No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Improving resident' oral health through staff education in nursing homes
Abstract
This study assessed the efficacy of oral care education among nursing home staff members to improve the oral health of residents. Nursing home support staff members (NHSSMs) in the study group received oral care education at baseline between a pretest and posttest. NHSSMs' oral care knowledge was measured using a 20-item knowledge test at baseline, posteducation, and at a 6-month follow-up. Residents' oral health was assessed at baseline and again at a 6-month follow-up using the Modified Plaque Index (PI) and Modified Gingival Index (GI). Among staff members who received the oral care education (n = 32), posttest knowledge statistically significantly increased from the pretest level (p < .05). Thirty-nine control residents of the nursing homes and 41 study residents participated. Among residents in the study group, PI decreased at 6 months compared to baseline (p < .05), but there was no statistically significant difference in their GI measurements between baseline and 6-month follow-up (p= .07).
... Several studies have consistently found that healthcare providers in LTCIs have limited oral care knowledge and neglect oral care practices due to tight schedules and poor perceptions [18][19][20]. To address this, educational programs on oral health and oral care have been recommended and investigated [22][23][24][25][26][27]. Numerous studies have demonstrated the effectiveness of these programs in improving healthcare providers' knowledge, attitudes, and practice (KAP) [22][23][24][25][26][27]. ...
... To address this, educational programs on oral health and oral care have been recommended and investigated [22][23][24][25][26][27]. Numerous studies have demonstrated the effectiveness of these programs in improving healthcare providers' knowledge, attitudes, and practice (KAP) [22][23][24][25][26][27]. However, variations in program designs pose challenges in assessing their overall effectiveness, and many studies have only evaluated short-term effects without considering program sustainability. ...
... The results indicated that the program effectively improved the knowledge and attitudes of caregivers toward oral health in nursing home residents, with sustained effects for two months. Similarly, Le et al. [26] conducted an interventional study targeting support staff in nursing homes. The program included knowledge about oral health conditions, oral health promotion, daily oral care provision, and oral care decision-making strategies. ...
Background: The importance of oral health in older adults, especially those in long-term care institutions (LTCIs), has been widely recognized. This study aimed to evaluate the sustainability of an oral health educational program (OHEP) for healthcare providers by measuring changes in their knowledge, attitudes, and practice (KAP) towards oral care provision 3 and 6 months after completing the OHEP. Methods: A pragmatic direct care nursing education trial with a control group was conducted to evaluate the sustainability of an OHEP by examining changes in KAP 3 and 6 months after the OHEP. The OHEP comprised both knowledge and skills related to oral care, whereas the control group received standard support in accordance with usual oral care practice. Results: The study included 20 healthcare providers in the intervention group and 20 in the control group. At 6 months post-OHEP, a significant difference in knowledge was observed between the two groups, with the intervention group maintaining a positive effect (mean 13.90). Conversely, the control group showed a significant decline in knowledge (from mean 14.25 to 12.10). Both groups showed an improvement in attitudes regarding oral health, with the intervention group exhibiting better results 3 months post-OHEP. Intervention group participants rated oral care as a higher priority. Conclusions: An OHEP program for LTCI direct care staff provides enhanced knowledge and attitudes toward oral health care. Regular training in direct care and additional support may be needed to sustain optimal effects on oral care practice.
... Poor knowledge, attitudes, and practice (KAP) have been reported among healthcare workers, highlighting the need for education programs to enhance their understanding of oral health and improve their attitudes and practice towards providing oral care to older residents [14][15][16][17]. Based on the interactions among these three constructs, KAP, education programmes are crucial to enhancing knowledge (about the basic concept of oral health, oral problems of older people, and oral care techniques) and substantially improving the attitudes and practice of healthcare workers in the oral care of older residents [18][19][20][21][22]. Although studies have been conducted on oral health educational programs, two systematic reviews on oral health interventions for healthcare staff in long-term care facilities have emphasized the importance of educational programs in maintaining the oral health of older residents. ...
... The OHE programme was developed based on previously established protocols [19][20][21][22]28,29]. It consisted of two parts, namely education and oral care skill demonstration. ...
... This study demonstrated that the oral health educational programme improved the attitude and overall KAP of the healthcare workers in the intervention group, consistent with previous research [16,22]. However, there was no improvement observed in the knowledge and practice of the intervention group after the OHE programme, possibly due to the limitations of the COVID-19 pandemic that was indeed not supportive for effective knowledge acquisition as well as the practice of oral health delivery. ...
Background: Much attention has been paid to advocate proper oral care/hygiene provision by healthcare providers in long-term care institutions (LTCIs). This study aimed to evaluate the effects of an oral health education (OHE) programme (intervention) on knowledge, attitudes, and practice (KAP) of healthcare providers in providing oral care/hygiene to older residents in LTCIs. Methods: A case control study was conducted at two LTCIs, with one assigned as the intervention group and the other as the control group. A KAP survey was administered before and after the intervention, and oral status was assessed by standardized clinical photographs taken before and after oral hygiene provision on three older residents. Results: A total of 40 healthcare providers (20 in intervention and 20 in control groups) participated, with the attitudes and overall KAP significantly improved in the intervention group after the OHE programme. Interestingly, the knowledge of those in the control LTCI was significantly declined at re-evaluation (mean scores were from 17.25 to 14.30), indicating inadequate oral health and care training despite having more experience in taking care of older people. Significant differences in practice were observed between the two groups after the OHE programme (p = 0.006). The three older residents exhibited poor oral health and multiple oral problems. Conclusions: This study revealed that the OHE programme effectively improved attitudes of the healthcare providers and provided a sustaining effect on attitude towards oral health and oral care. However, there were still inadequacies in oral hygiene provision by some healthcare providers, possibly due to unattended oral diseases and hygiene needs, as well as personal and environmental barriers that merit further investigation. Regular evaluation and enforcement of oral care/hygiene provision in LTCIs are necessary to maintain oral health and prevent dental and gum diseases in older residents. Immediate referral for dental treatment is recommended for older people with signs of dental/oral disease(s).
... Poor knowledge, attitudes, and practice (KAP) have been reported among healthcare workers, highlighting the need for education programs to enhance their understanding of oral health and improve their attitudes and practice towards providing oral care to older residents [14][15][16]. Based on the interactions among these three constructs, KAP, education programmes are crucial to enhancing knowledge (about the basic concept of oral health, oral problems of older people, and oral care techniques) and substantially improving the attitudes and practice of healthcare workers in the oral care of older residents [17][18][19][20][21]. ...
... The OHE programme was developed based on previously established protocols [18][19][20][21][22][23]. It consisted of two parts, namely education and skill demonstration of oral care. ...
... This study demonstrated that the oral health educational programme improved the attitude and overall KAP of the healthcare workers in the intervention group, consistent with previous research [15,21 However, there was no improvement observed in the knowledge and practice of the intervention group after the OHE programme, possibly due to the limitations of the COVID-19 pandemic that was indeed not supportive for effective knowledge acquisition as well as the practice of oral health delivery. The OHE programme should be simpli ed and improved to increase the awareness and interest of healthcare workers in oral health. ...
Background
Much attention has been paid to advocate proper oral care/hygiene provision by healthcare providers in long-term care institutions (LTCIs). This study aimed to evaluate the effects of an oral health education (OHE) programme (intervention) on knowledge, attitudes, and practice (KAP) of healthcare providers in providing oral care/hygiene to older residents in LTCIs.
Methods
A case control study was conducted at two LTCIs, with one assigned as the intervention group and the other as the control group. A KAP survey was administered before and after the intervention, and oral status was assessed by standardized clinical photographs taken before and after oral hygiene provision on three older residents.
Results
A total of 40 healthcare providers (20 in intervention and 20 in control groups) participated, with the attitudes and overall KAP significantly improved in the intervention group after the OHE programme. Interestingly, the knowledge of those in the control LTCI was significantly declined at re-evaluation. Poor oral health was observed in the three older residents.
Conclusions
This study revealed that the OHE programme effectively improved attitudes of the healthcare providers and provided sustaining effect on attitude upon oral health and oral care. However, there were still inadequacies in oral hygiene provision by some healthcare providers, possibly due to unattended oral diseases and hygiene needs, as well as personal and environmental barriers that worth further investigation. Regular evaluation and enforcement of oral care/hygiene provision in LTCIs are necessary to maintain oral health and prevent dental and gum diseases in older residents. Immediate referral for dental treatment is recommended for older people with signs of dental/oral disease(s).
... Four studies were conducted in Australia [30][31][32][33] ; one in the United States 34 ; three in Canada [35][36][37] ; three in the UK [38][39][40] ; thirteen in Europe including two in Germany, 41,42 three in the Netherlands, [43][44][45] one in Belgium, 46 two in Switzerland, 47,48 and-from the Scandinavian countries-three in Sweden, 49-51 one in Norway 52 and one in Denmark 53 ; ...
... Four distinct oral health workforce models were iteratively identified from the studies: nurse-led training of aged care nurses, 30,34,38,46 oral health professional-led training of aged care nurses, 35,36,[39][40][41]43,44,50,51 oral health professional-led training of nurses with ongoing clinical support [31][32][33]37,42,[47][48][49]52,53,58 and oral health professional support only. [54][55][56][57] Study results including the demographics and the quality appraisal are reported within these models (Tables 1 and 2). ...
... ies[30][31][32][33][34]36,38,41,43,49,50,52,54,56 showing a positive and statistically significant result at the end of the trial. These positive and statistically significant results were seen across all four models of care, nine studies produced positive results that were not statistically significant, and one study in the "oral health professional-led training of nurses with ongoing clinical support" 42 produced statistically significant negative results (Table 2and Appendix S3). ...
Background
In Australia and globally, there is an increasing problem of unmet oral health needs of older people above 65 residing in aged care facilities. Various workforce models have been trialled to implement oral health care programmes in aged care facilities, but the evidence behind these programmes and their underlying workforce models is not known.
Objective
To systematically review the literature on the effectiveness, and economic feasibility of the current workforce models addressing oral care in aged care facilities.
Methods
CINAHL, Cochrane CENTRAL, MEDLINE, EMBASE, EMB Reviews, NHS Economic Evaluation Database and grey literature were searched. Studies were included if they described an oral health workforce model with a clinical intervention and defined oral health outcome measures. Analysis was conducted using the NHMRC guidelines for scientific and economic evaluations.
