Influence of visual acuity, manual dexterity and handgrip strength on oral and denture hygiene ability of non-frail older people: Development of the Gerostomatological Assessment Battery.

BACKGROUND: Due to the heterogeneity of older people, it is difficult to identify reliable factors influencing oral health. OBJECTIVE: The aim was to illustrate the influence of visual acuity, manual dexterity, and handgrip strength on the oral and denture hygiene ability of older non-frail people. METHODS: In a cross-sectional study, conducted at a specialized dental clinic, at baseline, all participants received professional prophylaxis and instruction on daily oral and denture hygiene regimes for a 6-week intervention period. Data on the Quigley and Hein modified plaque index (QHI), respectively, the Denture Hygiene Index (DHI), visual acuity, manual dexterity and handgrip strength in non-frail participants (≥ 65 years) were collected. Recruitment was done within the clinic's patient clientele and within the staff (control cohort). RESULTS: Women showed significantly better manual dexterity than men (Mann-Whitney U, p = .01), while women's mean handgrip strength was significantly lower (Mann-Whitney U, p < .01). Manual dexterity (Mann-Whitney U, p = .003) and handgrip strength (Mann-Whitney U, p = .052) were associated with age. However, visual acuity, manual dexterity and handgrip strength had no influence on oral or denture hygiene. CONCLUSION: Visual acuity, manual dexterity and handgrip strength have no influence on oral and denture hygiene ability in older non-frail people. Further studies should investigate whether these factors also have no influence on oral and denture hygiene in vulnerable older patients. Therefore, an assessment tool for the evaluation of potential influencing factors of oral and denture hygiene is proposed in a dental context. This Gerostomatological Assessment Battery (G-AB) can be used as a helpful tool to check the individual cognitive function and comprehension, dental therapy approaches and their individual adaption.

Validation of a New Measuring Instrument for the Assessment of Bite Force.

BACKGROUND: this study aims to validate two occlusal-force-measuring devices by comparing them to a universal testing machine and assessing their reliability across various dental and prosthetic groups. The research comprised two parts: part 1 assessed the measurement accuracy of the Occlusal Force Meter GM 10® (OFM) (Morita, Nagano Keiki, Higashimagome, Ohta-ku, Tokyo, Japan) and a prototype (PRO) by comparing them to a calibrated universal testing machine (ZWICK). Part 2 involved analyzing the devices' reliability based on clinical bite force measurements from study participants. RESULTS: both devices become more accurate and reliable compared to the ZWICK over time of usage. Additionally, higher deviation from the ZWICK can be observed for higher values of forces applied and vice versa for both devices. The PRO's intraoral alignment influences its mean values compared to the OFM in different dental and prosthetic groups. CONCLUSION: both devices had limitations and required quadratic function calibration, making them suitable only for progression measurements. The study concludes that both the OFM and PRO devices can measure occlusal forces with improved accuracy over time. Intraoral alignment should be considered. Their easy-to-use clinical application would allow a more widespread use of masticatory function diagnosis, which could indicate the need for treatment and improve treatment planning.

Student Perceptions of Age and Ageing-An Evaluation of Swiss Dental Students Receiving Education in Gerodontology.

Society is ageing and the higher number of senior citizens in the total population is a challenge for society and often perceived as a burden. Negative images of old age can lead to ageism and poorer healthcare for older people. The younger generation will have to master these demographic challenges. Therefore, their attitude towards and their perception of the older generation has to be monitored. The aim of this study is to present the images of ageing held by dental students who received education in gerodontology and to assess possible changes between different generations of students over time and separated by gender. An annual, anonymous questionnaire survey was conducted among dental students at the end of the 10th semester each year between 2008 and 2021. The questionnaire surveyed personal attitudes towards ageing, the assessment of seniors, and personal experience with seniors (images of ageing, "Aging Semantic Differential"). In addition to confirming Friedan's phenomenon regarding the assessment of age limits, the present study was able to demonstrate a positive image of ageing in dental students, which has remained almost constant over the years. An education in gerodontology might positively influence student perceptions of age and aging.

On the Necessity of a Geriatric Oral Health Care Transition Model: Towards an Inclusive and Resource-Oriented Transition Process.

