Over the past decades, there has been an increase in the number of natural teeth that are maintained into older age, and this has represented an increase in the need for more complex dental treatment ...for this population. A trained workforce is needed in order to provide dental care to the different groups of elderly. Currently, the undergraduate training in gerodontology offered by dental schools seems to be limited, with great variation among dental schools worldwide. Given the heterogeneity of elderly groups, it is unlikely that new graduates from dental schools can be deemed competent to deal with the different groups of elderly. In this article, barriers to oral healthcare's provision to older adults are discussed, including the lack of appropriately trained dental professionals. Training pathways are discussed, including the preparation of undergraduate education to provide a suitable foundation to be developed further in postgraduate education. It is also proposed that older adults are classified according to their dependency level and each level is managed by properly trained dental professionals. In order to upskill general dental practitioners to care for these patients, postgraduate certification programmes could be structured to provide additional training. Furthermore, the development of geriatric oral health educational programmes for non-dental healthcare workers is recommended.
doi: 10.1111/j.1741‐2358.2011.00579.x
Impact of tooth replacement strategies on the nutritional status of partially‐dentate elders
Objective: To investigate the impact of tooth replacement on the ...nutritional status of partially dentate older patients, and, to compare two different tooth replacement strategies; conventional treatment using removable partial dentures and functionally orientated treatment based on the shortened dental arch.
Background: Amongst older patients, diet plays a key role in disease prevention, as poor diets have been linked to numerous illnesses. Poor oral health and loss of teeth can have very significant negative effects on dietary intake and nutritional status for elderly patients. There is evidence that good oral health generally, has positive effects on the nutritional intake of older adults.
Materials and methods: A randomised, controlled clinical trial was designed to investigate the impact of tooth replacement on the nutritional status of partially dentate elders. Forty‐four patients aged over 65 years completed the trial, with 21 allocated to conventional treatment and 23 allocated to functionally orientated treatment. Nutritional status was accessed at baseline and after treatment using the Mini Nutritional Assessment (MNA) and a range of haematological markers.
Results: At baseline, relationships were observed between the number of occluding tooth contacts and some measures of nutritional status. As the number of contacts increased, MNA scores (R = 0.16), in addition to vitamin B12 (R = 0.21), serum folate (R = 0.32) and total lymphocyte count (R = 0.35), also increased. After treatment intervention, the only measure of nutritional status that showed a statistically significant improvement for both treatment groups was MNA score (p = 0.03). No significant between group differences were observed from analysis of the haematological data.
Conclusion: In this study, prosthodontic rehabilitation with both conventional treatment and functionally orientated treatment resulted in an improvement in MNA score. Haematological markers did not illustrate a clear picture of improvement in nutritional status for either treatment group.
Abstract Objective To determine the risk indicators associated with root caries experience in a cohort of independently living older adults in Ireland. Methods The data reported in the present study ...were obtained from a prospective longitudinal study conducted in a cohort of independently living older adults (n = 334). Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and other clinical variables. Questionnaires were used to collect data on oral hygiene habits, diet, smoking and alcohol habits and education level. A regression analysis with the outcome variable of root caries experience (no/yes) was conducted. Results A total of 334 older dentate adults with a mean age of 69.1 years were examined. 53.3% had at least one filled or decayed root surface. The median root caries index was 3.13 (IQR 0.00, 13.92). The results from the multivariate regression analysis indicated that individuals with poor plaque control (OR 9.59, 95%CI 3.84-24.00), xerostomia (OR 18.49, 95%CI 2.00-172.80), two or more teeth with coronal decay (OR 4.50, 95% CI 2.02-10.02) and 37 or more exposed root surfaces (OR 5.48, 95% CI 2.49-12.01) were more likely to have been affected by root caries. Conclusions The prevalence of root caries was high in this cohort. This study suggests a correlation between root caries and the variables poor plaque control, xerostomia, coronal decay (≥2 teeth affected) and exposed root surfaces (≥37). The significance of these risk indicators and the resulting prediction model should be further evaluated in a prospective study of root caries incidence. Clinical significance Identification of risk indicators for root caries in independently living older adults would facilitate dental practitioners to identify those who would benefit most from interventions aimed at prevention.
Objectives
This qualitative study of dental professionals and patients with periodontal disease: (1) explored their knowledge and perceptions on the impact of periodontal disease on systemic health ...and quality of life (QoL); (2) assessed their familiarity with QoL instruments used to measure the impact of periodontal disease.
Methods
In‐depth semi‐structured face‐to‐face interviews were conducted with 10 dental professionals and 10 patients selected using purposive sampling. Audio recordings of the interviews were transcribed verbatim, coded and analysed using NVivo software (version 11, QSR International), followed by an inductive thematic analysis of the data.
