Dental practice during a world cruise: Characterization of oral health at sea

Aims: To describe oral health of passengers and crew attending the dental service aboard during a two months world cruise. Methods: In a retrospective, descriptive epidemiologic study design the routine documentation of all dental treatment provided at sea was analysed after the voyage. Subjects were n = 57 passengers (3.5 % of 1619) with a mean age of 71 (± 9.8) years and n =56 crew (5.6 % of 999) with a mean age of 37 (± 12.0) years. Age, gender, nationality, number of natural teeth and implants were extracted. The prosthetic status was described by recording the number of teeth replaced by fixed prosthesis and number of teeth replaced by removable prosthesis. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile (OHIP-14) and characterised by the OHIP sum score. Results: Women attended for treatment more often than men. Passengers had a mean number of 20 natural teeth plus substantial fixed and removable prosthodontics. Crew had a mean of 26 teeth. British crew and Australian passengers attended the dental service above average. Crew tended to have a higher average OHIP-14 sum score than passengers indicating an increased rate of perceived problems. Emergency patients from both crew and passengers have a higher sum score than patients attending for routine treatment. Conclusion: In passengers the average number of teeth appears to be higher than that of an age matched population of industrialized countries. However, the passengers’ socioeconomic status was higher which has an effect on this finding. Socioeconomic factors also serve to explain the high standard of prosthetic care in passengers. Crew in general present with less sophisticated prosthetic devices. This is in line with their different socioeconomic status and origin from developing countries. The level of dental fees aboard in comparison to treatment costs in home countries may explain some of the differences in attendance. Passengers have enjoyed high standards of prosthetic care in the past and will expect a similarly high standard from ship based facilities. The ease of access to quality dental care may explain the relatively low level of perceived problems as characterised by oral health-related quality of life scores. The dental officer aboard has to be prepared to care for very varied diagnostic and treatment needs

On the Necessity of a Geriatric Oral Health Care Transition Model: Towards an Inclusive and Resource-Oriented Transition Process

People in need of care also require support within the framework of structured dental care in their different life situations. Nowadays, deteriorations in oral health tend to be noticed by chance, usually when complaints or pain are present. Information on dental care is also lost when life situations change. An older person may rely on family members having oral health skills. This competence is often not available, and a lot of oral health is lost. When someone, e.g., a dentist, physician, caregiver, or family member notices a dental care gap, a structured transition to ensure oral health should be established. The dental gap can be detected by, e.g., the occurrence of bad breath in a conversation with the relatives, as well as in the absence of previously regular sessions with the dental hygienist. The aim of the article is to present a model for a structured geriatric oral health care transition. Due to non-existing literature on this topic, a literature review was not possible. Therefore, a geriatric oral health care transition model (GOHCT) on the basis of the experiences and opinions of an expert panel was developed. The GOHCT model on the one hand creates the political, economic, and legal conditions for a transition process as a basis in a population-relevant approach within the framework of a transition arena with the representatives of various organizations. On the other hand, the tasks in the patient-centered approach of the transition stakeholders, e.g., patient, dentist, caregivers and relatives, and the transition manager in the transition process and the subsequent quality assurance are shown

Student Perceptions of Age and Ageing-An Evaluation of Swiss Dental Students Receiving Education in Gerodontology

Society is ageing and the higher number of senior citizens in the total population is a challenge for society and often perceived as a burden. Negative images of old age can lead to ageism and poorer healthcare for older people. The younger generation will have to master these demographic challenges. Therefore, their attitude towards and their perception of the older generation has to be monitored. The aim of this study is to present the images of ageing held by dental students who received education in gerodontology and to assess possible changes between different generations of students over time and separated by gender. An annual, anonymous questionnaire survey was conducted among dental students at the end of the 10th semester each year between 2008 and 2021. The questionnaire surveyed personal attitudes towards ageing, the assessment of seniors, and personal experience with seniors (images of ageing, "Aging Semantic Differential"). In addition to confirming Friedan's phenomenon regarding the assessment of age limits, the present study was able to demonstrate a positive image of ageing in dental students, which has remained almost constant over the years. An education in gerodontology might positively influence student perceptions of age and aging

Validation of a New Measuring Instrument for the Assessment of Bite Force

BACKGROUND: this study aims to validate two occlusal-force-measuring devices by comparing them to a universal testing machine and assessing their reliability across various dental and prosthetic groups. The research comprised two parts: part 1 assessed the measurement accuracy of the Occlusal Force Meter GM 10$^{®}$ (OFM) (Morita, Nagano Keiki, Higashimagome, Ohta-ku, Tokyo, Japan) and a prototype (PRO) by comparing them to a calibrated universal testing machine (ZWICK). Part 2 involved analyzing the devices' reliability based on clinical bite force measurements from study participants. RESULTS: both devices become more accurate and reliable compared to the ZWICK over time of usage. Additionally, higher deviation from the ZWICK can be observed for higher values of forces applied and vice versa for both devices. The PRO's intraoral alignment influences its mean values compared to the OFM in different dental and prosthetic groups. CONCLUSION: both devices had limitations and required quadratic function calibration, making them suitable only for progression measurements. The study concludes that both the OFM and PRO devices can measure occlusal forces with improved accuracy over time. Intraoral alignment should be considered. Their easy-to-use clinical application would allow a more widespread use of masticatory function diagnosis, which could indicate the need for treatment and improve treatment planning

