The prevalence and experience of oral diseases in Adelaide nursing home residents

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Background: The twenty-first century will see the evolution of a population of dentate older Australians with dental needs very different from those of older adults in past years. This study provided comprehensive information concerning oral disease prevalence in older South Australian nursing home residents. Methods: This paper presents cross-sectional baseline results. Results: Most of the 224 residents, from seven randomly selected nursing homes, were functionally dependent, medically compromised, cognitively impaired and behaviourally difficult older adults who presented many complex challenges to carers and to dental professionals. Two-thirds (66 per cent) were edentulous with many dental problems and treatment needs. Dentate residents had a mean of 11.9 teeth present, higher than previously reported. The prevalence and experience of coronal and root caries and plaque accumulation was very high in dentate residents; especially males, those admitted more than three years previously, those who ate fewer food types and those who were severely cognitively impaired. These residents had more retained roots, decayed teeth and missing teeth, and fewer filled teeth when compared with data for community-dwelling older adults. Conclusions: This study highlighted the poor oral health status of these nursing home residents and the great impact of dementia on their high levels of oral diseases.JM Chalmers, C Hodge, JM Fuss, AJ Spencer, KD Carte

Oral healthcare access and adequacy in alternative long-term care facilities

This study was undertaken to determine practices and perceived barriers to access related to oral health by surveying administrators in Michigan alternative long-term care facilities (ALTCF). A 24-item questionnaire was mailed to all 2,275 Michigan ALTCF serving residents aged 60+. Facility response rate was 22% (n = 508). Eleven percent of facilities had a written dental care plan; 18% stated a dentist examined new residents; and 19% of facilities had an agreement with a dentist to come to the facility, with 52% of those being for emergency care only. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or private offices as well as financial concerns. Substantial barriers to care were uniformly perceived.Oral health policies and practices within Michigan ALTCF vary, as measured by resources, attitudes, and the availability of professional care. There is limited involvement by dental professionals in creating policy and providing consultation and service.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79086/1/j.1754-4505.2010.00132.x.pd

The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents : a systematic review

Background: Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties. Methods: This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines. Results: Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria. Conclusions: None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps

Preventative Oral Health Services Provided by Nurses\u27 Aides to Nursing Home Residents

The purposes of this investigation were to identify: 1) what preventive oral health services were provided by nurses\u27 aides to nursing home residents, 2) how frequent preventive oral health services were performed by nurses\u27 aides, 3) who nurses\u27 aides reported abnormal or suspicious findings detected in the resident\u27s mouth, 4) what factors discouraged and encouraged nurses\u27 aides performance of oral health services, and 5) how nurses\u27 aides rated their oral health knowledge of services they performed. The study population was comprised of a random sample of 40 percent of nursing home facilities in southeastern Virginia. A 14-item questionnaire was administered to nurses\u27 aides employed at 11 (79 percent of sample) nursing home facilities. Data were analyzed using the Statistical Analysis System (SAS). Frequency distributions and percentages were tabulated for discrete, nominal, and ordinal scaled data. Results suggest that nurses\u27 aides employed in southeastern Virginia nursing facilities typically perform preventive oral health services such as toothbrushing, mouthrinsing, and denture cleaning procedures for nursing home residents. The majority of nurses\u27 aides indicated that patient cooperativeness was a major factor that encouraged or discouraged the performance of oral health services. Nurses\u27 aides typically reported suspicious and abnormal findings detected in residents\u27 mouths to the nurse in charge of shift. The majority of nurses\u27 aides rated their oral health knowledge of denture cleaning and toothbrushing as excellent. However, a large percentage of nurses\u27 aides rated their oral health knowledge of saliva substitutes and flossing as poor

