The Association between Tannerella forsythia and the Onset of Fever in Older Nursing Home Residents: A Prospective Cohort Study.

Background: Periodontal pathogens are related to the incidence of systemic diseases. This study aimed to examine whether periodontal pathogen burden is associated with the risk of fever onset in older adults. Methods: Older adults in nursing homes, aged ≥65 years, were enrolled. The study was set in Kitakyushu, Japan. The body temperatures of participants were ≥37.2 °C and were recorded for eight months. As periodontal pathogens, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia were qualified by a real-time polymerase chain reaction at the baseline. For statistical analysis, the number of bacterial counts was logarithmically conversed to 10 as a base. Results: Data from 56 participants with a median age of 88 (62−98) years were available for analysis. The logarithmic-conversed bacterial counts of T. forsythia, but not P. gingivalis or T. denticola, were associated with the onset of fever in older residents. The Kaplan−Meier method revealed that the group with <104 of T. forsythia had significantly less cumulative fever incidence than the group with ≥104 of T. forsythia. The group with ≥104 of T. forsythia was associated with an increased risk of fever onset (hazard ratio, 3.7; 98% confidence interval, 1.3−10.2; p = 0.012), which was adjusted for possible confounders. Conclusions: Bacterial burden of T. forsythia in the oral cavity was associated with the risk of the onset of fever in older nursing homes residents.

Posterior teeth occlusion is related independently to onset of fever in residents of aged person welfare facility: Perspective cohort study.

BACKGROUND: Onset of fever is a common presentation of symptoms in older adults. Loss of posterior teeth occlusion provokes dysphagia, which is commonly related to infectious diseases of the respiratory tract. However, a correlation between posterior teeth occlusion and the onset of fever has not been studied. The aim of the present study was to investigate whether posterior teeth occlusion is correlated with the onset of fever in residents of aged person welfare facilities. METHODS: This perspective cohort study was carried out from February 2019 to December 2019 in Kitakyushu, Japan. The follow-up period was 8 months. Overall, 141 residents aged ≥ 65 years from 10 aged person welfare facility were included. Dates when the body temperatures of participants were more than 37.2°C were recorded. Posterior teeth occlusion was evaluated by assessing functional tooth units (FTUs). RESULTS: Data from 100 participants [median age, 89 (67-102)] were used for analysis. Total of 53 participants got a fever. The Kaplan-Meier analysis showed that the average period until onset of fever in participants with scores 0, 1-11 and 12 for FTU was 7.7 ± 0.6, 7.4 ± 1.0 and 3.9 ± 1.0, respectively. Cox's proportional hazards regression model revealed that participants with FTU = 0 were at higher risk of fever compared with those with FTU = 12 (hazards ratio: 3.2, 95% confidence interval: 1.4-7.7), adjusted for possible confounders. CONCLUSIONS: Posterior teeth occlusion correlated with the risk of fever in older residents of nursing homes.

Trypsin-Like Activity in Oral Cavity Is Associated with Risk of Fever Onset in Older Residents of Nursing Homes: An 8-Month Longitudinal Prospective Cohort Pilot Study.

This study aimed to evaluate the association between trypsin-like activity in the oral cavity and the onset of fever in independent older residents of nursing homes. Independent older residents aged ≥ 65 years in 10 nursing homes were included in this study, which was conducted in Kitakyushu, Japan. For 8 months, follow-up dates on which the body temperatures of participants were more than 37.2 °C were noted. Trypsin-like activity in the oral cavity was detected by ADCHECK® with five-grade evaluation at baseline. Data from 53 independent participants with median age 89.0 (67­102) years were available for analysis. ADCHECK® scores were associated with fever days (r = 0.312, p = 0.029). The average periods until the onset of fever in participants with ADCHECK® Scores 1 and 2, Score 3, and Scores 4 and 5 were 6.6 ± 0.5, 5.0 ± 0.7, and 4.1 ± 1.0 months, respectively. ADCHECK® Scores 4 and 5 signified a higher risk of fever compared to ADCHECK® Scores 1 and 2 (hazards ratio 5.9, 95% confidence interval 1.4­23.9, p = 0.013), adjusted for possible confounders. We concluded that trypsin-like activity in the oral cavity was associated with the risk of fever in independent older residents of nursing homes.

Comparison of dental plaque reduction after use of electric toothbrushes with and without QLF-D-applied plaque visualization: a 1-week randomized controlled trial.

