Greek dental students' perceptions of treating older patients.

BACKGROUND AND AIM: The oral problems of the older population are largely undertreated because of various barriers, including negative perceptions and ageist stereotypes, among care providers. The aim of this study was to record the perceptions of Greek dental students of treating older patients. MATERIALS AND METHODS: An anonymous written questionnaire including two open-ended questions about the positive and negative issues when treating older patients was administered to clinical dental students. A content analysis was conducted to identify the main themes. RESULTS: A total of 135 students responded to the questionnaire (response rate 88.23%). Five key themes were identified for the facilitating factors and six for the barriers/challenging factors. The facilitating factors of treating older people were the promotion of the patients' health and quality of life, the good interaction and communication with older patients, the dentist's intrinsic reward treating older people, the positive feedback from the patients and the improvement of professional dental competences when treating complex cases. The barriers included communication and cooperation problems, treatment challenges related to disease and disability, patients' negative beliefs about oral health, barriers to accessing dental care, complex and time-consuming treatment plans, and communication and cooperation problems with the patients' carers. CONCLUSION: A range of facilitating and challenging factors influence dental students' perceptions of treating older patients. More research is necessary on the methods that will enhance their geriatric knowledge and skills, help them overcome the challenges they detected and improve their attitudes and behaviours towards treating older patients.

Sociomedical and oral factors affecting masticatory performance in an older population.

OBJECTIVES: To assess the sociomedical and oral factors affecting masticatory performance in a community-dwelling older population. MATERIALS AND METHODS: Community-dwelling persons over 60 years were investigated using medical and dental oral interviews, oral and denture examination (natural teeth, tooth mobility, number of occluding tooth pairs, and removable dentures' prevalence and quality), and evaluation of masticatory performance using a mixing ability test. RESULTS: A total of 130 participants with a mean age of 73.9±8.5 years were recorded. Fifty-eight (44.6%) used various types of removable prostheses. Twenty were edentulous and used a pair of complete dentures. Univariate analyses revealed statistically significant associations (p≤0.05) between masticatory performance and aging, marital status, subjective chewing ability, use of removable dentures, use of various combinations of complete dentures, pain caused by maxillary denture, number of teeth, tooth mobility, posterior chewing pairs, all chewing contacts natural or prosthetic, retention of mandibular partial dentures, and dentures' occlusion. The multivariable quantile regression analysis revealed that fewer natural teeth (95% CI: -0.02-0.01, p<0.001), being edentulous and using a pair of complete dentures (95% CI: 0.09-0.35, p=0.001), and larger percentage of severely mobile teeth (95% CI: 0.07-0.82, p=0.020) were associated with lower masticatory performance. CONCLUSIONS: Poor masticatory performance in older adults was associated with fewer teeth, being edentulous and using a pair of complete dentures, and increased prevalence of severe tooth mobility. CLINICAL RELEVANCE: Retaining the natural dentition and preventing and treating periodontal disease are important measures to maintain masticatory performance in older adults.

Translation and preliminary validation of a French version of an ageism scale for dental students.

BACKGROUND AND AIM: The World Health Organization considers ageism an important barrier to age-appropriate care for older adults. A new ageism scale for dental students (ASDS) has been validated in the United States, Brazil, Greece and Romania. The aim of this study was to validate a French version (ASDS-Fr). METHOD AND MATERIALS: The 27-item ageism scale was translated from English into French, and its content validity was investigated using the content validity index. The translated version was completed by 180 dental students in the Dental School of Clermont-Ferrand in France. Principal component analysis (PCA) was performed and internal consistency reliability was calculated. RESULTS: The final PCA model resulted in 10 items and three components that together accounted for 57.2% of the overall variance. The first component contained four items that point to a negative view of older adults; the second contained three items that appeared to reflect an absolving of responsibility for providing care to older adults; and the third contained three items that deal with gerodontology education. CONCLUSIONS: This preliminary validation of the ASDS-Fr produced a new 10-item scale with three components with acceptable validity and reliability.

Oral factors and adherence to Mediterranean diet in an older Greek population.

