An Overview of Systemic Health Factors Related to Rapid Oral Health Deterioration among Older People.

The oral health of older individuals can be negatively impacted by various systemic health factors, leading to rapid oral health deterioration. This paper aims to present an overview of the published evidence on systemic health factors that contribute to rapid oral health deterioration in older individuals, and to explore the implications of these factors for both general healthcare and oral healthcare provision. Older people are at risk of experiencing adverse reactions to medications due to multimorbidity, polypharmacy, and changes in pharmacokinetics and pharmacodynamics. Hyposalivation, a significant side effect of some medications, can be induced by both the type and number of medications used. Frailty, disability, sarcopenia, care dependency, and limited access to professional oral healthcare can also compromise the oral health of older people. To prevent rapid oral health deterioration, a comprehensive approach is required that involves effective communication between oral healthcare providers, other healthcare providers, and informal caregivers. Oral healthcare providers have a responsibility to advocate for the importance of maintaining adequate oral health and to raise awareness of the serious consequences of weakened oral health. By doing so, we can prevent weakened oral health from becoming a geriatric syndrome.

Medications and addictive substances potentially inducing or attenuating sleep bruxism and/or awake bruxism.

Bruxism is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. It can occur during sleep, indicated as sleep bruxism, or during wakefulness, indicated as awake bruxism. Exogenous risk indicators of sleep bruxism and/or awake bruxism are, among others, medications and addictive substances, whereas also several medications seem to have the potential to attenuate sleep bruxism and/or awake bruxism. The objective of this study was to present a narrative literature on medications and addictive substances potentially inducing or aggravating sleep bruxism and/or awake bruxism and on medications potentially attenuating sleep bruxism and/or awake bruxism. Literature reviews reporting evidence or indications for sleep bruxism and/or awake bruxism as an adverse effect of several (classes of) medications as well as some addictive substances and literature reviews on medications potentially attenuating sleep bruxism and/or awake bruxism were used as starting point and guidelines to describe the topics mentioned. Additionally, two literature searches were established on PubMed. Three types of bruxism were distinguished: sleep bruxism, awake bruxism and non-specified bruxism. Generally, there are insufficient evidence-based data to draw definite conclusions concerning medications and addictive substances inducing or aggravating sleep bruxism and/or awake bruxism as well as concerning medications attenuating sleep bruxism and/or awake bruxism. There are insufficient evidence-based data to draw definite conclusions concerning medications and addictive substances inducing or aggravating sleep bruxism and/or awake bruxism as well as concerning medications attenuating sleep bruxism and/or awake bruxism.

Self-reported oral health in the Dutch 100-plus Study of cognitively healthy centenarians: an observational cohort study.

BACKGROUND: Due to improved healthcare, more people reach extreme ages. Oral health in the oldest-old has thus far been poorly described. Here, we investigated self-reported oral health factors, use of professional oral health care, and associations with clinical measures in centenarians considered cognitively healthy. METHODS: In this observational cohort study, we included 162 (74% female) centenarians from the Dutch 100-plus Study cohort who self-reported to be cognitively healthy, as confirmed by a proxy. Centenarians were questioned about their physical well-being including medication use and their cognitive functioning was evaluated using the Mini-Mental State Examination. Questions regarding oral health included preservation of teeth, oral pain or discomfort, chewing ability, xerostomia, and time since last visit to an oral health care provider. Associations between oral health and clinical measures were investigated with ordinal logistic or linear regression analyses, adjusted for gender, age, and education. RESULTS: The majority of the centenarians indicated to have good oral health: 76% felt no oral pain/discomfort, 65% indicated to chew well; while only 18% had symptoms of xerostomia. Of all centenarians, 83% were edentulous and were wearing removable complete maxillary and mandibular dental prostheses, 1% was edentulous with no dental prosthesis, while 16% was dentate with or without removable partial dental prostheses (10 and 6% respectively). Dentate and edentulous centenarians experienced similar levels of oral pain and/or discomfort, chewing ability, xerostomia, and their cognitive functioning was similar. No relationship between cognitive functioning and chewing ability was found. Xerostomia was associated with medication use (p = .001), which mostly regarded medications for cardiovascular diseases, diuretics, anti-coagulants, and antacids. Only 18% of the centenarians visited an oral health care provider during the year prior to the interview, of whom 48% were dentate centenarians. Notably, 49% of the centenarians had not visited an oral health care provider for ≥10 years. CONCLUSIONS: Most centenarians were edentulous and did not report oral complaints. Less than one-fifth of the centenarians continued to seek regular professional oral health care. Since the proportion of dentates in the oldest-old will increase in the near future, a proactive attitude toward this group is necessary.

