Oral disease burden of dentate older adults living in long-term care facilities: FINORAL study

Abstract

Background A growing number of older adults have natural teeth and are at high risk of oral diseases, which are induced by oral bacterial accumulation and proceed unnoticed and quietly. Our aim was (1) to examine the association of oral disease burden (ODB) with health and functioning among dentate long-term care residents, and (2) to find easily detectable signs for nurses to identify residents’ poor oral health. Methods In this cross-sectional observational study dentists examined 209 residents’ oral status, and nurses assessed residents for their functioning and nutrition in long-term care facilities in Helsinki, Finland. ODB was defined by asymptotic dental score (ADS). Six clinical signs of residents’ poor oral health were considered as potentially easy for nurses to detect: lesions on lips, teeth with increased mobility, lesions on oral mucosa, eating soft or pureed food, unclear speech, and needing assistance in eating. The association of these was tested with high ODB as outcome. Results Participants were grouped according to their ADS scores: low (n = 39), moderate (n = 96) and high ODB (n = 74). ODB was linearly associated with coronary artery disease and poor cognitive and physical functioning: needing assistance in eating, poor ability to make contact, and unclear speech but not with other diseases including dementia or demographic characteristics. Furthermore, ODB was linearly associated with eating soft or pureed food. Of the six selected, easily detectable signs, having at least two positive signs gave 89% sensitivity to detecting high ODB. Conclusion Poor oral health was common and ODB accumulated among residents with poor functioning. Nurses may use a few easily detectable signs to screen residents’ oral health when considering a resident’s need for consultation with an oral health professional.

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“…Oral hygiene is known to be poor especially among vulnerable, care-dependent institutionalized older people [ 50 , 51 ] [ 52 ], particularly among those who need assistance with oral hygiene [ 53 , 54 ], and fast deterioration of oral health because of caries or periodontal problems is possible [ 55 ]. In our earlier study [ 29 ] oral disease burden was associated with functional and cognitive decline according to MMSE among long-term care facility residents in line with prior studies [ 56 , 57 ].…”

“…Study was conducted from 2017 to 2019. The study design has been earlier published by Hiltunen et al [ 28 ] and Julkunen et al [ 29 ]. The City of Helsinki and the Ethics Committee of the Hospital District of Helsinki and Uusimaa approved the study protocol (HUS/2042/2016 and HUS/968/2017).…”

“…In both cohorts, the clinical oral examination (conducted for MINOPAR at the Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; for FINORAL at each participant’s long-term care facility) comprised a comprehensive assessment of the oral soft and hard tissues including a periodontal examination comprising probing pocket depth (PPD), both at six sites on all existing teeth, and registration of caries lesions [ 26 , 29 ]. In MINOPAR, the MMSE examination was performed prior to the oral examination at the same visit; other diagnoses were obtained from medical records, and use of medications was self-reported (questionnaire).…”

Translation, cross-cultural adaptation, and validation of the Chinese version of self-efficacy and attitudes for providing Mouth Care scale

“…As poor oral hygiene is a marker for poor health-related quality of life, long-term care facilities need oral care education from caregivers and regular dental check-ups [6]. However, caregivers often face various challenges due to ineffective communication, the uncertainty of risks, and comorbidities of older people, causing pressure and powerlessness to provide oral care [9]. Therefore, it is necessary to evaluate the self-efficacy and attitudes of Chinese caregivers in GCFs since they are often exposed to long-term work, time constraints, weak awareness, and insufficient training [27].…”

“…According to the fourth national survey in China, 71.6% of 4332 older persons had caries, while 64.5% had periodontal pockets and 47.6% had unrestored tooth spaces [8]. Oral disease burden was reported to be associated with poor cognitive and physical functioning in the FINORAL study, a cross-sectional observational study investigating 209 residents' oral status, functioning, and nutrition in long-term care facilities in Helsinki [9]. Persistent routine dental attendance and permanent tooth loss were detected as predictors of improvement and worsening oral health-related quality of life among older people in Sweden [10].…”