Results
Twenty‐eight studies were included. Four distinct workforce models of care were identified. 60% of the studies demonstrated short‐term effectiveness in clinical measures. Workforce models were similar in their effectiveness, with varying levels of quality within each model. Although three studies considered individual components of economic feasibility, only one provided a comprehensive economic analysis of both the costs and health outcomes.
Conclusions Implications of findings
All workforce models of care had some positive impact on oral health for residents of aged care. Oral health should be included as a health focus in age care facilities. Future studies should include longer‐term health outcomes with rigorous economic analysis to ensure sustainably delivered workforce models of care for oral health management within aged care.
... We included these data in our analyses. We identified 23 studies (Chalmers et al., 1996(Chalmers et al., , 1994Chung et al., 1997;de Mello and Padilha, 2009;Dharamsi et al., 2009;Fallon, 2009;Frenkel et al., 2002;Fricker and Lewis, 2009;Hardy et al., 1995;Jablonski et al., 2009;Janssens et al., 2016;Jones and Sleeman, 2009;Junges et al., 2014;Le et al., 2012;Lindqvist et al., 2013;McKelvey et al., 2003;McNally et al., 2012;Pyle et al., 1999;Reed et al., 2011;Tan et al., 2009;Wardh et al., 2003;Wardh and Wikstrom, 2014;Weeks and Fiske, 1994;Willumsen et al., 2012) that present results specifically reported by care aides (Table 3). The other 18 studies (Chami et al., 2012;De Visschere et al., 2015;Fiske and Lloyd, 1992;Forsell et al., 2010Forsell et al., , 2011Frenkel, 1999;Gately et al., 2011;Hilton et al., 2016;Paley et al., 2004;Paulsson et al., 2003Paulsson et al., , 2002Porter et al., 2015;Sonde et al., 2011;Sumi et al., 2001;Tham and Hardy, 2013;Wardh et al., 1997Wardh et al., , 2012Webb et al., 2015) include care aides in their study sample but report findings across various care provider groups and do not give results specific to care aides (Table 3). ...
... The other 18 studies (Chami et al., 2012;De Visschere et al., 2015;Fiske and Lloyd, 1992;Forsell et al., 2010Forsell et al., , 2011Frenkel, 1999;Gately et al., 2011;Hilton et al., 2016;Paley et al., 2004;Paulsson et al., 2003Paulsson et al., , 2002Porter et al., 2015;Sonde et al., 2011;Sumi et al., 2001;Tham and Hardy, 2013;Wardh et al., 1997Wardh et al., , 2012Webb et al., 2015) include care aides in their study sample but report findings across various care provider groups and do not give results specific to care aides (Table 3). Ten studies were conducted in Sweden (Forsell et al., 2010(Forsell et al., , 2011Lindqvist et al., 2013;Paulsson et al., 2003Paulsson et al., , 2002Sonde et al., 2011;Wardh et al., 1997Wardh et al., , 2003Wardh et al., , 2012Wardh and Wikstrom, 2014), six each in the UK (Fiske and Lloyd, 1992;Frenkel et al., 2002;Frenkel, 1999;Gately et al., 2011;Porter et al., 2015;Weeks and Fiske, 1994) and the USA (Chalmers et al., 1996(Chalmers et al., , 1994Hardy et al., 1995;Jablonski et al., 2009;Pyle et al., 1999;Reed et al., 2006), four each in Australia (Fallon, 2009;Fricker and Lewis, 2009;Jones and Sleeman, 2009;Paley et al., 2004;Tan et al., 2009;Tham and Hardy, 2013;Webb et al., 2015) and Canada (Compton and Kline, 2015;Dharamsi et al., 2009;Le et al., 2012;McNally et al., 2012), three in Brazil (de Mello and Padilha, 2009;Junges et al., 2014;Reis et al., 2011) two in Belgium (De Visschere et al., 2015Janssens et al., 2016), one each in Japan (Sumi et al., 2001), New Zealand (McKelvey et al., 2003, Norway , and Switzerland (Chung et al., 1997(Chung et al., , 2000, and two in multiple countries (Chami For many of the reported barriers it is unclear whether they were reported by interviewed managers or care aides, or whether they reflect the Weak (continued on next page) Hilton et al., 2016). Fifteen studies had a cross-sectional design (Chung et al., 1997(Chung et al., , 2000Fiske and Lloyd, 1992;Frenkel, 1999;Gately et al., 2011;Hardy et al., 1995;Jablonski et al., 2009;Junges et al., 2014;Paulsson et al., 2003;Porter et al., 2015;Pyle et al., 1999;Sumi et al., 2001;Wardh et al., 1997Wardh et al., , 2012Webb et al., 2015;Willumsen et al., 2012), 13 were qualitative studies (Chami et al., 2012;de Mello and Padilha, 2009;De Visschere et al., 2015;Lindqvist et al., 2013;McKelvey et al., 2003;McNally et al., 2012;Paley et al., 2004;Paulsson et al., 2002;Reis et al., 2011;Sonde et al., 2011;Tham and Hardy, 2013;Wardh et al., 2003;Weeks and Fiske, 1994), seven were mixed methods studies (Chalmers et al., 1996(Chalmers et al., , 1994Compton and Kline, 2015;Dharamsi et al., 2009;Fallon, 2009;Fricker and Lewis, 2009;Hilton et al., 2016;Jones and Sleeman, 2009;Tan et al., 2009;Wardh and Wikstrom, 2014), three applied a one-group pre-post design (Forsell et al., 2010(Forsell et al., , 2011Reed et al., 2006), and three were randomized controlled trials (Frenkel et al., 2002;Janssens et al., 2016;Le et al., 2012). ...
... Fifteen studies had a cross-sectional design (Chung et al., 1997(Chung et al., , 2000Fiske and Lloyd, 1992;Frenkel, 1999;Gately et al., 2011;Hardy et al., 1995;Jablonski et al., 2009;Junges et al., 2014;Paulsson et al., 2003;Porter et al., 2015;Pyle et al., 1999;Sumi et al., 2001;Wardh et al., 1997Wardh et al., , 2012Webb et al., 2015;Willumsen et al., 2012), 13 were qualitative studies (Chami et al., 2012;de Mello and Padilha, 2009;De Visschere et al., 2015;Lindqvist et al., 2013;McKelvey et al., 2003;McNally et al., 2012;Paley et al., 2004;Paulsson et al., 2002;Reis et al., 2011;Sonde et al., 2011;Tham and Hardy, 2013;Wardh et al., 2003;Weeks and Fiske, 1994), seven were mixed methods studies (Chalmers et al., 1996(Chalmers et al., , 1994Compton and Kline, 2015;Dharamsi et al., 2009;Fallon, 2009;Fricker and Lewis, 2009;Hilton et al., 2016;Jones and Sleeman, 2009;Tan et al., 2009;Wardh and Wikstrom, 2014), three applied a one-group pre-post design (Forsell et al., 2010(Forsell et al., , 2011Reed et al., 2006), and three were randomized controlled trials (Frenkel et al., 2002;Janssens et al., 2016;Le et al., 2012). Methodological quality was weak in 29 studies (details in Supplementary file 4) (Chalmers et al., 1996(Chalmers et al., , 1994Chami et al., 2012;Chung et al., 1997Chung et al., , 2000Compton and Kline, 2015;de Mello and Padilha, 2009;Fallon, 2009;Fiske and Lloyd, 1992;Forsell et al., 2010Forsell et al., , 2011Frenkel, 1999;Fricker and Lewis, 2009;Gately et al., 2011;Jablonski et al., 2009;Jones and Sleeman, 2009;Junges et al., 2014;Le et al., 2012;McKelvey et al., 2003;Paley et al., 2004;Paulsson et al., 2003;Porter et al., 2015;Pyle et al., 1999;Reed et al., 2006;Sonde et al., 2011;Sumi et al., 2001;Tan et al., 2009;Wardh et al., 1997Wardh et al., , 2012Wardh and Wikstrom, 2014;Webb et al., 2015;Weeks and Fiske, 1994;Willumsen et al., 2012). Two mixed methods studies had weak ratings for the cross-sectional component but low moderate (Dharamsi et al., 2009) or high moderate (Hilton et al., 2016) ratings for the qualitative component. ...
Background:
Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents.
Methods:
We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence.
Results:
We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%).
Conclusions:
We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.
... Another measure used for dental status was the presence and number of teeth. This measure was used in 21 studies [5,27,40,45,57,71,[76][77][78][79][80][81][82][83][84][85][86][87][88][89][90]. In some studies it was combined with counting the number of functional occluding pairs that had static contacts [27,40,69,77,79,91]. ...
... In 7 studies bleeding indices were reported: the modified sulcus bleeding index [93], the papilla bleeding index [86], the gingiva bleeding index [32,35,98], the sulcus bleeding index [55], presence of bleeding after probing [45]. Gingival indices were used in 12 studies and included the gingival or gingivitis index [39,50,60,62,80,86,88,99,102] and the modified gingiva index [73,82], to assess the visual appearance of inflammation of the gingiva (score 0-3 and score 0-4). ...
When elderly become frail and in need for complex care, they can no longer live independently at home and may be admitted to nursing homes. Various studies have shown that oral health in this population is remarkably poor, which may lead to distressing situations and impacts quality of life. A variety of definitions or descriptions for oral health is used. Without a uniform parameter, it is impossible to determine whether oral health in institutionalized elderly is actually improving or deteriorating over time, as well as the effect of (preventive) interventions. In search for an adequate and clinically applicable parameter to determine oral health in this specific patient group, this scoping review aims to give an overview of the currently used parameters for determining oral health in institutionalized elderly. Ninety different parameters were identified, and 50 parameters were solely used by one study. Only 4 parameters were frequently used (in > 20 studies). The relevance of these parameters for this specific patient group is discussed. To aid the planning and commissioning of future research and patient care, there is an urgent need for an adequate and uniform parameter for oral health determination in institutionalized elderly.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12903-024-04025-y.
... Also, the oral health status of the elderly people in the intervention group was significantly improved. The findings of the present study are in line with the results of the studies reported by McKeown et al., 21 Le et al., 22 Kim et al., 23 and De Visschere et al. 24 Le et al. carried out a study on residents in nursing homes. The caregivers were educated about oral care using a 40minute video, which was a shorter training session than provided in our study. ...
... The caregivers were educated about oral care using a 40minute video, which was a shorter training session than provided in our study. The results showed that the plaque index (PI) and the knowledge of the caregivers improved from the beginning of the oral health education program to six months after the intervention, 22 which agreed with the results of our study. Visschere et al. evaluated the implementation of an oral hygiene protocol over five years. ...
