Gerodontology最新文献

Objective: To investigate the relationship between the use of maxillary and mandibular complete dentures, head posture, and postural stability in edentulous older adults.

Background: Tooth loss can negatively impact both head posture and postural stability, increasing the risk of falls. Complete dentures (CD) may restore balance by improving occlusion and supporting head and neck alignment, but their full impact on balance is still unclear.

Materials and methods: An electronic search was performed in PubMed/MEDLINE, Cochrane Library, Scopus, and Embase up to June 2024. A search strategy was developed based on the Population, Intervention, Comparison, Outcome framework. The quality of the included studies was assessed using the Cochrane Risk of Bias tool, and the certainty of the evidence was evaluated with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

Results: Eight clinical trials were included, involving 167 participants aged 40 to 82 years. Most studies reported improvements in head posture and postural stability immediately after rehabilitation with complete dentures, with trends showing increased cranio-vertical angles, improved dynamic stability, faster walking speed, and reduced center of gravity sway, some of which persisted for up to 30 days. The certainty of evidence was moderate for body balance and very low for head posture.

Conclusions: Oral rehabilitation with CD appears to provide immediate improvements in head posture and body balance in edentulous individuals, potentially enhancing safety and reducing the risk of falls. However, further studies are needed to evaluate long-term effects and standardise methodologies.

Background: Aging is associated with a decline in physiological functions. Dysphagia, a disorder among older adults, impairs feeding and is related to morphological and functional changes in the stomatognathic system, which worsen with age-related physiological decline, particularly among institutionalised older adults.

Objective: To systematically review the association between oral health conditions, dental status, xerostomia, and dysphagia among institutionalised older adults.

Methods: This systematic review followed PRISMA guidelines and included a search of PubMed/MEDLINE and Embase for observational and randomised clinical trial studies published up to December 2024, with an update in January 2025.

Results: From 1761 identified articles, 44 were reviewed, and 11 met the inclusion criteria. These studies employed subjective measures such as dysphagia questionnaires, the Eating Assessment Tool-10 (EAT-10), the Dysphagia Risk Evaluation Protocol (PARD), and interviews using the Minimum Data Set for Nursing Home Resident Assessment (MDS-NH). Objective assessments included clinical evaluations, indirect and direct swallowing tests, and video analyses of feeding behaviour. Findings indicate that older individuals with fewer functional teeth, absent occlusal pairs, compromised natural teeth, gingivitis, or dental caries have a higher risk of dysphagia. In contrast, occlusal contact, natural teeth, or well-fitted dentures are associated with reduced swallowing difficulties. Neither denture use alone nor oral hygiene showed a direct association with dysphagia. However, severe xerostomia and reduced salivary flow were associated with a higher risk of dysphagia.

Conclusion: Dysphagia is associated with poor oral health and xerostomia in institutionalised older adults, though further research is needed to clarify these relationships.

Introduction: The World Health Organization (WHO) defines palliative care as a people-centred health service aiming at improving the quality of life of patients and their families when facing life-threatening illnesses. Oral health plays a significant role in the overall quality of life of these patients; yet, it is often overlooked. This study aims to explore the perceptions of patients, families and healthcare professionals on oral health and the need for oral health care in a palliative care unit (PCU).

Methods: This qualitative study employed a grounded theory approach. Semi-structured individual interviews were conducted in the PCU at Hospital Base of Valdivia in Chile. Data were transcribed, analysed and categorised through open and axial coding, allowing the identification and organisation of key concepts into thematic categories.

Results: A total of 15 interviews were conducted, involving seven healthcare professionals, four caregivers and four patients. Five thematic categories emerged from the analysis: (i) barriers to dental care, (ii) interdisciplinary team in palliative care, (iii) oral health training in palliative care professionals, (iv) oral health as part of general health and (v) strengths in dental care.

Conclusion: Participants recognised the importance of oral health for improving the quality of life within the palliative care setting. The integration of dental professionals into the interdisciplinary health team was identified as a critical yet challenging necessity.