People in need of care also require support within the framework of structured dental care in their different life situations. Nowadays, deteriorations in oral health tend to be noticed by chance, usually when complaints or pain are present. Information on dental care is also lost when life situations change. An older person may rely on family members having oral health skills. This competence is often not available, and a lot of oral health is lost. When someone, e.g., a dentist, physician, caregiver, or family member notices a dental care gap, a structured transition to ensure oral health should be established. The dental gap can be detected by, e.g., the occurrence of bad breath in a conversation with the relatives, as well as in the absence of previously regular sessions with the dental hygienist. The aim of the article is to present a model for a structured geriatric oral health care transition. Due to non-existing literature on this topic, a literature review was not possible. Therefore, a geriatric oral health care transition model (GOHCT) on the basis of the experiences and opinions of an expert panel was developed. The GOHCT model on the one hand creates the political, economic, and legal conditions for a transition process as a basis in a population-relevant approach within the framework of a transition arena with the representatives of various organizations. On the other hand, the tasks in the patient-centered approach of the transition stakeholders, e.g., patient, dentist, caregivers and relatives, and the transition manager in the transition process and the subsequent quality assurance are shown.

Undergraduate Dental Education in Gerodontology in Germany between 2004 and 2019-A case for compulsory teaching?

INTRODUCTION: The study surveys the present state of undergraduate dental education in gerodontology in Germany and highlights changes between 2004 and 2019. MATERIALS AND METHODS: In 2019, questionnaires were emailed to the department heads of all German dental schools. Data were analysed descriptively and compared to existing data from 2004, 2009 and 2014. RESULTS: Thirty-nine (86.7%) out of forty-five responding department heads stated to teach aspects of gerodontology in traditional core subject lecture series. Overall, 15 (55.6%) out of 27 responding dental university schools are offering special education in gerodontology (dedicated lecture series and/or practical training). A stronger focus on non-dental topics has been observed over the years. DISCUSSION: The 15-year observation period in Germany shows that teaching gerodontology should be mandatory. There is a lack of specialists in gerodontology at the dental schools, although specialisation has been possible for many years in the German professional association. Students should be sure that, as in other subjects, they are well trained for the very heterogeneous patient group of seniors. The financial and personnel prerequisites for the universities need to be established. CONCLUSION: Inclusion of gerodontology in the national syllabus is a decisive factor for the integration of the subject into undergraduate courses. The recommendations of the European College of Gerodontology (2009) and of the German Association of Gerodontology (DGAZ) regarding didactical and practical teaching should be implemented in the respective compulsory syllabus to prepare current undergraduate dental students for the demographic challenges of tomorrow.

Aspects of oral health and dementia among Swiss nursing home residents.

BACKGROUND: Little empirical evidence of high levels of oral diseases of people in need of care and the impact of dementia is available. The resident assessment instrument minimum data set (RAI-MDS) is an evaluation tool for caregivers. OBJECTIVE: The aim of this study was to show oral health of nursing home residents through RAI-MDS 2.0 data as a function of the cognitive impairment. METHODS: A retrospective analysis of RAI-MDS (general, cognitive, oral health variables) of 357 long-term care facilities in Switzerland (data of 105,835 residents) was carried out. The final sample size was 7922 residents after applying the inclusion/exclusion criteria in four evaluation groups (no dementia, moderate, severe and incident dementia). RESULTS: As dementia developed and severity increased over time, subjects often had fewer or no teeth and did not wear removable dentures. Chewing problems increased over time regardless of the dementia severity. Oral complaints increased over time in subjects with severe dementia, which in turn led to low body mass index (BMI) values (<23 kg/m2) and was associated with an higher risk of mortality. CONCLUSION: This dataset provides an overview on dental aspects in patients with dementia in nursing homes. The accuracy of the assessment of a given dental situation by nursing staff is to be questioned. The results indicated an underdetection of oral illnesses by nurses.

Interrater reliability and concurrent validity of oral/dental items in the resident assessment instrument minimum data set 2.0.

