Relationships Between Test Results for Oral Hypofunction, Subjective Frailty Symptoms and Oral Health-Related Quality of Life of Japanese Dental Outpatients: A Multicentre, Cross-Sectional Study.

BACKGROUND: Oral hypofunction is the stage before oral dysfunction. The subjective symptoms of poor oral function and the decline in oral health-related quality of life (OHRQoL) that occur in the oral hypofunction stage can be missed. OBJECTIVE: This multicentre cross-sectional study was performed to examine the relationships between the test results for oral hypofunction, subjective frailty symptoms and OHRQoL of outpatients in dental clinics. METHODS: The basic characteristics and oral function test results of 637 dental clinic outpatients were evaluated. The subjective symptoms of physical and oral frailty were investigated using a questionnaire. OHRQoL was assessed using the Japanese short version of the Oral Health Impact Profile (OHIP-JP16) and OHRQoL dimension score. RESULTS: The overall prevalence of oral hypofunction was 37.8%, with no significant difference between men and women. No significant differences in the presence or absence of subjective symptoms of frailty and a high OHIP score were observed based on sex. However, the prevalence of oral hypofunction was significantly different among the age groups and increased with age. The subjective symptoms of frailty score, OHIP score and OHRQoL dimension score were significantly higher in patients with versus without oral hypofunction. Age, number of underlying diseases, total score for subjective symptoms of frailty, total score for OHIP and OHRQoL dimension score were significantly associated with oral hypofunction. CONCLUSION: Oral hypofunction may affect the subjective symptoms of frailty and OHRQoL in older adults.

Oral health inequalities in Swedish older adults over 25 years of follow-up.

OBJECTIVES: The aim of this study was to describe inequalities in tooth loss and dissatisfaction with teeth related to time-invariant and time-variant socio-demographic characteristics and use of dental care across the middle and older life course and to assess whether oral health inequalities remain stable, widen or narrow from age 50 to 75. MATERIALS AND METHODS: In 1992, 6346 residents, aged 50, consented to participate in a prospective cohort study including postal questionnaire follow-ups every fifth year until age 75. Tooth loss and dissatisfaction with teeth were assessed at each survey wave in addition to socio-demographic factors and use of dental care. Multivariable logistic regression, generalised estimating equations, GEE, and random intercept logistic mixed models were used for estimation of population-averaged and person-specific odds ratio. Interaction terms of each covariate with the time indicator were added to test whether inequalities changed across time. RESULTS: Person-specific OR and 95% CI estimates for tooth loss varied from 1.29 (1.09-1.53) (unmarried vs married) to 9.20 (6.07-13.94) (foreign country vs native). Estimated ORs for tooth dissatisfaction ranged from 1.33 (1.15-1.55) (unmarried vs married) to 2.59 (2.15-3.11) (smoking vs no smoking). Inequalities in tooth loss according to sex, educational level and country of birth were smaller in magnitude in 2017 than in 1992. Inequality estimates in dissatisfaction with teeth according to use of dental care and perceived health were, respectively, smaller and greater at older than at younger age. CONCLUSION: Socio-demographic inequalities in oral health persisted from age 50 to 75 and varied in magnitude across time. Both convergence and widening of disparities in oral health occurred towards older ages.

Let us talk about it: An exploratory qualitative study of older adults' priorities for oral health in North West England.

OBJECTIVES: The aim of this study was to explore oral health experiences and priorities in a diverse group of adults aged over 60 in North West England, an area with high oral health inequality. METHODS: Participants were selected using purposive sample from multiple settings across the North West: community, primary dental care and residential care home. Data were collected between October 2018 and March 2019 and involved eight focus groups and three individual interviews with a total of 47 participants. The data were analysed using thematic analysis. RESULTS: Four key themes were identified. The first was issues important to people over 60, which included the appearance of one's teeth, communication, continuity of care and the treatment experience. These were informed by two further themes, past experiences of treatment, which were not always favourable, and perceived barriers, such as accessing NHS dentistry, cost, physical access and oral care in institutional settings. The fourth, connected theme focussed on how oral healthcare messages for different audiences should be disseminated. CONCLUSIONS: There are shortfalls in the provision of oral healthcare to older adults in the UK. Communication and continuity of care with a trusted oral healthcare provider are key priorities for this population. However, our participants felt that current public provision of dental services is not meeting their needs.

