Geriatric Phenotypes and Their Impact on Oral Health.

Older adults have multiple morbidities that can impact oral, systemic, and psychological health. Although each disorder requires consideration from the provider before treatment, by assessing the common phenotypic presentations of older adults, we can better understand, select, and coordinate treatment modifications that would need to be considered and implemented for dental care.

Oral health for baby boomers: Past, present, and future.

AIMS: This paper reviews the oral health services which were available for early (1945-1955) and late (1956-1964) baby boomers, as well as predicts their future oral healthcare needs. METHODS AND RESULTS: The knowledge, beliefs, and attitudes of the parents of the baby boomers toward dental hygiene and oral healthcare, are reviewed. The introduction of dental health screenings occurred from 1910 to early 1970s, the creation of the first dental hygiene school and the introduction of water fluoridation influenced oral healthcare. Technology introduced in the dental offices in the 1960s included the high-speed handpiece, followed by intraoral suction in 1979. Baby boomers are keeping their teeth at higher rates than preceding generations due to improved prevention and advances in the treatment of periodontal disease, and overall lower rates of smoking in older adults, when compared to younger adults. However, access to dental care remains an issue for many. Advances in prevention and treatment of periodontal disease, early detection of root caries, new restorative techniques, and improved technologies to replace teeth are also discussed. CONCLUSIONS: Early detection of periodontal disease, oral, and oropharyngeal cancer, risk factors for tooth loss and untreated caries are needed to improve the oral health for baby boomers. Access to oral healthcare is still an issue due to socio-economic disparities in America.

Opioids and older adults: Increasing trends in opioid usage in a dental population compared to a National Database (NHANES).

AIM: To examine self-reported opioid prevalence at a dental school clinic for patients ≥65 years old as compared to national data, comparing gender, ethnicity/race and older adult age groupings. METHODS AND RESULTS: Self-reported prescription opioid medication use was extracted from the medical record for dental patients ≥65 years old who visited the school's general dental clinic (GDC) in 2012 or 2017. This data was compared to the National Health and Nutrition Examination Survey (NHANES) data for 2011-2012 and 2017-18. There was a significant increase in prevalence of opioid use in adults ≥65 between 2012 (4.5%) and 2017 (6.5%) and for ages 65-79 (from 4.7% to 6.3%) and ≥80 (3.4% to 7.9%), women (4.8% to 7.0%), and African Americans (4.7% to 8.4%) in the GDC. Older adults at the GDC reported less opioid use than the NHANES national average for both periods no matter the gender or the age with variable results for race/ethnicity. CONCLUSION: The prevalence of older adults taking opioids in our general dental school clinic population increased significantly in 2017 as compared to 2012 but was lower than the national average for the respective periods. Awareness of existing opioid usage in older adult patients and its higher adverse risk potential is critical when prescribing analgesics for dental pain for this age group.

Association of Oral Health and Mini Nutritional Assessment in Older Adults: A Systematic Review with Meta-analyses.

PURPOSE: To evaluate whether poor oral health is associated with a higher risk of malnutrition based on the Mini Nutritional Assessment (MNA) or MNA-SF (short form) in older adults. STUDY SELECTION: For this meta-analysis, cohort and cross-sectional studies with adults 65 years and older, reporting oral health outcomes (i.e. edentulism, number of teeth) and either the MNA or MNA-SF were selected. Four electronic databases were searched (Medline via PubMed, Web of Science, Cochrane Library and EMBASE) through June 2020. Risk of bias was assessed with the checklist by the Agency for Healthcare Research and Quality scale. RESULTS: A total of 928 abstracts were reviewed with 33 studies, comprising 27,559 participants, aged ≥65 being ultimately included. Meta-analyses showed that the lack of daily oral hygiene (teeth or denture cleaning), chewing problems and being partially/fully edentulous, put older adults at higher risk of malnutrition (p<0.05). After adjustment for socio-demographic variables, the included studies reported lack of autonomy for oral care, poor/moderate oral health, no access to the dentist and being edentulous with either no dentures or only one denture were risk factors significantly associated with a higher risk of malnutrition (p<0.05). CONCLUSION: These findings may imply that once elders become dependent on others for assistance with oral care, have decreased access to oral healthcare, and lack efficient chewing capacity, there is increased risk of malnourishment. Limitations of the study include heterogeneity of oral health variables and the observational nature of the studies. Further studies are needed to validate our findings.