Orofacial pain and its potential oral causes in older people with mild cognitive impairment or dementia.

BACKGROUND: The number of people with dementia and natural dentition is growing. As dementia progresses, the degree of self-care decreases and the risk of oral health problems and orofacial pain increases. OBJECTIVES: To examine and compare the presence of orofacial pain and its potential causes in older people with Mild Cognitive Impairment (MCI) or dementia. METHODS: In this cross-sectional observational study, the presence of orofacial pain and its potential causes was studied in 348 participants with MCI or dementia with all levels of cognitive impairment in two outpatient memory clinics and ten nursing homes. RESULTS: Orofacial pain was reported by 25.7% of the 179 participants who were considered to present a reliable pain self-report (Mini-Mental State Examination score ≥14 points), while it could not be determined in people with more severe cognitive impairment. The oral health examination of the 348 participants indicated that potential painful conditions, such as coronal caries, root caries, tooth root remnants or ulcers were present in 50.3%. There was a significant correlation between the level of cognitive impairment and the number of teeth, r = 0.185, P = 0.003, teeth with coronal caries, r = -0.238, P < 0.001, and the number of tooth root remnants, r = -0.229, P = 0.004, after adjusting for age. CONCLUSIONS: This study indicated that orofacial pain and its potential causes were frequently present in participants with MCI or dementia. Therefore, a regular oral examination by (oral) healthcare providers in people with MCI or dementia remains imperative, even if no pain is reported.

Oral Health of Parkinson's Disease Patients: A Case-Control Study.

The aim of the study was to examine the oral health status of Parkinson's disease (PD) patients, to compare their oral health status to that of a control group, and to relate it to the duration and severity of PD. Materials and Methods. 74 PD patients and 74 controls were interviewed and orally examined. Among PD patients, the duration and the Hoehn and Yahr stage (HY) of the disease were registered. Results. More PD patients than controls reported oral hygiene care support as well as chewing/biting problems, taste disturbance, tooth mobility, and xerostomia, whereas dentate patients had more teeth with carious lesions, tooth root remnants, and biofilm. Both longer duration and higher HY were associated with more chewing problems and, in dentates, more teeth with restorations. In dentates, longer duration of the disease was associated with higher number of mobile teeth. Higher HY was associated with more oral hygiene care support as well as biting problems and, in dentates, more teeth with carious lesions and tooth root remnants. Conclusions. Comparatively, PD patients had weakened oral health status and reduced oral hygiene care. Both duration and severity of the disease were associated with more oral health and hygiene care problems.

Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: A retrospective, cross-sectional study.