PURPOSE: The aim of this study was to investigate the effect of oral factors on adherence to the Mediterranean diet in an older population METHODS: 130 persons over 60 years visiting Open Care Community Centers for Older People participated in this study. Oral interviews recorded demographic and sociomedical information, subjective oral complaints, and dental habits. Adherence to Mediterranean diet was assessed using the MDI_BNC4H index (range: 0-14). An oral examination was performed, and evaluation of the masticatory performance was carried out using a two-color chewing gum that was digitally analysed. RESULTS: The mean age of the study participants was 73.9 ± 8.5 years. The score of adherence to the Mediterranean diet ranged from 3 to 9 (5.6 ± 1.4). 58 participants used removable prostheses, while 20 used a pair of complete dentures. Univariate analyses revealed that the parameters that negatively significantly, or marginally significantly, affected the level of adherence to the Mediterranean diet were lower masticatory performance (p = 0.050), larger number of drugs per day (p = 0.056), higher BMI (p = 0.043) and smoking (p = 0.053). The multivariable analysis revealed that lower adherence to the Mediterranean diet was significantly associated with higher BMI (p = 0.047) and lower masticatory performance (p = 0.050). CONCLUSIONS: Increased masticatory performance was an independent predictor of better adherence to the Mediterranean diet in an older population.

Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care-dependent older people: An e-Delphi study.

OBJECTIVES: This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels. BACKGROUND: Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet. METHODS: The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1. RESULTS: A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative. CONCLUSIONS: Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people.

Translation and validation of the ageism scale for dental students in Romanian (ASDS-Rom).

AIMS: The aim of this paper was to validate the Romanian version of an ageism scale for dental students. MATERIALS AND METHODS: The initial 27-item ageism scale was translated into Romanian and administered to 210 dental students in Craiova. The data were analysed using principal components analysis (PCA) with an orthogonal, Varimax rotation. The answers were then compared across several demographic variables using a combination of independent samples t tests and one-way between-subjects analysis of variance (ANOVA). RESULTS: Adequate factorability was confirmed with a Kaiser-Meyer-Olkin (KMO) of 0.676 and a Bartlett's Test of Sphericity yielding P < 0.001. PCA revealed a 10-item scale distributed into three components that accounted for 58% of the overall variance. The first component contained 4 items related to the cost-benefit of providing care to older patients (α = 0.80). The second contained 3 items that revolved around the perceptions about older people and their value in the society (α = 0.59). The third contained 3 items related to gerodontology training (α = 0.46). Discriminant validity showed differences in the first component based on whether a student had an older family member. CONCLUSIONS: The 10-item, three components scale demonstrated acceptable validity and reliability.

Translation and preliminary validation of an ageism scale for dental students in Brazil (ASDS-Braz).

BACKGROUND AND OBJECTIVE: Ageism is a major barrier for age-appropriate care. The aim of this study was to translate and perform a preliminary validation of an ageism scale for dental students (ASDS) in Brazil (ASDS-Braz). METHODS: The 27-item original ageism scale was translated from English into Brazilian Portuguese. A panel of five Brazilian dental educators revised the scale to establish content validity. The translated version was completed by 156 dental students in the Federal University of Pelotas in Brazil. Principal component analysis, internal consistency reliability and discriminant validity were estimated. RESULTS: All items in the Brazilian Portuguese version received a content validity index score ≥0.80 indicating that they were relevant to the topic. The principal component analysis produced a 12-item scale with three components that accounted for 51% of the overall variance. The first component contained six items associated with a negative view of older adults; the second component contained three items dealing with the complexity of providing care for older adults; and the third component contained three items associated with a positive view of older people. Discriminant validity did not show any differences related to demographic factors, the semester of studies and history of living with older people. CONCLUSIONS: The preliminary validation of the ASDS-Braz produced a 12-item scale with three components with acceptable validity and reliability. Future research in a larger, multi-institutional sample is now warranted.

Translation and validation of the Greek version of an ageism scale for dental students (ASDS_Gr).