The oral health of elderly people plays a major role in their overall health and quality of life and is an integral part of personal care. The aim of this study was to evaluate the effect of implementing the oral health care program on the oral health status of elderly people living in rural areas. This quasi-experimental study was carried out using a pretest-posttest design on 60 elderly people (30 in the intervention group and 30 in the control group) residing in two randomly selected rural areas of lower-northern Thailand. In the intervention group, the “FUNDEE” model was applied to Hmong elderly people for 12 weeks. The control group received routine care. Using the oral health care behavior assessment tool, the oral health behavior status of elderly people was assessed in both groups on two occasions: a pretest at the onset of the study, and the 12th week after the start of the study. The oral health behavior status of the elderly people in both groups was not statistically significantly different at the baseline, but it changed significantly at the 12th week (p<0.01). The implementation of the “FUNDEE” model for elderly people residing in rural areas may improve their oral health status after 12 weeks. It is recommended that the “FUNDEE” model be included in the care plans of all rural areas to improve the elderly people’s oral health behavior status.
... worked in the presence of a member of the oral healthcare team of the nursing home to put the residents at ease. As a consequence, an informal repeated education approach was established, as already suggested in a previous study [44]. Figure 2 illustrates the intervention on a time scale for each nursing home included in this study, showing the start of the education process and the period that the mobile dental team was active in the nursing home. ...
... This finding makes the results on knowledge even more powerful. In the control group, knowledge also significantly improved which is in agreement with the results obtained by previous studies (17,44; Chapter 4 Part 1). This might be the consequence of the Hawthorne effect: drawing attention to a topic such as oral health and participating in a study, encourages the enhancement of knowledge. ...
... Few controlled studies exist measuring the increase of knowledge in an intervention group compared to a control group 24,25 . The results of the present study show a significant improvement of knowledge in both study groups with this increase being significantly higher in the intervention group compared to the control group. ...
... The results of the present study show a significant improvement of knowledge in both study groups with this increase being significantly higher in the intervention group compared to the control group. A study of Phu Le et al. 24 also showed increased knowledge in both the intervention and the control group but without significant group differences. A possible explanation for the knowledge improvement in the control group might be the Hawthorne effect: drawing attention to a topic such as oral health and knowing that one participates in a study, encourages enhancement of knowledge. ...
To explore the impact of a supervised implementation of an oral healthcare protocol, in addition to education, on nurses' and nurses' aides' oral health-related knowledge and attitude.
A random sample of 12 nursing homes, accommodating a total of 120-150 residents, was obtained using stratified cluster sampling with replacement. The intervention included the implementation of an oral healthcare protocol and three different educational stages. One of the investigators supervised the implementation process, supported by a dental hygienist. A 34-item questionnaire was developed and validated to evaluate the knowledge and attitude of nurses and nurses' aides at baseline and 6 months after the start of the intervention. Linear mixed-model analyses were performed to explore differences in knowledge and attitude at 6 months after implementation.
At baseline, no significant differences were observed between the intervention and the control group for both knowledge (p = 0.42) and attitude (p = 0.37). Six months after the start of the intervention, significant differences were found between the intervention and the control group for the variable knowledge in favour of the intervention group (p < 0.0001) but not for the variable attitude (p = 0.78). Out of the mixed model with attitude as the dependent variable, it can be concluded that age (p = 0.031), educational level (p = 0.009) and ward type (p = 0.014) have a significant effect. The mixed model with knowledge as the dependent variable resulted in a significant effect of the intervention (p = 0.001) and the educational level (p = 0.009).
The supervised implementation of an oral healthcare protocol significantly increased the knowledge of nurses and nurses' aides. In contrast, no significant improvements could be demonstrated in attitude.
© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.
... A number of studies have investigated the implementation of oral health education programs for formal caregivers and staff in nursing homes. The results of these studies were similar to ours regarding the improvement in knowledge [39][40][41][42][43][44][45] and/or attitudes after the intervention. 34,[46][47][48] The findings stressed the importance of training that increased the participants' self-confidence regarding the implementation of oral hygiene and regular oral screenings as also previously recorded. ...
Aim: The aim was the design, implementation, and evaluation of an oral health education program for nursing home caregivers.
Methods and results: Fifty-five formal caregivers working in the three units of a nursing home were allocated to either a control (n = 27) or an intervention group (n = 28). A knowledge and attitudes questionnaire about oral health was developed and completed by the caregivers. Then, an education program about oral heath in older people was applied to the intervention group, and the completion of the questionnaire was repeated by both the intervention and control groups. Two months after the intervention, the questionnaire was completed again by the intervention group. Within groups analyses revealed a statistically significant increase in knowledge and attitudes only in the intervention group after the implementation of the education program (P < .001). Between-group analyses showed that the total knowledge and attitudes score in the intervention group were statistically significantly higher than in the control group (P < .001 and P = .02, respectively). In the intervention group, knowledge and attitudes were maintained in the measurement recorded 2 months later (P = .11 and P = .21, respectively).
Conclusion: The education program was effective in improving the caregivers' knowledge and attitudes toward nursing home residents' oral health and maintaining them 2 months after implementation.
Keywords: elders; nursing home residents; oral health.
... Previous studies have examined the evidence related to oral health promotion and showed oral health education programs to improve primary care staff's knowledge of oral health issues [14][15][16][17]. Moreover, research has shown that specifically planned oral health care education increases physicians' knowledge and may help them promote children's oral health among deprived populations in developed countries [7,15]. ...
... Previous studies have examined the evidence related to oral health promotion and showed oral health education programs to improve primary care staff's knowledge of oral health issues [14][15][16][17]. Moreover, research has shown that specifically planned oral health care education increases physicians' knowledge and may help them promote children's oral health among deprived populations in developed countries [7,15]. ...
Background
Family physicians are in frequent contact with patients, and their contribution to oral health promotion programs could be utilized more effectively. We implemented an oral health care (OHC) educational seminar for physicians and evaluated its impact on their knowledge retention in OHC.
Methods
We conducted an educational trial for primary care physicians (n = 106) working in Public Health Centers in Tehran city. We launched a self-administered questionnaire about pediatric dentistry, general dental, and dentistry-related medical knowledge and backgrounds. Physicians in intervention group A (n = 38) received an educational intervention (Booklet, Continuous Medical Education (CME), and Pamphlet), and those in group B (n = 32) received only an OHC pamphlet. Group C (n = 36) served as the control. A post-intervention survey followed four months later to measure the difference in the physicians’ knowledge; the Chi-square test, ANOVA and linear regression analysis served for statistical analysis.
Results
The intervention significantly increased the physicians’ oral health knowledge scores in all three domains and their total knowledge score (p < 0.001). Those physicians who had lower knowledge scores at the baseline showed a higher increase in their post-intervention knowledge. The models showed no associations between the background variables and the knowledge change.
Conclusion
The primary care physicians’ OHC knowledge improved considerably after an educational seminar with a reminder. These findings suggest that OHC topics should be included in physicians’ CME programs or in their curriculum to promote oral health, especially among non-privileged populations.
... Many studies have examined the problems encountered and the training received by care providers in providing oral health care to institutionalised older people. Training care providers in long-term care institutions in the provision of oral hygiene procedures is vital for improving the oral health of older people 9,10 . Training can help workers identify residents who are at a risk of oral diseases and increase their confidence in their provision and maintenance of oral health care 11,12 . ...
Objectives
To investigate the circumstances in which home‐care aides (HAs) provide oral health care to homebound patients and to examine the degree of comfort and knowledge that HAs have regarding their own skills in providing oral health care.
Methods
Seven home‐care facilities in central Taiwan consented to participate in this cross‐sectional study. The participants were selected through convenience sampling. A total of 312 effective responses were obtained (the effective response rate was 64.0%). SPSS, version 17, was used to perform statistical analyses, including descriptive statistics, factor analysis and multiple regression analysis.
Results
Oral health‐care work had a minimal impact on the psychological burden of the HAs. However, factors affecting the self‐perception of the HAs regarding their competency in oral health‐care provision included ‘whether oral health care is a part of home care’ (β = −0.195, P = 0.006), ‘whether patients had difficulty chewing’ (β = −0.178, P = 0.001), ‘vomiting during oral health care’ (β = 0.133, P = 0.001), ‘having HA certification’ (β = 0.120, P = 0.030), ‘whether premeal oral exercises were performed’ (β = 0.141, P = 0.012), ‘finger biting during the provision of oral care’ (β = −0.115, P = 0.039) and ‘time constraints for provision of care’ (β = 0.143, P = 0.042).
Conclusions
Enhancing HAs’ self‐perception of their competency in oral health‐care provision can help develop in‐service training courses focused on oral health care for older adults, thereby further strengthening HAs’ competency in oral health‐care provision.
... The indexes of Silness & Löe 16 and Löe & Silness 17 that we used are frequently used in these types of studies. 23 Besides this, ROAG was used as an outcome measurement as well as an instrument to select participants that needed additional and customized written oral hygiene prescriptions for each patient for special oral hygiene devices, procedures or products. ROAG is constructed with nine items that could be considered dependent of each other; hence, we analysed each item separately. ...
Objectives
Oral health in nursing homes for elderly is often unsatisfactory, and oral health education to nursing staff has not shown sufficient results why there is need for novel approaches. The aim of the study was to trial a new oral healthcare educational programme and to evaluate the effects on residents’ oral health. In addition, attitudes among the nursing staff in the intervention nursing home were explored.
Methods
In a controlled clinical trial, two comparable nursing homes were randomly assigned for intervention or control. Interventions included weekly theoretical and hands‐on guidance from dental hygienists on oral hygiene procedures and discussions on oral care routines. The residents’ oral health, measured by the Revised Oral Assessment Guide (ROAG), dental plaque and gingival bleeding were evaluated at baseline and after 3 months. Attitudes among the staff to oral health care were measured at the intervention nursing home.
Results
Revised Oral Assessment Guide gums and lips scores showed a tendency to decrease in the intervention group, but remained high in the control group. Plaque levels improved significantly after intervention, and a trend towards less gingival bleeding was observed. The intervention nursing staff seemed to be more aware of their own limitations concerning oral health care after intervention and valued more frequent contact with dental services to a greater extent.
Conclusions
The oral healthcare situation for elderly people today is so complex that theoretical education at the group level regarding different aspects of oral health is not sufficient. Individual hands‐on guidance by dental hygienists on a regular basis in everyday care may be a new approach.