Challenges in oral health research for older adults.

BACKGROUND: The high burden of chronic disease in older adults presents significant organisational and funding challenges to healthcare policymakers. However, it is a matter of debate whether research is informing oral healthcare policy at scale. OBJECTIVE: The objective of the study was to identify barriers to translation of research into oral healthcare policy and practice for older adults and suggest strategies to address these barriers. RESULTS: The effectiveness of current models of oral health care, particularly for vulnerable older adults with special needs, is not well established. Researchers need to engage more proactively with stakeholders such as policymakers and end-users from the study design phase. This is particularly relevant for research in residential care settings. Building a rapport and developing trust with these groups will enable researchers to align their research with the priorities of policymakers. The evidence-based care paradigm, which is underpinned by randomised clinical trials (RCTs), may not be practical in population oral health research involving older adults. Alternative methods should be considered to develop an evidence-informed paradigm for oral health care in older adults. Since the pandemic, there are opportunities to use electronic health record data and digital technology. Further research is needed to evaluate the effectiveness of tele-health in oral health of older adults. CONCLUSION: Use of a wider range of co-designed studies rooted in the practicalities of "real world" health service delivery is recommended. This may address issues of concern to policymakers and stakeholders regarding oral health and increase the likelihood of translation of geriatric oral health research into oral healthcare policy and practice.

Stereophotometric facial changes in edentulous older adults after rehabilitation with complete dentures.

OBJECTIVES: To evaluate the facial characteristics of edentulous older adults who underwent rehabilitation using complete dentures, and to compare them with dentate individuals. BACKGROUND: Edentulism rehabilitation with complete dentures aims to restore occlusion and facial aesthetics. MATERIALS AND METHODS: The study included 102 edentulous participants needing prosthodontic rehabilitation with complete dentures and 30 with a natural dentition (aged >65). The 3D facial scans were performed using an Artec optical scanner. Superficial facial landmarks were identified, and 16 parameters were calculated. Regional analysis with the superimposition of two scans was used to calculate the average distances and percentage of non-matching surfaces in the 11 regions. Paired and independent t-tests (α = .05) were used to test for group differences, as appropriate. RESULTS: After rehabilitation with complete dentures, facial changes were most noticeable in the perioral region: wider rima oris, longer upper lip, wider upper vermilion, and more protruded profile. The comparison of facial regions without and with dentures showed fuller and curvier cheeks, with no direct influence of dentures. The edentulous faces with dentures appeared shorter and more retruded than those of dentate individuals. A narrower lower vermilion, retruded upper lip, and more flattened facial profile were observed in females with dentures than in their dentate peers. CONCLUSION: Besides the expected positive influence of rehabilitation with complete dentures on facial appearance in the perioral region, there are some unexpected changes, such as fuller cheeks, but there is still deficiency in vertical facial dimensions and a more flattened facial profile.

Clinical parameters that affect performance and patient satisfaction of root-retained overdentures: A systematic review of randomised controlled clinical trials.

OBJECTIVE: To evaluate clinical parameters that affect the performance of root-supported overdentures (ROD) and to identify the possible factors that may affect it. BACKGROUND: ROD still serve as an alternative and successful treatment plan nowadays for partially edentulous patients. Nonetheless, there is not yet conclusive evidence about their clinical evaluation. MATERIALS AND METHODS: A search strategy was developed following a PIO (Population, Intervention, Outcome) framework including an electronic search in the following databases: PubMed, Cochrane Library and Scopus. The systematic search included only randomised controlled clinical trials (RCTs), published until January 2023 in English language and was performed by two independent reviewers. Quality assessment of the included studies was conducted according to the Cochrane Risk of Bias tool. RESULTS: The final selection of studies included 11 RCTs. Clinically relevant variables derived from this search were: Complications, with caries being the most frequently reported, periodontal aspects and bone changes around abutment teeth. Additionally, methods and clinical suggestions for the maintenance of these restorations and patient-related outcomes were assessed. According to the risk of bias assessment, nine studies were considered of high risk, whereas only 2 of low risk. A meta-analysis was not feasible. CONCLUSION: Within the limitations of this systematic review, ROD remain a viable treatment plan, offering better denture stability and bone preservation around abutment teeth and high patient satisfaction. Thorough oral hygiene and regular follow-ups are of utmost importance. Further well-designed RCTs are necessary for firmer conclusions.

