Use of oral health care services among older home care clients in the context of an intervention study.

BACKGROUND: An increasing number of care-dependent older people living at home need external support to receive regular dental care. OBJECTIVES: To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition. MATERIALS AND METHODS: This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up. RESULTS: At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use. CONCLUSIONS: In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

Oral Health Outcome Measures: A Feasibility Evaluation.

OBJECTIVES: Outcomes of oral health care must be measured and analysed to improve oral health care delivery, outcomes, and quality. This study aims to develop and test outcome measures for the needs of oral health organisers and explore their feasibility using clinical data. METHODS: Based on the literature review and oral health advisory board, outcome measures for oral health care were identified, developed, and tested. Data from 425,000 clinical examinations were obtained from the clinical records of 8 public oral care providers in Finland. RESULTS: The advisory board selected 7 outcome measures: 1 on oral self-care, 2 on periodontitis, 3 on caries, and 1 on missing teeth. A large variation was found in the diagnostic and data entry practices of these outcome measures. The coverage of caries and missing teeth entries was good, but the quality of initial and remineralised caries entries was questionable. The caries and missing teeth measures show statistically significant differences amongst some providers. CONCLUSIONS: The measures "new cavitated caries surfaces," "cavity-free clinical examinations," and "the change in the missing value" were evaluated as feasible. The results of these measures provided insight about the effectiveness of oral care and enabled the comparison between the providers and age groups. Statistically significant differences between the providers in the measures imply potential possibilities for providers to learn from each other.

Eating problems among old home care clients.

AIMS: The purpose was to examine the prevalence and determinants of self-reported eating problems in old home care clients, screened separately by a clinical nutritionist and a dental hygienist. METHODS AND RESULTS: The data came from the Nutrition, Oral Health and Medication (NutOrMed) study, the participants of which were ≥75-year-old home care clients living in Finland. The structured interviews were conducted at the participants' (n = 250) homes. Of the participants, 29% reported poor appetite, 20% had problems with chewing, and 14% had problems with swallowing when asked by a clinical nutritionist. Additionally, 18% reported oral health-related eating problems when asked by a dental hygienist. Participants with continuous xerostomia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0-9.0) or poor self-reported oral health (OR: 4.3, 95% CI: 1.4-13.0) had a higher risk for problems with chewing when asked by a clinical nutritionist. Edentulous participants (OR: 3.5, 95% CI: 1.2-10.9) and participants with toothache or problems with dentures (OR: 10.3, 95% CI: 4.0-26.0) had a higher risk for oral health-related eating problems when asked by a dental hygienist. CONCLUSION: Eating problems are common in older adults, and interprofessional collaboration is required for their identification and alleviation.

Oral Health and Hygiene and Association of Functional Ability: A Cross-Sectional Study Among Old Home Care Clients.

PURPOSE: To describe oral health and hygiene in old home care clients and investigate how functional ability was associated with them. MATERIALS AND METHODS: This study employed part of the baseline data of a multidisciplinary intervention study of 269 home care clients aged ≥75 years, living in Eastern and Central Finland. Structured interviews were used to measure ability to function in activities of daily living (ADL), instrumental activities of daily living (IADL), comorbidity (functional comorbidity index, FCI), depression (geriatric depression scale, GDS-15), cognitive function (mini-mental state examination, MMSE), nutritional status (mini nutritional assessment, MNA) and numbers of prescription drugs used. Clinical oral examination was included. RESULTS: The majority of participants were at least moderately dependent on support for ADL. Of the examined, 46% were edentulous and average number of teeth was 8.4. Dental plaque in ≥ 20% of teeth present was detected in 74%, bleeding on probing in ≥ 25% of teeth examined in 75%, and caries in 30% of the dentate participants. In multivariate analyses, better functional ability (ADL) was statistically significantly associated with lower occurrence of dental plaque in ≥ 20% of teeth present. Better functional ability (ADL) and higher number of teeth were associated with lower occurrence of bleeding on probing in ≥ 25% of teeth examined and higher number of teeth with plaque with higher occurrence of bleeding on probing. CONCLUSION: Impaired functional ability is an important determinant of poor oral health and hygiene among old home care clients.