... Therefore, it is necessary to develop efficient educational program to promote the performance of oral health checkups. Some studies have reported the effects of such educational programs on non-oral health professionals' knowledge and attitudes towards oral healthcare [12][13][14]. In addition, there have been some studies concerning educational programs on oral heath checkups for small numbers of non-oral health professionals [15][16][17]. ...
Objectives: The purpose of this study was to investigate the effect of a group-based educational program on the awareness, attitudes, and confidence of nurses in the performance of oral health checkups.Materials and methods: The subjects (n=184) were nurses who worked in a hospital and an affiliated long-term care facility in Fukuoka Prefecture, Japan. The subjects were divided to an intervention group and a control group. The intervention group participated in the program, which was a combination of a lecture and training program on oral assessment and oral healthcare. To investigate the effect of the program on their awareness, attitudes, confidence, and performances of oral health checkups, questionnaire surveys were conducted before and one month after the intervention.Results: Sixty-two nurses participated in the program. Fifty-five (88.7%) in the intervention group and 68 (84.0%) in the control group who completed both surveys were employed for the analysis. In the intervention group, there were significant differences between the baseline and follow-up in their awareness of detecting oral cancer and confidence in examining oral cleanliness (p<0.05). However, there were no positive changes in their attitudes toward and performance of oral health checkups in either group.Conclusion: These results suggest in addition to the continuous participation of nurses in the program, the introduction of oral assessment tools into their oral healthcare protocols might be needed to promote the performance of oral health checkups in their facilities. We believe that these findings will help promote the performance of oral health checkups in hospitals and long-term care facilities.
... [14][15][16][17] A study by Le et al. among nursing home staff members of Canada, showed that posttest knowledge statistically significantly increased from the pretest level after imparting oral health knowledge to them (P < 0.05). [18] Another postintervention survey among community workers of south India showed statistically significant improvement in various knowledge domains like oral hygiene habits, importance of milk teeth, causes of dental diseases, prevention of dental diseases, and treatment of certain dental conditions. [15] Our study also demonstrated a statistically significant improvement in skills using skill based package as compared to the knowledge based package. ...
Introduction: Despite a serious public health problem, oral hygiene is largely ignored
by community. Anganwadi workers (AWWs) can be trained on oral hygiene so that
they disseminate information to a wider section of society. Objective: To compare
the impact of two oral hygiene training packages on the knowledge and skills of AWW
of Chandigarh. Materials and Methods: Before and after comparison study was
conducted on AWWs of Chandigarh. The AWWs of Project-1 (n = 112) were provided
with knowledge based training package and AWWs of Project-2 (n = 98) were provided
with skill based training package. The difference between two packages was analyzed
using Chi-square test and difference-in-difference analysis of group scores. Results:
The pre-posttraining difference of a number of respondents scoring <22 in the knowledge
domain was 43% (pretraining — 11% and posttraining - 54%) in Project-1, whereas, in
Project-2 this increase was higher at 54% (pretraining - 6% and posttraining - 60%). The
difference-in-difference results showed that there was statistically significant (P = 0.04)
improvement in the knowledge scores of AWWs of two projects scoring <22 marks. The
increase in skill scores between two projects was found to be statistically significant (P
= 0.000). Conclusion: Increase in skills of AWWs imparted with skill based package
was significantly better as compared to the knowledge based package, thus indicating
its usefulness over a knowledge-based package. Skill-based oral hygiene package
should be imparted to community workers.
... The caregivers were educated about oral care using a 40-minute video, which was a shorter training session than provided in our study. The results showed that the plaque index (PI) and the knowledge of the caregivers improved from the beginning of the oral health education program to 6 months after the intervention (21), which agreed with the results of our study. Visschere et al. evaluated the implementation of an oral hygiene protocol over 5 years. ...
Background
Oral health of elderly people plays a major role in their overall health and quality of life, and is an integral part of personal care.
Aim
The aim of this study was to evaluate the effect of implementing the oral health care program (OHCP) on oral health status of elderly people resident in nursing homes.
Materials and Methods
This quasi-experimental study was carried out using a pretest-posttest design on 101 elderly people (46 in the intervention group and 55 in the control group) resident in two randomly selected nursing homes in Mashhad, Iran. In the intervention group, the OHCP was carried out by caregivers for 8 weeks. The control group received routine care. Using the oral health assessment tool, the oral health status of elderly people was assessed in both groups at three times; onset of the study, 4th, and 8th week after the start of the study.
Results
The oral health status of the elderly people in both groups was not statistically significantly different at baseline, but it changed significantly at the 4th, and 8th weeks (p<.001).
Conclusion
The implementation of the OHCP for elderly people resident in nursing homes may improve their oral health status after 4 weeks. It is recommended that OHCP be included in care plans of all nursing homes to improve the elderly people’s oral health status.
... This finding makes the results on knowledge even more powerful. In the control group, knowledge also significantly improved which is in agreement with the results obtained by previous studies [17,45]. This might be the consequence of the Hawthorne effect: drawing attention to a topic, such as oral health and participating in a study, encourages the enhancement of knowledge. ...
Objectives
The objective of the study was to evaluate the effect of an oral healthcare programme in nursing homes on care staff knowledge and attitude regarding oral health. Methods
The study sample consisted of the nurses and nurses’ aides from 63 nursing homes, which either received an oral healthcare programme including mobile dental care or were on a waiting list to receive this programme. A validated questionnaire completed at baseline and again after the study period assessed the care staff knowledge and attitude. Paired t test, independent t test, general linear and linear mixed models were used to examine the changes in attitude and knowledge scores. ResultsIn total, 546 questionnaires were completed by the same people from 36 nursing homes at baseline and on completion of the study. After the intervention period, knowledge significantly improved in both study groups (I p < 0.001; C p < 0.001), the intervention group significantly showing the largest increase (p < 0.001). The outcome variable attitude only showed a significant improvement in the intervention group (p < 0.001). The mixed models confirmed the impact of some aspects of the intervention on the attitude and the knowledge of the caregivers. Conclusions
The oral healthcare programme including a mobile dental team resulted in a significant increase of the care staff knowledge and attitude regarding oral health. Clinical relevanceThe integration of a dental professional team in nursing home organisations should be encouraged because it could be valuable to tackle barriers for the provision of daily oral hygiene and to support the continuous integration of oral health care into general care.
... This finding makes the results on knowledge even more powerful. In the control group, knowledge also significantly improved which is in agreement with the results obtained by previous studies [17,45]. This might be the consequence of the Hawthorne effect: drawing attention to a topic, such as oral health and participating in a study, encourages the enhancement of knowledge. ...
Effect of a mobile dental team on care staff knowledge and attitude regarding oral health: a non-randomised intervention trial.
... Research has shown that oral hygiene care status in residents with dementia was poor despite established guidelines for oral care and the fact that oral care assistance was being provided (2,4,12,13). A number of studies suggest that the personal attitudes and values of PCAs related to oral hygiene remain one of the most significant barriers to residents receiving adequate oral health assistance (12,(14)(15)(16)(17). Barriers to providing daily oral care reported by PCAs include the lack of time, a perceived lack of support by facility management, lack of knowledge or training for care staff (12,18), residents refusal (12,19) or psychological barriers to perform oral hygiene care in a resident's mouth (20). ...
Objectives: To investigate whether, within a residential care facility, increasing personal care assistants' (PCAs) awareness of their own oral health status and self-care skills would alter existing attitudes and behavioural intentions related to the oral health care of residents. Methods: PCAs (n = 15) in the dementia care unit of a residential care facility in Melbourne, Australia, were invited to participate in a small research project that appeared to test the effectiveness of a workplace oral health educational programme in enhancing their own oral health whilst masking the actual outcome of interest, namely its effect on PCAs oral healthcare attitudes and practices towards the residents. Results: Post-intervention, the self-reported confidence of the PCAs to identify their personal risk for oral health problems, identifying common oral health conditions and determining the factors contributing to their personal oral health was increased significantly (P < 0.05). Post-intervention, the self-reported confidence of the PCAs to feeling confident to identify factors that could contribute to poor oral health of residents, identify resident's higher risk for poor oral health and feeling confident in identifying common oral health conditions in residents was also increased significantly (P < 0.05). Conclusion: The results of this pilot study show that the educational intervention to increase the personal care assistants' (PCAs) awareness of their own oral health status and self-care skills increased the confidence of the carers to identify oral health risks in the residents, as well as increasing their self-reported confidence in providing oral care to residents.
... [14][15][16][17] A study by Le et al. among nursing home staff members of Canada, showed that posttest knowledge statistically significantly increased from the pretest level after imparting oral health knowledge to them (P < 0.05). [18] Another postintervention survey among community workers of south India showed statistically significant improvement in various knowledge domains like oral hygiene habits, importance of milk teeth, causes of dental diseases, prevention of dental diseases, and treatment of certain dental conditions. [15] Our study also demonstrated a statistically significant improvement in skills using skill based package as compared to the knowledge based package. ...
... [3][4][5] However, despite its preventive effects, denture cleaning is not routinely carried out by residents living in nursing facilities because of insufficient staffing. 6 Dentures are cleaned by mechanical methods, such as brushing and ultrasonic treatment, or chemical methods using denture cleaner. A combination of brushing and ultrasonic treatment is an effective mechanical method. ...
The purpose of the present study was to evaluate the application possibility of water containing organic acids (WOA), made by some organic acids used as food additives, for chemical denture cleaning for older adults by microbial investigation.
Using an in vitro biofilm study, we determined the effects of WOA on Streptococcus sanguinis, S. pneumoniae and Candida albicans attached to heat-cured acrylic resins. Specimens were divided into three groups as follows: control group (TW), commercial denture cleaner group (DC) and WOA group (WOA). Specimens were treated with each for 5 min, 30 min or 8 h, and the numbers of attached microbes were determined by counting colony-forming units or adenosine triphosphate analysis. Using an in vivo biofilm study, we studied the effects of these same solutions on 60 complete dentures. The dentures were divided randomly and blindness into three groups as described above, and treated for 10 min. The numbers of microbes attached to dentures before and after treatment were determined by counting colony-forming units.
For the in vitro biofilm study, there were significant differences in the numbers of microbes between WOA and TW, although there were no significant differences between WOA and DC except for C. albicans. For the in vivo biofilm study, there were significant differences between WOA, DC and TW, although there was no significant difference between WOA and DC.
