The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review.

With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed.

Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomised clinical trial.

OBJECTIVE: Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents. METHOD: Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute. RESULTS: Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level. CONCLUSION: Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.

Dental clinicians recognizing signs of dental anxiety: a grounded theory study.

INTRODUCTION AND OBJECTIVE: There is a knowledge gap in how dental clinicians recognise dental anxiety. The aim of this study was to identify, describe and generate concepts regarding this process. MATERIALS AND METHODS: Eleven semi-structured interviews were conducted with dental clinicians from the public dental service of Östergötland, Sweden. Purposive and theoretical sampling was used. Theoretical saturation was reached after eight interviews. The interviews were audio-recorded and transcribed verbatim. Classical grounded theory was used to inductively analyse data by constant comparative analysis. RESULTS: The core category was identified as; 'the clinical eye', clinicians noticing behaviours possibly due to dental anxiety based on their knowledge, experiences, or intuition. The core category comprises the five categories: Sympathetic activation, Patient-reported anxiety, Controlling behaviours, Avoidance and Accomplishment. Initially there is usually uncertainty about whether a behaviour is due to dental anxiety or part of a patient's normal behaviour. To gain additional certainty, clinicians need to recognise a stressor as something in the dental setting by observing a change in behaviour, for better or for worse, in the anticipation, presence or removal of the stressor. CONCLUSIONS: Clinicians identify patients as dentally anxious if their behaviour changes with exposure to a stressor.

Oral Care Cards as a Support in Daily Oral Care of Frail Older Adults: Experiences and Perceptions of Professionals in Nursing and Dental Care-A Qualitative Study.

Frail older adults often have poor oral health. In Sweden, oral care cards are designed to be used as an interprofessional tool for documenting the oral health status of older adults with extensive care needs and to describe oral care recommendations. The aim of this study was to explore nursing and dental professionals' experiences and perceptions of oral care cards. Nursing and dental care staff were interviewed in groups or individually. The recorded data were transcribed verbatim and analyzed using qualitative content analysis. A theme emerged: Navigating an oral care responsibility that is not anchored in the nursing and dental care context. The theme was elucidated in three categories: "Accessibility and usefulness", "Coordination between nursing and dental care", and "Ethical approach". The participants perceived a lack of surrounding frameworks and collaboration concerning oral care and the use of oral care cards. An oral care card could ideally facilitate interprofessional and person-centered oral care. However, oral health does not seem to have found its place in the nursing care context. Further research is needed to investigate how oral care cards ought to be developed and designed to support oral health care work.

The Relation between Masticatory Function and Nutrition in Older Individuals, Dependent on Supportive Care for Daily Living.

INTRODUCTION: Associations between masticatory function and nutritional status have been suggested. Masticatory function can be divided into two subdomains, the objective capacity of an individual to mix solid food and the individual's subjectively assessed ability to masticate solid food. AIM: The aims of this study were to assess the relationship between these subdomains and nutritional variables in older, care-dependent individuals. MATERIALS AND METHODS: From a group of 355 individuals with care dependency and functional limitations, individuals aged 60 and older were selected. By home visits, the subjects underwent an oral examination and answered chewing related questions. Nutritional status was assessed using the Mini Nutritional Assessment. A total of 196 individuals met the age requirement of 60 years or older. Of these, 86 subjects were able to answer the questions. RESULTS: We could not find any concluding significant associations between the subdomains of masticatory function or the nutritional variables. CONCLUSIONS: The absence of associations could be explained by the lack of standardized and validated methods to assess masticatory function and they possibly reflect varying underlying constructs. Self-reported questionnaires seem less useful among older and care-dependent individuals, while an objective clinical measurement will be needed when evaluating masticatory function.

Oral health care beliefs among care personnel working with older people - follow-up of oral care education provided by dental hygienists.

OBJECTIVES: The proportion of older people in the population is increasing rapidly. Along with this comes an increase in the number of people requiring assistance in daily living, including oral care. Swedish law stipulates that care personnel who work with older people should be offered oral health education every year. The aim of this study was to investigate oral health care beliefs among such personnel. METHODS: A questionnaire study was conducted among 2167 personnel providing care to older people at special accommodation sites and in home care. Data were collected using the Nursing Dental Coping Beliefs Scale. Descriptive statistics were calculated and logistic regression analysis was performed. RESULTS: Personnel working in home care had lower odds of having an internal locus of control than those working in special accommodation, and personnel with less than 10 years of working experience had lower odds than their more experienced counterparts. Men had higher odds of having an external locus of control than women. CONCLUSIONS: It seems important to ensure that home care personnel and less experienced personnel attend oral care educational sessions, and to encourage male staff to focus on oral care work.