BACKGROUND: Nursing home-acquired pneumonia (NHAP) is a common infection among nursing home residents. There is also a high prevalence of dysphagia in nursing home residents and they suffer more often from comorbidity and multimorbidity. This puts nursing home residents at higher risk of (mortality from) NHAP. Therefore it is important to gain more insight into the incidence of NHAP and the associated medical conditions in nursing home residents with dysphagia. OBJECTIVE: To investigate possible associations between NHAP and dysphagia in nursing home residents and to search for a medical risk profile for NHAP. DESIGN: A retrospective cross-sectional study. SETTING: Three nursing homes in The Netherlands. PARTICIPANTS: 416 electronic medical files of nursing home residents aged 65 or older living in 3 nursing homes. METHODS: Data about age, gender, diagnosis of dysphagia and/or pneumonia, medical diagnosis and possible cause of death of the nursing home residents were extracted from electronic medical files. RESULTS: The data of 373 electronic medical files were analyzed. A significant difference in the prevalence of dysphagia was found between the nursing homes (p < 0.001). The incidence of NHAP was 5-12% in the participating nursing homes. Statistically significant higher incidence of NHAP was found in residents with dysphagia (p = 0.046). Residents with dysphagia had statistically significantly more diseases compared to residents without dysphagia (p = 0.001). Logistic regression analyses revealed no statistically significant associations between NHAP and the number of diseases and the ICD-10 diseases. CONCLUSIONS: Dysphagia was found to be a risk factor for NHAP. Awareness of the signs of dysphagia by nurses and other care providers is important for early recognition and management of dysphagia and prevention of NHAP.

Risks, consequences, and prevention of falls of older people in oral healthcare centers.

One-third of community-dwelling people older than 65 years of age fall each year, and half of them fall at least twice a year. Older care home residents are approximately three times more likely to fall when compared to community-dwelling older people. Risk indicators for falls are related to the older people's body, environment, behavior, and activities. An important health risk indicator is (orthostatic or postprandial) hypotension, which may induce cerebral hypoperfusion. Although the majority of falls remain without major consequences, 10% to 25% of falls in care homes result in bodily trauma. Prevalent fall-related injuries are brain injury, lower extremity fracture including hip fracture and forearm/wrist fracture, facial fracture, humeral fracture, and rib/scapular fracture. As fall accidents by older people can have severe consequences, prevention of falls is of paramount importance. Healthcare providers, including oral healthcare providers, should inform older people on risks of falling and draw attention to potentially hazardous arrangements.

Self-perceived halitosis influences social interactions.

BACKGROUND: To determine the impact of self-perceived halitosis on social interactions, and the effect of using an oral rinse for management of halitosis. METHODS: A survey among a representative sample of the Dutch population (n = 1082), and a pre-post study among a sample of consecutive coming-by volunteers (n = 292). RESULTS: Participants of the representative sample rated their oral odor as 66.8 ± 17.2 and the consecutive volunteers as 70.9 ± 16.7 (range: 0-100). Sizable proportions (15.3 % and 38.1 %, respectively) indicated to always take into account their (bad) oral odor when meeting a person for the first time. The worse people perceived their oral odor, the more likely they were to take into account to keep a certain distance. Following the use of the oral rinse, a significant decline was found of the extent to which the participants reported to take into account their oral odor when meeting a person for the first time. Both studies identified a subgroup of individuals (9.1 % and 28.1 % respectively) who reported to keep a certain distance when meeting other people, despite a "fresh" self-perceived oral odor. CONCLUSION: The results suggest that self-perceived oral odor negatively affects social interactions, and that adequate management of halitosis has the potential to improve such interactions.

Defining characteristics and risk indicators for diagnosing nursing home-acquired pneumonia and aspiration pneumonia in nursing home residents, using the electronically-modified Delphi Method.

