Gerodontology最新文献

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.

Background and objectives: There is limited evidence on knowledge of related health among healthcare personnel who care for older adults. The objective of this study was to investigate the knowledge and experience of oral health care among family members and medical staff responsible for older adults with varying degrees of cognitive impairment and Alzheimer's disease.

Materials and methods: This qualitative study explored the experiences and knowledge of 30 family members and medical staff through in-depth, semi-structured interviews. The interviews were recorded using both audio and video formats: digital platforms were used for immediate family members, while formal caregivers were interviewed in person. Researchers transcribed and analysed the recordings, categorising the answers to identify emerging topics until reaching saturation.

Results: The core emerging themes among the direct family members were: (1) Lack of knowledge about oral health; (2) Oral hygiene role for the patients; (3) Consequences of a poor oral care; and (4) Recommendations for a better oral health care. For the formal caregivers the emerging themes were: (1) Lack of knowledge and experiences about oral health; (2) Deficient oral hygiene of residents; (3) Impact on quality of life; and (4) Suggestions for improving oral health.

Conclusion: Despite recognising the significance of oral health, direct family members and formal caregivers of older adults with cognitive impairment or dementia still need additional tools to effectively carry out necessary hygiene techniques and care.

Objectives: The study compares three minimally invasive approaches for the retention of implant supported mandibular complete dentures, particularly focusing on patient satisfaction.

Background: The McGill Consensus Statement recommends restoration of the edentulous mandible with an overdenture retained on two implants. Alternatively, less invasive treatment concepts with shorter treatment times have been developed for critical cases.

Material and methods: Thirty-nine patients (with a total of 78 implants) with advanced mandibular bone atrophy were randomly assigned to three groups: "single standard implant-retained overdentures" (SSO) and "mini-implant-retained overdentures" (MO), which was further subdivided into "two mini-implant-retained overdentures" (TMO) and "four mini-implant-retained overdentures" (FMO). The technical and biological parameters and oral health-related quality of life were evaluated over a 10-year period. Data were analysed for group comparisons and longitudinal trend analysis.

Results: Sixteen patients (42%) dropped out during the study period. At the time of follow-up, 98.4% of the implants were in situ. The first need for technical intervention occurred after 3.8 ± 1.1, 4.2 ± 0.9, and 4.6 ± 1.3 years in the TMO, SSO, and FMO groups, respectively. Attachment exchange (39%) was the most frequently performed intervention in all groups. Healthy peri-implant and mucosal conditions were observed in 74% and 40% of patients after 1 and 10 years, respectively. The OHIP-G14 score was 22.6 before implantation, 7.6 at 1 year (effect size [ES]: 1.1), and 5.4 at 10 years (ES: 2.3).

Conclusion: Irrespective of the minimal concept selected, complete mandibular dentures retained on implants improved the subjective perception of the quality of life. Application of these alternative minimal concepts may be practical in clinical practice.

Objective: This study aims to map the existing literature on natural products used as disinfection substances for conventional polymethyl methacrylate (PMMA) and computer-aided design and manufacturing (CAD-CAM) dentures.

Background: Denture wearers are at high risk for denture stomatitis. Natural products have attracted the interest of the scientific community as an alternative to synthetic ones.

Materials and methods: The guiding question "Which natural products have been applied to disinfect complete dentures in conventional PMMA or CAD-CAM PMMA resin?" Searches were conducted in the PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases, and manual searches were performed in reference journals in the area with studies published until December 2023, without language or date restrictions.

Results: A total of 4272 articles were identified, and 46 studies were included after applying the eligibility criteria. Thirty-nine natural products were evaluated. Of the included studies, 43 presented positive findings and three obtained negative findings on the effectiveness of natural products in inhibiting or killing Candida albicans.

Conclusion: Natural products, predominantly sourced from the Plantae kingdom, have demonstrated efficacy in reducing Candida albicans on the surface of conventional PMMA. However, the evidence primarily stems from in vitro studies, underscoring the necessity for additional clinical research to validate their applicability under real microbiological conditions in prosthesis users.

Objective: To evaluate the validity of the newly developed Oral Hygiene Ability Instrument (OHAI), created to assess the cause of any inability of older adults to perform oral hygiene, and to revise the instrument based on the results.

Background: Good oral hygiene is among the most important prophylactic measures for oral health. This applies especially to older adults, among whom risk factors and physical and cognitive barriers are more common and can hamper oral hygiene.

Methods: The OHAI contains (I) an interview, (II) clinical examination, (III) observation of oral hygiene activities and a summarising part. In the study, 149 older adults in three groups participated: stroke, cognitive disorder and general dental patients. Inclusion criteria were to be ≥65 years old, have at least one tooth and to manage oral hygiene without assistance. For criterion validity, sensitivity and specificity were calculated using eight reference instruments. To determine construct validity, we used known group validity, factor analysis and Rasch analysis.