OBJECTIVES: To describe the validation of a new 27-item ageism scale for dental students in Greece. BACKGROUND: A new ageism scale for dental students has been developed by American and European Gerodontology educators and was preliminary validated in the United States. METHODS: The scale was translated into Greek and administered to 8th- and 10th-semester dental students in Athens. Principal components analysis was used to explore the internal structure of the measure; internal consistency reliability was assessed using Cronbach's α coefficient; corrected item-total correlations were calculated to decide which low contributing items should be removed from the scale; and discriminant validity was tested investigating variation in relation to demographic and educational factors. RESULTS: A total of 152 students responded to the questionnaire. The Principal component analysis offered a 15-item scale distributed into four factors that accounted for 56.4%, of the total variance, produced stronger factor loadings, a comparable amount of overall component variance and logical sets of components. The four factors produced were values/ethics about older people (four items, α = 0.71), patient compliance (four items, α = 0.72), barriers to dental care (four items, α = 0.57) and dentist-older patient interaction (three items, α = 0.64). Discriminant validity revealed statistically significant differences in factors and items related to semester of studies, gender and family's permanent residence. CONCLUSION: The preliminary validation of the Greek version of the ageing scale for dental students revealed a 15-item questionnaire that demonstrated acceptable validity and reliability and could be further tested in larger samples.

How do we incorporate patient views into the design of healthcare services for older people: a discussion paper.

BACKGROUND: Across the European Union costs for the treatment of oral disease is expected to rise to €93 Billion by 2020 and be higher than those for stroke and dementia combined. A significant proportion of these costs will relate to the provision of care for older people. Dental caries severity and experience is now a major public health issue in older people and periodontal disease disproportionately affects older adults. Poor oral health impacts on older people's quality of life, their self-esteem, general health and diet. Oral health care service provision for older people is often unavailable or poor, as is the standard of knowledge amongst formal and informal carers. The aim of this discussion paper is to explore some of the approaches that could be taken to improve the level of co-production in the design of healthcare services for older people. MAIN TEXT: People's emotional and practical response to challenges in health and well-being and the responsiveness of systems to their needs is crucial to improve the quality of service provision. This is a particularly important aspect of care for older people as felt, expressed and normative needs may be fundamentally different and vary as they become increasingly dependent. Co-production shifts the design process away from the traditional 'top-down' medical model, where needs assessments are undertaken by someone external to a community and strategies are devised that encourage these communities to become passive recipients of services. Instead, an inductive paradigm of partnership working and shared leadership is actively encouraged to set priorities and ultimately helps improve the translational gap between research, health policy and health-service provision. DISCUSSION: The four methodological approaches discussed in this paper (Priority Setting Partnerships, Discrete Choice Experiments, Core Outcome Sets and Experience Based Co-Design) represent an approach that seeks to better engage with older people and ensure an inductive, co-produced process to the research and design of healthcare services of the future. These methods facilitate partnerships between researchers, healthcare professionals and patients to produce more responsive and appropriate public services for older people.

Higher education in Gerodontology in European Universities.

BACKGROUND: The rapid aging of the European population and the subsequent increase in the oral care needs in older adults necessitates adequate training of dental professionals in Gerodontology (Geriatric Dentistry). This study was designed to investigate the current status of Gerodontology teaching amongst European dental schools at the undergraduate, postgraduate and continuing education levels. METHODS: An electronic questionnaire was developed by a panel of experts and emailed to the Deans or other contact persons of 216 dental schools across 39 European countries. The questionnaire recorded activity levels, contents and methodology of Gerodontology teaching as part of dental education programs. Repeated e-mail reminders and telephone calls were used to encourage non-responders to complete the questionnaire. RESULTS: A total of 123 responses from 29 countries were received (response rate: 56.9%). Gerodontology was taught in 86.2% of schools at the undergraduate level, in 30.9% at the postgraduate level and in 30.1% at the continuing education level. A total of 43.9% of the responding schools had a dedicated Gerodontology program director. Gerodontology was taught as an independent subject in 37.4% of the respondent schools. Medical problems in old age, salivary impairment and prosthodontic management were the most commonly covered topics in Gerodontology teaching. Clinical teaching took place in 64.2% of the respondent schools, with 26.8% offering clinical training in outreach facilities. CONCLUSIONS: The vast majority of European dental schools currently teach Gerodontology at the undergraduate level. More training opportunities in oral care of frail elders should be offered, and more emphasis should be placed on interdisciplinary and interprofessional training, educational collaborations, and the use of modern technologies. Dedicated postgraduate Gerodontology courses need to be developed to create a significant number of specialized dentists and trained academics.