Masticatory ability in older individuals: A qualitative interview study.

AIM: To explore older individuals' experienced masticatory ability and the impact of masticatory ability in daily life. MATERIAL AND METHODS: This study applied an open-ended exploratory approach using inductive reasoning. The design was inspired by the qualitative method grounded theory. The final sample consisted of twelve older participants. Seven were men, and five were women. The interviews were audio-recorded and transcribed verbatim. The interviewer successively read the transcribed data and analysed the material in cooperation with the authors. RESULTS: Three categories developed from the data; Deteriorating oral health and functional loss, Eating habits, Prosthetic rehabilitation and function. A core category named Adaptation emerged. Adaptation describes how individuals successfully could adapt to a decreased function and in spite of this develop a positive view of their masticatory ability. DISCUSSION: The participants described an experience of gradually deteriorating oral function that had affected their masticatory ability. By adapting to this functional degradation, some of the participants overcame the functional deficiencies. Most participants perceived their masticatory ability to be good, even though their ability to process some food types was described as inadequate. CONCLUSION: The participants had experienced deteriorating oral health and function throughout life, and they overcame this through adaptation by adjusting their eating habits. Even though prosthetic treatment might be considered successful by the participant, this does not necessarily improve dietary habits. Future research should therefore focus on how dental treatment can be combined with other interventions, such as dietary counselling and physiotherapy to recover physiological function.

Use of online knowledge base in primary health care and correlation to health care quality: an observational study.

BACKGROUND: Evidence-based information available at the point of care improves patient care outcomes. Online knowledge bases can increase the application of evidence-based medicine and influence patient outcome data which may be captured in quality registries. The aim of this study was to explore the effect of use of an online knowledge base on patient experiences and health care quality. METHODS: The study was conducted as a retrospective, observational study of 24 primary health care centers in Sweden exploring their use of an online knowledge base. Frequency of use was compared to patient outcomes in two national quality registries. A socio-economic Care Need Index was applied to assess whether the burden of care influenced the results from those quality registries. Non-parametric statistical methods and linear regression were used. RESULTS: Frequency of knowledge base use showed two groups: frequent and non-frequent users, with a significant use difference between the groups (p < 0.001). Outcome data showed significant higher values for all seven National Primary Care Patient Survey dimensions in the frequent compared to the non-frequent knowledge base users (p < 0.001), whereas 10 out of 11 parameters in the National Diabetes Register showed no differences between the groups (p > 0.05). Adjusting for Care Need Index had almost no effect on the outcomes for the groups. CONCLUSIONS: Frequent users of a national online knowledge base received higher ratings on patient experiences, but figures on health care quality in diabetes showed near to no correlation. The findings indicate that some effects may be attributed to the use of knowledge bases and requires a controlled evaluation.

Effects of Domiciliary Professional Oral Care for Care-Dependent Elderly in Nursing Homes - Oral Hygiene, Gingival Bleeding, Root Caries and Nursing Staff's Oral Health Knowledge and Attitudes.