Geriatric Phenotypes and Their Impact on Oral Health.

Older adults have multiple morbidities that can impact oral, systemic, and psychological health. Although each disorder requires consideration from the provider before treatment, by assessing the common phenotypic presentations of older adults, we can better understand, select, and coordinate treatment modifications that would need to be considered and implemented for dental care.

Efficacy of denture adhesives in complete denture wearers compared to denture wearers not using denture adhesives. A systematic review.

AIM: The objective of this systematic review was to evaluate the efficacy of denture adhesives (DAs) in completely edentulous denture wearers compared to not using DAs. METHODS AND RESULTS: PubMed, Web of Science, Cochrane Library, and EMBASE were searched from the database inception up to 6 February 2020 for Randomized Controlled Trials (RCTs) involving patients with complete dentures in both arches where the use of DAs was compared to no use of DAs. A total of 497 abstracts were reviewed, resulting in inclusion of 10 RCTs. Outcomes reported in the included trials were thoroughly reviewed and tabulated. The Cochrane risk of bias tool was used. All 10 studies were assessed at unclear (10%) or high risk of bias (90%). Studies showed DAs improved mainly retention/stability, and masticatory/chewing ability/performance, compared to no adhesives. CONCLUSION: Most studies showed favorable results for DAs on retention and stability of complete dentures, masticatory performance, patient's comfort and satisfaction. Due to the heterogeneity of the outcomes, unclear/high risk of bias and small sample sizes, the quality of the evidence was very low. More high-quality research is needed with improved blinding and use of standardized methods to evaluate the efficacy of DAs.

The Children's Health and Maintenance Program (CHAMP): An innovative community outreach oral health promotion program: A randomized trial.

OBJECTIVE: To describe CHAMP (Children's Oral Health Promotion Program) evaluating the impact of two motivational methods in increasing dental care access. METHODS: CHAMP is a multi-dimensional oral health promotion programme that recruited and screened underprivileged children/families from community sites in Los Angeles County between 2012 and 2018. A randomized clinical trial (RCT) enrolled children/families into one or more motivational interventions (intra-oral camera and/or social work consultation) designed to impact subsequent scheduling of dental appointments. RESULTS: CHAMP served 24 535 families. RCT had 418 families with 68.5% scheduling appointments by second follow-up (P < .001). Excluding children with scheduled appointments by first follow-up, children experiencing both interventions were 4.1 (95% CI 1.5-11.2) times more likely to schedule appointments by second follow-up than were the controls (P=<.01). When experiencing both interventions and had never previously been to the dentist, 68.3% scheduled dental appointments; this was significantly higher than the controls (46.7%) (P = .04). The best predictor for families to have scheduled appointments was a dental visit within the last six months [OR = 3.8 (95% CI 2.2-6.6), P < .001]. CONCLUSIONS: Outreach health promotion programmes are important and should consider utilizing various motivational techniques to encourage enrolment and treatment at dental homes.

Efficacy of saliva substitutes and stimulants in the treatment of dry mouth.

AIMS: To evaluate the efficacy of saliva substitutes and stimulants compared to placebo in improving findings of dry mouth not caused by SjÓ§gren's. METHODS AND RESULTS: Four databases were searched (PubMed, Web of Science, Cochrane Library, and EMBASE) through March 2018. Only randomized controlled trials (RCT) using placebo interventions with dry mouth patients were included. Outcomes included salivary flow and self-reported patient improvement. The Cochrane Collaboration's tool for assessing risk of bias was used. A total of 348 references were reviewed, resulting in 7 RCTs with 257 dry mouth patients with 5 studies at high risk of bias, 1 unclear and 1 low risk being included. Topical spray of 1% malic acid increased unstimulated (Difference in Means [DM] = 0.096, 95% CI = 0.092-0.100; P < 0.001) and stimulated (DM = 0.203, 95% CI = 0.106-0.300; P < 0.001) salivary flow in 2 studies. Patients using 1% malic acid topical spray were 5.4 times more likely to report improvement compared to placebo (95% CI = 2.634-11.091; P < 0.001) in 2 studies. No significant improvements were found with other products when compared to placebo. CONCLUSION: Use of 1% malic acid topical spray seems to improve dry mouth compared to placebo. Quality of the evidence was low due to risk of bias and imprecision.