Body expression skills training in a communication course for dental students.

BACKGROUND: In the health professions, competency in communication skills is necessary for the development of a satisfactory physician-patient interaction. Body expression is an important domain of the communication process, often not adequately addressed. The aim of this study was to describe the methodology and content of a pilot introductory training session in body expression for dental students before the beginning of their clinical training. METHODS: The educational methods were based on experiential learning and embodied training, where the session's content focused on five themes representing different phases of the dental treatment session. A questionnaire was distributed before and after the session to assess any changes in students' self-perceptions in communication skills. RESULTS: There were statistically significant improvements in the total values of the students self-perceptions of their communication skills obtained before and after the training and in specific elements such as small group situations, performing an interview, understanding the feelings of others and expressing one's own feelings. DISCUSSION: The dental students in the present study felt that this preclinical experiential learning session improved their communication skills. The feedback from this training experience will enable further development of an effective communication course for clinical dentistry.

Appropriate use of antibiotics for oral/dental conditions in older adults: a narrative review.

OBJECTIVES: Considering the high rates in the use of antibiotics for oral/dental conditions in older patients and the rise in antimicrobial resistance, appropriate antibiotic prescription is important. This narrative review aimed to discuss the challenges and special considerations when prescribing antibiotics to older patients for oral/dental conditions. METHODS: PubMed/MEDLINE, Scopus, Web of Science, and articles' reference lists were searched for antibiotics use for oral conditions by older patients. Moreover, scientific and professional organisations' official websites were searched for guidelines on antibiotic use in dentistry. RESULTS: Despite several guidelines about the use of antibiotics in dentistry, specific information on their administration to older patients is missing. Relevant challenges include age-related changes in pharmacokinetics and pharmacodynamics, comorbidities and polypharmacy associated with low adherence, contraindications, adverse reactions, and drug-drug interactions. In unfit and frail older patients some antibiotics should be avoided, or doses should be adjusted, according to medical conditions or medications received. Amoxicillin, with doses adapted to renal function, is one of the safest options, while other antibiotics should be chosen with caution upon indications and individual patient characteristics. CONCLUSIONS: Healthcare providers should prescribe antibiotics to unfit and frail older adults with caution, given the multitude of comorbidities and potential interactions with medications received. Further research is needed on the safe and effective use of antibiotics in older patients.

Ageism scale for dental students (ASDS): A focus group review of content validity.

PURPOSE/AIM: Improve content validity of the Ageism Scale for Dental Students (ASDS) and identify barriers to using the scale. METHODS: Thematic analysis of transcripts of three purposively sampled focus groups of 1) geriatric dentistry specialists, 2) older adult dental patients, and 3) dental students. RESULTS: Twenty-five participants engaged in focus groups. No new concepts to define ageism were identified. Experts found the scale acceptable and appropriate, yet they raised specific potential revisions to scale questions. Commonly reported themes already addressed by ASDS included the importance of tailoring decision-making to patient preference and not making assumptions about older adults' capacity or preferences for dental care. Barriers to identifying ageism or using the scale included experiential differences in interpreting scale items, cultural differences in attitudes towards older adults, and potential overlap with social determinants of health. Secondary findings include recommendations for older-adult focused training for dental students to provide positive, concrete guidance on caring for older adults. CONCLUSION: There are opportunities to refine the Ageism Scale for Dental Students and to allow tailoring of the scale for specific national or cultural contexts.

Towards an operational definition of oral frailty: A e-Delphi study.

