BackgroundFrailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people.MethodsWe conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers.ResultsThree major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports.ConclusionThe level and type of frailty influences people’s perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures aimed at recognizing indicators for poor oral care behavior, and providing appropriate information and support, are discussed.

Objectives To describe the ‘Caries Assessment Spectrum and Treatment’ (CAST) instrument, its origin and content, and to provide an example of how results can be reported. Methods The CAST instrument covers the complete range of stages of carious lesion progression: from no carious lesion, through caries protection (sealant) and lesion care (restoration) to lesions in enamel and dentine, the advanced stages of carious lesion progression in pulpal and its consequences on tooth‐surrounding tissue and tooth loss due to caries. Using the RAND modified e‐Delphi consensus method two independent panels, comprising a total of 56 epidemiologists from 27 countries, determined the face and content validity of CAST. Panellists assessed 17 statements related to the content, description, suitability and international use of CAST. Agreement of 75% or higher was required for reaching consensus on a statement. Construct validity and reliability testing of CAST have been carried out, but results are not yet available. Results All 17 statements were approved by the panellists, who found the RAND modified e‐Delphi consensus method suitable for achieving consensus. The CAST codes were ordered hierarchically. External validity was obtained. Reporting using CAST can be performed for orally healthy dentitions and those having morbidity and mortality. A DMF score can easily be calculated from the CAST codes, thereby enabling retention of the use of existing DMF scores. Conclusion The CAST instrument for use in epidemiological surveys is very promising. Face and content validation is obtained. Construct validity and reliability testing will be completed soon. A structure for reporting results in a comprehensive, pragmatic and easily understood way is being developed.

Insufficient evidence is available to determine whether or not asymptomatic disease-free impacted wisdom teeth should be removed. Although asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is of very low quality. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision making with patients who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain asymptomatic disease-free impacted wisdom teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.

BackgroundIn order to adapt oral care and treatment to the demands of the growing group of frail dentulous older people, it is important to understand how and to which extent having natural teeth contributes to the quality of life (QoL) of frail older people and how frailty influences their perspective.MethodsA qualitative approach was used. Interviews with 38 Dutch frail older dentulous people were tape-recorded, transcribed, coded for content and analyzed. Additional information was collected which included age, gender, living situation, use of dental prostheses, self-reported oral health status, chronic disorders, and an index for frailty.ResultsSeven themes were identified in the relationship between natural teeth and the QoL of the participants: pride and achievement; intactness; sense of control; oral function; appearance; comfort; along with coping and adapting to disabilities. Having natural teeth generally had a positive effect on QoL. Positive effects through pride and achievement, intactness, and sense of control were most apparent for the most severely frail. They compared themselves with peers who are more often edentate, and valued the good state of their teeth against the background of their declining health, especially those with disabilities causing severe chronic pain or impaired fine-motor skills. The effect of coping with and adaptation to tooth loss was also most apparent for the most severely frail. There was a gender effect in that the men generally cared less about having natural teeth than women, regardless of their level of frailty.ConclusionsQoL of frail older people is positively influenced by natural teeth, and this effect seems to increase with increasing frailty. Preservation of teeth contributes to a positive body image and self-worth. Oral care for frail people should aim to preserve natural teeth if possible.

Notes This trial has been stopped this year (2004). At this moment the reason has not been communicated to the reviewers 13 Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults (Review)