Background: Older adults face substantial barriers to oral healthcare. Digital innovations are emerging as promising tools to improve access, prevention and education for older adults.

Aim: To map digital interventions designed to promote oral health in older adults, describe their targeted conditions, summarise study designs and delivery mechanisms and incorporate reported insights into user experiences and preferences.

Method: Following the Joanna Briggs Institute guidelines for scoping reviews, a comprehensive search was conducted across five databases up to January 2025. Eligibility criteria were defined using the PCC framework. Data were charted on intervention types, target oral health measures, study designs, delivery mechanisms and any reported user experiences or preferences. Findings were synthesised descriptively and organised into key themes to map the scope of current evidence.

Results: A total of 42 studies with diverse methods were included, covering Teledentistry, mobile applications, web platforms, social media, virtual reality, augmented reality and AI-driven technologies. These interventions targeted diagnosis and monitoring, clinical management, behaviour change, triage and screening, functional oral health improvements and oral health-related quality of life. Several studies also reported on user experiences and preferences, highlighting perceived benefits such as convenience, improved access, increased motivation and enhanced knowledge, alongside barriers including low digital literacy, technical difficulties and reliance on caregivers.

Conclusion: Digital interventions show promise for promoting oral health in older adults by improving knowledge, supporting self-care and enhancing access to care. Their sustainable adoption, however, depends on usability and acceptability, particularly among community-dwelling older adults. These findings should be interpreted with caution due to potential publication bias and limited generalisability of available evidence. Future studies should employ more rigorous and longitudinal designs, incorporate user perspectives and assess both effectiveness and cost-effectiveness to guide scalable, sustainable implementation. These findings should be interpreted with caution due to potential publication bias and the limited generalisability of the available evidence.

Objective: Thailand is experiencing rapid demographic aging and currently ranks third globally in population aging. Despite national initiatives such as the National Oral Health Plan for Senior Citizens (2015-2022), variability persists in undergraduate geriatric dentistry education across Thai dental schools. This study surveyed current curricular practices and clinical training opportunities in geriatric dentistry across Thai dental schools.

Methods: A structured questionnaire was developed and distributed electronically to all 18 accredited dental schools in Thailand. The questionnaire collected information on institutional characteristics and details on geriatric dentistry curricula, including topics such as teaching methods, clinical training and funding sources. Responses were collected using the Qualtrics software platform. Ethical approval for this study was obtained from the Thammasat University Ethics Board.

Results: Twelve dental schools completed the survey, yielding a response rate of 66.7%. All responding institutions included geriatric dentistry in their undergraduate curricula, though the methods of delivery varied considerably. Approximately 66.7% offered dedicated didactic courses, whereas the remainder integrated geriatric topics within broader coursework. The most commonly taught topics included oral tissue changes associated with aging, drug-induced dental diseases and systemic medical problems. However, topics such as the restorative management of older adults with psychological or neurological conditions were less frequently included. Most of the schools reported delivering clinical exposure for their students; however, these activities ranged from annual oral health screenings to compulsory clinical rotations at remote or primary care units or nursing homes.

Conclusion: Thai dental schools widely recognise the importance of geriatric dentistry education; however, the extent and depth of curricular implementation vary considerably. Establishing standardised national guidelines and expanding clinical training opportunities are essential to adequately prepare future dental professionals to meet the complex oral health needs of older adults.

Objective: This systematic review and meta-analysis evaluated the relationship between nutritional status and the oral health of older adults (aged 75 years or older). The PECO focus question was, 'What is the occurrence, association and impact of nutritional state on the oral health outcomes and its management in older adults?'

Methods: A comprehensive literature search was performed across MEDLINE (PubMed), Embase and the Cochrane Library. Publications up to April 2025 were considered, yielding 3324 records for initial screening. Quality assessment of the included studies predominantly revealed a low to moderate risk of bias.

