Oral health intervention among community-dwelling older people: a randomised 2-year intervention study.

OBJECTIVE: The aim of this study was to investigate the effects of a 2-year oral-health-promoting intervention on oral health behaviour and oral health among people aged 75 years or older. MATERIALS AND METHODS: In a 2-year randomised intervention study, 279 community-dwelling older people completed the study: 145 persons in an intervention group and 134 in a control group. Interviews and clinical oral examinations were performed at the beginning of the study and at a 2-year follow-up. Changes in oral health behaviour and oral health were used as outcomes. INTERVENTION: Oral health intervention included individually tailored instructions for oral and/or denture hygiene, relief of dry mouth symptoms, decrease of sugar-use frequency, use of fluoride, xylitol or antimicrobial products, and professional tooth cleaning. RESULTS: More participants in both the intervention and control groups had better dental and denture hygiene and were free of oral diseases or symptoms at the 2-year follow-up than at the baseline. The differences in changes in outcomes between the intervention and control groups were not statistically significant. CONCLUSION: The results of this study showed that oral health of community-dwelling older people could be improved. Oral health improved in both groups, more among the participants in the intervention group compared with control group, but the effect attributed to oral-health-promoting intervention remained small.

Determinants for preventive oral health care need among community-dwelling older people: a population-based study.

The aim was to study the determinants of preventive oral health care need among community-dwelling old people. The study population consisted of 165 participants, a subpopulation in the Geriatric Multidisciplinary Strategy for Good Care of Elderly People (GeMS) study. Fifty-five percent of the edentate participants with full dentures and 82% of the dentate had a need for preventive oral health care. In the total study population, the need for preventive care was associated with co-morbidity (measured by means of the Modified Functional Co-morbidity Index) odds ratios (OR) 1.2 (confidence intervals [CI] 1.0-1.5), being pre-frail or frail, OR 2.5 (CI 1.2-5.1), presence of natural teeth, OR 4.8 (CI 2.2-10.4), and among dentate participants, the use of a removable partial denture, OR 12.8 (CI 1.4-114.4). Primary care clinicians should be aware of the high need for preventive care and the importance of nonoral conditions as determinants of preventive oral health care need.

Salivary flow rate and risk of malnutrition - a study among dentate, community-dwelling older people.

OBJECTIVE: To analyse the relation between unstimulated and stimulated salivary secretion and the risk of malnutrition among home-dwelling elderly people. BACKGROUND: Saliva has an important role in eating. Despite this, there are only a few studies on the role of salivary secretion in the development of malnutrition among elderly people. MATERIALS AND METHODS: The study population consisted of 157 subjects aged 75 or older. This was a part of GeMS study carried out in Kuopio, in eastern Finland. The data used in this study were collected by means of interviews and geriatric and oral clinical examinations. The risk of malnutrition was measured using the Mini Nutritional Assessment Short-Form. Logistic regression models were used to estimate odds ratios (OR) and their 95% Confidence Intervals (CI). RESULTS: Subjects with a low unstimulated salivary flow rate (<0.1 ml/min) or stimulated salivary flow rate (<1.0 ml/min) had no statistically significant increase in risk of malnutrition, OR: 1.3, CI: 0.5-3.9, OR: 1.5, CI: 0.5-4.2, respectively, when compared with those with a normal unstimulated and stimulated salivary flow rate. CONCLUSION: Our results do not support the concept that low salivary secretion is an important risk factor for malnutrition among community-dwelling elders.

Associations of instrumental activities of daily living and handgrip strength with oral self-care among home-dwelling elderly 75+.

OBJECTIVE: To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self-care among dentate home-dwelling elderly people in Finland. MATERIALS AND METHODS: The study analysed data for 168 dentate participants (mean age 80.6 years) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004-2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry. RESULTS: Study participants with high IADL (scores 7-8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1-6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8-5.2) and for having good oral hygiene of 2.8 (CI 1.0-8.3) when compared with participants with low IADL (scores ≤6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4-1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4-1.8) and for good oral hygiene of 1.1 (CI 0.5-2.4) in comparison with the study subjects in the lowest tertile of handgrip strength. CONCLUSION: The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self-care among the home-dwelling elderly.

Dementia and oral health among subjects aged 75 years or older.

OBJECTIVE: To study the association between diagnosed dementia and oral health, focusing on the type of dementia, among an elderly population aged 75 years or older. BACKGROUND: Elderly people with dementia are at risk from oral diseases, but to date, only a few studies have analysed the association between type of dementia and oral health, and their results are inconclusive. MATERIALS AND METHODS: This cross-sectional study is based on the Geriatric multi-disciplinary strategy (Gems) study that included 76 demented and 278 non-demented subjects. The data were collected by means of an interview and an oral clinical examination. The type of dementia was diagnosed according to DSM-IV criteria. Poisson's and logistic regression models were used to determine relative risks (RR), odds ratios (OR) and 95% confidence limits (CI). RESULTS: Our results showed that patients with Alzheimer's disease and those with other types of dementia had an increased likelihood of having carious teeth, teeth with deep periodontal pockets, and poor oral and denture hygiene, compared with non-demented persons. The results showed that the type of dementia does not seem to be an essential determinant of oral health. CONCLUSIONS: Among the elderly aged 75 years or older, patients with Alzheimer's disease or other types of dementia are at increased risk of poor oral health and poor oral hygiene.

Preference for dentist's home visits among older people.

OBJECTIVES: To investigate factors associated with older people's preference for a dentist's home visit. METHODS: This is a report on 321 home-dwelling participants (mean age 81.6) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study, conducted in 2004-2005 in the city of Kuopio in eastern Finland. The information about sociodemographic and general health-related factors and the use of social and health services was collected by two study nurses using a structured interview. Each study subject was given a clinical oral examination and an interview about oral health and the use of dental health care services by one of two dentists. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Of the study subjects, 25.9% preferred a dentist's home visit. The preference for choosing a dentist's home visit was associated with a low score (≤24) in the Mini-Mental State Examination, OR 6.1 (CI: 2.9-13.6), and a low score (<8) on the scale of Instrumental Activities of Daily Living, OR 8.0 (CI: 3.6-18.6). It was also associated with living alone, OR 5.9 (CI: 2.7-13.0), and high use of home care services, OR 9.3 (CI: 4.6-19.0). CONCLUSIONS: The findings of this study emphasize the need to organize dentists' home visits in order to increase equality in the use of dental health care services among the older people with disabilities.