OBJECTIVES: Building upon our recently developed conceptual definition of oral frailty (the age-related functional decline of orofacial structures), this e-Delphi study aims to develop an operational definition of oral frailty by identifying its components. METHODS: We used a modified e-Delphi study to reach a consensus among international experts on the components of oral frailty. Twelve out of fifteen invited experts in the field of gerodontology participated. Experts responded to three rounds of an online 5-point scale questionnaire of components to be included or excluded from the operational definition of oral frailty. After each round, scores and rationales were shared with all experts, after which they could revise their position. A consensus was reached when at least 70% of the experts agreed on whether or not a component should be included in the operational definition of oral frailty. RESULTS: The experts achieved a high level of agreement (80 - 100%) on including eight components of oral frailty and excluding nineteen. The operational definition of oral frailty should include the following components: 1) difficulty eating hard or tough foods, 2) inability to chew all types of foods, 3) decreased ability to swallow solid foods, 4) decreased ability to swallow liquids, 5) overall poor swallowing function, 6) impaired tongue movement, 7) speech or phonatory disorders, and 8) hyposalivation or xerostomia. CONCLUSION: This e-Delphi study provided eight components that make up the operational definition of oral frailty. These components are the foundation for the next stage, which involves developing an oral frailty assessment tool.

Current status and trends in oral health in community dwelling older adults: a global perspective.

PURPOSE: To record the available current national and regional data on the oral health of community-dwelling (living in their own homes, not institutionalised) older people globally and discuss the future trends considering existing dangers and opportunities. MATERIALS AND METHODS: A literature search on tooth loss, dental decay and periodontal disease in the elderly was performed using available databases and electronic sources. RESULTS: The findings revealed that the updated national data are scarce in many parts of the world, particularly in Africa, Asia and South America, and direct comparisons are not always possible due to methodological variations. The available information may indicate that dental disease in older adults worldwide is more prevalent compared to younger age groups, with significant variation between countries and regions. Tooth loss is currently more common in the developed countries, while dental decay and periodontal disease are more widespread globally. There are important threats for further deterioration of the oral status among older adults in many developed and less developed areas due to existing sociodemographic and economic risk factors. CONCLUSION: National studies should be undertaken to record the specific oral problems of the elderly in each area. It is also necessary to develop gerodontology study programmes globally at the undergraduate, postgraduate and continuing education levels which will enhance dentists' knowledge, skills and attitudes towards oral care in the older population, and will promote opportunities for further research and development of relevant policies.

Baby boomers in Europe: demography, socioeconomic and health status, and oral health needs.

The European countries are aging fast. Baby boomers in Europe constitute a diverse population group with several differences in life events and living conditions. The fiscal effects of the aging of European population have led to changes in policies and legislation that largely affect the lives of baby boomers necessitating an increase in their working lives. Furthermore, reforms are planned in the existing health and long-term care systems. Although some baby boomers in Europe face chronic medical conditions, the majority perceive their general health as good or very good. However, approximately one quarter have reported unmet needs for medical care, mainly due to cost or long waiting lists with large variability among different countries. The oral health of baby boomers has improved compared to previous generations particularly related to tooth loss. However, older groups in many countries face an increase in dental caries and periodontal disease. Some baby boomers may enter very old age with many natural teeth, functional impairment, limited ability to perform oral hygiene and an increased demand for more complex dental care as well as domiciliary care. However, in contrast to medical care, dental expenses in Europe are mainly financed with out-of-pocket payments while domiciliary dental care is rarely provided leading to unmet dental care needs for the most vulnerable individuals. Educational interventions for all healthcare professionals, as well as formal and informal carers and the public are required, and appropriate policies and legislations are needed to promote the oral health of the aging European population.

Association between Oral Hygiene Information Sources and Daily Dental and Denture Care Practices in Urban Community-Dwelling Older Adults.