BACKGROUND: In nursing home residents, it is not possible to distinguish pneumonia and aspiration pneumonia clinically. International literature reveals no consensus on which and how many characteristics and risk indicators must be present to diagnose (nursing home-acquired) pneumonia and aspiration pneumonia. The aim of this survey was to reach consensus among a panel of clinical medical experts in geriatrics and pulmonology about the characteristics required for diagnosing pneumonia, and about the risk indicators needed to consider the diagnosis aspiration pneumonia in nursing home residents with pneumonia. METHODS: Literature review and three expert-rating iterations using the electronically-modified Delphi Method were carried out. After each expert rating iteration, data analysis was performed. Qualitative responses and additional (nursing home-acquired) pneumonia characteristics which were mentioned in reply to structured open-ended questions were summarised, whilst similar responses were combined and these combinations were ordered by frequency in order to use them in the next iteration. Characteristics which failed to reach consensus were considered as inconclusive and eliminated. Consensus was reached when at least 70 % of the participants agreed. RESULTS: Literature review revealed 16 currently used common characteristics for diagnosing (nursing home-acquired) pneumonia. No consensus was reached about characteristics and the number of characteristics required for diagnosing (nursing home-acquired) pneumonia. However, 57 % agreed that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are the most important characteristics and the responses by the participants suggested that two or three characteristics should be present. Subsequently, 80 % of the participants agreed on the risk indicators dysphagia, choking incident, (history of) tube feeding, neurological disease and cognitive impairment for considering the diagnosis aspiration pneumonia in nursing home residents with pneumonia. CONCLUSIONS: No final consensus could be reached about which and how many characteristics are required for diagnosing pneumonia in nursing home residents. However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. With regard to considering aspiration pneumonia in nursing home residents with pneumonia, final consensus was reached about the risk indicators dysphagia, choking incident, (history of) tube feeding, neurological disease and cognitive impairment.

Opinions of dentists on the barriers in providing oral health care to community-dwelling frail older people: a questionnaire survey.

OBJECTIVE: The aim of this study was to investigate to what extent dentists in the Netherlands experience barriers in providing oral health care to community-dwelling older people. BACKGROUND: As most publications on the barriers in providing oral health care to older people consist of surveys on oral health care in care homes, it was decided to investigate the barriers dentists experience in their own dental practices while providing oral health care to community-dwelling frail older people. MATERIAL AND METHODS: A representative sample of 1592 of the approximately 8000 dentists in the Netherlands aged 64 or younger were invited to respond to a questionnaire online. The dentists were asked to respond to 15 opinions concerning oral healthcare provision to community-dwelling frail older people aged 75 years or more who experience problems in physical, psychological and social areas, as well as possible financial problems. RESULTS: The total response rate was 37% (n = 595; male=76%; average age 49). The majority of those who responded agreed that the reimbursement of oral health care to older people is poor. Two thirds of those who responded (66%) agreed that there are limited opportunities to refer the frail and elderly with complex oral healthcare problems to a colleague with specific knowledge and skills. CONCLUSION: Dentists experienced barriers in two domains; a lack of knowledge and practical circumstances. It was concluded that the dentist's gender, age, year of graduation and the number of patients aged 75 years or more treated weekly were in some respect, related to the barriers encountered.

Effect of daily application of a 0.05% chlorhexidine solution on the incidence of (aspiration) pneumonia in care home residents: design of a multicentre cluster randomised controlled clinical trial.

INTRODUCTION: Pneumonia is an important cause of death in care home residents. Dysphagia and poor oral health are significant risk factors for developing aspiration pneumonia. Oral hygiene care reduces the number of oral bacteria and the risk of aspiration pneumonia. However, it is not clear yet which oral hygiene care intervention is most efficacious in reducing the risk of aspiration pneumonia. The aim of the study is to assess whether the application of a 0.05% chlorhexidine-containing solution in addition to the usual daily oral hygiene care reduces the incidence of pneumonia in physically disabled care home residents with dysphagia. METHODS AND ANALYSIS: The study was designed as a multicentre cluster randomised controlled clinical trial, with care homes as units of randomisation. During 1 year, 500 physically disabled care home residents with dysphagia will be followed. The intervention consists of applying a 0.05% chlorhexidine-containing solution twice daily, immediately after the usual oral hygiene care, whereas the control group receives no application after the usual oral hygiene care. The primary outcome is the incidence of pneumonia diagnosed by a physician, using a set of strictly described criteria. The effect of the intervention on the incidence of pneumonia will be determined using a Cox regression analysis. The secondary outcomes are correlations between incidence of pneumonia, age, gender, diagnosed diseases, dysphagia severity, care dependency, actually used medication, number of teeth and implants present and the presence of removable dentures. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Medical Ethical Committee of Radboud university medical centre: NL.nr: 41990.091.12. Written and informed consent will be obtained from all participating care homes and residents. The study's findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: The trial has been registered in the Netherlands in the National Trial Register: TC=3515.