OBJECTIVE: To examine interrater reliability and concurrent validity of oral/dental items in the Resident Assessment Instrument Minimum Data Set (RAI-MDS) 2.0. BACKGROUND: RAI-MDS is a standardised instrument used in nursing to determine health status and nursing needs. The extent to which oral/dental items in the RAI-MDS describe dental treatment needs concerning oral health has been questioned. MATERIALS AND METHODS: This study evaluated the interrater reliability (dentist vs. nurse) and validity of oral/dental items in the Swiss version of RAI-MDS 2.0 (areas: K-nutritional status, L-oral/dental status) using professional oral examinations as a benchmark. Data of 168 residents of five long-term care facilities in the canton of Zurich, Switzerland, were collected within 1 year between October 2017 and December 2018. The statistical evaluation used descriptive statistics and Cohen's kappa (95% CI). RESULTS: RAI-MDS items K1a, chewing (κ 0.098, 95% CI: 0.004-0.19); K1c, pain (κ 0.039, 95% CI: -0.03 to 0.11); L1a, debris (κ 0.117, 95% CI: 0.02-0.21); L1c, dental status (κ 0.229, 95% CI: 0.12-0.34); L1d, dental disease (κ 0.129, 95% CI: 0.02-0.24); L1e, periodontal diseases (κ -0.005, 95% CI: -0.07 to -0.03); and L1f, daily cleaning (κ -0.031, 95% CI: -0.05 to -0.01) showed weak or no agreement, whereas L1b, denture status (κ 0.634, 95% CI: 0.52-0.75), showed substantial agreement. CONCLUSION: Oral/dental items in RAI-MDS lack reliability and validity. Recognition of oral health situation/treatment needs by nursing staff does not seem to be possible with the current version of this tool.

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland.

BACKGROUND: Life expectancy of people with permanent disabilities has increased. The dental care of these vulnerable patients is one of the greatest challenges for the dentist and the dental team due to limited or non-existent cooperation and the associated lack of health competence. In order to be able to provide safe and acceptable, quality dental treatment without psychological and physical stress for these patients, it is therefore necessary to resort to sedation or general anaesthesia (GA) under medical supervision. The aim of the analysis is to highlight the need for dental treatment performed under GA for people with disabilities and the associated indications and treatment patterns. METHODS: Ten-year retrospective analysis of outpatient dental care under GA for people with disabilities. RESULTS: Of all adult patients (n = 221) who attended the GA pre-assessment, 69.7% (n = 154) received dental treatment under GA based on the clinical findings or in cases of suspected pain. Most patients received one GA. A total of 205 dental treatment sessions were performed under GA mostly for conservative (n = 442, 52%) and surgical (n = 389, 45.8%) procedures. Endodontic treatment (n = 19, 2.2%) was rare. The failure rate related to all teeth in need of treatment (n = 850) was 5.1% (n = 43), in most cases due to secondary caries (n = 40; 93.0%). Patients were enrolled in an annual recall for dental examination and prophylaxis without GA. Non-compliant patients for whom oral hygiene was impossible received a periodic GA. CONCLUSION: There is a high need of people with disabilities for dental treatment under GA. Main indications for treatment under GA are dental complaints, pain or suspected pain. Dental care can be successful if, for the benefit of patients with special needs, all carers cooperate closely. Caregivers have to be trained in nutrition control as well as in oral hygiene. These factors in conjunction help to prevent dental emergencies.

Attitudes of German undergraduate dental students towards the aged.

OBJECTIVE: To describe attitudes towards the aged and changes in attitudes of dental students during their participation in an undergraduate gerodontology programme. BACKGROUND: Attitudes of dentists have been shown to influence their willingness to provide dental services to the aged. METHODS: A questionnaire was administered to 160 (50 men) dental students at Leipzig University aged 19.2-30.5 (mean, 21.7; SD, 2.3) years before entering (T1) and when completing (T2) a gerodontology course. A definition of being young and old and of hopes and fears associated with age was requested. The semantic ageing differential (SAD) was used to measure the students' attitudes towards the aged in three categories. Statistical analysis comprised mean age definitions by gender and mean scores of the SAD at T1 and T2. RESULTS: Old age was defined as beginning between 56 and 64 years. Female students at T1 regarded a woman as young up to 35.8 years, for male students a woman was young only up to 33.5 years. Male students consider men as old from 60.1 years and women 4.4 years earlier from 55.7 years. Old age fears related mainly to impairment of health and loss of relatives. Hopes for relaxation, rest and serenity were paramount. The SAD results were near neutral in all three dimensions. Minor changes between T1 and T2 occurred. CONCLUSION: Students' attitudes were well balanced. Specific barriers to the provision of dental care to the aged emanating from dental students' negative attitudes or fears were not identified. Changes in attitudes occurring during the course appeared small.

