Gerodontology最新文献

Objectives: To summarise the current evidence on the involvement of dental hygienists (DHs) in residential aged care facilities (RACFs) with respect to the feasibility of integration improved oral health for residents with dementia and multidisciplinary collaboration.

Background: The oral health of RACF residents with dementia is reported to be poor. However, little is known about how DHs can be integrated into RACFs to improve oral health, particularly as part of a multidisciplinary team.

Method: A scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) method. Multiple databases were searched for peer-reviewed articles and grey literature that included a DH working in a RACF with dementia patients, or as part of a multidisciplinary team. Data were charted using a modified version of the JBI source of evidence template.

Results: Fifty-eight studies were identified for inclusion. Integration strategies were categorised as support-focused or service-focused, but there was little evaluation of their feasibility. Five key facilitators to multidisciplinary collaboration were identified: using multiple strategies; clearly defining roles; changes to existing administrative systems; fostering multidisciplinary collaboration skills; and encouraging innovation. However, no examples of collaboration within RACFs were identified.

Conclusion: There has been limited effort in multidisciplinary collaboration or integration of DHs into RACFs with some evidence that both support-focused and service-focused strategies can improve the oral health of residents with dementia.

Objectives: To identify different clusters of health-related behaviours and examine whether these clusters are associated with maintaining 20 or more teeth.

Background: Engaging in risky behaviours impacts tooth loss, particularly among older adults. Maintaining 20 teeth is a challenge for this age group. The co-occurrence of health-risk behaviours is common and has been linked to an increased risk of multiple chronic diseases, including tooth loss.

Material and methods: A cross-sectional analysis of wave 7 of the English Longitudinal Study of Ageing (ELSA) was conducted. Functional dentition was self-reported as having 20 or more teeth. Four health-related behaviours (smoking, alcohol intake, fruit and vegetable consumption, and physical activity) were analysed to investigate their association with functional dentition. Demographic characteristics (sex, age, ethnicity) and socioeconomic factors (education, wealth) were included as covariates. Latent Class Analysis (LCA) was conducted using four dichotomised behaviour variables to identify clusters of behaviours. Logistic regression modelling was used to examine the association between clusters of health-related behaviours and functional dentition. The model was adjusted for demographic and socioeconomic factors.

Results: A total of 7783 participants were included. The LCA model identified three clusters: (1) risky, (2) moderate and (3) healthy. In the fully adjusted logistic regression model, the odds of having a functional dentition were 1.42 higher among those in the moderate cluster (95% CI: 1.23, 1.65), and 1.70 higher among those in the healthy cluster (95% CI: 1.39, 2.09) than for participants in the risky cluster.

Conclusion: Risky behaviours tend to cluster among older adults. Engaging in multiple risky behaviours is associated with having fewer than 20 teeth. Initiatives and public health campaigns that focus on these clustering patterns, as well as the underlying factors, could benefit both oral and general health.

Objectives: To evaluate various oral functions in patients with jaw defects after oral tumour surgery and to clarify factors associated with their quality of life (QoL).

Background: In patients with jaw defects, oral function and QoL are severely impaired. No studies have evaluated oral functions of patients with jaw defects and examined their relationships with QoL.

Materials and methods: The study participants were 72 patients (mean age: 70.7 ± 10.1 years, range 48-93 years) who underwent prosthetic treatment with a removable denture to treat a jaw defect following oral tumour surgery. Masticatory performance, maximum bite force, oral dryness, tongue pressure, and tongue-lip motor function (oral diadochokinesis, /pa/, /ta/, /ka/ syllables) were evaluated after prosthetic treatment. The Japanese version of the EORTC QLQ-H&N 35 was used to assess QoL. From the QoL assessment, the "Pain", "Swallowing", "Sense", "Speech", "Social eating", and "Social contact" scales were extracted. Multiple regression analysis was conducted using each QoL scale as the dependent variable and oral functions as explanatory variables.

Results: In the multiple regression model for "Swallowing", the oral diadochokinesis /ta/ was a significant explanatory variable. In the model for "Sense", tongue pressure was a significant explanatory variable. In the model for "Speech", age was a significant explanatory variable. In the model for "Social contact", tongue pressure was the significant explanatory variable.

Conclusion: In patients with jaw defects following oral tumour surgery, lower tongue pressure is associated with poorer QoL in a wider range of ways than other oral functions are.