We conclude that water containing organic acids exerts antimicrobial effects as strong as commercial denture cleaner, and it has an application possibility of use for safe chemical denture cleaning for older adults. Geriatr Gerontol Int 2015; ●●: ●●-●●.
© 2015 Japan Geriatrics Society.
... For a study to receive a global rating of strong, four of the six scored subsections must be rated as strong, with no weak ratings among the six subsections. Ultimately, one study was given a global rating of strong (Frenkel, Harvey, & Newcombe, 2001), seven were rated as moderate (Budtz-Jørgensen, Mojon, Rentsch, & Deslauriers, 2000;De Visschere, Schols, van der Putten, de Baat, & Vanobbergen, 2012;MacEntee et al., 2007;Mojon, Rentsch, Budtz-Jørgensen, & Baehni, 1998;Nicol, Sweeney, McHugh, & Bagg, 2005;Simons, Baker, Jones, Kidd, & Beighton, 2000;van der Putten et al., 2013), and four as weak (Bassim, Gibson, Ward, Paphides, & DeNucci, 2008;Le, Dempster, Limeback, & Locker, 2012;Peltola, Vehkalahti, & Simoila, 2007;Pyle, Massie, & Nelson, 1998). ...
Nurses have a critical role in promoting oral health in dependent older adults residing in long-term care or having extended hospital stays. Strategies aimed at improving the quality of oral hygiene care nurses provide may contribute to better oral hygiene outcomes. The purpose of this systematic review was to examine the effect of intervention programs designed to enhance the ability of nurses or those to whom they delegate care to improve oral hygiene outcomes in frail older adults. Studies reported an educational program, either alone or augmented in some way. The study interventions consisted of: (a) single in-service education sessions; (b) single in-service education sessions supplemented by a “train-the-trainer” approach; and (c) education sessions supplemented with ongoing active involvement of a dental hygienist. None of the approaches emerged as being desirable over the others, as methodologically strong studies with good intervention integrity were lacking, and a variety of oral health outcomes were used to measure effectiveness of the interventions, making comparisons across studies difficult.
[Res Gerontol Nurs. 2014; 7(2):87–100.]
Introduction:
The oral health status of older adults in the United States is a public health crisis and a silent epidemic. Maine's Oral Team-Based Initiative Vital Access to Education (MOTIVATE) Program is an innovative interprofessional oral health program aimed at enhancing oral health education and practice of interprofessional health care teams in nursing homes. Using a blended learning model, a combination of in-person and online learning, this program provides a foundation from which to implement evidenced based oral care in nursing homes.
Methods:
Learning outcomes were assessed via a three-part timed series survey. A set of self-report assessment items measured skills implemented at baseline and post-training.
Results:
Learning domain scores increased over time from baseline to post-training. Confidence in providing oral healthcare and role clarity in providing oral health care improved over time. Staff identified using new skills in daily oral care and communication across the interprofessional team.
Discussion:
The MOTIVATE program is an effective collaborative-based model for developing oral health competencies and promoting evidence-based oral health care in nursing homes.
Background
There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health.
Objective
The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people.
Methods
We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta‐analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system.
Results
We included a total of 30 randomised clinical trials assessing educational and non‐educational interventions for community‐dwelling older people ( n = 2) and those residing in long‐term care facilities ( n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long‐term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system.
Conclusion
Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long‐term effect of interventions, and further research is needed, especially targeting community‐dwelling older people.
PROSPERO ID: CRD42021231721.
As patients age, there are changes in dependency, medical conditions and mobility that directly affect treatment needs and recommendations. Some of these patients can be treated in a private practice setting while others require treatment in long-term care facilities or places of residency. As older adults transition through stages of dependency and housing environments, oral health care providers simultaneously must transition how care is managed in the areas of assessment, prevention, treatment and communication.
Hintergrund Menschen mit Pflege- oder Unterstützungsbedarf oder einer Behinderung haben einen schlechteren Mundgesundheitsstatus als Menschen ohne diesen Bedarf. Die zunehmende Anzahl älterer Menschen, die über eigene Zähne verfügen, erfordert spezifische Maßnahmen zur Förderung der Mundgesundheit. Während 1997 jeder 4. Mensch zwischen 65 und 74 Jahren zahnlos war, galt dies 2016 nur noch für jeden 8. Besondere Herausforderungen in der Mundpflege stellen sich bei älteren Menschen und Personen mit Demenz. Zur Bewältigung braucht es eine interprofessionelle Herangehensweise und Zusammenarbeit während der gesamten Versorgung. Zielsetzung Interprofessionelle Entwicklung eines Expertenstandards zur Förderung der Mundgesundheit durch Pflegefachpersonen mit Fokus auf ältere Menschen. Methoden Grundlage des Expertenstandards bildet eine systematische Literaturanalyse. Aufbauend auf den Ergebnissen formulierte eine interprofessionelle Expertinnen- und Expertenarbeitsgruppe unter Beteiligung von Pflege, Zahnmedizin und einem Vertreter aus der Selbsthilfe Empfehlungen zur Förderung der Mundgesundheit von Menschen mit pflegerischem Unterstützungsbedarf. Ergebnisse Die interprofessionelle Herangehensweise prägte die Auswahl der leitenden Fragen der Literaturrecherche, die Literaturauswertung und die Formulierung der Empfehlungen. Zu den leitenden Fragen des Expertenstandards konnten Maßnahmen zu Erhalt und Förderung der Mundgesundheit ausgewiesen werden, beispielsweise bei oralen Pilzerkrankungen, Mukositis oder Gingivitis sowie bei Begleiterscheinungen wie Mundtrockenheit und Schmerzen. Diskussion Maßnahmen zur Förderung der Mundgesundheit bei Menschen mit Pflege- oder Unterstützungsbedarf oder einer Behinderung konnten im pflegerischen Kontext vertieft fokussiert und durch eine interprofessionelle Gruppe formuliert werden = Background: People in need of care or with severe disability have a worse oral health status compared to people without these needs. The increasing number of older people who are able to keep their own teeth requires specific steps to support oral health. Whereas in 1997 1 in 4 people between 65 and 74 years of age was toothless, in 2016 this figure had risen to 1 in 8. Special challenges in oral care arise for older people and people with dementia. The management requires an interprofessional approach. Objective: Interprofessional development of an expert standard for the promotion of oral health by nurses and a focus on older people. Methods: The expert standard is based on a systematic literature analysis. Based on this, members of an interprofessional expert working group consisting of nurses, dentists and a representative of those affected formulated recommendations to promote oral health of people in need of care. Results: The interprofessional approach defines the selection of the guiding questions for the literature search, the evaluation of the literature and the formulation of the recommendations. Interventions to maintain and promote oral health were identified for the guiding questions of the expert standard, for example, in cases of oral fungal diseases, mucositis, gingivitis or accompanying symptoms, such as dry mouth and pain. Discussion: Interventions to promote oral health of people in need of care or with severe disability could be focused more deeply within the nursing profession and formulated by an interprofessional group to guide their actions. Keywords: Dementia; Evidence-based care; Oral care; Prevention; Quality development in Nursing care.
Background:
People in need of care or with severe disability have a worse oral health status compared to people without these needs. The increasing number of older people who are able to keep their own teeth requires specific steps to support oral health. Whereas in 1997 1 in 4 people between 65 and 74 years of age was toothless, in 2016 this figure had risen to 1 in 8. Special challenges in oral care arise for older people and people with dementia. The management requires an interprofessional approach.
Objective:
Interprofessional development of an expert standard for the promotion of oral health by nurses and a focus on older people.
Methods:
The expert standard is based on a systematic literature analysis. Based on this, members of an interprofessional expert working group consisting of nurses, dentists and a representative of those affected formulated recommendations to promote oral health of people in need of care.
Results:
The interprofessional approach defines the selection of the guiding questions for the literature search, the evaluation of the literature and the formulation of the recommendations. Interventions to maintain and promote oral health were identified for the guiding questions of the expert standard, for example, in cases of oral fungal diseases, mucositis, gingivitis or accompanying symptoms, such as dry mouth and pain.
Discussion:
Interventions to promote oral health of people in need of care or with severe disability could be focused more deeply within the nursing profession and formulated by an interprofessional group to guide their actions.
Introduction:
People living in long-term care (LTC) facilities face many oral health challenges, often complicated by their medical conditions, use of medications and limited access to oral health care.
Objective:
To determine Manitoba dentists' perspectives on the oral health of LTC residents and to identify the types of barriers and factors that prevent and enable them to provide care to these residents.
Methods:
Manitoba general dentists were surveyed about their history of providing care and their views on the provision of care to LTC residents. Descriptive statistics, bivariate analysis and logistic regression analysis were carried out.
Results:
Surveys were emailed to 575 dentists, with a response rate of 52.5%. Most respondents were male (62.8%), graduates of the University of Manitoba (85.0%), working in private practice (89.8%) and located in Winnipeg (72.4%). Overall, only 26.2% currently treat LTC residents. A predominant number of respondents identified having a busy private practice (60.0%), lack of an invitation to provide dental care (53.0%) and lack of proper dental equipment (42.6%) as barriers preventing them from seeing LTC residents. Receiving an invitation to provide treatment, professional obligation and past or current family or patients residing in LTC were the most common reasons why dentists began treating LTC residents.
Conclusion:
Most responding dentists believe that daily mouth care for LTC residents is not a priority for staff, and only a minority of dentists currently provide care to this population.
Objectives
Provision of oral health care (OHC), including oral hygiene (OH) or oral/dental treatment, to dependent older people (DOP) is frequently insufficient. We aimed to assess barriers and facilitators perceived by different healthcare professionals towards providing OHC to DOP.
Materials and methods
A systematic review was performed. Studies reporting on knowledge, attitudes, and beliefs acting as barriers and facilitators for provision of OHC were included. One database (PubMed) was searched and data extraction independently performed by two reviewers. Thematic analysis was used and identified themes translated to the domains and constructs of the theoretical domains framework (TDF) and aligned with the domains of the behavior change wheel (BCW). Analyses were stratified for the two target behaviors (providing oral hygiene and providing oral/dental treatment) and according to different stakeholders’ perspective. For quantitative analysis, frequency effect sizes (FES) were calculated.