The integration of oral health care into day-to-day care in nursing homes: a qualitative study.

OBJECTIVE: This qualitative study explored barriers and enabling factors to the implementation of an oral hygiene protocol in nursing homes. BACKGROUND: Oral health care in nursing homes in Flanders (Belgium) is inadequate. MATERIALS AND METHODS: Qualitative data were obtained from nurses employed in 13 nursing homes involved in two randomised controlled trials in Flanders-Belgium. Data were collected by focus group and face-to-face interviews during April 2005 and December 2009. All transcripts were analysed with support of NVivo 8 (Version 2008). Transcripts were intuitively analysed in a two-step method. RESULTS: Most revealed barriers were consistent with previous findings in the literature. Newly reported barriers were respect for residents' self-determination, experience based oral health care by nurses, residents' oral health status and nurses' inability to notice residents' oral health status. Demand-driven oral health care was found to be a strong enabling factor. CONCLUSION: The integration of oral health care into day-to-day care seems to be a major problem due to a multitude of barriers. In future implementation innovations in oral health care an a priori assessment of influencing factors is recommended.

Risk of aspiration in care home residents and associated factors.

Pneumonia is a prevalent cause of death in care home residents. Dysphagia is a significant risk factor of aspiration pneumonia. The purpose of the current study was to screen for risk of aspiration in care home residents in the Netherlands and assess potential risk factors of aspiration. Five experienced speech-language therapists assessed 203 care home residents (115 primarily physically disabled, 88 primarily cognitively impaired) 60 and older in the first week after admission to a care home. In 43 (21.2%) residents, speech-language therapists assessed risk of aspiration and found no significant difference between physically disabled (26.1%) and cognitively impaired (14.8%) residents. After multivariate logistic regression analysis, the final prediction model for risk of aspiration showed Parkinson's disease as a significant factor (odds ratio = 5.11; 95% confidence interval [1.49, 17.52]) . The authors therefore conclude that risk of aspiration is a relevant care problem among Dutch care home residents and requires further assessment.

Diagnostics of halitosis complaints by a multidisciplinary team.

AIM: The study objective was to collect diagnostic data, to explore correlations between diagnostic variables, to provide an accurate initial diagnosis, and to provide appropriate management in consecutive subjects consulting with a multidisciplinary halitosis team because of a halitosis complaint. METHOD: Nine hundred and fifty-four subjects with halitosis complaints applied for consultation. Subjects' history data were collected and organoleptic measurements and a physical examination were performed. Finally, genuine halitosis or pseudo-halitosis/halitophobia was diagnosed initially and management was provided. RESULT: Genuine oral halitosis was diagnosed initially in 93% of cases. Using oral cleaning materials, performing mechanical tongue cleaning, and periodical dentist consultation were over-represented in women, whereas men were more likely to have observable biofilm and carious lesions than women. Female gender was associated with tongue coating. Positive associations were found between age and performing mechanical tongue cleaning, organoleptic measurement scores as well as poor oral health. Educational level was positively associated with oral self care behaviours. Performing mechanical tongue cleaning was not associated with periodical dentist consultation. CONCLUSION: In nearly all subjects complaining of halitosis, an oral cause could be detected.

Poor oral health, a potential new geriatric syndrome.