Results of offering oral rapid HIV screening within a dental school clinic.

To broaden the availability of human immunodeficiency virus (HIV) testing, we offered rapid HIV screening tests to 811 patients attending a dental school for routine dental hygiene care. Study design is a prospective cross-sectional study. The 319 (39.3%) agreeing to test, self-identified as: Hispanic (34.4%), White (25.8%), African American (13.1%), Asian (8.3%), Native American/Pacific Islander (0.9%), more than one race/ethnicity (1.1%) or declining to state (16.5%). Over 35% (n = 113) were first time HIV test takers, with another 2.2% (n = 7) unaware of their testing history. Approximately 60% of the decliners choose "just don't want test today" as the reason. Following a strictly structured algorithm, four possible undiagnosed infections were initially identified, with one completing the algorithm to case confirmation. In conclusion, the confirmed incidence rate finding of HIV seropositivity of 0.31% found through initial screening at the dental clinic, compared with the 0.018% incidence rate of HIV with confirmed diagnosis in Los Angeles County, indicates that a rapid HIV screening test offered in a dental school clinic can potentially play an important role in discovering undiagnosed HIV individuals.

Oral Health-Related Outcomes in Edentulous Patients Treated With Mandibular Implant-Retained Dentures Versus Complete Dentures: Systematic Review With Meta-Analyses.

The objective of this systematic review was to determine the effect on oral health-related outcomes from mandibular implant-retained dentures opposing maxillary complete dentures in edentulous middle-age and older adults, compared with complete removable dentures in both arches. Randomized controlled trials included participants with an average age of 65 years or older. The Cochrane Library, MEDLINE, and Web of Science were searched. A total of 228 abstracts were reviewed for inclusion criteria, with 14 trials included and analyzed for risk of bias. Eleven of these studies were assessed as being at an unclear risk of bias, and 3 were at high risk. Mandibular implant-retained overdenture therapy showed statistically significant improvements in the patients' general satisfaction ( P = .003), oral health-related quality of life ( P < .001), and chewing ability ( P < .001), over the patients with complete dentures. There were no significant differences in the percentage of patients who were satisfied with their overdentures vs complete dentures for comfort, retention, esthetics, or chewing ability; however, only 2 studies reported these outcomes. In terms of nutritional status 1 year after treatment, vitamin B12 blood levels increased significantly in the implant-retained group ( P = .003), but not the other nutritional values. Implant-retained mandibular overdentures are an option for middle-aged and elderly edentulous patients as they significantly improve some of the outcomes; however, the quality of the evidence was moderate/low, due to the small number of studies included and the risk of bias. Future research should include objective outcomes such as masticatory performance, chewing efficacy, and muscular coordination.

Oral Health Status of Children Attending a Mobile Dental Clinic--A Comparative Study.

Periodicity of dental visits for children is based on age and disease susceptibility. Frequently mobile dental clinics are unable to provide follow-up care at recommended intervals. This study compared the oral health of children attending the mobile clinic (MC) twice with matched children by age, gender, race, and ZIP code attending for the first time. Dental charts (n=888) were reviewed and scored for decayed and filled surfaces. Seventy-eight children (mean age 9.6 years; 98.7% Hispanic) attended the clinic twice over a mean interval between visits of 1.5 years. These children had statistically significant lower rates of decay in deciduous and permanent tooth surfaces than matched children visiting the clinic for the first time (p<.05; p<.001), and significantly less decay in their deciduous and permanent teeth than at the first visit (p<.001; p<.05). Mobile clinics can be effective in decreasing the decay in teeth, even when the interval between visits is longer than current recommendations.

Attitude toward rapid HIV testing in a dental school clinic.

Detection of HIV infection provides an opportunity for transmission reduction and lifesaving treatment strategies. This study examined patients' willingness to take a routine, rapid oral HIV test if offered at a dental school clinic. For fifteen days in 2011, an anonymous survey containing demographic information and willingness to be tested questions was offered to all patients awaiting treatment. A total of 383 of 443 people approached, answered the questionnaire (40.2% Hispanic, 27.2% Caucasian, and 19.3% African American) with 58.8% indicating that they had been previously tested for HIV (as compared to the California mean of 39.2%). Patients were highly likely to participate (84.0% of Hispanics, 63.6% of Caucasians, 80.0% of African Americans and 66.7% of Asians) in a free HIV rapid test when given the opportunity. Of respondents never tested before, 62.6% reported a willingness to be tested in this study. HIV screening in a dental clinic during routine visits may allow new undiagnosed cases to be detected with subsequent referral into medical treatment.