Australian dental school academics' perceptions of gerodontology education in the undergraduate curriculum.

INTRODUCTION: Australia's rapidly growing population of dentate, frail, care-dependent older people require graduates skilled in managing the health needs of this patient group. The perceptions of academics teaching gerodontology may inform future dental curricula recommendations. This study explored the perceptions of gerodontology education amongst Australian dental school academics. MATERIALS AND METHODS: All nine Australian dental schools providing entry-to-practice dentistry programs were invited to participate in semi-structured interviews. Academics from six dentistry programs took part, and the data were analysed using a thematic approach. RESULTS: The three main themes identified from interviews included 'clinical exposure', 'organisational levers', and 'sociological barriers'. The attitudes of students, as well as society and health professionals, were seen as strongly influential in preparing the workforce for managing the oral health of older people. The themes inter-linked with a knock-on effect where societal attitudes and organisational levers impact on the ability to successfully support students' preparation for gerodontology practice. Limited resources were barriers to achieving ideal learning and teaching and continued upon graduation as oral health care for older people was perceived as undervalued and under-resourced. CONCLUSION: There has been a continued cycle of failure in healthcare schemes and advocacy for the improvement of oral health for older people which has contributed to the inadequate preparation of dental graduates for managing frail and care-dependent older people. Organisational, societal, and political change is needed to support the education of dental students in this area to ensure graduate dentists are competent to manage the oral care needs of this growing population.

Evaluation of student-perceived competence of interprofessional working in Gerodontology.

OBJECTIVE: To evaluate pharmacy, dental and dental therapy undergraduate students' perceived competence of interprofessional working before and after attending an interprofessional education (IPE) Gerodontology workshop. BACKGROUND: Whilst there is international recognition of the importance of collaboration between the dental profession and systemic healthcare providers to enhance patient care, there remains a paucity of research into IPE in Gerodontology. MATERIALS AND METHODS: Pharmacy, dental and dental therapy undergraduate students attended a 2-hour Gerodontology case-based workshop. Students completed anonymised Interprofessional Collaborative Competencies Attainment Surveys (ICCAS) before and after attendance. RESULTS: 108 questionnaires were received, 7 were withdrawn (1 incomplete with only pre-workshop side completed, 6 did not identify degree programme). From 101 included questionnaires, 37 were from pharmacy, 56 dental and 8 dental therapy students resulting in response rates of 84%, 82% and 67%, respectively. Each student group recorded an increase in positive reflective competence median (IQR) after taking part in the workshop. Overall median (IQR) reflective competence before the workshop was 6 (1), 5 (2) and 6 (2) for pharmacy, dental and dental therapy students, respectively, which increased to 7 (1) for all groups. There was variability in reflective competence before attending the workshop between dental and pharmacy students for two questions, and dental and dental therapy students for two different questions. CONCLUSION: All students reported increased reflective competence of interprofessional working following the workshop. These findings suggest that introduction of IPE events into Gerodontology curricula may improve student understanding and appreciation of interprofessional working when providing care for older people.

Current status of geriatric dentistry education in selected dental schools in Latin America and the Caribbean.