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

BACKGROUND Life expectancy of people with permanent disabilities has increased. The dental care of these vulnerable patients is one of the greatest challenges for the dentist and the dental team due to limited or non-existent cooperation and the associated lack of health competence. In order to be able to provide safe and acceptable, quality dental treatment without psychological and physical stress for these patients, it is therefore necessary to resort to sedation or general anaesthesia (GA) under medical supervision. The aim of the analysis is to highlight the need for dental treatment performed under GA for people with disabilities and the associated indications and treatment patterns. METHODS Ten-year retrospective analysis of outpatient dental care under GA for people with disabilities. RESULTS Of all adult patients (n = 221) who attended the GA pre-assessment, 69.7% (n = 154) received dental treatment under GA based on the clinical findings or in cases of suspected pain. Most patients received one GA. A total of 205 dental treatment sessions were performed under GA mostly for conservative (n = 442, 52%) and surgical (n = 389, 45.8%) procedures. Endodontic treatment (n = 19, 2.2%) was rare. The failure rate related to all teeth in need of treatment (n = 850) was 5.1% (n = 43), in most cases due to secondary caries (n = 40; 93.0%). Patients were enrolled in an annual recall for dental examination and prophylaxis without GA. Non-compliant patients for whom oral hygiene was impossible received a periodic GA. CONCLUSION There is a high need of people with disabilities for dental treatment under GA. Main indications for treatment under GA are dental complaints, pain or suspected pain. Dental care can be successful if, for the benefit of patients with special needs, all carers cooperate closely. Caregivers have to be trained in nutrition control as well as in oral hygiene. These factors in conjunction help to prevent dental emergencies

Development of undergraduate gerodontology courses in Austria, Switzerland, and Germany from 2004 to 2009

The growing number of individuals over the age of sixty-five with specific dental needs requires increased teaching efforts to adequately prepare predoctoral dental students. The study assessed whether such increases in undergraduate gerodontology teaching in German-speaking countries between 2004 and 2009 occurred. Questionnaires were mailed in 2004 and 2009 to all deans (n=37) and all department heads (n=140) of Austrian, Swiss, and German dental schools. Results show that gerodontology is still mostly included in traditional core subjects but that specific lecture series and practical teaching have increased. These cover a broad variety of subjects including geriatric medicine, gerontopsychiatry, nursing care, pharmacology, and public health. The number of departments with dedicated staff for gerodontology, research activities, and mean number of publications has increased. Barriers to the further integration of the subject include its continued exclusion from final examinations in Austria and Germany. Guidelines of the European College of Gerodontology (2009), which aim to prepare students to provide dental treatment to seniors by teaching theoretical knowledge, practical skills, patient management techniques, and the ethical foundation of gerodontology, need to be implemented. Continued professional education of faculty in all departments, intensified cooperation between universities, and the presence of faculty specializing in gerodontology are suggested

Influence of visual acuity, manual dexterity and handgrip strength on oral and denture hygiene ability of non‐frail older people: Development of the Gerostomatological Assessment Battery

Background: Due to the heterogeneity of older people, it is difficult to identify reliable factors influencing oral health. Objective: The aim was to illustrate the influence of visual acuity, manual dexterity, and handgrip strength on the oral and denture hygiene ability of older non‐frail people.MethodsIn a cross‐sectional study, conducted at a specialized dental clinic, at baseline, all participants received professional prophylaxis and instruction on daily oral and denture hygiene regimes for a 6‐week intervention period. Data on the Quigley and Hein modified plaque index (QHI), respectively, the Denture Hygiene Index (DHI), visual acuity, manual dexterity and handgrip strength in non‐frail participants (≥ 65 years) were collected. Recruitment was done within the clinic's patient clientele and within the staff (control cohort).ResultsWomen showed significantly better manual dexterity than men (Mann–Whitney U, p = .01), while women's mean handgrip strength was significantly lower (Mann–Whitney U, p < .01). Manual dexterity (Mann–Whitney U, p = .003) and handgrip strength (Mann–Whitney U, p = .052) were associated with age. However, visual acuity, manual dexterity and handgrip strength had no influence on oral or denture hygiene. Conclusion: Visual acuity, manual dexterity and handgrip strength have no influence on oral and denture hygiene ability in older non‐frail people. Further studies should investigate whether these factors also have no influence on oral and denture hygiene in vulnerable older patients. Therefore, an assessment tool for the evaluation of potential influencing factors of oral and denture hygiene is proposed in a dental context. This Gerostomatological Assessment Battery (G‐AB) can be used as a helpful tool to check the individual cognitive function and comprehension, dental therapy approaches and their individual adaption