The association of frailty with oral cleaning habits and oral hygiene among elderly home care clients.

BACKGROUND: Increasing numbers of frail elderly people living at home but dependent on supportive care will face complex oral health challenges. OBJECTIVES: To investigate the associations of frailty status with oral cleaning habits and oral hygiene taking into account the effects of preventive oral health intervention among home care clients aged 75 or over. METHODS: Data were gathered by interviews and clinical oral examinations at baseline and after a 6-month follow-up. Frailty status was evaluated at baseline using the abbreviated comprehensive geriatric assessment (aCGA) scale, which consists of 15 questions from three different domains: cognitive status, functional status and depression. A total of 231 home care clients completed the aCGA at baseline and the interview and clinical oral examination both at baseline and after the follow-up. RESULTS: Using the aCGA classification with at least one score in the ≥2 domain, 62% of clients were classified as frail at baseline. They had poorer oral cleaning habits and hygiene, and they had lost more teeth than nonfrail participants. Multivariate analysis showed that being frail at baseline was statistically significantly associated with a lower frequency of toothbrushing and denture cleaning (OR = 0.4, 95% CI = 0.1-0.9 and OR = 0.3, 95% CI = 0.1-0.8) at baseline, but not after the follow-up. Membership in the intervention group was associated with better oral cleaning at the follow-up. However, among the frail participants, toothbrushing frequency was still significantly lower and oral hygiene poorer than among the nonfrail group. CONCLUSIONS: Oral cleaning habits of frail elderly people were slightly improved as a result of external support, which had a positive effect on oral hygiene. Individual preventive actions in the context of oral health and hygiene should be integrated into the daily care plan of home care clients with the first signs of frailty.

The combined effect of individually tailored xerostomia and nutritional interventions on dry mouth among nutritionally compromised old home care clients.

OBJECTIVE: To examine the effectiveness of tailored xerostomia and nutritional 6-month interventions on xerostomia among home care clients aged 75 years or over who were malnourished or at risk of malnutrition. BACKGROUND: A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and oral health. Medical conditions, polypharmacy, dehydration and malnutrition are often underlying causes of xerostomia. MATERIALS AND METHODS: The data are based on the NutOrMed study with a dietary intervention group of 119 patients and control group of 97 patients. In-home interviews were carried out by home care nurses, nutritionists, dental hygienists and pharmacists and tailored interventions by nutritionist and dental hygienists. Xerostomia intervention included individual counselling on dry mouth care and was applied to all those suffering occasionally or continuously from xerostomia (57%, n = 66) in the intervention group. Nutritional intervention was applied to all participants in the intervention group, and it included instructions on increasing the number of meals, energy, protein intake and liquid intake. RESULTS: Among participants who received both interventions, xerostomia decreased by 30% and malnutrition or risk of malnutrition decreased by 61%. The interventions were highly significant (OR 0.1, 95% CI: 0.06; 0.2) in reducing xerostomia. CONCLUSIONS: Home care clients suffering from xerostomia profited significantly from tailored xerostomia and dietary interventions. Evaluation and treatment of xerostomia are important among older persons who are malnourished or at risk of malnutrition as a part of a comprehensive health intervention to improve their nutrition and oral health.

Preventive oral health intervention among old home care clients.

Background: poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene. Aim: to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over. Patients and methods: the intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months. Results: the intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene. Conclusions: the intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses.

Oral Health Behavior and Lifestyle Factors among Overweight and Non-Overweight Young Adults in Europe: A Cross-Sectional Questionnaire Study.

Being overweight is a risk factor for many chronic diseases including oral diseases. Our aim was to study the associations between oral health behavior, lifestyle factors and being overweight among young European adults, 2011-2012. The subjects constituted a representative sample of adult population aged 18-35 years from eight European countries participating in the Escarcel study. The participants completed a self-administered questionnaire on dietary habits, oral health behavior, smoking, exercise, height, and weight. Overweight was defined as body mass index (BMI) ≥ 25 kg/m² using the World Health Organization criteria. Mean BMI was 23.2 (SD 3.48) and 24.3% of the study population were overweight. Those who were overweight drank more soft drinks (p = 0.005) and energy drinks (p = 0.006) compared with those who were non-overweight. Brushing once a day (OR 1.6; 95% CI 1.3-2.0), emergency treatment as the reason for last dental visit (OR 1.6; 95% CI 1.3-1.9) and having seven or more eating or drinking occasions daily (OR 1.4; 95% CI 1.1-1.7) were statistically significantly associated with overweight. Associations were found between oral health behavior, lifestyle and overweight. A greater awareness of the detrimental lifestyle factors including inadequate oral health habits among overweight young adults is important for all healthcare providers, including oral health care professionals.

