Prevention of Oral Functional Decline.

OBJECTIVES: The oral cavity functions in eating, speaking, socializing, and serving as a natural barrier to external pathogens. In the prevention of oral function decline in older people, oral health conditions should be maintained through public health actions. METHODS: This article discusses public health actions to prevent oral functional decline through addressing three major issues among older people: tooth loss, hyposalivation, and oral cancer. Negative impacts of tooth loss, hyposalivation, and oral cancer will be described, followed by describing public health approaches to prevent these problems RESULTS: Tooth loss, commonly caused by dental caries and periodontal diseases, affects one's ability to eat, speak, and socialize freely. Prevention of tooth loss can be done in clinical settings, community settings, and through national policies. Saliva plays an important role in eating, swallowing, and protecting oral mucosa from pathogens. The major causes of dry mouth are polypharmacy and the use of anticholinergic medications among older people. Public health actions to promote collaboration between dentists and doctors in the adjustment of drug prescriptions are warranted. Oral cancer can affect oral function largely both from the disease itself and from cancer treatments due to the destruction of oral structures and salivary gland function. Tobacco use and alcohol consumption are major risk factors for oral cancer; they also contribute to various systemic diseases and cancers of other organs. CONCLUSIONS: Public health policies and interventions using the common risk factor approaches to tackle tobacco and alcohol consumption should be encouraged. Rather than focusing on older people, the prevention of oral function decline should be planned through a life-course perspective.

Global Perspectives of Oral Health Policies and Oral Healthcare Schemes for Older Adult Populations.

The aim of this study was to present a concise summary of the oral health policies and oral healthcare schemes for older adult populations in a number of selected countries around the world. In this paper, the current and planned national/regional oral health policies and oral healthcare schemes of nine countries (Australia, Brazil, China including Hong Kong, India, Japan, Switzerland, Thailand, the United Kingdom, and the United States) are reported. Barriers and challenges in oral health promotion in terms of devising oral health policies, implementing oral health schemes, and educating the future dental workforce are discussed. In response to the aging of population, individual countries have initiated or reformed their healthcare systems and developed innovative approaches to deliver oral health services for older adults. There is a global shortage of dentists trained in geriatric dentistry. In many countries, geriatric dentistry is not formally recognized as a specialty. Education and training in geriatric dentistry is needed to produce responsive and competent dental professionals to serve the increasing number of older adults. It is expected that oral health policies and oral healthcare services will be changing and reforming in the coming decades to tackle the enduring oral health challenges of aging societies worldwide.

Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium.

BACKGROUND: The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs. METHODS: Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence. RESULTS: Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP). CONCLUSIONS: The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.

Association between objectively measured chewing ability and frailty: A cross-sectional study in central Thailand.

AIM: Limited data are available on the association between oral function and frailty, especially in developing countries. Additionally, the association between objectively assessed chewing function and frailty has not been well studied. The present cross-sectional study tested the hypothesis that objectively measured poor chewing ability is associated with frailty in community-dwelling older Thai adults. METHODS: The study population comprised 141 people in Nakhon Pathom, Thailand (median age 72 years). Demographic and clinical data were collected at a community center. Participants were asked to chew a gum designed for assessing chewing ability. The differences in gum color before and after chewing (ΔE*ab) were calculated and used as the exposure variable, where a lower ΔE*ab indicates lower chewing ability. Frailty phenotypes were defined by weakness, slowness, weight loss, low physical activity level and exhaustion components, and used as the outcome variable. Participants with three or more components were considered frail, and those with one or two components were considered pre-frail. Ordinal logistic regression analyses were carried out to assess the association of objective chewing ability with frailty. RESULTS: Of the 141 participants, 32 (22.7%) were categorized as frail and 78 (55.3%) as pre-frail. In the analysis adjusted for demographic and health characteristics, the adjusted odds ratio of the presence and severity of frailty was significantly higher in participants with lower ΔE*ab (adjusted odds ratio for one decrease in ΔE*ab 1.05, 95% confidence interval 1.01-1.10, P = 0.03). CONCLUSIONS: Objectively measured chewing ability was significantly associated with frailty in community-dwelling older Thai adults. Geriatr Gerontol Int 2018; 18: 860-866.

A scoping review and research synthesis on financing and regulating oral care in long-term care facilities.

BACKGROUND: Oral health care for frail elders is grossly inadequate almost everywhere, and our knowledge of regulating and financing oral care in this context is unclear. OBJECTIVE: This scoping study examined and summarised the published literature available and the gaps in knowledge about regulating and financing oral care in long-term care (LTC) facilities. METHODS: We limited the electronic search to reports on regulating and financing oral care, including reports, commentaries, reviews and policy statements on financing and regulating oral health-related services. RESULTS: The broad electronic search identified 1168 citations, which produced 42 references, including 26 pieces of grey literature for a total of 68 papers. Specific information was found on public and private funding of care and on difficulties regulating care because of professional segregation, difficulties assessing need for care, uncertainty on appropriateness of treatments and issues around scope of professional practice. A wide range of information along with 19 implications and 18 specific gaps in knowledge emerged relevant to financing and regulating oral healthcare services in LTC facilities. CONCLUSIONS: Effort has been given to enhancing oral care for frail elders, but there is little agreement on how the care should be regulated or financed within the LTC sector.

Insights from students following an educational rotation through dental geriatrics.

Little is known about how dental students respond to dental geriatrics. This article describes a qualitative analysis of reflective journals submitted over two years by ninety-two senior students who participated in a brief clinical rotation in long-term care facilities. We used an inductive interpretive approach to analyze the journals. Eight themes emerged from the analysis: 1) complexity of the institutional environment; 2) heterogeneity of the resident population; 3) multidisciplinary environment; 4) record keeping; 5) interactions with residents; 6) the difficulty of oral health care for frail residents; 7) bridging the gap between theory and practice; and 8) the emotional impact of the clinical experiences. Apparently, the students appreciated the opportunity to witness the complexity of care in a multidisciplinary context and to observe a practical program of oral health care. They described the rotations as unique and emotionally challenging but very worthwhile. Overall, they wrote positively about their experiences with the elderly residents, acknowledged the contribution of the rotation as important to their clinical maturation, and reported that the experience enhanced their appreciation of a dentist's professional responsibilities.