Results
Three themes were identified for the dental professionals: (1) knowledge of periodontal disease, systemic health and QoL; (2) experience in managing patients with periodontal disease to improve their QoL; (3) perceived value of having a disease‐specific QoL instrument for periodontal disease. Three themes were identified for patients with periodontal disease: (1) knowledge of periodontal disease, systemic health and QoL; (2) experience and perception of how periodontal treatment can improve QoL; (3) perceived value of having a disease‐specific QoL instrument for periodontal disease. Both groups were knowledgeable about the relationship between periodontal disease, systemic health and QoL and had experienced how periodontal treatment could improve QoL. Both groups also agreed that a disease‐specific QoL instrument for periodontal disease would be beneficial.
Conclusions
Both the dental professionals and patients with periodontal disease were aware of the relationship between periodontal disease, systemic health and QoL, including the benefits of periodontal treatment in improving QoL. The value of developing a disease‐specific QoL instrument for periodontal disease was recognized by both groups.
Abstract Congenital absence of teeth presents a number of clinical challenges in young patients, and little is known about the success rate of restorative dental treatment in these patients. The aim ...of this study was to conduct a prospective clinical study of the performance of resin bonded bridges in patients with hypodontia. Methods A prospective clinical observation study was undertaken in Cork Dental School and Hospital, Ireland. Forty patients (22 males, 18 females; age range 18–21 years) with a confirmed diagnosis of hypodontia rated as mild (n = 26), moderate (n = 8) or severe (n = 6) participated. Following completion of the orthodontic phase of care, all patients had missing teeth restored with resin bonded bridgework (RBB) using a standardised protocol (48 FF; 17CL design). Patients were followed up for 24 months, with recall visits at 6, 12 and 24 months following provision of RBBs. Results 65 RBBs were provided, 49 in the maxilla and 16 in the mandible; 43 bridges replaced anterior teeth and 22 replaced posterior teeth. After 24 months, 63 bridges were still in function and deemed to satisfy the preset criteria for success and survival. Two posterior bridges had failed due to repeated debond, and this was attributed to occlusal overload. 20% of the patients demonstrated some evidence of post orthodontic relapse, but this did not require further intervention. Conclusion In the short to medium term, resin bonded bridgework provides a reliable and minimally invasive solution for replacing missing teeth in patients with hypodontia.
To determine the prevalence of possible tooth grinding (TG) and possible sleep bruxism (SB) and to examine their impacts on oral health-related quality of life (OHRQoL) among Asian adults.
A total of ...3,072 subjects (18 to 65 years of age) from 12 dental centers were invited to complete a self-administered questionnaire on TG/SB and OHRQoL, and 2,417 were included in the study. Participants were subsequently categorized into three groups (no TG/SB, possible TG, and possible SB) based on the International Classification of Sleep Disorders. The 14-item Oral Health Impact Profile (OHIP-14) severity, extent, and prevalence scores were subsequently computed and compared. Data were examined using Kruskal-Wallis and Mann-Whitney U tests, Spearman correlation, and univariate regression analysis (P < .05).
Of the 2,417 subjects (mean age 24.79 ± 7.49 years), 42.82% reported either possible TG (n = 921; 38.11%) or possible SB (n = 114; 4.72%). Significant differences in global and domain OHIP-14 scores were found between the groups, except for the extent scores in functional limitation and physical disability. Mean global severity scores of the possible SB group (9.36 ± 9.45) were 1.5- and 2.2-fold larger than the possible TG (6.39 ± 7.61) and no TG/SB (4.22 ± 6.15) groups, respectively. A significant but weak correlation (r = 0.14 to 0.19) was found between the number of positive responses for TG/SB and OHIP-14 severity scores.
A high prevalence of possible TG and SB was found among the Asian cohort studied. Possible TG and SB were significantly associated with poorer OHRQoL. The physical pain, psychologic discomfort, and psychologic disability domains were most influenced by TG/SB. More epidemiologic studies on the functional, physical, and psychosocial influences of SB are required.
Objectives
This study aimed to develop and validate the Oral and Systemic Health Impact Profile for Periodontal Disease (OSHIP‐Perio), a disease‐specific instrument for assessing the impact of ...periodontal disease on both general and oral health‐related quality of life.