Adult heavy and low users of dental services: treatment provided.

The aim of this study was to compare treatment provided to adult heavy and low users of dental services in the Finnish Public Dental Service (PDS) and to analyse changes in patients' oral health status. We assigned all adults who attended the PDS in Espoo in 2004 to a group of heavy users (n = 3,173) if they had made six or more dental visits and to a comparison group of low users (n = 22,820), if they had made three or fewer dental visits. Data were obtained from the patient register of the PDS. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and types of visits, oral health status and treatment provided was collected from treatment records. Both groups were followed-up for five years. Restorative treatment measures dominated the heavy and low users'treatments; 88.8% of heavy users and 79.6% low users had received restorations during the five-year period. Fixed prosthetic treatments were provided to just 2% of the heavy users and 0.8% of the low users. Emergency visits were more common for heavy users (74.8%) than for low users (21.6%) (p < 0.001). Fewer than half of the heavy (46.1%) or low (46.5%) users were examined twice. Typical for heavy use of oral health services was a cycle of repetitive repair or replacement of restorations, often as emergency treatment, a lack of proper examinations and preventive care; crown therapy was seldom used. Immediately after the major dental care reform in Finland, the PDS in Espoo had problems providing good quality dental care for the new adult patients. Older patients with lower social class background were not accustomed to regular dental care and the PDS did not actively propose proper comprehensive regular care for adults.

[Oral health among the elderly]. / Vanhusten suun terveys.

A large proportion of our population is ageing with own teeth in the mouth. Good oral health and an adequate number of teeth improve the functional capacity of an elderly person. Oral diseases are, however, becoming more common among the elderly population with the accumulation of risk factors such as insufficient self-care, cariogenic diet, reduced salivation, smoking and systemic diseases. Dryness of the mouth due to the adverse effects of drugs or systemic diseases makes eating and cleaning of the mouth more difficult. Prevention of oral diseases with good self-care and regular dental examinations is essential.

Heavy consumption of dental services; a longitudinal cohort study among Finnish adults.

BACKGROUND: A reform to Dental Care legislation in 2002 abolished age limits restricting adults' use of public dental services in Finland. In the Public Dental Service (PDS) unit of Espoo, the proportion of adult patients rose from 36% to 57%. The aim of this study was to investigate heavy use of dental services by adults and its determinants. METHODS: A longitudinal cohort study was undertaken based on a PDS patient register. Of all adults who attended the PDS in Espoo in 2004, those who had six or more visits (n=3,173) were assigned to the heavy user group and a comparison group of low users (n=22,820) had three or fewer dental visits. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and type of visit, oral health status and treatment provided was collected from treatment records. Each group was followed-up for five years and information on the number and types of visit was recorded for each year from 2005 to 2009. RESULTS: Most heavy users (61.6%) became low users and only 11.2% remained chronic heavy users. Most low users (91.0%) remained low users. For heavy users, the mean number of dental visits per year (3.0) during the follow-up period was significantly lower than initially in 2004 (8.3) (p<0.001) but 74.8% of heavy users had had emergency visits compared with 21.6% of the low users (p<0.001).A third (33%) of the visitors in each group had no proper examination and treatment planning during the 5-year follow-up period and two or more examinations were provided to fewer than half of the heavy (46.1%) or low (46.5%) users.The mean number of treating dentists was 5.7 for heavy users and 3.8 for low users (p<0.001). CONCLUSIONS: Frequent emergency visits were characteristic of heavy users of dental services. Treatment planning was inadequate, probably partly due to the many dentists involved and too many patients requesting care. Better local management and continuous education are needed to ensure good quality adult dental care and to reduce heavy consumption.