BACKGROUND: To evaluate the efficacy of a newly developed electric toothbrush in reducing dental plaque via a quantitative light-induced fluorescence-digital (QLF-D)-applied visualisation system in the brush head. METHODS: Participants included 20 adults aged 19 to 28 years. Participants were randomly assigned either (i) an electric toothbrush with a monitor to visualise red-fluorescent dental plaque via a camera built into the brush head (monitor usage group, n = 10) or (ii) an electric toothbrush without a monitor (monitor-non-use group, n = 10). The amount of dental plaque was assessed by personal hygiene performance (PHP) at baseline and 1 week later. RESULTS: In the monitor-usage group, PHP score was significantly lower at the 1-week follow-up than at baseline (6 vs 16; range, 0-12 vs 13-21; P = 0.029). This change was not observed in the monitor-non-use group (14 vs 13; range, 6-21 vs 2-26; P = 0.778). After 1 week, the change in PHP scores in the monitor usage group was significantly greater than that in the monitor non-use group (- 10 vs 0; range, - 21 to 9 vs - 8 to 16; P = 0.021). CONCLUSIONS: Our results clearly demonstrate that brushing teeth while looking at a monitor that depicts red-autofluorescent dental plaque via application of QLF-D improved the efficacy of dental-plaque removal relative to brushing teeth without a monitor. TRIAL REGISTRATION: Trial registration number: UMIN000033699. Name of registry: Study on effect of new devise for oral care on dental plaque clearance. Date of registration: 8th September 2018. Status of registration: Completed.

Relationship between the state of tongue hygiene and the number of residual teeth in convalescent-ward inpatients, cross- sectional study.

BACKGROUND: The changed disease landscape in Japan because of an increasing aging population has contributed to an increase in convalescent inpatients, warranting important considerations of their oral care needs. However, information on the oral state of these inpatients is scarce. We evaluated the correlation between the number of residual teeth and tongue hygiene state in these inpatients. METHODS: This cross-sectional study included convalescent-ward inpatients, aged 34-100 years. The study was conducted between April 2017 and March 2018 in Kitakyushu, Japan. Data regarding age, sex, number of residual teeth, odontotherapy requirement, medications with oral side effects, and the reason for hospitalization, were collected. Oral hygiene level was assessed using the Oral Health Assessment Tool (OHAT). The correlation between each element of OHAT and the number of residual teeth was analyzed using Pearson's correlation analysis. The risk of a remarkable tongue state was analyzed using binominal logistic regression analysis. RESULTS: Correlations were observed between the number of residual teeth and OHAT subscales, including tongue, saliva, and dentures. A significantly higher percentage of inpatients with ≤19 teeth had a tongue state score of 1 or higher, compared with those with ≥20 teeth. (78.6% vs 57.7%, p = 0.047). In inpatients with ≥20 teeth, the remarkable saliva state significantly increased the risk of the remarkable tongue state by 10.49-fold (95% confidence interval = 2.86-38.51), after adjusting for potential confounders. CONCLUSION: Poor tongue hygiene is associated with the number of teeth and salivary state in convalescent-ward inpatients. Inpatients with ≤19 teeth had a higher risk of poor tongue hygiene, regardless of the salivary condition, as assessed using OHAT.

Dental Hygiene Students' Attitudes and Knowledge Regarding People with Dementia: A Four-Year Prospective Study.

In an increasingly aging society, dental hygienists who are prepared to provide care for patients with dementia are much needed. The aim of this study was to identify factors related to dental hygiene students' willingness to treat patients with dementia, including their attitudes towards these patients and their knowledge of the disease. All 134 students in three dental hygiene programs in Japan were invited to participate in the study; data were analyzed for 122 students (91% response rate). Students' attitudes towards patients with dementia and their knowledge of dementia were assessed in the first, second, and third years and at the end of the third year. Questionnaires were administered to assess the students' willingness to treat patients with dementia, relationship and cohabitation with individuals with dementia, and cohabitation with elderly people. For each characteristic, a higher score implied better/more favorable behavior/performance. Students' scores for attitudes towards patients with dementia peaked at the end of the third year, following a decrease earlier in the third year. Meanwhile, their scores for knowledge increased with each year. Their dementia-related attitudes and knowledge were inversely correlated in the first year, but the correlation became positive after the third year. The proportion of students who expressed willingness to treat was highest at the end of the third year, following a decline earlier in the third year. The willingness to treat was positively correlated with yearly promotion (odds ratio: 1.20 [1.01-1.43]; p=0.035) and attitudes (odds ratio: 1.08 [10.4-1.11]; p<0.001), but not with knowledge (p=0.973). These results support the idea that, to promote dental hygiene students' willingness to treat patients with dementia, it is important to cultivate in them a positive attitude towards these patients.

Attitudes towards people with dementia: a cross-sectional study comparing dental hygiene students with registered dental hygienists.

OBJECTIVE: In order to adequately care for patients with dementia, it is necessary for dental hygienists to develop unprejudiced attitudes towards and obtain sufficient knowledge of dementia. The aim of this study was to assess attitudes towards and knowledge of dementia among Japanese dental hygiene students and identify related factors to the attitude and the knowledge. We compared the attitude and the knowledge between dental hygiene students and practising dental hygienists. BACKGROUND: Dental hygienists are required to care for patients with dementia by developing appropriate attitudes towards dementia and gaining knowledge of dementia. MATERIAL AND METHODS: Between May 2016 and July 2016, 191 third-grade dental hygiene students and 64 registered dental hygienists were surveyed. We modified questionnaires to assess attitudes towards and knowledge of dementia. Ageism was assessed using the Fraboni Ageism scale. To determine potential dementia awareness factors, information regarding participants' experiences with dementia was collected. RESULTS: Factor analysis revealed four factors in the attitude scale (Cronbach's α, 0.652-0.820). All item-total correlation coefficients for the knowledge scale were above 0.3, and Cronbach's α was 0.827. All awareness factors for dementia were significantly different between students and registered dental hygienists. Total scores of attitude and knowledge were higher among registered dental hygienists, indicating better attitude and knowledge, but total scores of ageism were lower among registered dental hygienists, indicating worse ageism. Multiple regression analysis revealed that the attitudes towards dementia correlated with years of experience, ageism, interest in dementia and desire to work with patients with dementia. CONCLUSION: Registered dental hygienists had more positive and more knowledge compared to dental hygiene students. Attitudes towards dementia, but not knowledge of dementia, were significantly positively correlated with ageism.