PURPOSE: The primary aim was to describe the effects for nursing home residents of monthly professional cleaning and individual oral hygiene instruction provided by registered dental hygienists (RDHs), in comparison with daily oral care as usual. The secondary aim was to study the knowledge and attitudes among nursing staff regarding oral health care and needs. PATIENTS AND METHODS: In this randomised controlled trial (RCT), 146 residents were recruited from nine nursing homes in Regions of Stockholm and Sörmland and were randomly assigned (on nursing home level) to either intervention group (I; n=72) or control group (C; n=74). Group I received monthly professional cleaning, individual oral hygiene instructions and information given by an RDH. Group C proceeded with daily oral care as usual (self-performed or nursing staff-assisted). Oral health-related data was registered with the mucosal-plaque score index (MPS), the modified sulcus bleeding index (MSB), and root caries. The nursing staff's attitudes and knowledge were analysed at baseline and at six-month follow-up. Statistical analysis was performed by Fisher's exact test and two-way variance analysis (ANOVA). RESULTS: Improvements were seen in both Group I and Group C concerning MPS, MSB and active root caries. The nursing staff working with participants in Group I showed significant improvements regarding the Nursing Dental Coping Beliefs Scale (DCBS) in two of four dimensions, oral health care beliefs (p=0.0331) and external locus of control (p=0.0017) compared with those working with Group C. The knowledge-based questionnaire showed improvement (p=0.05) in Group I compared with Group C. CONCLUSION: Monthly professional oral care, combined with individual oral health care instructions, seems to improve oral hygiene and may reduce root caries among nursing home residents. This may also contribute to a more positive attitude regarding oral hygiene measures among nursing home staff, as compared with daily oral care as usual.

The relation of poor mastication with cognition and dementia risk: a population-based longitudinal study.

We investigated the effect of poor masticatory ability on cognitive trajectories and dementia risk in older adults. 544 cognitively intact adults aged ≥50 were followed for up to 22 years. Cognitive domains (verbal, spatial/fluid, memory, and perceptual speed) were assessed at baseline and follow-ups. Dementia was ascertained according to standard criteria. Masticatory ability was assessed using the Eichner Index and categorized according to the number of posterior occlusal zones: A (all four), B (3-1), and C (none).At baseline, 147 (27.0%) participants were in Eichner category A, 169 (31.1%) in B and 228 (41.9%) in C. After the age of 65, participants in Eichner category B and C showed an accelerated decline in spatial/fluid abilities (ß: -0.16, 95% CI: -0.30 to -0.03) and (ß: -0.15, 95% CI: -0.28 to -0.02), respectively. Over the follow-up, 52 incident dementia cases were identified. Eichner categories B or C were not associated with an increased risk of dementia, compared to category A (Hazard Ratio [HR]: 0.83, 95% CI: 0.39 to 1.76 and HR: 0.63, 95% CI: 0.30 to 1.29, respectively).Poor masticatory ability is associated with an accelerated cognitive decline in fluid/spatial abilities, however it was not related to a higher risk of dementia.

Discussing elder abuse and neglect in undergraduate dental education: a commentary.

The intra- and extra-oral signs of physical abuse and neglect can appear visible to a dental professional during routine care. Yet, little is known about the existing pedagogies employed to discuss elder abuse and neglect in undergraduate dental education and the level of knowledge undergraduate dental students have about elder abuse and neglect. The purpose of this commentary is to present a literature review exploring how the subject of elder abuse and neglect is taught in dental schools and to discuss the results of a brief knowledge-based questionnaire focused on elder abuse and neglect applied to Canadian undergraduate dental students.

Quality of life related to tooth loss and prosthetic replacements among persons with dependency and functional limitations.

Objectives: To examine if tooth loss or treatment with different prosthetic replacements are associated with oral health-related or health-related quality of life (OHRQoL or HRQoL) among persons with dependency and functional limitations.Material and Methods: Comparisons between results of questionnaires and clinical data (number of teeth, Eichner index, presence, type, and condition of prosthetic replacements) from a population of 180 individuals with dependency and functional limitations sampled from the register of increased financial support in Norrbotten County, Sweden.Results: The associations between clinical variables and the questionnaire responses were weak overall, e.g. Spearman's rho was 0.162 (p = .033) for correlation between number of teeth and GOHAI, 0.094 (p = .249) for number of teeth and OHIP, -0.070 (p = .356) for complete dentures and GOHAI, and -0.108 (p = .185) for complete dentures and OHIP.Conclusions: The weak associations between clinical variables and questionnaire results in the present study suggest that good results on measured QoL do not necessarily indicate good oral health. As we cannot expect this specific population to report oral disorders by themselves, regular check-ups are necessary.

Evaluation of the ability of dental clinicians to rate dental anxiety.

The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of Östergötland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients' levels of dental anxiety on a Visual Analogue Scale. The correlation (rs ) between the clinicians' and patients' ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians' and patients' ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians' confidence and their ability to rate a patient's dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self-assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.

Systematic review of measurement properties of methods for objectively assessing masticatory performance.