Results
In total, 1621 articles were identified and 41 (32 quantitative, 7 qualitative, 2 mixed method) studies included. Within these 41 studies, there were 7333 participants (4367 formal caregivers, 67 informal caregivers, 1100 managers of care, 1322 dentists, 340 DOP). Main barriers for providing OH were “lack of knowledge” (FES 65%, COM-B domain: capability, TDF domain: knowledge) and “patients refusing care” (62%, opportunity, environmental context and resources). Main facilitators were “OHC training/education” (41%, capability, skills) and “presence of a dental professional” (21%, opportunity, environmental context and resources). Main barriers for provision of dental treatment were “lack of suitable facilities for treatment/transportation of patients” (76%) and “patients refusing care” (53%) (both: opportunity, environmental context and resources). Main facilitators were “regular visiting dentist” (35%) and “routine assessment/increased awareness by staff” (35%) (both: opportunity, environmental context and resources).
Conclusions
A number of barriers and facilitators for providing different aspects of OHC were identified for different stakeholders.
Clinical relevance
Our findings help provide the evidence to develop implementation strategies for providing high-quality systematic OHC to DOP.
Registration
This review was registered at Prospero (CRD42017056078).
Objectives:
To investigate whether, within a residential care facility, increasing personal care assistants' (PCAs) awareness of their own oral health status and self-care skills would alter existing attitudes and behavioural intentions related to the oral health care of residents.
Methods:
PCAs (n = 15) in the dementia care unit of a residential care facility in Melbourne, Australia, were invited to participate in a small research project that appeared to test the effectiveness of a work-place oral health educational programme in enhancing their own oral health whilst masking the actual outcome of interest, namely its effect on PCAs oral healthcare attitudes and practices towards the residents.
Results:
Post-intervention, the self-reported confidence of the PCAs to identify their personal risk for oral health problems, identifying common oral health conditions and determining the factors contributing to their personal oral health was increased significantly (P < 0.05). Post-intervention, the self-reported confidence of the PCAs to feeling confident to identify factors that could contribute to poor oral health of residents, identify resident's higher risk for poor oral health and feeling confident in identifying common oral health conditions in residents was also increased significantly (P < 0.05).
Conclusion:
The results of this pilot study show that the educational intervention to increase the personal care assistants' (PCAs) awareness of their own oral health status and self-care skills increased the confidence of the carers to identify oral health risks in the residents, as well as increasing their self-reported confidence in providing oral care to residents.
Poor oral health has been associated with systemic diseases, morbidity and mortality. Many patients in hospital environments are physically compromised and rely upon awareness and assistance from health professionals for the maintenance or improvement of their oral health. This study aimed to identify whether common individual and environment factors associated with hospitalisation impacted on oral hygiene.
Data were collected during point prevalence audits of patients in the acute and rehabilitation environments on three separate occasions. Data included demographic information, plaque score, presence of dental hygiene products, independence level and whether nurse assistance was documented in the health record.
Data were collected for 199 patients. A higher plaque score was associated with not having a toothbrush (p = 0.002), being male (p = 0.007), being acutely unwell (p = 0.025) and requiring nursing assistance for oral hygiene (p = 0.002). There was fair agreement between the documentation of requiring assistance for oral care and the patient independently able to perform oral hygiene (ICC = 0.22).
Oral hygiene was impacted by factors arising from hospitalisation, for those without a toothbrush and male patients of acute wards. Establishment of practices that increase awareness and promote good oral health should be prioritised.
© 2015 Nordic College of Caring Science.
INTRODUCTION
Poor oral health has been associated with systemic diseases, morbidity and mortality. Many patients in hospital settings are physically compromised and rely upon awareness and assistance from health professionals for the maintenance or improvement of their oral health.
This study aimed to identify, if common individual and environment factors associated with hospitalisation impacted on oral hygiene.
METHOD:
There were three snapshot audits of all patients in the acute and rehabilitation wards over a six month period. Data included demographic information, plaque score, presence of dental hygiene products, independence level and if nurse assistance was documented in the health record.
RESULTS:
Data was collected for 199 patients. A higher plaque score was associated with not having a toothbrush (p=0.002), being male (p=0.007), being acutely unwell (p=0.25) and requiring nursing assistance for oral hygiene (p=0.002). There was fair agreement between the documentation of requiring assistance for oral care and the patient independently able to perform oral hygiene (ICC=0.22).
CONCLUSION:
Oral hygiene was impacted by factors arising from hospitalisation in this setting, for those without a toothbrush and male patients of acute wards. Establishment of practices that increase awareness and promote good oral health should be prioritised. Interprofessional teams play a role in identifying risk and supporting change to influence the health of patients.
An interprofessional educational approach was used to provide five in-service training sessions for all direct health care providers in a long-term care facility, and one half-day seminar/live webinar for community-licensed health care professionals. Content included presentations by five disciplines: (a) periodontist: oral-systemic relationship, (b) oral pathologist: oral pathology, (c) pharmacist: oral health-pharmacological link, (d) dietitian: oral health-dietary link, and (e) occupational therapist: providing and practicing proper oral hygiene. Significant improvement in posttest scores for the five in-service training sessions and the half-day seminar/live webinar was revealed in t-test results, representing an increase in knowledge gained. Approximately 80% of the 145 participants indicated that they would make a change in patient care. Findings indicate that the in-service training sessions and half-day seminar/live webinar supported development of the geriatric work force by utilizing an interprofessional educational approach which will assist in meeting the oral health care needs of the geriatric population.
Objective The objectives of this study were: to evaluate carers' knowledge of oral health; to provide a high quality, consistent, oral health training programme for carers in residential homes; to evaluate the quality of this programme by examining both carers' changes in knowledge and any changes in carers' behaviour as reported by residents and to assess any changes in the oral health of the elderly residents after one year.Design A cross-sectional, multi-centre study using a carer training programme, evaluated by both a questionnaire conducted with carers and residents and oral examination of residents.Setting In August 1996, 20 (20%) of the residential/nursing homes, in West Hertfordshire were chosen at random and all managers contacted and offered an oral examination for all their residents. Ten (10%) of the homes were also offered an oral health training programme for their carers. Eighteen homes accepted the oral examination for all consenting residents and 7 of the 10 homes offered accepted the carer training.Subjects Thirty-nine carers from 7 of the residential homes attended an oral health training course and 213 elderly residents in the 18 homes were examined both at baseline and after 12 months.Results Carers' baseline knowledge about oral health was poor; the oral health training programme was enjoyed and their knowledge gain after one week was high. However, the elderly residents perceived no change in the oral care given by carers either after one week or after one year and there was no measurable improvement in the oral health of residents after carer training, except for an increase in filled coronal surfaces. Few of the carers originally trained were still working in the same residential homes after one year.Conclusion Although the carer training programme was well received, no changes in oral health practice resulted. Barriers to practice of oral care by carers remained and training, even when including practical skills, evaluation by peers and a high knowledge gain, failed to reduce these barriers.
Objective:
The aim of this study was to compare the knowledge and views of nursing staff on both acute elderly care and rehabilitation wards regarding elderly persons' oral care with that of carers in nursing homes.
Subjects:
One hundred nurses working on acute, sub-acute and rehabilitation wards for elderly people (Group 1) and 75 carers in nursing homes (Group 2) were surveyed.
Design:
A semi-structured questionnaire.
Results:
Similar percentages of each group of nurses were registered with a dentist (86% and 88% respectively), although more hospital-based nurses were anxious about dental treatment compared with the nursing home group (40% and 28% respectively). More carers in nursing homes gave regular advice about oral care than the hospital-based nurses (54% and 43% respectively). Eighteen per cent of each group thought that edentulous individuals did not require regular oral care. Eighty-five per cent of hospital-based nurses and 95% of nursing home carers incorrectly thought that dentures were 'free' on the NHS. Although trends were observed between the two groups, no comparisons were statistically significant (Chi-square; level p < 0.05).
Conclusions:
Deficiencies exist in the knowledge of health care workers both in hospital and in the community setting, although the latter were less knowledgeable but more likely to give advice to older people.
This cluster-randomised controlled trial assessed whether oral health care education (OHCE) for nursing home caregivers would achieve improvements in clients' oral health.
Twenty-two nursing homes were randomly allocated to intervention or control group. Clients were examined at baseline and at follow-up visits 1- and 6-months after caregivers received OHCE. Main outcome measures were denture plaque, denture-induced stomatitis, dental plaque and gingivitis. Differences in group means/medians were compared with adjustment for cluster randomisation.
Clients' baseline oral health was poor. After OHCE, the intervention group's oral health scores improved significantly. Reductions in denture plaque scores (0-4 scale) exceeded those of the control group by 1.15 (95%CI=0.83, 1.47) at 1 month and by 1.47 (95%CI=1.13, 1.80) at 6 months. Denture-induced stomatitis prevalence reduced significantly over 6 months compared to the control group (P<0.0001). Group differences in favour of the intervention group were 0.41 (95%CI=0.18, 0.65) at 1 month and 0.34 (95%CI=0.14, 0.53) at 6 months for dental plaque (0-3 scale), and 0.17 (95%CI= -0.01, 0.35) at 1 month and 0.28 (95%CI 0.15, 0.42) at 6 months for gingivitis (0-2 scale). Key differences remained significant after adjustment for clustering effects. The provider's costs would currently be approximately pounds 6700 per year to deliver the intervention to a Health Authority with 100 homes.
Although final levels of residents' oral health were still short of ideal, this study clearly shows that, for a modest cost, OHCE can improve caregivers' knowledge, attitudes and oral health care performance for elderly, functionally dependent clients.
One of the most immediate and important functional consequences of many oral disorders is a reduction in chewing ability. The ability to chew is not only an important dimension of oral health, but is increasingly recognized as being associated with general health status. Whether perceived chewing ability and oral health-related quality of life (OHRQoL) are correlated to a similar degree in patient populations has been less investigated. The aim of this study was to examine whether perceived chewing ability was related to OHRQoL in partially dentate patients.
Consecutive partially dentate patients (N = 489) without signs or symptoms of acute oral disease at Tokyo Medical and Dental University's Prosthodontic Clinic participated in the study (mean age 63.0 ± 11.5, 71.2% female). A 20-item chewing function questionnaire (score range 0 to 20) was used to assess perceived chewing ability, with higher scores indicating better chewing ability. The 14-item Oral Health Impact Profile-Japanese version (OHIP-J14, score range 0 to 56) was used to measure OHRQoL, with higher scores indicating poorer OHRQoL. A Pearson correlation coefficient was calculated to assess the correlation between the two questionnaire summary scores. A linear regression analysis was used to describe how perceived chewing ability scores were related to OHRQoL scores.