Development of undergraduate gerodontology courses in Austria, Switzerland, and Germany from 2004 to 2009.

The growing number of individuals over the age of sixty-five with specific dental needs requires increased teaching efforts to adequately prepare predoctoral dental students. The study assessed whether such increases in undergraduate gerodontology teaching in German-speaking countries between 2004 and 2009 occurred. Questionnaires were mailed in 2004 and 2009 to all deans (n=37) and all department heads (n=140) of Austrian, Swiss, and German dental schools. Results show that gerodontology is still mostly included in traditional core subjects but that specific lecture series and practical teaching have increased. These cover a broad variety of subjects including geriatric medicine, gerontopsychiatry, nursing care, pharmacology, and public health. The number of departments with dedicated staff for gerodontology, research activities, and mean number of publications has increased. Barriers to the further integration of the subject include its continued exclusion from final examinations in Austria and Germany. Guidelines of the European College of Gerodontology (2009), which aim to prepare students to provide dental treatment to seniors by teaching theoretical knowledge, practical skills, patient management techniques, and the ethical foundation of gerodontology, need to be implemented. Continued professional education of faculty in all departments, intensified cooperation between universities, and the presence of faculty specializing in gerodontology are suggested.

Oral health of seafarers - a review.

BACKGROUND: Poor oral health of seafarers is known to cause pain and suffering for individuals and logistical complications for shipping companies during voyages. The aim of the study was to discuss the oral health of seafarers against the backdrop of available publications. MATERIAL AND METHODS: A systematic review of all literature listed in PubMed up to August 2010 plus a hand search analysing origin of article, target group, data presented, and recommendations given. Excluded were papers on forensic dental identification and papers on mercy ships. RESULTS: Most articles deal with oral health issues in the military, are published in English, and originate from the US or Great Britain. Screening systems, organisation of dental services, and the provision of dental treatment ashore and aboard are dominant themes. Papers dealing with the merchant navy, fishing vessels, and cruise ships crews mostly present basic epidemiological data, focus on oral health at sea, and originate from industrialised countries. The growing numbers of cruise ship passengers is the subject of seven studies. Generally, dental care offered to navy crews appears more comprehensive than that offered to civilian crews. CONCLUSIONS: The research base needs to be expanded to cover all seafarers. Dental professional expertise should be sought in policy and guideline development relevant to oral health. A strategy comprising preventive, screening, and treatment service components should be developed and a certificate of dental health introduced. Funding strategies in a complex environment of transnational stakeholders for the improvement of oral-health services for seafarers are needed. Aspects of military oral health care systems could be an example for civilian operators.

Dental care of frail older people and those caring for them.

AIMS AND OBJECTIVES: To describe oral health utilisation patterns of frail older people and contrast these with attitudes and utilisation patterns of nursing staff who are caring for them. BACKGROUND: In view of widespread poor oral health of frail older people in long-term care, staff attitudes have been identified as an area of interest. In addition to data on attitudes, the current study contributes a description of aspects of oral health related behaviour of staff and clients. DESIGN: Cross-sectional study. METHODS: Structured interviews of a random selection of long-term care staff (n=320) and frail older people (n=172), within the two groups of home-care services (HCS) and long-term care facilities (LTCF). RESULTS: Of staff members, 55·3% attach the same importance to their own oral health compared to that of clients and 35·7% regard their own oral health as more important; 98·4% of staff attended two or more dental examinations per year; 3·4% of HCS and 37·1% of LTCF routinely arranged oral examinations. In 81·4% HCS and in 34·4% of LTCF, there was no routine dental service available. Patterns of oral health service attendance greatly differ between staff and clients. CONCLUSION: The oral health awareness of the majority of long-term care staff did not translate into adequate oral health care for clients. A gap exists between attitudes supportive of oral health, adequate and prevention driven own oral health related behaviour of staff and actual oral health care delivered to clients. RELEVANCE TO CLINICAL PRACTICE: To bridge the gap identified, a concept is suggested for nursing educators and managers of LTCF targeting educational measures while taking into account individual attitudes.