The objectives of this study is to identify methods for objectively assessing masticatory performance (MP) and to evaluate their measurement properties. A secondary objective was to identify any reported adverse events associated with the methods to assess MP. Bibliographic databases were searched, including MEDLINE, Embase, Web of Science Core Collection, Cochrane, and Cinahl databases. Eligible papers that satisfied predefined inclusion and exclusion criteria were appraised independently by two investigators. Four other investigators independently appraised any measurement properties of the assessment method according to the consensus-based standards for the selection of health measurement instruments checklist. The qualities of the measurement properties were evaluated using predefined criteria. The level of evidence was rated by using data synthesis for each MP assessment method, where the rating was a product of methodological quality and measurement properties quality. All studies were quality assessed separately, initially, and subsequently for each method. Studies that described the use of identical assessment method received an individual score, and the pooled sum score resulted in an overall evidence synthesis. The level of evidence was synthesized across studies with an overall conclusion, that is, unknown, conflicting, limited, moderate, or strong evidence. Forty-six out of 9,908 articles were appraised, and the assessment methods were categorized as comminution (n = 21), mixing ability (n = 23), or other methods (n = 2). Different measurement properties were identified, in decreasing order construct validity (n = 30), reliability (n = 22), measurement error (n = 9), criterion validity (n = 6), and responsiveness (n = 4). No adverse events associated with any assessment methods were reported. In a clinical setting or as a diagnostic method, there are no gold standard methods for assessing MP with a strong level of evidence for all measurement properties. All available assessment methods with variable level of evidence require lab-intensive equipment, such as sieves or digital image software. Clinical trials with sufficient sample size, to infer trueness and precision, are needed for evaluating diagnostic values of available methods for assessing masticatory performance.

Repetitive Saliva Swallowing Test: Norms, Clinical Relevance and the Impact of Saliva Secretion.

Screening tests can be performed to identify stroke patients who require further assessment of swallowing function. The Repetitive Saliva Swallowing Test (RSST) is a screening test during which the patient is asked to swallow saliva as many times as possible for 30 s, while deglutition is counted through palpation of the larynx. This study aimed to establish normative values for three age groups of non-patients (total N = 120) on RSST. One patient group (N = 40) was also recruited from a geriatric stroke unit to assess whether RSST scores predicted outcomes on the Standardised Swallowing Assessment-Svenska (SSA-S), a clinical screening tool here used as a reference test. Since the RSST involves the swallowing of saliva, this study also measured the participants' saliva secretion in order to examine its effect on RSST performance. This study showed that RSST results vary with age (lower among older) and gender (higher for men than women), while the number of doctor-prescribed medications, objective saliva secretion and self-assessed dryness of mouth did not affect the performance significantly. In comparison to a more extensive clinical screening procedure (SSA-S), the RSST correctly predicted 93% of negative cases and 69% of positive cases. This suggests that patients who show signs of aspiration according to SSA-S have a lower probability of detection with RSST.

Oral health and dental care of older persons-A systematic map of systematic reviews.

OBJECTIVES: To examine the current knowledge on oral health status and dental care of older persons through a systematic mapping of systematic reviews of low or moderate risk of bias. BACKGROUND: Geriatric dentistry covers all aspects of oral health and oral care of older persons. Oral health is part of general health and contributes to a person's physical, psychological and social wellbeing. METHODS: A literature search was performed in three different databases (PubMed, The Cochrane Library and Cinahl) within 12 domains: Dental caries, periodontitis, Orofacial pain and temporomandibular joint (TMJ) pain, mucosal lesions, oral motor function, dry mouth, halitosis, interaction between oral status and other medical conditions, ability to interrelate and communicate, quality of life, ethics and organisation of dental care for older persons. Systematic reviews were identified and scrutinised, highlighting scientific knowledge and knowledge gaps. RESULTS: We included 32 systematic reviews of which 14 were judged to be of low/moderate risk of bias. Most of the domains lack systematic reviews with low or moderate risk of bias. In two of the domains evidence was identified; in institutionalised people aged 65 or older, effective oral hygiene can prevent pneumonia. Furthermore, there is an evidence of a relationship between malnutrition (protein energy-related malnutrition, PEM) and poor appetite and edentulousness. CONCLUSIONS: There is an urgent need for further research and evidence-based knowledge within most domains in geriatric dentistry and in other fields related to oral health and dental care for older persons striving for multi-disciplinary research programmes.