OBJECTIVE: Latin American and Carribean (LAC) are currently experiencing a rapid aging of their population, coupled with a significant burden of oral diseases. Despites this, there is a scarcity of evidence regarding the manner in wich geriatric dentistry is being taught in dental schools across LAC. So, the objective of this study is to investigate the current status of geriatric dentistry education at undergraduate and postgraduate levels in selected LAC dental schools. METHODS: An electronic questionnaire was developed and emailed to all 539 dental schools in 19 LAC countries. The questionnaire recorded activity levels, contents and methodology of geriatric dentistry education as part of dental degree programmes. Reminders by email and telephone calls were used to encourage non-responders to complete the questionnaire. RESULTS: In total, 317 schools from 17 countries responded to the questionnaire (response rate: 58.8%). Geriatric dentistry was taught in 54.6% of the schools at the undergraduate level and in 6.9% at the postgraduate level. Thirty two percent of the schools had a programme director trained in geriatric dentistry. Geriatric dentistry was taught as an independent course in 14.5% of the schools. Dry mouth, periodontal disease, denture-related conditions and prosthodontic management, oral mucosal disease and age-related changes of the orofacial complex were the most frequently covered topics. Clinical teaching of geriatric dentistry was reported by 26.5% of the schools, with 38.0% providing clinical training in outreach facilities. CONCLUSIONS: Geriatric dentistry education remains incipient in LAC, with only one in every four dental school offering it as a standalone course. There is an urgent need to further develop geriatric dentistry education in the continent, including further research to develop a minimum geriatric dentistry curriculum.

A novel prosthesis presentation test to screen for cognitive and functional decline.

OBJECTIVES AND BACKGROUND: To validate a novel screening test for cognitive and functional decline in older patients rehabilitated with complete removable dental prostheses (CRDPs). MATERIALS AND METHODS: Edentate old in-patients rehabilitated with CRDPs were included in this study. Participants were requested to remove their prostheses before their intraoral examinations. The prostheses were then presented in an inverted orientation. Participants had to correct the orientation of the prostheses and insert them in the appropriate jaws. The test was repeated after the intraoral exam. Appropriate statistical models were used (⍺ = .05) to associate the test results with the participants' mini-mental state examination (MMSE) score, functional independence measure (FIM), age and sex. RESULTS: Among the 86 participants (mean-age: 85.4 ± 6.4 years; mean MMSE: 19.8 ± 5.5; mean FIM: 77.9 ± 20.8), 21 (24.4%) failed to correctly insert the prosthesis. The prosthesis presentation test (PPT) was associated with the FIM but not the MMSE. Regression models further confirmed an association with age (P = .043), but not sex. Additional analyses revealed the PPT test is associated with the FIM's cognitive sub-sets of memory, problem solving and social interaction. CONCLUSION: The PPT is a novel, simple and quick screening tool that can help detect functional difficulties in older people. It can easily be performed during an oral examination. Future studies are needed to determine whether the PPT can be used to detect deficits in executive function, as a complement to the MMSE and also as a first assessment of a patient's ability to manage dentures independently.

Why and when older people lose their teeth: A study of public healthcare patients aged 60 years and over in 2007-2015.

OBJECTIVES: This register-based study on public sector patients aged 60 years and over assessed annual age-specific volume of and reasons for tooth extractions as well as changes in these across the period 2007-2015. BACKGROUND: Alongside the rapidly ageing population, the demand for public oral healthcare services is growing. Damaged teeth may induce a long-lasting inflammation burden in old age. MATERIALS AND METHODS: Data used the electronic documentation of oral healthcare procedures recorded according to healthcare regulation. The study population consisted of all patients over 60 years of age (n = 216 059) who were treated 2007-2015 in public oral health care available to all citizens of Helsinki, Finland. Data for the 9-year time series included reasons for tooth extractions and were aggregated by patient age into 5-year groups. Statistical analyses included rates and proportions, mean values, correlation coefficients and linear regression modelling. RESULTS: Extraction patients (n = 48 623) were more likely in the older age groups: 21.8% in the age group 60-64 and 27.5% in the age group 90+. Mean number of tooth extractions among all patients was 0.4 per patient and 1.7 per extraction patient. Among all tooth extractions (n = 82 677), main reasons were caries 29.5%, apical periodontitis 19.4%, tooth remnant 19.4% and periodontitis 18.0%. Tooth remnant predominated as extraction reason in the oldest age groups, while apical periodontitis displayed an upward trend by calendar year. CONCLUSION: Tooth extractions attributable to caries were common in all old-age groups, tooth remnant extractions were most common in older age groups, and apical periodontitis abounded as extraction reason during 2007-2015.