Results: The criterion and construct validity of the OHAI were found to be acceptable to good. In the stroke group, balance and fine motor skills were assessed to affect oral hygiene most; in the cognitive disorder group, it was balance, coordination, spatial ability and cognitive functions. Analyses revealed that one item had no added value and that some response options were not optimal.

Conclusion: The OHAI proved to be valid for the group it is intended for, with only minor revisions needed, resulting in a 32-item instrument. The OHAI could be a valuable person-centred tool in prophylactic work with older adults with failing oral hygiene.

Objectives: This study explored the attitudes of New Zealand (NZ) general dental practitioners (GDPs) towards older adults living within the community and the barriers and difficulties caring for their oral health needs.

Background: Adults are living longer and retaining teeth. Their dentitions are complex and alongside their dental needs, older adults often experience age-related systemic disease or decline. Ageism and stereotypical views of older adults impedes access to dental care. While there is some understanding of older adults and ageism from the perspective of dental students, there is a paucity of knowledge about dentists' management of this patient demographic.

Materials and methods: A mixed-methods survey questionnaire collected quantitative and qualitative data. Quantitative data were analysed descriptively followed by bivariate analysis. Qualitative data responses to open-ended questions were analysed thematically.

Results: A total of 382 GDPs participated (response rate of 24%) and demonstrated positive attitudes and low levels of ageism towards older adults who they enjoyed treating. Confidence was positively related to clinical experience, and most dentists had engaged in gerodontology updates. Barriers to care for older adults were perceived to be beyond their control and mostly related to cost, chronic disease or age-related change. Consent processes could create difficulty and so collaboration with family or caregivers was important.

Conclusion: The GDPs displayed positive attitudes and confidence towards older adults who are a rewarding patient cohort. Gerodontology education during training and following graduation is critical to enhance oral health outcomes for older patients.

Objectives: Limited access to oral health services contributes to poor oral health in institutionalised older adults. The objective of this study was to map and analyse the distribution of residential age-care facilities (RACFs) in relation to dental practices across Australia.

Methods: Age-care data were sourced from the Australian Institute of Health and Welfare. The data were categorised according to the Australian Bureau of Statistics remoteness index in each state and territory, defined by a geographic coordinate system. The structure of remoteness area data was integrated into RACF data using a geographic information system. Buffer analysis in QGIS was employed to calculate the buffer distance surrounding RACFs by identifying dental practices relative to a measuring distance.

Results: In total, Australia had 2718 RACFs and 7379 dental practices (both private 95.5% and public 4.5%). In all States, more than a third of metropolitan RACFs were within accessible reach of a private practice (ranging from 37% of RACFs in NSW to 55% in WA). However, proximity to public clinics was low, ranging from only 4% (WA) to 9% (QLD). More than one-fifth of metropolitan RACFs in NSW, QLD, WA and ACT (ranging from 20% to 24%) were not within accessible proximity of either a public or private dental clinic/practice. While more than 70% of RACFs in regional and remote Australia are reasonably close to dental practices, areas with inadequate access exist, with the highest percentage recorded in WA (6%).

Conclusion: Ensuring an equitable distribution of dental practices relative to RACFs is crucial in bridging the service access gap in underserved areas.

Objective: The purpose of this study was to investigate the effect of coronectomy on postoperative quality of life in older adults.

Background: Coronectomy is an alternative to complete surgical removal of a mandibular third molar that lies close to the inferior alveolar nerve.

Materials and methods: This prospective study included patients >60 years old who had an indication for coronectomy of a mandibular third molar. Patients were asked to complete the Dutch version of the Oral Health Impact Profile-14 (OHIP-14) daily during the first postoperative week. Postoperative pain, swelling, limited mouth opening, chewing ability and infection were also recorded. Furthermore, the effect of the impaction pattern, state of eruption, presence of preoperative pathology, patient health status according to the American Society of Anaesthesiologists score, gender, smoking on the postoperative OHIP-14 and pain scores were investigated.

Results: Thirty patients (16 males, 14 females) with a mean age of 71.2 (SD 8.3, range 60-91) years were included in the study. OHIP-14 and pain scores were highest on the first postoperative day and gradually declined during the first postoperative week. Patients who underwent coronectomy of a fully impacted mandibular third molar had significantly higher OHIP-14 scores on the first postoperative day than those who underwent coronectomy on a (partially) erupted mandibular third molar. We did not observe any postoperative complications up to 1 year after the surgery.

Conclusion: Mandibular third molar coronectomy seems to present a valid treatment option in older adults.