Undergraduate teaching in gerodontology in Leipzig and Zürich--a comparison of different approaches.

OBJECTIVE: To evaluate undergraduate students' attitude towards the clinical components of the Leipzig (LPEG) and Zürich (ZPEG) Programmes of Education in Gerodontology. BACKGROUND: Undergraduate student education is the seedbed for conscientious professionals. Extramural clinical education contributes to the formation of positive attitudes. Students in Zürich participate in three clinical activities (in-house gerodontology clinic, extramural acute geriatrics ward, mobile dental service), in Leipzig they visit a long-term care facility on six occasions within 4 years. METHODS: A structured questionnaire with 10 items was administered to students in Leipzig [n = 34, 70.6% female, mean age 25.8 (SD 3.04) years] at the beginning and after completion of gerodontology training and to students in Zürich [n = 33, 48.5% female, mean age 27.0 (SD 3.28) years] on three occasions after clinical training. Students indicated the degree of their agreement with seven statements presented using a 5-point scale. A choice of responses which characterised the course was offered for assessment. RESULTS: Close collaboration with dental tutors, while self-treating patients in the mobile dental service (mobiDent) attracted the most positive responses. Ratings from students completing their training in Leipzig were less favourable than their initial responses. CONCLUSION: The lack of a dental service and Leipzig students' inability to offer treatment in the presence of disease was associated with frustrations. Practical training should go beyond dental examinations at a long-term care facility and include the opportunity for dental treatment. Personnel and equipment required for mobile treatment exceed resources available at most German dental schools.

Undergraduate education in gerodontology in Germany: the Leipzig Programme.

OBJECTIVE: To evaluate students' attitude towards the clinical component of the Leipzig Programme of undergraduate Education in Gerodontology (LPEG). BACKGROUND: Undergraduate student education has long been recognised as a mainstay of fostering the aims of gerodontology. Extramural clinical education with direct exposure to various groups of vulnerable elderly is known to contribute to the formation of positive attitudes. LPEG has been designed to include didactic components and six visits to a long-term care facility (LTC) spread over 4 of the 5 years of the dental course. METHODS: A structured questionnaire with 10 items was administered to 230 students (60.9% female) on three occasions in 2004-05. Total return was 411 questionnaires. The mean age of respondents was 24.3 (SD 2.67) years. Students were asked to indicate the degree of their agreement with seven statements presented using a 5-point scale. A choice of responses which characterised the course was offered to mark all those deemed agreeable. RESULTS: The vast majority of students responded positively. In the students perception there was no significant difference (Kruskal-Wallis p = 0.24) in the amount of knowledge acquired between subjects participating once, twice or three times. 'Interesting' and 'feel pity for patients' were the two items that received the most support. Respondents expressed the wish to accompany up to 10 patients during their course with a mean of 3.5 (SD 2.9) but 31 (7.5%) subjects did not wish to see any frail elderly patients at all. CONCLUSION: The LPEG is well received by dental students. A complex subject including overarching social skills has been integrated seamlessly into the dental curriculum.

Cruise medicine: the dental perspective on health care for passengers during a world cruise.

BACKGROUND: Although more than 100 million passengers have taken a cruise since 1980, it is not known what dental treatment needs occur at sea. METHODS: The routine dental documentation of a 2-month period at sea on a cruise ship carrying 1,619 passengers was analyzed. The subjects for the study were 57 passengers (3.5% of 1,619), with a mean age of 71 years (+/-9.8 y). Age, gender, number of natural teeth and implants, prosthetic status, diagnosis, treatment performed, percentage of emergency and routine procedures, number of appointments, duration of appointment, time since last visit to the dentist, and cabin category as indicator of socioeconomic status were extracted. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile. RESULTS: Passengers had a mean number of 20 natural teeth plus substantial fixed and removable prosthodontics. Emergency dental treatment accounted for 97% of the chairside time. The three most frequent emergency diagnoses were defective restorations (36%), pulpal disease (20%), and defective prosthesis and caries (both 11.5%). Common emergency therapies provided were complex surgical-prosthodontic rehabilitation, various endodontic treatments, and extractions. Per 1,000 persons/month, passengers required 21.6 emergency plus 2.5 routine appointments; 49% of passengers had seen a dentist within 3 months before going to sea. CONCLUSIONS: Passengers do attend their dentist for routine care/checkups before the voyage, yet experience complex dental emergencies. This is due to the presence of a high number of restorations that fail unexpectedly. Some failures are so severe that they would have forced the passenger to abort the cruise had there been no dental service available. The ease of access to quality dental care may explain the relatively low level of perceived problems as characterized by OHRQoL scores.