Development of undergraduate gerodontology courses in Austria, Germany and Switzerland 2004-2014

PURPOSE/OBJECTIVES In view of the demographic shift, undergraduate dental students should be prepared for growing numbers of older people and their specific needs. The study examines changes in undergraduate dental teaching in Austria, Germany and Switzerland between 2004 and 2014. METHODS Questionnaires were mailed in 2004, 2009 and 2014 to all deans and all department heads of Austrian (n = 4), German (n = 30) and Swiss (n = 4) dental schools. RESULTS Response rates were 51% for deans and 47% for heads of department. Gerodontology was taught in 5 German universities, all 3 Swiss and 1 Austrian dental school. Aspects of gerodontology were included in traditional core subjects; however, in a large number of German (88%) and Austrian (50%) universities, dedicated lecture series and seminars are lacking. Changes over time indicate firmly established teaching in Switzerland, minor fluctuations in Austria and reduced dedicated teaching activities in Germany. CONCLUSIONS 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) regarding didactical and practical teaching should be implemented in the respective compulsory syllabus to prepare current undergraduate dental students for the challenges of tomorrow

Interrater reliability and concurrent validity of oral/dental items in the resident assessment instrument minimum data set 2.0

OBJECTIVE To examine interrater reliability and concurrent validity of oral/dental items in the Resident Assessment Instrument Minimum Data Set (RAI-MDS) 2.0. BACKGROUND RAI-MDS is a standardised instrument used in nursing to determine health status and nursing needs. The extent to which oral/dental items in the RAI-MDS describe dental treatment needs concerning oral health has been questioned. MATERIALS AND METHODS This study evaluated the interrater reliability (dentist vs. nurse) and validity of oral/dental items in the Swiss version of RAI-MDS 2.0 (areas: K-nutritional status, L-oral/dental status) using professional oral examinations as a benchmark. Data of 168 residents of five long-term care facilities in the canton of Zurich, Switzerland, were collected within 1 year between October 2017 and December 2018. The statistical evaluation used descriptive statistics and Cohen's kappa (95% CI). RESULTS RAI-MDS items K1a, chewing (κ 0.098, 95% CI: 0.004-0.19); K1c, pain (κ 0.039, 95% CI: -0.03 to 0.11); L1a, debris (κ 0.117, 95% CI: 0.02-0.21); L1c, dental status (κ 0.229, 95% CI: 0.12-0.34); L1d, dental disease (κ 0.129, 95% CI: 0.02-0.24); L1e, periodontal diseases (κ -0.005, 95% CI: -0.07 to -0.03); and L1f, daily cleaning (κ -0.031, 95% CI: -0.05 to -0.01) showed weak or no agreement, whereas L1b, denture status (κ 0.634, 95% CI: 0.52-0.75), showed substantial agreement. CONCLUSION Oral/dental items in RAI-MDS lack reliability and validity. Recognition of oral health situation/treatment needs by nursing staff does not seem to be possible with the current version of this tool

The Effect of a Masticatory Muscle Training Program on Chewing Efficiency and Bite Force in People with Dementia

Until now, no study has investigated the effects of masticatory muscle training on chewing function in people with dementia. This study aimed to investigate whether physiotherapeutic exercises for the masticatory muscles have an influence on chewing efficiency and bite force in people with dementia. In a clinical trial with stratified randomization subjects were assigned to three groups based on the Mini Mental State Examination (MMSE: group 1-28-30, group 2-25-27, group 3-18-24). Each group was divided into an experimental (ExpG, intervention) and control group (ConG, no intervention). As intervention a Masticatory Muscle Training (MaMuT) (part 1: three physiotherapeutic treatments and daily home exercises, part 2: daily home exercises only) was carried out. Chewing efficiency and bite force were recorded. The MaMuT influenced the masticatory performance regardless of the cognitive state. Bite force increased in ExpG 1 and 2. Without further training, however, the effect disappeared. Chewing efficiency increased in all ExpG. After completion of the training, the ExpG 2 and 3 showed a decrease to initial values. Subjects of ExpG 1 showed a training effect at the final examination, but a tendency toward the initial values was observed. ExpG 3 seemed to benefit most from the physiotherapeutic exercises in terms of improving chewing efficiency by the end of the intervention phase. ExpG 1 showed the greatest gain in bite force. The MaMuT program is a potential method of improving masticatory performance in people with cognitive impairment or dementia when used on a daily basis