[A prospective single-cohort study of implant-supported full-arch metal-ceramic prosthesis with gold-platinum alloy framework for treatment edentulous mandible in elderly patients: 15-year report]. / Implantatsionnoe protezirovanie protyazhennymi metallokeramicheskimi konstruktsiyami s karkasom iz zolotoplatinovogo splava u pozhilykh patsientov: rezul'taty 15-letnego perspektivnogo odnogruppovogo kogortnogo issledovaniya.

OBJECTIVE: To study the effectiveness of implant-supported full-arch metal-ceramic prosthesis with gold-platinum alloy framework in elderly patients. MATERIALS AND METHODS: The study included patients with complete and/or partial loss of teeth and terminal dentition. In 2007-2008, 354 implants were inserted in 27 patients. The age of the patients was 61.31±5.08 years. Mombelli index criteria (mBI [modified Sulcus Bleeding Index]) were used. The plaque index was determined using a modified Löe & Silness method. The state of the peri-implant bone (ΔMBL) was determined by a series of OPG. The Geriatric Oral Health Index (GOHAI) was used to assess oral health in the elderly. RESULTS: Metal-ceramic full-arch implant prostheses with a gold-platinum alloy framework, based on a sufficient and optimal number of implants (6-8), showed high survival rate (100%) after 15 years. Marginal bone loss (ΔMBL) after 15 years was -1.44±1.27 mm. The survival rate of implants was 99.4%. Scores on the GOHAI scale were higher in patients after orthopedic rehabilitation (from 52.7±7.1 to 54.1±8.4, p<0.001). CONCLUSION: After 15 years, all prostheses had mechanical defects, which at the same time allowed them to be used without restrictions. Screw fixation of full-arch implant prostheses, although it was associated with mechanical complications, nevertheless made it possible to perform surgical interventions in a timely manner and stop the development of inflammatory complications. Thus, we do not see any grounds for removing metal-ceramic prostheses and replacing them with new implant prostheses even after a 15-year period of operation. At the same time, it is necessary to take into account the reduction in the possibility of individual oral hygiene in elderly patients, as well as possible restrictions on self-visiting a dentist or dental hygienist.

Characteristics of desirable ambulatory health and oral healthcare from the perspective of community-dwelling people aged 80 and over-a qualitative examination.

BACKGROUND: people aged 80 and over frequently have diverse and complex health trajectories, which has been well studied. But their oral health is seldom included in care models. To realise comprehensive healthcare, both general and oral ambulatory (i.e. outpatient) healthcare need to be explored and conceptualised equally. OBJECTIVE: to elicit what matters to very old people regarding ambulatory health and oral healthcare. METHODS: interviews were conducted with non-institutionalised people aged 80 and over living in the area of Cologne, Germany. They were interviewed regarding their experiences of and views on ambulatory healthcare and oral healthcare care, respectively. Thematic analysis was performed to understand their motives and elicit relevant characteristics of desirable health services. RESULTS: from the interviews with 22 participants, 16 characteristics of good healthcare were described. These were generally similar for both general and oral healthcare and had a particular focus on patient-provider interaction and the organisation of care. However, regarding oral healthcare, the participants focused more strongly on the technical-medical skills of professionals and the perceptible treatment results and were more concerned about costs. It was noticeable that older people had the urge to differentiate themselves from 'others unnecessarily using health services'. They were unaware of possible future oral health deterioration and the resulting future needs. CONCLUSIONS: characteristics of good health and oral healthcare from the perspective of older people should be incorporated to ensure patient-centredness in care models. Older patients, as well as healthcare providers, need to be sensitised to their oral health needs to realise comprehensive healthcare.

Utilization of dental services and health literacy by older seniors during the COVID-19 pandemic.