Results: Eighty-three studies were included for data analysis. Meta-analyses demonstrated that older adults at risk of malnutrition had fewer teeth (SMD = -0.29; 95% CI: -0.46, -0.11; p = 0.002). Those with < 20 teeth and who were not rehabilitated with dentures were more likely to be malnourished (OR = 4.00; 95% CI: 1.21, 13.18; p = 0.02). Malnutrition was associated with self-reported chewing problems (OR = 2.38; 95% CI: 1.74, 3.26; p < 0.0001), swallowing problems (OR = 3.18; 95% CI: 2.20, 4.61; p < 0.0001) or dry mouth (OR = 2.35; 95% CI: 1.91, 2.88; p < 0.0001). Conversely, those with oral pain showed lower odds of malnutrition risk (OR = 0.68; 95% CI: 0.52, 0.89; p = 0.005).

Conclusions: Fewer teeth, existing chewing or swallowing problems, dry mouth and the absence of removable dentures where needed, were associated with malnutrition in care-dependent older adults. The current lack of longitudinal studies and proof of causality for malnutrition affecting oral health outcomes underscores the need for further research to better clarify the complex relationship between oral health and nutrition in older populations.

Trial registration: PROSPERO Registration: CRD420251003549.

Introduction: Improved dental services have increased the retention of natural teeth and prostheses, creating complex oral care needs among older adults. Care managers are key in overseeing residents' oral health; their perceptions can inform strategies to improve geriatric oral health in residential aged care facilities (RACFs).

Objective: To explore care managers' perceptions of the oral healthcare experiences and needs of older adults in RACFs.

Methods: A descriptive qualitative study, grounded in a constructivist paradigm, was conducted using the Socio-Ecological Model to guide data collection and analysis at individual, interpersonal, organisational, community and policy levels. Ten care managers were purposively sampled and interviewed online using a semi-structured guide. Data were analysed using reflexive thematic analysis following Braun and Clarke's framework.

Results: Participants (n = 10; age 28-59 years; mean age 41.7; 5 males, 5 females) were from urban and semi-urban areas of western India. Five themes were identified: (1) A Moral Duty to Care-Personal Beliefs and Emotional Drivers of Oral Health Practice; (2) Navigating Relational Complexities-Care Amidst Resistance, Trust and Support; (3) Systemic Gaps and Adaptive Practices in Resource-Limited Settings; (4) Disconnected Services and the Social Devaluation of Residents' Oral Health; and (5) Calls for Oral Health Care Delivery/Systemic Reforms-Embedding Oral Health in Aged Care Policy.

Conclusion: Care managers perceived residents' oral health as often being deprioritized in RACFs due to competing general health demands. An interdisciplinary care team, including a dentist, stronger policy support, and targeted training for care managers and staff, was strongly recommended to improve older adults' oral health outcomes in residential settings.

Background: Root caries is a major dental public health concern, particularly among the geriatric population residing in old age homes. Preventive and noninvasive strategies, such as topical fluorides, have shown promise in managing root caries. This study compares the effectiveness of silver diamine fluoride (SDF) and sodium fluoride (NaF) varnish in preventing and arresting root caries in this population.

Methods: A parallel group randomised clinical trial was conducted among elders (60-89 years) in old-age homes of Udupi District, India. Participants with at least one exposed root surface caries lesion were recruited and randomly allocated to either the SDF group or the NaF group. Caries activity status (active vs. arrested) was assessed at baseline, 1 month and 3 month follow-ups using explorer probing and ICDAS codes, with the primary outcome being arrest or progression of root caries lesions. Within-group changes were evaluated using McNemar's test, and between-group differences by Chi-square test, with p < 0.05 considered significant.

Results: A total of 57 participants were included (SDF group: 29; NaF group: 28). At 1 month follow-up, 96.6% of the SDF group showed arrested root caries, but only 50% in the NaF group showed arrested root caries (p < 0.001). At 3 months, 89.7% of the SDF group remained arrested, whereas only 21.63% of the NaF group maintained arrested caries (p < 0.001).

Conclusions: SDF may serve as a simple and practical treatment option for managing root caries, particularly in institutional care settings. Strengthening such preventive strategies can help address the growing burden of root caries in ageing populations and improve their overall quality of life.