Oral health care for older adults during COVID-19 pandemic

IntroductionCoronaviruses are a family of viruses identified in the 1960s (1). In December 2019 Chinese scientists and clinicians identified a new coronavirus, SARS-CoV-2 as the pathogen that causes the coronavirus disease 2019 (COVID19) (2, 3). Age is the most considerable risk factor for COVID-19 disease and its fatal clinical outcomes (4-6). Angiotensin-converting enzyme 2 (ACE2) receptors are the critical receptors for the pathogenesis of COVID-19(7). The virus has a high affinity to ACE2 receptors, which are expressed in alveolar cells in the lungs (3) A significant number of aged people have prescribed ACE2 inhibitors and angiotensin II receptor blockers to control hypertension, diabetes, and chronic kidney disease, therefore, these medications increase the risk of infection by SARS-CoV-2 (8).It has shown that ageing individuals with serious medical conditions are more susceptible to develop a severe illness due to COVID-19 infection than healthy individuals (9, 10). However, poor oral hygiene increases the risk of developing the same medical disorders. Thus, improving oral health in older people  may decrease the morbidity of COVID-19 (10). Also this specific population is at risk for developing severe complications related to COVID-19 (11, 12) Due to the restrictions preventing the spread of COVID-19, oral health care provision for older adults has reduced considerably (13). Besides, older adults may have the fear of being exposed to dental aerosol-generating procedures (14). The reduction in access to dental care during this current pandemic may have considerable and lasting impacts (13).such as worsening oral health, triggering infections lead to local and systemic complications, and compromising general health (15). Oral health care has been stopped in most Long-term Care Facilities due to the recommended measures for isolation (16). Abrams et al. stated the necessity of special infection control in nursing homes during COVID-19 outbreaks (17). The manifestations of covid-19 in geriatric patients might be severe difficulty in breathing, confused state of mind, bluish lips, and persistent pressure on the chest (15). Due to the weak immune system of geriatrics, dermatological manifestations may be helpful during screening. An irregular oral ulcer has been reported which was suspected to be the oral symptom for SARS-CoV-2 (18). A critical aspect of geriatric oral health care is knowing reduced immunity and impaired healing capacity while managing COVID positive adults (15). Other manifestations of SARS-CoV-2 patients include myalgia, encephalopathy, encephalitis, necrotizing hemorrhagic encephalopathy, stroke, and epileptic seizures (19, 20). Mao et al. (21), reported  36% of the patients who experienced neurological symptoms, were older adults. As the dentists must use additional personal protective equipment during COVID-19 (22), it may develop challenges in patients who have a cognitive impairment, or dementia, because the use of this equipment makes communication difficult. For example, elderly people who have a hearing impairment, find it more difficult to understand a dentist who uses this equipment (23). Sivaraman et al. (15) proposed five basic steps for effective screening, diagnosis, and treatment of aged patients in the COVID-19 pandemic. These steps are inducted through telephone, texting, or video calls before the patient arrives. In the first step, dentists document personal details and the chief complaint of the patients. In the next step, they should record, medical dental, and drug history. In the third step they evaluate special clinical manifestations of SARS-CoV-2 Infection. Then they present a treatment plan based on the chief complaint and necessity. In the last step, they mention recommendations before, during, and after dental treatment (15). The dental team must emphasize the importance of oral hygiene to the older patient as a part of post-operative instructions (15). Poor oral hygiene can increase the risk of acute respiratory distress syndrome, pneumonia, septic shock, sepsis, and death in COVID positive aged patients (24).Thus, improved oral hygiene and frequent professional oral health care reduce the progression or occurrence of respiratory diseases, especially in older people (25). Two strategies can be used to deliver dental care to aged people during the current pandemic: (23) minimal intervention dentistry (MID)(26) and tele-dentistry (27). According to the restrictions during the pandemic, MID can become the low risk strategy for caring for dependent older adults (23). Tele-dentistry is a cost-effective approach to provide the oral care needs for the aged who have no access to care (28, 29). The oral health program including Oral Health Therapists (OHTs) and tele-dentistry can improve the oral health status of residents of nursing homes(30). In conclusion, MID and tele-dentistry can become the new standard way of care for pandemic dentistry for elderly people, including those with cognitive impairment and dementia (23).                                       IntroductionCoronaviruses are a family of viruses identified in the 1960s (1). In December 2019 Chinese scientists and clinicians identified a new coronavirus, SARS-CoV-2 as the pathogen that causes the coronavirus disease 2019 (COVID19) (2, 3). Age is the most considerable risk factor for COVID-19 disease and its fatal clinical outcomes (4-6). Angiotensin-converting enzyme 2 (ACE2) receptors are the critical receptors for the pathogenesis of COVID-19(7). The virus has a high affinity to ACE2 receptors, which are expressed in alveolar cells in the lungs (3) A significant number of aged people have prescribed ACE2 inhibitors and angiotensin II receptor blockers to control hypertension, diabetes, and chronic kidney disease, therefore, these medications increase the risk of infection by SARS-CoV-2 (8).It has shown that ageing individuals with serious medical conditions are more susceptible to develop a severe illness due to COVID-19 infection than healthy individuals (9, 10). However, poor oral hygiene increases the risk of developing the same medical disorders. Thus, improving oral health in older people  may decrease the morbidity of COVID-19 (10). Also this specific population is at risk for developing severe complications related to COVID-19 (11, 12) Due to the restrictions preventing the spread of COVID-19, oral health care provision for older adults has reduced considerably (13). Besides, older adults may have the fear of being exposed to dental aerosol-generating procedures (14). The reduction in access to dental care during this current pandemic may have considerable and lasting impacts (13).such as worsening oral health, triggering infections lead to local and systemic complications, and compromising general health (15). Oral health care has been stopped in most Long-term Care Facilities due to the recommended measures for isolation (16). Abrams et al. stated the necessity of special infection control in nursing homes during COVID-19 outbreaks (17). The manifestations of covid-19 in geriatric patients might be severe difficulty in breathing, confused state of mind, bluish lips, and persistent pressure on the chest (15). Due to the weak immune system of geriatrics, dermatological manifestations may be helpful during screening. An irregular oral ulcer has been reported which was suspected to be the oral symptom for SARS-CoV-2 (18). A critical aspect of geriatric oral health care is knowing reduced immunity and impaired healing capacity while managing COVID positive adults (15). Other manifestations of SARS-CoV-2 patients include myalgia, encephalopathy, encephalitis, necrotizing hemorrhagic encephalopathy, stroke, and epileptic seizures (19, 20). Mao et al. (21), reported  36% of the patients who experienced neurological symptoms, were older adults. As the dentists must use additional personal protective equipment during COVID-19 (22), it may develop challenges in patients who have a cognitive impairment, or dementia, because the use of this equipment makes communication difficult. For example, elderly people who have a hearing impairment, find it more difficult to understand a dentist who uses this equipment (23). Sivaraman et al. (15) proposed five basic steps for effective screening, diagnosis, and treatment of aged patients in the COVID-19 pandemic. These steps are inducted through telephone, texting, or video calls before the patient arrives. In the first step, dentists document personal details and the chief complaint of the patients. In the next step, they should record, medical dental, and drug history. In the third step they evaluate special clinical manifestations of SARS-CoV-2 Infection. Then they present a treatment plan based on the chief complaint and necessity. In the last step, they mention recommendations before, during, and after dental treatment (15). The dental team must emphasize the importance of oral hygiene to the older patient as a part of post-operative instructions (15). Poor oral hygiene can increase the risk of acute respiratory distress syndrome, pneumonia, septic shock, sepsis, and death in COVID positive aged patients (24).Thus, improved oral hygiene and frequent professional oral health care reduce the progression or occurrence of respiratory diseases, especially in older people (25). Two strategies can be used to deliver dental care to aged people during the current pandemic: (23) minimal intervention dentistry (MID)(26) and tele-dentistry (27). According to the restrictions during the pandemic, MID can become the low risk strategy for caring for dependent older adults (23). Tele-dentistry is a cost-effective approach to provide the oral care needs for the aged who have no access to care (28, 29). The oral health program including Oral Health Therapists (OHTs) and tele-dentistry can improve the oral health status of residents of nursing homes(30). In conclusion, MID and tele-dentistry can become the new standard way of care for pandemic dentistry for elderly people, including those with cognitive impairment and dementia (23).   Conflict of interest Author declares no conflict of interest.                             &nbsp