Methods
A pool of 58 items, developed from the Oral Health Impact Profile (OHIP‐49) and data generated through semi‐structured patient interviews, was tested on 80 case subjects with periodontal disease and 80 control subjects. The dimensionality of the preliminary measure was evaluated using exploratory factor analysis (EFA). Rasch analysis was then performed on the primary dimension using the Winsteps software (Version 5.1.4.0) to render the final items for the OSHIP‐Perio. The reliability and validity of the final OSHIP‐Perio were subsequently determined.
Results
Using an EFA factor loading >0.50, the primary dimension comprised 18 items. Using Rasch analysis, four items were subsequently excluded. The final OSHIP‐Perio with 14 items showed excellent test–retest reliability (overall intraclass correlation coefficient index = 0.99) and internal consistency (overall Cronbach's alpha coefficient = 0.96). It also exhibited good discriminant validity when case and control groups were compared (p < 0.001). It showed very strong correlations (rho coefficients >0.90) with the OHIP‐5, OHIP‐14 and OHIP‐49, exhibiting good concurrent validity. It demonstrated a moderate correlation (rho coefficient = 0.60) with the global health rating, exhibiting a moderate convergent validity.
Conclusions
The 14‐item OSHIP‐Perio exhibited good psychometric properties comparable to the OHIP‐5, OHIP‐14 and OHIP‐49 for evaluating the impact of periodontal disease on quality of life.
Objectives
The Oral and Systemic Health Impact Profile for Periodontal Disease (OSHIP‐Perio) was developed to measure health‐related quality of life (HRQoL) and oral health‐related quality of life ...(OHRQoL). This study aimed to determine the responsiveness and minimal importance difference (MID) of the OSHIP‐Perio.
Methods
Subjects with periodontal disease completed the OSHIP‐Perio at baseline and six to ten weeks after non‐surgical periodontal therapy. Comparisons of the clinical variables and the OSHIP‐Perio scores before and after treatment were analysed using the Wilcoxon signed‐rank test, together with the Oral Health Impact Profile (OHIP‐49, OHIP‐14 and OHIP‐5) scores. The MIDs for all the instruments were calculated using distribution‐based methods.
Results
Fifty‐one case subjects who completed periodontal treatment and the OSHIP‐Perio instrument were included for analysis. Significant improvement in all clinical variables after treatment (p < 0.001) was observed. The OSHIP‐Perio total score as well as its four‐dimensional scores (periodontal, oral function, orofacial pain and psychosocial impact) were significantly reduced after treatment (p < 0.001), indicating better OHRQoL. Findings were consistent with the other OHIP instruments. In determining the MID, the percentage point change of the OSHIP‐Perio was found to be lower than the shorter OHIP‐5 instrument when using both effect sizes (ES) (10.71% vs. 15.0% at 0.5SD) and standard error of measurement (SEM) (5.36% vs. 10.0% at 1SEM; 8.93% vs. 20.0% at 2SEM) calculations.
Conclusions
The OSHIP‐Perio demonstrated good responsiveness which was comparable to the OHIP‐49 and its short‐form derivatives. Its required percentage point change in determining its MID is smaller than the OHIP‐5.
Summary
Background
Symptoms of Temporomandibular Disorders (TMD) could affect oral health‐related quality of life (OHRQoL) and psychological distress.
Objective
This study aims to determine the ...prevalence of TMD symptoms, and impact of type and number of TMD symptoms on OHRQoL and psychological states among Asian military personnel.
Method
The study was conducted across 12 military dental centres using self‐administered questionnaire comprising demographical data, DC/TMD symptom questionnaire, OHIP‐14 and DASS‐21. A total of 3028 personnel, aged between 18‐65 years old, were invited to participate with an acceptance rate of 90.5%. Data analysis was done using non‐parametric tests, regression analysis and Spearman correlation (P < 0.05).
Results
Out of 2043 subjects (1998 males; 45 females, mean age 24.18 ± 7.18 years), 36.32% (n = 742) reported at least one TMD symptom. Significant differences in summary OHIP‐14, depression, anxiety and stress scores were observed between subjects with and without TMD symptoms. Significant differences in OHIP‐14 and DASS‐21 scores were observed between dissimilar type and number of TMD symptoms in the TMD group. Those with headaches and 2‐3 symptoms have substantially poorer OHRQoL and greater psychological distress. Associations between number of TMD symptoms, quality of life, depression, anxiety and stress were significant but weak (r = 0.19‐0.40).
Conclusions
Symptoms of Temporomandibular Disorders were prevalent among Asian military population. Significant differences in OHRQoL and psychological states were observed between subjects with and without TMD symptoms. Specific type and number of TMD symptoms impacted OHRQoL and psychological states differently. Associations between number of TMD symptoms and quality of life, depression, anxiety and stress were significant but weak.
PDF