Objectives: This study evaluated the impact of masticatory difficulty on the development and progression of malnutrition, frailty, sarcopenia, and disability in community-dwelling adults, using data from the Korean Frailty and Aging Cohort Study.

Methods: Participants were categorised by presence of masticatory difficulty. The Fried frailty phenotype, mini-nutritional assessments, and diagnostic criteria proposed by Asian Working Group on Sarcopenia were adopted to diagnose frailty, malnutrition, and sarcopenia respectively. Physical disabilities were measured using the Korean activities of daily living (ADL) and Korean instrumental activities of daily living (IADL) scales.

Results: A total of, 3010 participants were initially enrolled, 2864 participants remained in the study after 2 years, reflecting a 95.1% retention compliance. At baseline, the prevalence of frailty (28.0% vs. 18.1%), malnutrition (1.5% vs. 0.8%), IADL disability (10.1% vs. 7.7%), and ADL disability (10.8% vs. 8.0%) was higher among those experiencing masticatory difficulty than in those without. After 2 years, baseline masticatory difficulty was associated with the incidence of malnutrition (OR, 2.62; 95% CI, 0.99-6.90; p = 0.042) after full adjustment for confounders. However, no associations were found between baseline masticatory difficulty and the incidence of frailty, sarcopenia or physical disability over 2 years after adjustment. Additionally, masticatory difficulty did not affect the persistence or remission of malnutrition, frailty, sarcopenia, IADL disability, and ADL disability in individuals who already had these conditions at baseline.

Conclusion: Restoring chewing function and masticatory satisfaction improves not only oral health but also contributes to overall health and promotes healthy aging in older individuals.

Objectives: To evaluate the changes in nutritional status, chewing ability and oral health-related quality of life in edentulous individuals who have initially been rehabilitated with immediate complete dentures (CD) which are then transformed to implant-supported overdentures (IOD) after a period of osseointegration.

Background: Compared to those with conventional dentures, individuals with IODs exhibit improved patient-reported outcomes, chewing capacity and biting force. While prior research highlights differences in nutritional markers between these groups, there is limited investigation into intra-individual changes in nutritional status, chewing ability and oral health-related quality of life during the transition from CDs to IODs.

Materials and methods: Edentulous individuals aged 50 years or older and needing oral rehabilitation with IODs were eligible for this prospective study. The primary outcome measure was the nutritional status as measured by the Mini Nutritional Assessment (MNA). The Oral Health Impact Profile (OHIP-14) questionnaire and chewing ability questionnaire represented secondary outcome measures. These measures were assessed at baseline (T0), 3-month follow-up after application of the CD (T1), and 3- and 6-month follow-up after the CD had been transformed to IOD (T2 and T3). Statistical analyses used repeated measures ANOVA or the Friedman test for OHIP-14 and MNA scores, with logistic regression used for malnutrition risk.

Results: Thirty-five participants were included in the final analysis. MNA scores significantly worsened from the baseline to the 3-month follow-up after the application of the CD. There was no significant change in nutritional status between baseline and the IOD 3- and 6-month follow-up appointment. IODs led to significant improvements in the OHIP total score at both the 3- and 6-month follow-ups (p < 0.001, W = 0.60) with a strong effect size. Difficulty in chewing decreased significantly, affecting 91.4% of participants at baseline, which reduced to 51.4% (18/35) by the 6th month.

Conclusion: Implant-supported overdentures do not influence nutritional status, but they improve chewing ability and oral-health related quality of life in older adults.

Objective: To assess the effects of oral screen training in patients with dysphagia post-stroke.

Background: Oral screen training has been identified as an effective method for improving orofacial and oropharyngeal motor functions. However, the evidence supporting a positive transfer effect on swallowing capacity post-primary stroke rehabilitation is still unclear. The aim of this randomised controlled trial was to investigate the effect of a 12-week oral screen training programme using a prefabricated oral screen, with swallowing capacity as the primary outcome.

Materials and methods: In a randomised trial, stroke survivors with residual dysphagia post-rehabilitation were randomised into intervention group (n = 12) and control group (n = 12). The intervention group underwent 12 weeks of oral screen training. The main outcome was swallowing capacity, with lip force as a training indicator. Secondary outcomes were assessed by the Eating Assessment Tool, Masticatory performance, Nordic Orofacial Test-Screening, Life Satisfaction Questionnaire and the Edmonton Symptom Assessment System.