Tooth loss is associated with accelerated cognitive decline and volumetric brain differences: a population-based study.

Tooth loss has been related to cognitive impairment; however, its relation to structural brain differences in humans is unknown. Dementia-free participants (n = 2715) of age ≥60 years were followed up for up to 9 years. A subsample (n = 394) underwent magnetic resonance imaging at baseline. Information on tooth loss was collected at baseline, and cognitive function was assessed using the Mini-Mental State Examination at baseline and at follow-ups. Data were analyzed using linear mixed effects models and linear regression models. At baseline, 404 (14.9%) participants had partial tooth loss, and 206 (7.6%) had complete tooth loss. Tooth loss was significantly associated with a steeper cognitive decline (ß: -0.18, 95% confidence interval [CI]: -0.24 to -0.11) and remained significant after adjusting for or stratifying by potential confounders. In cross-sectional analyses, persons with complete or partial tooth loss had significantly lower total brain volume (ß: -28.89, 95% CI: -49.33 to -8.45) and gray matter volume (ß: -22.60, 95% CI: -38.26 to -6.94). Thus, tooth loss may be a risk factor for accelerated cognitive aging.

Oral Status and Prosthetic Treatment Needs in Functionally Impaired and Elderly Individuals.

PURPOSE: The purpose of this cross-sectional study was to describe the oral status and prosthetic treatment needs of dependent, functionally impaired individuals and dependent elderly individuals in comparison with the general population. METHODS: A total of 355 subjects, sampled from the register of increased financial support for dependent and functionally impaired individuals in the north of Sweden, were examined. The variables were number of teeth, Eichner Index, type and condition of prostheses, and treatment needs. Statistical analyses were carried out using an independent samples t test for means and chi-square tests for proportions. Comparisons were made with the results of an earlier study (EPI-Norr) of 908 patients from the general population in the same county. RESULTS: The study group had fewer teeth compared with the general population (20% edentulous in the study group vs 7% in the general population; P < .001), as well as more dentures and fewer tooth- and implant-supported prostheses. A total of 42% of the dentures in the maxilla and 51% of the dentures in the mandible were in poor condition. There was no difference in complications from dental implants between the groups. CONCLUSION: Since the Swedish system for financial support enables dental care to the patient groups in question, the situation is probably better in Sweden than in many other countries. As more accentuated differences can be assumed between these population groups in other countries, these findings are also interesting from an international perspective.

Methods for objectively assessing clinical masticatory performance: protocol for a systematic review.

BACKGROUND: Chewing and masticatory function constitutes one of the most important oral health factors that affect quality of life, especially in older individuals. Little consensus currently exists regarding ways to objectively assess clinical masticatory performance (in this context, performance refers an individual's objective ability to mix or comminute food bolus). That said, many methods were developed to assess masticatory performance. Consequently, systematic review of the literature would be of great value when it comes to identifying various methods for objectively assessing clinical masticatory performance and for evaluating these methods. DESIGN: This study protocol describes a systematic review that intends to (i) identify methods to objectively assess clinical masticatory performance and (ii) evaluate psychometric properties (such as validity and reliability) of the identified methods. A systematic literature search is required to do so in these sources: MEDLINE (Ovid), Embase (embase.com), Web of Science Core Collection (Thomson Reuters), Cochrane (Wiley), and Cinahl (Ebsco). INCLUSION CRITERIA: studies in scientific, full-text articles; development articles; validation articles; studies of the general adult population, ages ≥18. EXCLUSION CRITERIA: topics and article types that cover interview methods and self-reported questionnaires; methods/instruments that measure subjective masticatory performance; qualitative studies and case studies; opinion and editorial pieces; animal studies; studies of humans with severe oral health complications. DISCUSSION: This systematic review will result in a comprehensive assessment of various methods designed to objectively measure clinical masticatory performance. This systematic review will rate these methods, assess their reliability and validity, and identify one or more methods that can be recommended for use in clinical and scientific environments. From what is currently known, no systematic evaluation of various methods for objectively assessing clinical masticatory performance has been published. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016037700.