This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation constitutes a biological foundation of ageing and the onset of age-related diseases. Multimorbidity and polypharmacy, together with alterations in pharmacokinetics and pharmacodynamics, make older people at risk of adverse medication reactions. A side effect of several medications is causing xerostomia and hyposalivation, and both the type and number of medications used are relevant. New options of general healthcare provision to community-dwelling older people are the use of mobility aids and assistive technology devices, domiciliary health care, respite care and telecare. Their oral health status may be jeopardised by frailty, disability, care dependency and limited access to professional oral health care. Recommendations for improvement are the following: better integrating oral health care into general health care, developing and implementing an oral healthcare guideline, providing customised oral hygiene care aids, domiciliary oral healthcare provision, visiting dental hygienists and/or nurses, oral hygiene telecare, easily and safely accessible dental offices, transforming dentistry into medical oral health care and upgrading dentists to oral physicians. In case oral healthcare providers do not take the responsibility of persuading society of the importance of adequate oral health, weakened oral health of community-dwelling older people will become a potential new geriatric syndrome.

Subjective dysphagia in older care home residents: a cross-sectional, multi-centre point prevalence measurement.

BACKGROUND: Dysphagia has been found to be strongly associated with aspiration pneumonia in frail older people. Aspiration pneumonia is causing high hospitalization rates, morbidity, and often death. Better insight in the prevalence of (subjective) dysphagia in frail older people may improve its early recognition and treatment. OBJECTIVE: First, to assess the prevalence of subjective dysphagia in care home residents in the Netherlands. Second, to assess the associations of subjective dysphagia with potential risk factors of dysphagia. DESIGN: Retrospective data-analysis of a cross-sectional, multi-centre point prevalence measurement. SETTING: 119 care homes in the Netherlands. PARTICIPANTS: Data of 8119 care home residents aged 65 years or older were included and analyzed. METHODS: Subjective dysphagia was assessed by a resident's response to a dichotomous question with regard to experiencing swallowing problems. If a resident was not able to respond (e.g. residents with dementia or aphasia), the question was answered by the ward care provider, or the resident's file was consulted for registered swallowing complaints and/or dysphagia. Several residents' data were collected: gender, age, (number of) diseases, the presence of malnutrition, the Care Dependency Scale score, and the body mass index. RESULTS: Subjective dysphagia was found in 751 (9%) residents. A final model for subjective dysphagia after multivariate backward stepwise regression analysis revealed eight significant variables: age (B -0.022), Care Dependency Scale score (B -0.985), 'malnutrition' (OR 1.58; 95% CI 1.31-1.90), 'comorbidity' (OR 1.07; 95% CI 1.01-1.14), and the disease clusters 'dementia' (OR 0.55; 95% CI 0.45-0.66), 'nervous system disorder' (OR 1.55; 95% CI 1.20-1.99), 'cardiovascular disease' (OR 0.81; 95% CI 0.67-0.99) and 'cerebrovascular disease/hemiparesis' (OR 1.74; 95% CI 1.45-2.10). CONCLUSION: It seems justified to conclude that subjective dysphagia is a relevant care problem in older care home residents in the Netherlands. Care Dependency Scale score, 'malnutrition', and the disease clusters 'dementia', 'nervous system disorder', and 'cerebrovascular disease/hemiparesis' were associated with the presence of subjective dysphagia in this study. Age, 'comorbidity' and 'cardiovascular disease' showed very small influence.

Effect of oral healthcare education on knowledge, attitude and skills of care home nurses: a systematic literature review.

OBJECTIVES: To systematically review the literature on the effect of providing oral healthcare education to care home nurses on their oral healthcare knowledge and attitude and their oral hygiene care skills. METHODS: A literature search was obtained for relevant articles on oral healthcare education of nurses in care homes, using five electronic retrieval systems and databases. The search was limited to human studies, articles published in English and articles published during the period January 1990 to December 2011. The methodological quality of an article was assessed on the basis of criteria published by the Cochrane Collaboration. For articles not meeting all methodological quality criteria, relevance criteria were used to determine how much scientific evidence could be assigned to the study findings. RESULTS: In accordance with the methodological quality criteria, two randomized controlled trials were included. Additionally, four studies were included after determining the scientific evidence of the study findings. The studies included revealed some scientific evidence and indications that an oral healthcare education programme for care home nurses may improve the nurses' oral healthcare knowledge and attitude. Any effect of oral healthcare education to care home nurses' oral hygiene care skills could not be determined. CONCLUSIONS: Oral healthcare education may have a positive effect on care home nurses' oral healthcare knowledge and attitude and on care home residents' oral hygiene, whereas any effect on care home nurses' oral hygiene care skills could not be found.