Relationship of Nutritional Status with Oral Health Status in Visual Impairment

To analyze the relationship of nutritional status with oral health status among visual impairment. The subjects were 146 elderly people (70 males and 76 females) aged 20-72 years (mean 48.8±6.2 years), Phitsanulok, Thailand. Mini Nutritional Assessment (MNA) questionnaires were administered. Oral examinations investigated the number of present teeth, DMFT and Functional Tooth Units (FTUs). According to the MNA score, 44.5% of subjects were categorized as normal nutrition, 47.3% as questionable, and 8.2 % as malnutrition. The mean numbers of present teeth and FTUs were 17.8±6.9 and 6.9±3.2, respectively. Subjects with malnutrition had lower numbers of present teeth (10.7±1.4) and FTUs (4.3±1.7) than those with normal nutrition (20.2±0.7 and 12.3±0.5) (p≤0.05). Nutritional status of visual impaired Thai was associated with mean numbers of present teeth and FTUs. Keeping many natural teeth or having appropriate numbers of FTUs by replacing missing teeth with dentures would prevention malnutrition

Oral hygiene and health-related quality of life in institutionalized older people

Purpose We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored. Methods This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants' background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden. Results Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender. Conclusions Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents' oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups. Key summary pointsAim We evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities. Findings Only one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL. Message Oral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities.Peer reviewe