The mean chewing function score was 12.1 ± 4.8 units. The mean OHIP-J14 summary score was 13.0 ± 9.1 units. Perceived chewing ability and OHRQoL were significantly correlated (Pearson correlation coefficient: -0.46, 95% confidence interval [CI]: -0.52 to -0.38), indicating that higher chewing ability was correlated with lower OHIP-J14 summary scores (p < 0.001), which indicate better OHRQoL. A 1.0-unit increase in chewing function scores was related to a decrease of 0.87 OHIP-J14 units (95% CI: -1.0 to -0.72, p < 0.001). The correlation between perceived chewing ability and OHRQoL was not substantially influenced by age and number of teeth, but by gender, years of schooling, treatment demand and denture status.
Patients' perception of their chewing ability was substantially related to their OHRQoL.
The University of British Columbia Geriatric Dentistry Program (GDP) offers dental services and provides a comprehensive in-service education program for nursing and residential care-aide (RCA) staff in the provision of daily mouth care for elders in various long-term care (LTC) facilities in Vancouver. This study examined the general impact of the education initiative at one LTC site. A survey (N=90), semi-structured open-ended interviews (N=26), and product audits were conducted to 1) examine the impact of the GDP education initiative on the level of knowledge, attitudes, and practices of RCAs and nursing staff regarding the provision of daily mouth care; 2) identify the enablers and barriers that influenced the provision of daily mouth care practices, policies, and protocols using the PRECEDE-PROCEED model of health promotion research; and 3) assess the self-perceptions of RCAs and nursing staff members regarding their oral health. A knowledge gap was evident in some key areas pertaining to prevention of dental diseases. Twenty-five percent of residents were missing toothbrushes and toothpaste for daily mouth care. Residents who exhibit resistance to mouth care tended not to receive regular care, while issues such as time, increased workload, limited staff, and the lack of an accountability structure are disenabling factors for provision of daily mouth care. Results suggest that the impact of educational interventions is affected by the quality of in-service education, an absence of identified predisposing, reinforcing, and enabling factors, and a strong commitment among LTC staff to the provision of daily mouth care for frail elders.
To evaluate care home (N) staff knowledge of oral care provision for dependent older people in comparison to guidelines from NHS Quality Improvement Scotland (NHSQIS). This pilot study also aimed to identify barriers to delivering oral care and determine if oral health educator (OHE) training had an effect upon staff knowledge of oral care delivery.
This cross-sectional analytic investigation was undertaken within the Greater Glasgow & Clyde area between 2005 and 2007.
From 33 care homes (N), 28 participated in data gathering through an interview schedule involving 109 staff. A 'knowledge check-list' founded upon daily oral care guidelines from the NHSQIS best practice statement (BPS) served as a template for knowledge assessment. An OHE undertook small group discussions related to the BPS in a sub-group of original participants and a second round of data was collected.
The majority of surveyed staff (n = 86, 79%) agreed that residents required assistance with oral care and placed oral care (n = 85, 78%) in a moderate to high priority. However, only 57% of managers and 49% of nurses had received training in oral care provision. Most staff (79% of managers, 85% of nurses) were unaware of the NHSQIS BPS. Deficiencies in knowledge were identified in several areas of the BPS. In particular, knowledge in the care of the natural dentition was inadequate. Between pre- and post-OHE training, the research suggests the following areas are liable to change: prioritisation given to oral care (p = 0.01), perceived competence (p <0.0001) and confidence in providing oral care advice (p <0.0001). Following OHE intervention, staff knowledge in oral care procedures compliant with best practice guidelines increased by 45%.
Knowledge of oral health provision by those responsible for the care of home residents was deficient. An OHE training programme structured around the NHSQIS BPS demonstrated a measurable increase in levels of staff knowledge of oral care procedures.
This study compares differences in attitude, of oral health care of nursing personnel working with dependent elderly and severely disabled patients. A questionnaire was administered to 398 personnel covering (1) personal oral health care habits, (2) experiences and attitudes in assisting oral care and (3) willingness to assist patients/residents with their daily oral hygiene. Three hundred and sixty-four persons answered the questionnaire, including 70 registered nurses, 148 nursing assistants and 146 home care aides. The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities. Although registered nurses were found to have more positive attitudes toward oral care assistance than the other nursing groups, they were seldom involved in the daily practice of oral hygiene care. The results indicate a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.
The objectives of this study were: to evaluate carers' knowledge of oral health; to provide a high quality, consistent, oral health training programme for carers in residential homes; to evaluate the quality of this programme by examining both carers' changes in knowledge and any changes in carers' behaviour as reported by residents and to assess any changes in the oral health of the elderly residents after one year.
A cross-sectional, multi-centre study using a carer training programme, evaluated by both a questionnaire conducted with carers and residents and oral examination of residents.
In August 1996, 20 (20%) of the residential/nursing homes, in West Hertfordshire were chosen at random and all managers contacted and offered an oral examination for all their residents. Ten (10%) of the homes were also offered an oral health training programme for their carers. Eighteen homes accepted the oral examination for all consenting residents and 7 of the 10 homes offered accepted the carer training.
Thirty-nine carers from 7 of the residential homes attended an oral health training course and 213 elderly residents in the 18 homes were examined both at baseline and after 12 months.
Carers' baseline knowledge about oral health was poor; the oral health training programme was enjoyed and their knowledge gain after one week was high. However, the elderly residents perceived no change in the oral care given by carers either after one week or after one year and there was no measurable improvement in the oral health of residents after carer training, except for an increase in filled coronal surfaces. Few of the carers originally trained were still working in the same residential homes after one year.
Although the carer training programme was well received, no changes in oral health practice resulted. Barriers to practice of oral care by carers remained and training, even when including practical skills, evaluation by peers and a high knowledge gain, failed to reduce these barriers.
Oral diseases and conditions have been identified as a significant problem for elderly residents of long-term care (LTC) hospitals in developed countries, yet little recent information is available for the Canadian population.
To describe the medical, dietary, oral microbial, oral hygiene and dental status of elderly Canadians living in LTC hospitals in Vancouver and surrounding communities.
A sample of 369 elderly dentate hospital residents (mean age 83.9 years, 281 women [76.2%]) were examined, and their medical status and medications, oral status and type of hospital were documented. Oral hygiene practices and diet (specifically intake of refined carbohydrates) were evaluated. Subjects with xerostomia and subjects taking medications with hyposalivary side effects were identified, and salivary Streptococcus mutans and Lactobacillus were cultured.
The mean plaque index was 1.3; men had a higher plaque index than women and residents of extended care hospitals had a higher plaque index than those in intermediate care hospitals. The mean bacterial score per millilitre of saliva was 9.7 105 colony-forming units (CFU) for Streptococcus mutans and 1.6 105 CFU for Lactobacillus. On average, each subject had 6.3 sound teeth, and 9.3 teeth had been restored.
Although almost half of the subjects had visited a dental office in their community within the past 5 years, the elderly hospital residents in this study had few remaining teeth and suffered from poor oral hygiene. Prevention strategies (such as diet, oral hygiene and antimicrobial agents) rather than dental interventions (such as restorations and extractions) alone may be needed to control oral diseases in this susceptible population.
The number of dependent elderly with natural teeth is increasing dramatically. If these elderly persons do not receive proper oral health care, severe oral problems are likely to result. In conjunction with an oral health care education program for the staff of nursing facilities, oral health status was assessed and semi-structured interviews performed with residents and their relatives about oral health care. The assessments were made at baseline and at an 18-month follow-up. The project was conducted as a longitudinal, controlled study with an intervention and a control group. The aim of the study was to evaluate differences between the intervention and control group after oral health care intervention. At follow-up, it was shown that the intervention group had established more dental contacts. However, the results also indicated that the residents were not concerned about their oral health. Nursing staff therefore have to be responsible for oral health care if improved care for residents is to be realized.
To describe the general health, oral health status, and treatment needs of dependent older people living in Christchurch rest homes.
210 Grade 3 residents from seven randomly selected care facilities were examined for: dental/denture status, caries, periodontal disease, and oral cleanliness.
Age ranged from 65 to 103 with an average age of 84.6 years. The female-to-male ratio was 3:1. Thirty-two percent of residents were dentate (average 14 teeth). This figure was up from 16-19% one decade ago (p<0.01; chi-squared test). Sixty-five percent of dentate residents had caries. Each dentate person had an average of 2.38 teeth with carious lesions in the root or crown. 51.5% of residents required restorative treatment and 38.2% required an extraction. Twenty residents had at least one 'carious stump'. Eighty-two percent of residents required scaling of the teeth. Two thirds had no natural teeth, and one third of those with dentures required treatment. Eighty-nine residents (42%) were unable to communicate about past dental behaviours.
These data indicate that (compared to one decade ago) more dependent elderly people are retaining their natural teeth--but they are keeping no more teeth, and the health of the teeth has not improved. Most elderly people do not regularly receive dental assessments or care.
Several epidemiological studies have demonstrated an association between periodontal disease and coronary heart disease (CHD). The association could be a result of confounding by mutual risk factors. The present study was undertaken in a Danish population to reveal the significance of common risk factors.
The investigation was conducted as a case-control study comprising 250 individuals: 110 individuals with verified CHD from a Department of Cardiovascular Medicine and 140 control individuals without CHD from the Copenhagen City Heart Study. Information on diabetic status, smoking habits, alcohol consumption, physical activity, school attendance, household income, body weight and height, triglyceride, and serum cholesterol was obtained. Full-mouth probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), and alveolar bone level (ABL) on radiographs were registered. ABL was stratified into ABL1=ABL<or=2 mm; ABL2=ABL>2 to <or=4 mm; and ABL3=ABL>4 mm. Multiple logistic regression models with stepwise backward elimination were used allowing variables with P<0.15 to enter the multivariate analysis.
The CHD group had a significantly lower outcome with respect to PD, BOP, CAL, and ABL. For participants<60 years old, only risk factors such as smoking and diabetic status entered the multivariate analysis. For the ABL3 group, there was a significant association with CHD for participants<60 years old, the odds ratio being 6.6 (1.69 to 25.6). For participants>or=60 years old, there was no association.
The present study showed a positive association between periodontal disease and CHD in agreement with several other studies. The association was highly age dependent and could only be attributed to diabetes and smoking to some extent.
The aim of this cross-sectional study was to assess the level of oral hygiene in elderly people living in long-term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness.
Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes.
Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score = 3) and the mean denture plaque score was 2.13 (maximum possible score = 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43).