Dry mouth: a critical topic for older adult patients.

PURPOSE: Diminished salivary flow, or dry mouth impacts the oral health of many older adults, dentate and edentulous. As a result typical oral conditions can prove more challenging to both the patient's comfort and home care and the treatment selected by the clinician. This paper will review issues of dry mouth from a clinical and symptomatic perspective and will include the condition's causes, treatment and prevention. STUDY SELECTION: We performed a review of PubMed using the words: older adults, dry mouth, xerostomia, radiation-induced xerostomia, and salivary gland hypofunction. We selected 90 articles with a clinical application perspective. RESULTS: When it comes to treatment of dry mouth conditions, either objective or subjective, there are no easy answers as to the best course of action for a specific individual. While most of the cited studies have examined the most difficult cases of dry mouth (e.g., Sjögren's syndrome, and that seen during and post head and neck cancer treatments), there are many older adults who demonstrate dry mouth from the use of multiple medications. This paper presents a summary of the etiology, diagnosis, prevention, and pharmacological and non-pharmacological treatment of dry mouth (salivary hypofunction and xerostomia in older adults). CONCLUSIONS: It is important to understand the causes of dry mouth and to educate our patients. Starting a prevention program as early as possible considering the most practical, cost effective and efficient treatments with the best risk-benefit ratio will help to diminish dry mouth symptoms and sequelae.

Assessment of student interprofessional education (IPE) training for team-based geriatric home care: does IPE training change students' knowledge and attitudes?

Our study assesses changes in students' knowledge and attitudes after participation in an interprofessional, team-based, geriatric home training program. Second-year medical, physician assistant, occupational therapy, social work, and physical therapy students; third-year pharmacy students; and fourth-year dental students were led by interprofessional faculty teams. Student participants were assessed before and after the curriculum using an interprofessional attitudes learning scale. Significant differences and positive data trends were noted at year-end. Our study suggests that early implementation, assessment, and standardization of years of student training is needed for optimal interprofessional geriatric learning. Additionally, alternative student assessment tools should be considered for future studies.

Comparing methods of cultural competency training and assessment in a predoctoral dental course.

Cultural competence is considered an important skill in health care delivery; accordingly, it requires an effective and efficient course of training. Web-based teaching has increasingly been used in medical education with a few reports also in the dental field; however, there is a lack of evidence of its full application and usefulness. The objective of this study was to evaluate the efficacy of web-based case scenarios in comparison with seminar-based training to deliver cultural competency material to the health care provider in training. Eighty-one fourth-year dental students attending a mandatory Special Patients' Care clinical rotation were randomly allocated to receive first either a session of seminar or web-based case scenarios on cultural competence, with all students receiving a manual containing information about various cultures and the issues of cultural diversity on the first day of the training. All students underwent pre- and post-training examinations, which were conducted using a multiple-choice questionnaire and a self-analytic evaluation. Both the seminar and the web-based case scenarios resulted in significant improvement (p≤0.001) of scores comparing the pre- and posttest outcomes. Training either as a seminar or a series of web-based case scenarios combined with written material presented in a manual was found to increase students' cultural competence.

The impact of oral health on the academic performance of disadvantaged children.

OBJECTIVES: We measured the impact of dental diseases on the academic performance of disadvantaged children by sociodemographic characteristics and access to care determinants METHODS: We performed clinical dental examinations on 1495 disadvantaged elementary and high school students from Los Angeles County public schools. We matched data with academic achievement and attendance data provided by the school district and linked these to the child's social determinants of oral health and the impact of oral health on the child's school and the parents' school or work absences. RESULTS: Students with toothaches were almost 4 times more likely to have a low grade point average. About 11% of students with inaccessible needed dental care missed school compared with 4% of those with access. Per 100 elementary and high school-aged children, 58 and 80 school hours, respectively, are missed annually. Parents averaged 2.5 absent days from work or school per year because of their children's dental problems. CONCLUSIONS: Oral health affects students' academic performance. Studies are needed that unbundle the clinical, socioeconomic, and cultural challenges associated with this epidemic of dental disease in children.

