<p>Short-Term Effects of a Deterioration of General Health on the Oral Health of Nursing-Home Residents</p>

Abstract

The purpose of this study was to identify how changes to general health might affect the oral health of nursing-home residents over a six-month period. Materials and Methods: The study was conducted in nine nursing homes in Germany. Sociodemographic and general data were collected at baseline and after six months. Complete baseline and follow-up data were available for 114 participants. The Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS) were used to identify the presence and, if applicable, severity of dementia among participants. The Apraxia Screen of TULIA (AST) was used to identify motor impairment. A comprehensive dental examination of each participant was also performed. The examination included the documentation of dental and denture status and the number of decayed, missing and filled teeth (DMF-T). In addition, dental and denture hygiene were quantitatively assessed using the Plaque Index (PI) and the Denture Hygiene Index (DHI), respectively. Global dental treatment needs were evaluated by use of the Oral Health Assessment Tool (OHAT). Univariate and multivariate linear regression models were compiled to analyse possible factors affecting the dependent target variables. Results: During the study period, denture hygiene among the study population worsened by an average of 15%. The regression models detected that a more advanced age (in years) was associated with a less pronounced deterioration of denture hygiene as measured by use of the DHI (−0.806 per additional year of age; p = 0.030). Furthermore, an increase in the level of care needed (coefficient (C): −1.948; p = 0.002) and a more poorly graded assessment of general health compared with the value at baseline (C: 1.054; p = 0.026) were both associated with a deterioration of oral health as evaluated by use of the OHAT. In addition to these results, an increase in care needs was also associated with a deterioration of dental health as evaluated by use of the DMF-T (C: 0.966; p = 0.013). Conclusion: In the short term, a deterioration of general health, including an increase in care needs, seems to be the predominant factor associated with a more pronounced deterioration of oral health among nursing-home residents.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

“…Caries experience (DMFT) was calculated in six types of disadvantaged individuals, of which the elderly were those with the highest DMFT 18.7 SD 2.4 ([95% CI 13.5–24]; 1160 participants, 17 studies) [ 25 , 28 , 30 , 31 , 34 , 40 , 41 , 44 , 48 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], followed by homeless subjects with DMFT 17.3 SD 0.4 ([95% CI 12.6–22.1]; 100 participants, two studies) [ 67 , 68 ], immigrants with 14.9 SD 0.9 ([95% CI 9.6–18.7]; 843 participants, two studies) [ 51 , 52 ], alcohol and drug abusers with 12.9 SD 0.8 ([95% CI 11.2–14.6]; 1891 participants, nine studies) [ 49 , 50 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ], low-income people with9.9 SD 0.5 ([95% CI 3–16.7];3043 participants, two studies) [ 60 , 76 ], low-education people with 9.8 SD0.03 ([95% CI 9.4–10.2]; 3043 participants, two studies) [ 60 , 76 ] and prisoners with 8.9 SD 0.8 ([95% CI 6.3–10.4]; 802 participants, three studies) [ 22 , 23 , 24 ]. Lower DMFT was found in sex workers with 2.3 (249 participants) [ 77 ] and in subjects who work without any specific qualification with 2.9 (510 participants) [ 78 ].…”

“…Specifically, a greater probability of having a higher DMFT index was found in low-education people (OR 1.40 [95% CI 1.29–1.52], p < 0.05; 6051 participants) [ 57 ], in low-income people (OR 3.7 [95% CI 2.8–4.6], p < 0.05; 1695 participants, two studies, I 2 = 78%) [ 56 , 76 ] and in professionals who sustain an excessive hourly workload (>40 h of overtime) (OR 2.56 [95% CI 1.23–5.33] p = 0.012 to OR 3.01 [95% CI 1.13–7.97] p = 0.027; 950 participants) [ 79 , 80 ]. Moreover, institutionalized elderly people (resident in care homes) showed a higher caries experience than non-institutionalized elderly people with a DMFT 25.4 SD 2.1 ([95% CI 19.9–30.9]; 2608 participants, six studies) versus 16.1 SD 2.1 ([95% CI 11.2–21]; 8276 participants, nine studies) [ 29 , 31 , 34 , 40 , 41 , 44 , 48 , 60 , 61 , 63 , 64 , 81 , 82 ]. This difference between the two was essentially due to an increased number of teeth lost because of caries, with MT 21.4 SD 2.9 ([95% CI 12.2–30.6]; 2123 participants, seven studies) in institutionalized elderly individuals versus 9.7 SD 0.5 ([95% CI 8.4–11]; 7641 participants, four studies) in non-institutionalized ones [ 29 , 31 , 34 , 40 , 41 , 48 , 62 , 63 , 64 , 66 , 81 ].…”

Prevalence and Clinical Correlation of Decayed, Missing, and Filled Teeth in Elderly Inpatients With Schizophrenia

“…In conclusion, long-term elderly inpatients with schizophrenia have cognitive impairments themselves. Their limited oral self-maintenance capacity, combined with the potential conflict between respecting patients' autonomy and providing good daily care ( 49 ), makes many effective oral care practices difficult to implement, further exacerbating the lack of oral health management in this population. This condition may not only aggravate the cognitive impairment of patients and affect the quality of life but also increase the risk of respiratory nosocomial infection and seriously hamper the improvement of the quality of medical services.…”

Influence of professional dental hygiene on oral and general health of retirement home residents: A comparative study

“…Examination of their oral health reveals a poor situation in terms of dental status, periodontal situation and cleanliness of the dentures, the tongue or the oral cavity (Al Baker et al, 2017; Bilder et al, 2014; Henriksen et al, 2004; Klotz et al, 2020; Nitschke & Muller, 2004; Ozkan et al, 2011; Simons et al, 2001; van der Putten et al, 2014; Weyant et al, 1993). This impaired oral health is influenced by multiple general health problems such as dementia, frailty, psychological disorders, or malnutrition and the according multiple drugs therapy (Klotz et al, 2020). A reduced oral health could influence the general health status, and especially regarding nutritional status, cardiovascular diseases, or aspiration pneumonia (Altenhoevel et al, 2012; Klotz et al, 2018; Komiyama et al, 2016; Paganini‐Hill et al, 2011; Rohrig et al, 2020).…”