Gerodontology最新文献

Background: Detecting deterioration in frail oral community-dwelling older people's oral health may be delayed as a consequence of decreased visits to oral health care professionals. Older people are becoming increasingly dependent on medical care and visit other healthcare professionals, highlighting the importance of interprofessional collaboration. There is a need for an easy-to-use, time- and cost-efficient oral health assessment tool for non-oral healthcare professionals. This systematic review aimed to identify self-reported items that predict the risk of oral health deterioration in older people to inform such a tool.

Method: The OVID/Medline, Embase, EBSCO/CINAHL, and Web of Science databases were systematically searched. An additional reference check was performed to ensure that no records were missing. The primary outcome was predictive value, defined as the probability of a specific question or self-reported item predicting the risk of oral health deterioration or the need for dental referral. When available, the data were presented as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Results: The initial search resulted in 2471 records. Eleven articles met the inclusion criteria and were analysed. A high predictive value for oral health deterioration was observed for the self-reported items: "Are you generally pleased with your mouth and teeth?" (specificity: 93.0%), "Would you say your mouth health is generally good?" (specificity: 95.2%), "Does your mouth feel dry?" (specificity: 82.7%), and "Do you have regular dental checkups?" (sensitivity: 90.0%-100%); and "Do you have tooth and/or mouth problems that make it hard to eat?" (specificity: 92.0).

Conclusion: A screening tool for use by non-oral health professionals, that consists of 2-4 highly predictive self-reported items, such as dry mouth, satisfaction with oral health, recent dental visits and food consumption problems, could be used for early detection and timely referral of older people at risk of oral health deterioration.

Background: The global ageing population has increased demand for healthcare services in residential aged care (RAC), with oral health recognised as crucial for overall well-being. Despite this, the implementation of oral health assessment tools in RAC faces significant challenges.

Objective: This scoping review explored the implementation and acceptance of oral health assessment tools in RAC facilities, identifying key barriers and facilitators influencing their adoption by non-dental healthcare professionals.

Methods: Five databases were searched, including Web of Science, Scopus, Embase, Medline OVID and CINAHL, with a focus on oral health assessment tools utilised by non-dental healthcare professionals in residential aged care. The review adhered to the Joanna Briggs Institute (JBI) Methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines, with data extraction guided by the Promoting Action on Research Implementation in Health Services framework, focusing on evidence, context and facilitation.

Results: The review included 26 studies on the implementation of oral health assessment tools in residential aged care facilities, highlighting diverse barriers and facilitators impacting tool adoption by non-dental professionals. Key barriers included insufficient training, high staff turnover and inconsistent prioritisation of oral health across facilities. In contrast, facilitators involved targeted in-service training and the presence of oral health champions to support tool usage. Despite the variety of tools identified, none of the studies employed an implementation science framework.

Conclusions: There is a need to incorporate implementation science to enhance the sustainability and effectiveness of oral health assessment tools in RAC settings. Addressing the identified barriers and using facilitators could improve the adoption and integration of oral health assessment tools, ultimately enhancing residents' oral health and well-being.

Introduction: Dry mouth is moderately prevalent in the older population. Pharmacological and non-pharmacological alternatives have been assessed to manage its manifestation. This umbrella review synthesised the evidence on approaches to managing xerostomia and hyposalivation.

Material and methods: We searched for systematic reviews of interventions to manage dry mouth in Cochrane Database of Systematic Reviews, EMBASE, PubMed, Prospero and DARE databases (up to September 2023). References were managed and selected by reading titles and abstracts using Rayyan QCRI. Selection of studies, data extraction and methodological quality assessment (AMSTAR 2) were conducted independently, in duplicate. Data were extracted to a previously tested form that included information about dry mouth causes, interventions, outcomes and findings.

Results: There were 3323 records. At the end of the selection process, 48 studies were included and had data extracted. Only three high-quality systematic reviews were found to support methods for managing dry mouth. Limited evidence suggests that topical therapies offer significant palliative or stimulating effects for relieving dry mouth symptoms. Furthermore, low-quality evidence indicates a slight increase in saliva production with acupuncture, dry mouth prevention with amifostine, and saliva stimulation using pilocarpine in patients who have undergone head and neck radiotherapy.

Conclusion: Salivary substitutes and stimulants mostly acted as moisturisers and some as saliva stimulants, with short-term effect. More than 80% of the reviews were appraised as 'critically low' quality. Well-designed and well-reported systematic reviews are still needed to increase the level of evidence on dry mouth management methods.

Protocol registration: Prospero Registration CRD42022325854.

Objectives: This study investigated the prevalence and associations of xerostomia in older adults in southern Brazil.

Methods: A cross-sectional study was carried out in Pelotas, Brazil, during 2014. A representative sample of the city's older adult population (60+) was selected. The dependent variable was self-reported feeling of dry mouth in the past 6 months. Covariates included socio-economic status, schooling, gender, age, tobacco and alcohol consumption, polypharmacy, hypertension, diabetes, arthritis, depression, dentition status and use of removable dental prostheses. Descriptive analysis was carried out, and Poisson regression was used to obtain prevalence ratios and 95% confidence intervals. Analyses used STATA 15.1.

Results: Most of the 1451 participants were female (63.3%). The prevalence of xerostomia was 36.7% (95% CI 34.3-39.1). Adjusted analysis showed that xerostomia was significantly more common among females (PR 1.44, 95% CI 1.22-1.74), those with less schooling (PR 1.31, 95% CI 1.10-1.51), those exposed to polypharmacy (PR 1.22, 95% CI 1.05-1.37), people with arthritis (PR 1.42, 95% CI 1.23-1.61) and those with depression symptoms (PR 1.45, 95% CI 1.23-1.70).

Conclusion: Xerostomia is common among older adults. Health workers need to pay attention to its associated factors for early identification and promotion of appropriate interventions, particularly the rational use of medicines.

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.