BACKGROUND: This study aimed to investigate the utilization of dental services by older seniors during the COVID-19 pandemic and to evaluate their ability of finding, understanding, and using information on COVID-19. METHODS: At the end of February 2021, a survey addressing demographic characteristics of the participants, (pain-associated) utilization of dental services, worries regarding a potential COVID-19 infection, the individual use of protective masks, and difficulties regarding the access to information on COVID-19 (by using the modified European Health Literacy Questionnaire [HLS-EU-Q16]) was developed. It was sent to all patients of the Dental Clinic of University of Leipzig who were either 75, 80, or 85 years old (n = 1228). Participation was voluntarily and anonymously; questionnaires had to be returned within six weeks, no reminders were sent. RESULTS: Of the 439 replies (response rate 35.7%), twelve were excluded from data extraction due to disinterest, dementia, or lack of age information. Of the older seniors, 81.5% (n = 348) had utilized at least one dental examination and 54.2% of the dentulous patients (n = 199) had attended at least one dental hygiene appointment within the past year. Up to 55.8% of all participants said it was "difficult" or "very difficult" to find, understand, and use information on COVID-19, especially when judging reliability of information presented in the media, which was especially true for seniors with assigned care levels presenting odds ratios up to 5.30. CONCLUSIONS: The investigation revealed a frequent utilization of dental services by older seniors during the COVID-19 pandemic. However, the older seniors encountered difficulties finding, using, and understanding information about COVID-19.

Intranasal midazolam for the sedation of geriatric patients with care-resistant behaviour during essential dental treatment: An observational study.

OBJECTIVES: To describe the efficacy and safety of intranasal midazolam for sedation during essential dental treatment of geriatric patients with major neurocognitive disorder (MND) and care-resistant behaviour (CRB). BACKGROUND: Dental treatment is often impossible in geriatric MND patients with CRB. Intranasal midazolam may provide a non-invasive sedation method, but there is currently no information on its use in geriatric patients. METHODS: In this observational study, we included geriatric patients with severe MND and CRB needing urgent dental treatment. Each patient received 5 mg midazolam intranasally. Agitation/sedation levels, heart rate, respiration rate and oxygen saturation were recorded at 5-minute intervals. RESULTS: Thirty two patients were included. Mean age was 84 (±7) years. Mean (SD) time to treatment start was 13 (±5) minutes, and mean time to maximum sedation 17 (±11) minutes. Sedation was sufficient to enable dental treatment to be completed in 31 (97%) patients. Anxiolysis/light sedation occurred in 16 (50%) patients, and moderate to deep sedation occurred in 16 (50%) patients. No patients suffered from apnoea, although 3 patients required a chin-lift manoeuvre. Hypoxaemia occurred in 1 of these patients and in 2 other patients without airway obstruction. All patients recovered uneventfully. In a regression model, age, weight and other sedative medication use were found not to be associated with maximum sedation depth. CONCLUSIONS: Of 5 mg intranasal midazolam facilitates treatment of geriatric patients with MND in the comfort of their own environment. More information is needed to guide titration to balance the desired sedation level and patient safety.

[A prospective single-cohort study of an immediate prefabricated three-implant-supported full-arch prosthesis for treatment edentulous mandible in elderly patients: 3-year report.]

The use of implant prosthetics in the elderly and senile patients is highly relevant. Many clinicians advocate a wider introduction of immediate implant restorations in the elderly due to the fastest restoration of aesthetics and function. The purpose of the work is to study the efficacy of implant prosthetics in elderly patients with extended replacement structures with a small number of artificial supports. The patients underwent implant restoration of the mandible with an extended metal-polymer structure «Trefoil¼ with a prefabricated standard frame and three artificial supports. The overall implant survival rate was 96%. The cumulative survival rate of patients was 93%. The cumulative survival level of prostheses was 98,3%. The high implant and prosthesis survival rates, the good condition of the peri-implant mucosa and bone three years after restoration, as well as the high level of patient satisfaction and the significantly higher level of their quality of life, along with the high medical and economic efficiency of the method, allow us to consider it a promising standard of geriatric dentistry.

Third-party toothbrushing is associated with a positive patient experience: randomized, single-blind, patient-centered analysis.

