid, and bone marrow edema. Internal derangement was classified as normal, anterior disc displacement with reduction, and anterior disc displacement without reduction (ADDWOR); condylar morphology was classified as normal, moderate bony change, and severe bony change. The odds ratio (OR) for each MRI variable for nonpainful versus painful TMJs was computed using logistic regression analysis. RESULTS: Compared with joints with normal disc position, the OR of those with ADDWOR was 2.74 (P < .001) for TMJ pain. Similarly, compared with joints with normal condylar morphology, the OR of those with severe bony change was 4.62 (P = .02) for TMJ pain. In addition, the risk of TMJ pain increased by 2.37 in joints with joint fluid (P < .001) and by 2.34 in joints with bone marrow edema (P = .006). The risk of TMJ pain increased significantly with ADDWOR in combination with severe bony change, joint fluid, and bone marrow edema. CONCLUSIONS: These results suggest an association between TMJ pain and ADDWOR, severe bony change, joint fluid, and bone marrow edema. Thus, combining various MRI variables may improve the diagnostic accuracy of TMJ pain.

MRI changes in the temporomandibular joint following mandibular setback surgery using sagittal split ramus osteotomy with rigid fixation.

OBJECTIVES: This study examined the changes in temporomandibular joint dysfunction (TMD) symptoms and investigated the variations in the disc position, disc and condylar morphology following sagittal split ramus osteotomy (SSRO) with rigid fixation in patients with mandibular prognathism. Furthermore, the authors examined the correlation between mandibular setback and TMD symptoms. METHODS: The study included 24 Japanese patients with jaw deformities who were treated using bilateral SSRO and Le Fort I osteotomy. The clinical and magnetic resonance imaging findings in the temporomandibular joint were evaluated preoperatively and at three and six months postoperatively. RESULTS: The preoperative TMD symptoms were significantly associated with the prevalence of TMD symptoms at six months postoperatively. Anterior disc displacement improved in four joints with slight displacement and with no morphological change. There were no postoperative changes in condylar morphology. There was no significant correlation between mandibular setback and the postoperative TMD symptoms. CONCLUSION: Postoperative TMD symptoms may be influenced mainly by preoperative TMD symptoms rather than mandibular setback using SSRO with rigid fixation. Therefore, patients with TMD symptoms require physical examination and MRI for appropriate diagnosis preoperatively.

Effects of an interactive simulation material for clinical dentistry on knowledge acquisition and memory retention in dental residents.

With the development of technology, the knowledge and skills needed to become a dentist are increasing. Computer-assisted simulation learning materials have been utilized for dental education because of their high efficiency and efficacy. However, it is not well understood which material design is strongly associated with an education effect. We therefore investigated the effects of interactivity with learning materials on learners' knowledge acquisition, memory retention, and anxiety reduction. Learning effects and degree of anxiety were compared between dental residents who learned using an interactive-type material, which required decision making and provided feedback (Group I, n=26), and those who learned using a display-type material, which merely displayed the appropriate action on a computer screen (Group D, n=23). Quiz scores immediately after learning and 3 weeks later were significantly higher in Group I than those in Group D (p<0.001 and 0.016, espectively). Regarding anxiety, state anxiety after learning with interactive material was significantly decreased in Group I (p<0.05), whereas no significant change was observed in Group D. Our results suggest that interactivity with computerassisted simulation materials is more effective for knowledge acquisition, memory retention, and anxiety reduction.