Barriers of delivering oral health care to older people experienced by dentists: a systematic literature review.

OBJECTIVE: To identify barriers of delivering oral health care to older people experienced by dentists. METHODS: A comprehensive literature search was carried out for studies published in the period January 1990-December 2011, using free text and MESH term search strategies for PubMed (Medline), EMBASE and CINAHL. RESULTS: The initial search identified 236 potentially relevant publications: PubMed (Medline; n = 127), EMBASE (n = 108) and CINAHL (n = 1). After screening of titles and abstracts, 14 publications were revealed as relevant for further review. Seven articles, focusing on dentists delivering oral health care to older people in care homes, were suitable for this review, and seven articles did not meet the previously determined quality criteria. One of these articles also focused on barriers experienced by dentists working in their own practice and delivering oral health care to community-dwelling older people. CONCLUSIONS: The most common barriers of delivering oral health care to older people were identified respectively as: the lack of adequate equipment in a care home and no area for treatment available (n = 4) and the lack of adequate reimbursement for working in a care home (n = 5). In addition, the inadequate training and experience in delivering oral health care to older care home residents (n = 2) were mentioned. Four publications indicated the loss of time from private practice as a barrier to deliver oral health care in a care home. We suggest that additional research should be initiated to investigate more in detail the barriers dentists experience in delivering oral health care to older people in their own dental practices.

Oral health care and aspiration pneumonia in frail older people: a systematic literature review.

OBJECTIVE: To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia. BACKGROUND: Oral health care seems to play an important role in the prevention of aspiration pneumonia in frail older people. METHODS: Pubmed, Web of Science, Cochrane Library, EMBASE and CINAHL were searched for eligible intervention studies. Only publications with regard to hospitalized or institutionalized older people, who were not dependent on mechanical ventilation were eligible. Two authors independently assessed the publications for their methodological quality. RESULTS: Five publications were included and reviewed. Two studies showed that improvement of oral health care diminished the risk of developing aspiration pneumonia and the risk of dying from aspiration pneumonia directly. The three studies remaining showed that adequate oral health care decreased the amount of potential respiratory pathogens and suggested a reduction in the risk of aspiration pneumonia by improving the swallowing reflex and cough reflex sensitivity. CONCLUSIONS: According to the results of the current systematic literature review oral health care, consisting of tooth brushing after each meal, cleaning dentures once a day, and professional oral health care once a week, seems the best intervention to reduce the incidence of aspiration pneumonia.

Saliva secretion rate and acidity in a group of physically disabled older care home residents.

A growing number of older people have teeth, which are vulnerable to oral diseases. To maintain good oral health, an adequate amount of saliva should be secreted and the saliva should possess adequate buffer capacity. The study aim was to investigate the associations of saliva secretion rate and acidity with gender, age, and some medical characteristics in a convenience sample of physically disabled older care home residents. In 20 male and 30 female physically disabled older care home residents with a mean age of 78.1 ± 9.7 years, the resting, chewing-stimulated, and acid-stimulated whole saliva secretion rate and acidity, as well as the main medical diagnosis and the number of medications used, were registered. Resting, chewing-stimulated and acid-stimulated whole saliva secretion rates were lower in women than in men and negatively associated with age and the number of medications used. In female residents, the acidity of acid-stimulated whole saliva was negatively associated with the acid-stimulated whole saliva secretion rate. In residents aged >70 years, the acidity of resting whole saliva was positively associated with age. The acidity of acid-stimulated whole saliva of all residents was positively associated with the number of medications used.