BACKGROUND: As the need for care increases with higher age, so does the need for assistance with oral hygiene. A recent study analyzed the clinical effectiveness of oral hygiene assistance provided by caregivers. The current secondary analysis of this study aimed to assess pleasant and unpleasant perceptions of patients while being brushed and to investigate whether these perceptions depend on the qualification of the person brushing and the type of toothbrush used (manual vs. powered). METHODS: First, a qualitative study was conducted. This aimed at developing the questionnaire. Items were extracted on the basis of qualitative interviews with a sample of 6. A delphi process ensured the content validity of the final instrument. The main study comprised 39 periodontitis patients with reduced oral hygiene capability randomized to one of four groups: brushing carried out by trained laypeople or dental professionals, each using a manual or powered toothbrush at three different time points during anti-infective periodontal therapy. Patient perceptions of the third-party toothbrushing were assessed immediately after brushing. RESULTS: Patients reported mainly positive feelings regarding being brushed by a third person and the interaction with this person during brushing. Neither the professional background of the brushing person nor the type of brush had a significant influence on pleasant and unpleasant perceptions (all F < 3.30, all p > 0.07, all η2 < 0.10). CONCLUSIONS: Patient perceptions of third-party toothbrushing are mainly positive regarding wellbeing and interactions with the toothbrushing person, and do not depend on the qualification of the brushing person or the toothbrush used (manual versus powered). Trial registration https://www.germanctr.de , No. DRKS00018779 (04/11/2019).

Impact of an interdisciplinary curriculum for dental students (GeriDent-Cologne) on attitudes and awareness towards older people and geriatric conditions.

INTRODUCTION: Training of dental students in the treatment of older patients must also consider the multiple chronic medical conditions that may be present. We developed an interdisciplinary gerodontology training curriculum for dental students (GeriDent-Cologne) to investigate its influence on the attitudes and expectancies of dental students towards the treatment of older patients. MATERIALS AND METHODS: The curriculum (given to fourth-year students) comprised five clinical examination stations that simulated different medical conditions affecting older people. Students were able to experience related issues first hand, express their fears and problems concerning dental treatment in older people and, through discussion with the supervisor, develop strategies to overcome these difficulties and enhance treatment. An extended version of the Los Angeles Geriatric Attitudes Scale was given to fourth- and fifth-year students (who acted as controls) over one semester. RESULTS: Dental students had a positive attitude towards older people, and their attitude did not change after attending the curriculum. However, participating in GeriDent-Cologne had a significant beneficial impact on the feeling of being prepared to treat older people, led to a significantly greater understanding of the impact of medical issues and resulted in a considerably higher level of geriatric clinical knowledge over time. CONCLUSIONS: GeriDent-Cologne led to positive and semester-long changes in awareness and knowledge of specific geriatric problems that influence dental treatment. We recommend the curriculum as a blueprint for the module of senior dentistry implemented in the new German dental licencing regulations.

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

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

A model for a geriatric teaching programme and its impact on self-rated and tested competencies of undergraduate dental students.

INTRODUCTION: In the light of the growing ageing population, it is important that future dentists be taught geriatric competencies to assure good dental care and treatment addressing the special needs of older patients. MATERIALS AND METHODS: We developed and evaluated a geriatric teaching programme amongst final year undergraduate dental students (n = 30) at the University of Bern, Switzerland. The geriatric teaching programme was based on the European undergraduate curriculum in geriatric medicine for medical students covering the following eight geriatric domains that were considered relevant to dental care: Analgesics, cognitive impairment, decision-making capacity, gait and balance disorder, hearing impairment, malnutrition, polypharmacy and vision impairment. Using a pre/post-design, we administered a structured questionnaire including standardised questions on self-rated and tested competencies. Both assessments scores were standardised to a maximum score of 100 points. Data were evaluated by comparison of pre-test and post-test mean scores. RESULTS: The geriatric teaching programme proved to be feasible covering eight geriatric domains based on a case-based didactic approach in totally eight 45-minute lessons. Both self-rated and tested competencies of dental students increased in all eight domains in the course of the geriatric teaching programme. After the geriatric teaching programme, both mean self-rated competency scores (67.9 vs. 49.6, p < .001) and mean tested competency scores (78.7 vs. 56.7 points, p < .001) significantly improved compared to baseline. CONCLUSIONS: Integrating a consolidated refined geriatric teaching programme is a potentially feasible and effective method for dental undergraduate students and is expected to have an impact on better dental care of older patients.