Dental practice during a world cruise: treatment needs and demands of crew.

AIMS: To describe dental treatment needs and demands of crew on a cruise ship during a world cruise. METHODS: The routine dental documentation of a two months period at sea on a cruise ship carrying 999 crew was analysed. Age, gender, diagnosis, treatment performed, percentage of emergency and routine procedures, number of appointments, duration of appointment and time since last visit to the dentist were recorded. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile. RESULTS: Subjects were n = 56 crew with a mean age of 37 (+/- 12.0) years. Out of 114 patient contacts n = 29 (25%) were for emergency treatment. Caries and its sequelae accounted for 85% of time spent treating emergencies and 50% of routine treatment time. The two most frequent treatment options during emergency appointments were extractions and endodontics. In routine cases fillings and periodontal treatment were dominating. Per 1000 persons per month crew required 14.5 emergency plus 42.5 routine appointments. 80 % of crew had seen a dentist within 12 months before their shipboard dental appointment. Oral health-related quality of life was most impaired in case of emergency patients with a particular emphasis on the diagnosis of pulpal disease. CONCLUSION: High numbers of dental emergencies largely due to caries indicated that International Labour Organisation (ILO) recommendations requiring seafarers to be dentally fit were not adhered to. It is suggested that some doctors performing pre-sea medical examinations may not adequately diagnose caries. A pre-sea examination by a dental professional has the potential to reduce the number of emergency port referrals to dentists. Treatment costs and attitude to preventive dental care were identified as barriers impeding the access of low-wage crew to the ship's dental clinic. Cosmetic dentistry and prophylaxis attracted those crew with an interest in prevention and the ability to pay the fees. In large cruise ships there is a substantial demand for both emergency and routine dental care among crew.

Dental practice during a world cruise: characterisation of oral health at sea.

AIMS: To describe oral health of passengers and crew attending the dental service aboard during a two months world cruise. METHODS: In a retrospective, descriptive epidemiologic study design the routine documentation of all dental treatment provided at sea was analysed after the voyage. Subjects were n = 57 passengers (3.5 % of 1619) with a mean age of 71 (+/- 9.8) years and n =56 crew (5.6 % of 999) with a mean age of 37 (+/- 12.0) years. Age, gender, nationality, number of natural teeth and implants were extracted. The prosthetic status was described by recording the number of teeth replaced by fixed prosthesis and number of teeth replaced by removable prosthesis. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile (OHIP-14) and characterised by the OHIP sum score. RESULTS: Women attended for treatment more often than men. Passengers had a mean number of 20 natural teeth plus substantial fixed and removable prosthodontics. Crew had a mean of 26 teeth. British crew and Australian passengers attended the dental service above average. Crew tended to have a higher average OHIP-14 sum score than passengers indicating an increased rate of perceived problems. Emergency patients from both crew and passengers have a higher sum score than patients attending for routine treatment. CONCLUSION: In passengers the average number of teeth appears to be higher than that of an age matched population of industrialized countries. However, the passengers' socioeconomic status was higher which has an effect on this finding. Socioeconomic factors also serve to explain the high standard of prosthetic care in passengers. Crew in general present with less sophisticated prosthetic devices. This is in line with their different socioeconomic status and origin from developing countries. The level of dental fees aboard in comparison to treatment costs in home countries may explain some of the differences in attendance. Passengers have enjoyed high standards of prosthetic care in the past and will expect a similarly high standard from ship based facilities. The ease of access to quality dental care may explain the relatively low level of perceived problems as characterised by oral health-related quality of life scores. The dental officer aboard has to be prepared to care for very varied diagnostic and treatment needs.