Oral health-related quality of life in patients treated by implant-supported fixed dentures and removable partial dentures.

OBJECTIVES: This study investigated the association between denture status [implant-supported fixed dentures (IDs) and removable partial dentures (RPDs)] and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Consecutive patients with IDs and RPDs were recruited from the Prosthodontics Departments at Showa University and Tokyo Medical and Dental University. The Japanese version of the Oral Health Impact Profile (OHIP-J-49) was administered to each subject. For each OHIP-J-49 question, the subjects were asked to indicate the frequency with which they had experienced a dental problem during the last month. Responses were recorded on a 5 point Likert rating scale, with 0 being never and 4, very often. Summary scores were calculated and regression analyses conducted to investigate the association between denture status and OHIP-J-49 summary score. RESULTS: In total 79 ID subjects (mean age±SD of 51.7±12.4 years, 44.3% men) and 109 RPD subjects (mean age of 66.5±8.6 years, 30% men) participated after giving informed consent. The regression analysis between the type of treatment and the OHIP-J-49 summary score revealed a significant association with a coefficient of 17.0 (Confidence interval, CI: 10.9-23.1). When age and duration of denture usage, which had significant associations with OHIP-J-49, were included in this model, the regression coefficient remained virtually unchanged at 17.4 (CI: 9.75-25.0), thus indicating little potential confounding by them. CONCLUSIONS: OHRQoL in patients with implant-supported fixed dentures is generally less impaired than it is in those patients with RPDs.

Oral health-related quality of life and perceived dental needs in the United States.

OBJECTIVES: The purpose of this study is to investigate the oral health-related quality of life (OHRQOL) in the US population by sociodemographic factors, perception of dental needs, reported dental visits, and saliva indicators. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 were used. NHANES measured OHRQOL by a modified version of the Oral Health Impact Profile. RESULTS: The study had 6,183 subjects who averaged an OHRQOL score of 2.8 points. About 40% had painful aching in the mouth during the last year on at least one occasion. Perceived need to relieve dental pain was the strongest risk factor for poor OHRQOL (resulting in a higher score by 5.2 points), followed by perceived need for a denture or feeling of dry mouth (each resulting in a higher score by about 2 points). CONCLUSIONS: OHRQOL is the poorest among those with perceived dental needs especially those with the perceived need to relieve dental pain.

Dental students' attitudes toward underserved populations across four years of dental school.

The objective of this study was to assess dental students' attitudes toward underserved populations across their four years of dental school. Students at the Herman Ostrow School of Dentistry of the University of Southern California were invited to take part in the study. Participating students completed a questionnaire on their attitudes toward the underserved at three time points: 1) during orientation week; 2) at the end of their second year after taking part in some community dental programs; and 3) at the end of their fourth year after they had completed all their mandatory and volunteer rotations in community dental programs. Students' attitudes were measured in four categories: societal expectations, dentist/student responsibility, personal efficacy, and access to care. First-year students scored 85 out of a maximum of 115 on the questionnaire. Female students scored higher than male students (P=0.006). Age, debt, and past history of volunteer work were not related to first-year students' total attitude scores; however, students with a history of volunteer experience scored higher on the dentist/student responsibility category (P=0.04). Students' attitude scores declined across the four years of dental school (P=0.001). The same patterns were evident for all categories except societal expectations. The decline was not related to age, gender, debt, or volunteer work experience. Follow-up studies are needed to help explain the factors that may be related to this decline.

Dental caries in underprivileged children of Los Angeles.

OBJECTIVES: The purpose of this study is to investigate the disease of dental caries among a population of poor, migrant, minority children in Los Angeles County. METHODS: The study team developed an instrument to be completed by parents about their children's determinants of oral health, and adapted the Association of State and Territorial Dental Directors (ASTDD) protocol for conducting clinical examinations. The target groups were 2-5, 6-8 and 14-16 year-old children. Subjects were selected from public schools and early childhood programs. RESULTS: The study recruited 2,313 children and found that 73% of all children had untreated caries (29% of them had white spot lesions only), 53% had fillings or crowns, and 81% needed dental care. CONCLUSIONS: This is the most comprehensive study of oral health among disadvantaged children of Los Angeles County. The study documented an epidemic of dental caries in the County, the oral health profiles of disadvantaged children, and prepared for the design of appropriate intervention programs.