The purpose of this cross-sectional study was to explore the sources of daily oral hygiene information among urban community-dwelling older adults in Athens, Greece and associate them with their dental and denture care habits. One hundred and fifty-four older adults (aged 71.7 ± 9.2 years) participated in the study, and their dental status, denture use, daily oral care habits according to current gerodontology recommendations, and oral care information sources were investigated. Daily oral hygiene practices were poor, and a small number of individuals recalled having received oral hygiene advice from a dentist. Only 41.7% of the 139 dentate participants performed toothbrushing with fluoride-based toothpaste at least twice a day, and 35.9% completed regular interdental cleaning. Among 54 denture wearers, 68.5% removed their denture(s) at night, and 54% cleaned them at least twice a day. Oral hygiene information sources included dentists (for approximately half of the participants), media, friends/relatives, non-dental health care providers and dental technicians. Dentate participants who had received oral hygiene information from dentists had a greater probability of brushing their teeth with fluoride toothpaste at least twice a day (p = 0.049, OR = 2.15) and performing regular interdental cleaning (p < 0.001, OR = 29.26). Denture wearers who had received instructions about denture hygiene from dentists were more likely to use a brush and mild soap (p = 0.016, OR = 14.67) and remove their denture(s) at night (p = 0.003, OR = 8.75). Dentists should improve their oral health prevention and promotion strategies for their older patients.

Is Europe prepared to meet the oral health needs of older people?

OBJECTIVE: To discuss the preparedness of the social and health care systems and the health workforce in Europe to manage the increasing general and oral health care needs of older adults. BACKGROUND AND DISCUSSION: There are large inequalities across European countries and regions in the demographic, socioeconomic and health status of the elderly. The ageing of the population and the economic crisis put at risk the existing social and health care systems and are expected to further widen the existing inequalities. Despite the increase in funding for the general health care, public funding for dental care has reduced, limiting the access for the disadvantaged elderly. Dental care is isolated from health care policies and funding. At the same time there is a significant shortage of adequately trained personnel in the care of the elderly and a shortage of training opportunities particularly at a postgraduate and continuing education level. CONCLUSION: Immediate action is needed and appropriate strategies need to be implemented. Oral health prevention, delivery policies and funding should be integrated within the general health care system. Clinical protocols and guidelines need to be developed on the oral care of the elderly. Interdisciplinary training in the care of the elderly needs to be implemented for all health care workers (dentists, physicians, nurses, health care aids, social workers) at all education levels to enhance comprehensive care.

Oral health status of elderly hospitalised psychiatric patients.

OBJECTIVES: This study investigated the oral health status of an elderly mentally ill population hospitalised in a psychogeriatric ward in Athens. MATERIALS AND METHODS: A structured interview recorded sociodemographic and dental data, and an oral examination recorded the status of oral tissues and the existing dentures. The patients' medical records were examined by a hospital's physician. RESULTS: One hundred and eleven patients with a mean age of 73 years participated in the study. Almost half of them suffered from schizophrenia. Forty percent were completely edentulous but only 38.6% of them used a pair of dentures. The dentate had an average of 12.9 teeth, 50.7% of them had at least one decayed tooth, 44.8% needed at least one extraction, and only 26.7% had filled teeth. The dental hygiene was poor in 83.6% of the patients. More than 60% of the dentures had a defect. Multiple regression analyses showed that increasing age and dementia were significantly related to fewer remaining teeth, and the use of atypical antipsychotics was related to fewer caried teeth. CONCLUSION: The oral health of the elderly psychiatric patients was very poor. Access to dental care should improve, and the health care staff should be trained to identify oral problems.

Policies Supporting Oral Health in Ageing Populations Are Needed Worldwide.

This literature review examines the need to develop appropriate policies specific to the oral health needs of older people that are individualised, cost-effective, and sustainable. Poor oral health and impaired oral function negatively affect the health and quality of life of older adults. Developing care systems that aim to meet patients' normative needs as well as their perceived needs and expectations is one factor in successful delivery of appropriate dental care. Cost is another significant driver of utilisation, and many older adults worldwide lack adequate resources for dental care. Failure to address these issues results in poor outcomes and increased costs of dental and medical care. Disease prevention and control at early stages can preserve public and private financial resources as well as quality of life and well-being for older adults at any stage of life.