Relationship between anxiety/depression and oral health-related quality of life in inpatients of convalescent hospitals.

The aim of this study is to examin the association between anxiety/depressive tendency and oral health-related quality of life in inpatients of convalescent wards. This cross-sectional study included inpatients of convalescent wards (age range 34-100 years). Data on age, sex, functional independence measure, number of teeth, odontotherapy status, and primary disease for which hospitalization was required were collected. The Hospital Anxiety and Depression Scale (HADS) was used to assess emotional distress. The oral health-related quality of life was evaluated by the Geriatric Oral Health Assessment Index (GOHAI). Oral hygiene level was assessed by the Oral Health Assessment Tool (OHAT). We performed a multiple regression analysis to assess relationships among HADS, GOHAI, and OHAT. Following the analysis, causal connections of these factors were evaluated with structural equations modeling. The scores of GOHAI and OHAT in the caseness cohort (HADS score > 11) were significantly worse than those in the non-caseness cohort (HADS score < 7). Multiple regression analysis revealed that GOHAI was a statistically significant predictor of HADS score (p = 0.012), and that HADS and OHAT scores were predictors of GOHAI (p = 0.012 and < 0.001, respectively), adjusted by sex and age. We found that a model connected from OHAT to HADS through GOHAI was a good fit for the data of inpatients. Oral health-related quality of life, affected by oral hygiene status, was strongly associated with emotional distress in inpatients of convalescent wards. Daily oral care and assessment by healthcare professionals can reduce the emotional distress of inpatients in convalescent wards.

Relationship Between Resilience and Self-Rated Health in Dental Hygiene Students and Registered Dental Hygienists.

The aim of this study was to investigate whether two aspects of resilience-acquired and innate resilience-were related to self-rated health status in registered dental hygienists and students. In May through July 2017, 405 students at three dental hygiene programs and 85 registered dental hygienists, all in Fukuoka prefecture in Japan, were invited to participate in a survey including three scales: the Bidimensional Resilience Scale (BRS) to assess innate and acquired resilience, the Stress Response Scale-18 (SRS-18) to assess daily stress responses, and the Sense of Coherence 13-item scale (SOC-13) to assess the sense of coherence. Information about self-rated health status and number of years of clinical experience was also collected. Respondents were 398 students (98.2% response rate) and all 85 dental hygienists (100% response rate). The cohort with a self-rated "healthy" status scored higher on total scale and each domain of the BRS, SRS-18, and SOC-13 scales than the cohort with other self-rated health statuses. These three scales and self-rated health status were significantly correlated with each other. When innate resilience increased by one point, average self-rated health was 1.14-fold higher. In contrast, when the depression/anxiety domain score of SRS-18 increased by one point, self-rated health was 0.84-fold lower. The number of years of clinical experience was also negatively correlated with self-rated health. For these participants, innate resilience was a significant predictor of better self-rated health. To maintain the health of dental hygienists and students, it is important to understand their innate resilience as well as stress responses related to depression/anxiety factors and length of clinical experience.

Validity and reliability of the oral health-related caregiver burden index.

OBJECTIVE: This study developed the Oral Health-related Caregiver Burden Index (OHBI), which contains nine questions with five response options each. As a secondary objective, we aimed to clarify the relationship between oral health-related caregiver burden and general caregiver burden. BACKGROUND: There are a few reports of the oral health-related caregiver burden. METHODS: Between January 2016 and February 2016, 155 participants enrolled in the study. We conducted the survey to examine the validity and reliability of OHBI. Additionally, the cut-off score for this scale was calculated, and the relationship between OHBI and general caregiver burden (BIC-11) was examined by binomial logistic regression. RESULTS: Survey 1 was completed by 102 caregivers, of whom 58 (56.9%) were female. Survey 2 was completed by 40 caregivers, of whom 22 (55.0%) were female. Factor analysis revealed four factors in OHBI. Cronbach's α was .691-.866. OHBI scores were significantly associated with scores for each factor of the BIC-11. OHBI had a cut-off score of 10 (AUC=.881, sensitivity=.828, specificity=.744). A good-poor analysis revealed significant differences for discriminant validity. ICC, an indicator of reliability, was .449-.842. There was a significant relationship between caregiver burden and oral health-related caregiver burden according to binomial logistic regression analysis (P<.05). CONCLUSION: We developed the OHBI as a multidimensional care burden scale, which comprises nine items covering five domains. Further, we verified the relationship between general caregiver burden and oral health-related caregiver burden.