Results: At the 3-month follow-up, the group that trained with an oral screen showed a significantly greater increase in lip force than the control group (mean lip force increase 10.2 N vs. 3.1 N; p = 0.02). There was no significant improvement in swallowing capacity (mean increase 0.7 mL/min vs. 0.8 mL/min; p = 0.43), or in any of the secondary variables in the intervention group relative to the control group.

Conclusion: The findings from this study showed that oral screen training initiated after completion of regular rehabilitation post-stroke can increase lip force. However, there was no indication of any transfer effect on swallowing capacity.

Trial registration: Clinicaltrial.gov identifier: NCT03167892.

Objective: This study aimed to examine the effects of an oral hypofunction management protocol incorporating oral function training and provision of dietary advice for 3 months on the nutritional status and oral function of older patients diagnosed with oral hypofunction.

Background: Oral hypofunction is associated with poor nutritional status, emphasising the need for management protocols incorporating provision of nutritional guidance and dietary advice. However, the efficacy of such protocols remains unclear.

Materials and methods: This quasi-randomised controlled clinical trial included 80 patients (age ≥ 65 years) diagnosed with oral hypofunction who were divided into two groups (intervention and control). The intervention group was provided with dietary advice and instructed to perform daily oral function training. The patients' nutritional status and oral function were evaluated every 1.5 months. Intergroup and intragroup comparisons were made.

Results: The intervention group exhibited a significant increase in the mean Mini Nutritional Assessment score over the study period (baseline: 25.4 ± 3.2; after 3 months: 26.3 ± 3.0), whereas no significant difference was observed in the control group (baseline: 26.4 ± 2.4; after 3 months: 26.4 ± 2.7). The mean number of symptoms of poor oral function was 4.0 ± 1.0 and 3.9 ± 0.9 at baseline and 2.8 ± 1.3 and 3.0 ± 1.3 after 3 months in the intervention and control groups, respectively, with a significant difference within the groups.

Conclusion: Management protocols incorporating provision of nutritional advice effectively improved the oral function and nutritional status of older patients with oral hypofunction.

Objective: To investigate the association between mortality and masticatory function in older adults living in long-term care facilities (LTCFs), controlling for demographic and health covariates.

Background: Poor oral health has been associated with mortality; however, no previous study investigated whether objective and self-reported poor masticatory function is a predictor of early mortality in LTCFs.

Materials and methods: Baseline characteristics of 295 participants were collected, including age, sex, polypharmacy, mobility, activities of daily living, frailty, nutritional status, and objective (masticatory performance - chewing gum) and self-reported masticatory function. The participants were followed-up with for 4 years to record the mortality data. Cox regression models were run to analyse the data (α = .05).

Results: During the 4-year follow-up, 124 (42.0%) participants died. Older adults with poor masticatory performance (hazard ratio [HR] = 1.59, 95% confidence interval [95% CI] = 1.07-2.36) and those who self-reported masticatory dysfunction (HR = 1.48, 95% CI = 1.01-2.16) were at higher risk of early death than those with good mastication. However, in a multivariate model including both objective and self-reported masticatory function, only the objective measurement remained associated with early death (HR = 1.52, 95% CI = 1.02-2.27).

Conclusion: Poor masticatory performance seems to be associated with early death in older adults living in LTCFs, but they may have shared risk factors accumulated throughout life that were not covered by the study period.

Background: Over the course of brushing, aerosolised particles develop in the mouth. In individuals who do not have the ability to expel these oral aspirates, they can be inhaled and cause aspiration pneumonia. This article showcases a novel vacuum toothbrush, termed "ToothVac," and provides findings from its first human trial.

Methods: The ToothVac device suctions saliva and aspirates during brushing, storing them in a removable reservoir at the bottom of the brush, to minimise the risk of inhalation and subsequent infection. Further descriptions of the various components of the ToothVac are included. This trial involved 18 participants who brushed using the ToothVac with the vacuum suction turned on and then off.

Results: The volume of saliva produced was measured and compared. The ToothVac significantly reduced the amount of saliva that was produced by these participants when brushing.

Conclusion: The device has potential clinical potential in that it may reduce the risk of aspiration pneumonia and related lung infections. Potential future research may include clinical trials for specific indications or marketing for oral aspirate removal, as well as optimisation of brush design using injection moulding for scalable manufacturing.