Oral hygiene was poor, both for dentures and remaining teeth in residents in long-term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively.
In an oral health survey, 1375 adults aged 85 and older were examined in North York, Canada. Only 31% of dentate nursing home residents and 47% of dentate independently living subjects had received dental care in the year previous to examination. The overall prevalence of edentulism was 66%, and about 80% of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated decay, and 47% of nursing home residents had untreated root decay. Regarding clinically defined treatment needs, high levels of unmet need were identified in subjects from both types of residences. Among nursing home residents, about 45% of dentate subjects required tooth extraction, and 56% required prosthodontic treatment. Although only 27% of dentate independently living residents required tooth extraction, over 60% needed restorative treatment. Higher prevalence of both untreated decay and unmet treatment needs was associated with lower utilization of dental care for dentate subjects. For edentulous subjects, prosthetic treatment was required by 70% of nursing home residents and by 51% of independently living subjects. These results indicate that, for both nursing home and independently living residents, dental diseases and treatment needs continue throughout the lifespan.
The numbers of dentate elderly are growing rapidly in all industrialized countries, and epidemiological information about their oral health is urgently needed. Our study is part of the population-based Helsinki Ageing Study (HAS), and this paper describes the periodontal health status as well as the need for periodontal treatment among the dentate elderly born in 1904, 1909, and 1914 and living in January, 1989, in Helsinki, Finland (n = 175). The dental examinations were carried out during 1990 and 1991 at the Institute of Dentistry, University of Helsinki, Finland. The subjects' periodontal health was recorded by the CPITN (Community Periodontal Index of Treatment Needs) method. The mean number of remaining teeth was 15.1 among men and 14.0 among women, with the mean number of remaining sextants 3.7 and 3.5, respectively. Healthy periodontal tissues (CPI = 0) were found in 7% of the subjects. Bleeding on probing (CPI = 1) was recorded in 6%, and calculus and/or overhanging margins of restorations (CPI = 2) in 41% of the subjects, as the worst finding. Altogether, 46% of the subjects had deep periodontal pockets, 35% with at least one 4- to 5-mm pocket (CPI = 3), and 11% with at least one ≥ 6-mm pocket (CPI = 4). Overall, 93% of the subjects required oral hygiene instruction, 87% scaling and root planing, and 11% complex periodontal treatment. The periodontal treatment need was significantly higher in men than in women; however, no significant differences were observed among the three age cohorts. The need for complex periodontal treatment was unexpectedly low, probably explained by the fact that there were many missing teeth, especially molars, perhaps lost due to poor periodontal health.
Since 1980, a mobile program has delivered dental care to 14 different long‐term care facilities that care for frail and functionally dependent older persons. These facilities lie within a 60‐mile radius of the University of Iowa College of Dentistry.
This paper reports comparisons between characteristics of users versus nonusers of dental care in the program. Of the 853 residents in the long‐term care facility who were screened, it was determined that 66% would benefit from some type of dental care. When the residents and their families were approached for treatment permission, 48% of those recommended permitted treatment; treatment was completed on 38% of those persons recommended for treatment. No differences were observed in the distribution or diagnoses of major medical problems for the users versus nonusers of care. Recommended treatment was similar for users and nonusers in nursing homes. The majority of non‐users refused treatment because they or their families did not perceive a need for dental care.
In Sweden, efforts are being made to create strategies for evaluating realistic dental treatment needs among the elderly, who are retaining more natural teeth. These strategies focus on the importance of maintaining adequate oral hygiene. Elderly in long-term-care facilities often depend on nursing personnel for carrying out daily oral hygiene procedures. Therefore, the nursing personnel's knowledge about and attitudes toward oral health make oral health education for health care professionals an important concern. The purpose of this study was to evaluate the clinical oral health outcome in residents after their caregivers had undergone a one-session, four-hour oral health education program. The study consisted of an intervention with a pre- and a post-test and was carried out in three municipalities in the southwestern part of Sweden. A newly developed oral health screening protocol was carried out for 170 subjects living in long-term-care facilities both before and 3–4 months after nursing personnel had attended an oral health education program. Following the Intervention, a statistically significant improvement was recorded for changes in oral mucosal color, a modi-fled plaque index which measured oral hygiene status, and a mucosal index which recorded mucosal inflammation. This study indicated that a limited, one-session, four-hour oral health education, offered to caregivers within long-term-care facilities, had a positive impact on the oral health status of residents.
The objective of this study was to determine what impact, if any, oral health was having on the quality of life for selected seniors in Prince Edward Island, Canada. The attitudes of seniors towards oral health and its relationship to quality of life is important to define. This self-reported assessment provides information on this particular relationship. The research design was a random cluster sampling that covered all geographical areas of Prince Edward Island. It represented the cultural diversity within these geographical areas. The survey instrument selected was the Subjective Oral Health Indicators' Status, a validated survey instrument. This particular instrument addressed all the issues raised in the objectives. Data were analysed using Pearson's correlation with age and number of teeth present. The independent t-test was used to identify differences in responses by gender. Results of the survey showed identification of individual indicators that were having an impact on quality of life. Gender differences in responses were identified in four of the eight subject areas. The level of worry/concern was inconclusive because of the high non-response rate to the last question. Non-response rates increased with each topic in the questionnaire. More research is needed to identify clinical needs of seniors on Prince Edward Island. Qualitative study to determine attitudes and beliefs could provide groundwork for future programme design.
To assess attitudes and perceptions towards oral hygiene tasks among geriatric nursing home staff, before and after a dental hygiene education.
A survey questionnaire was distributed to the nursing staff (n = 105), at a geriatric nursing home in Stockholm, Sweden.
The response rate to the questionnaire was 83%. A vast majority (87%) of the nursing staff considered oral hygiene tasks unpleasant. The main reason for considering oral care unpleasant was a perceived unwillingness from the residents. The perceived unwillingness from the residents among the nursing staff was reduced after the dental hygiene education (chi-square test, P = 0.02). A vast majority of the nursing staff experienced, always or sometimes, resistance from the residents towards oral care.
Nursing home staff members consider oral care tasks unpleasant, and frequently experience resistance from the nursing home residents towards oral care. The perceived unwillingness from the residents is reduced after an advanced dental hygiene education. Further studies are needed to evaluate the effects of education on nursing staff's attitudes and perceptions towards oral care tasks, with the overall aim of improving the oral health among older people in hospitals and nursing homes.
The aim of this study was to qualitatively explore caregivers' perceptions of oral health care and factors influencing their work in a public long-term care institution for the elderly in Goiania, Brazil.
Data were collected from a sample of 10 caregivers using personal in-depth interviews and observation.
Caregivers were mainly nurses' aides without training in oral health care. Oral health was associated with access to dental treatment, oral hygiene and use of dentures. Edentulousness, use of inappropriate dentures and appetite loss were perceived as negative images. Procedures used for oral hygiene were toothbrushing, mouth cleaning with a gauze and using a mouthwash. Conflicting priorities in routine care, lack of caregivers' knowledge and the co-operation of the elderly were the main obstacles to satisfactory oral care.
Oral health care of the elderly was perceived as a burden by caregivers, and did not follow a standard protocol. Caregivers' knowledge and perceptions reinforce the need for education and training in oral health issues.
To investigate the oral state in participants cared for in residences for senior citizens in Styria, Austria.
Four hundred and nine participants in Styria from nine homes for senior citizens were examined employing parameters in accordance with those of Folstein's Mini Mental Status (MMS), DMFT, basic periodontal examination, the modified oral hygiene index, pain experienced during the preceding year, the subjective and objective need for treatment, and also requirements involving surgical and prosthetic treatment. Furthermore, the habitual methods of maintaining oral hygiene were examined establishing by whom this was carried out - whether by the patient, the nurse, or by patient and nurse together.
Four hundred and nine participants were examined, 48.3% were found to have retained on average 4.9 of their own teeth while 69% were fitted with dentures; however, 81% of the participants required prosthetic treatment. 28.9% of the participants had experienced acute dental pain during the preceding year and surgical treatment was found to be necessary in 47.7% of those with original teeth. Eighty-four per cent of the participants showed acute inflammation of the periodontium while the state of oral hygiene, measured on a scale of 0-4, reached an average of 2.43. Oral hygiene was carried out by the nurses in only 7.46% of the cases which showed an average MMS measurement of 18.
The results compared with those reported in other recent surveys and our data show an urgent need in Austria to improve the standards in dental care for the hospitalised elderly. Regular dental checks, carried out in the actual home by a dental surgeon should be introduced, whilst the nursing staff should be made fully aware of the problems caused by insufficient oral care and receive regular support from specialised oral hygiene assistants. The results of this survey also suggest that nursing staff should be equipped with simple instruments in order to judge to the extent to which the patient is capable of carrying out oral care independently and then according to the results to supplement this with additional care.
The purpose of this study was to examine the knowledge, beliefs, and practices of nursing assistants (NAs) providing oral hygiene care to frail elders in nursing homes, with the intent of developing an educational program for NAs.
The study occurred in two economically and geographically diverse nursing homes. From a sample size of 202 NAs, 106 returned the 19-item Oral Care Survey.
The NAs reported satisfactory knowledge regarding the tasks associated with providing mouth care. The NAs believed that tooth loss was a natural consequence of aging. They reported that they provided mouth care less frequently than is optimal but cited challenges such as caring for persons exhibiting care-resistive behaviors, fear of causing pain, and lack of supplies.
Nurses are in a powerful position to support NAs in providing mouth care by ensuring that they have adequate supplies and knowledge to respond to resistive behaviors.
A survey of nurses, director-supervisors, and nursing home health aides who provide home care in Iowa showed that many misconceptions exist about what constitutes appropriate oral and dental care practices for the older adult. Despite differences in formal education among these nursing personnel, several misunderstandings about dental problems among older adults were common to all three employment groups. These misconceptions represented a broad range of topics from the characteristics of orai cancer lesions to the appropriate use of denture adhesives; two dealt specifically with the recognition of potential oral cancer lesions. This paper describes attitudes and misinformation held by the respondents, and suggests ways to correct these fallacies through in-service training programs.
As a part of this funded project, a complete package for presenting a 3 1/2 hour continuing education program about oral health in the elderly was produced. This set entitled “Oral Health in the Elderly: A Workshop Curriculum and Teacher's Guide” includes color slides, 2 video tapes, teaching instructions, and a script and is available at cost. Other materials specifically designed for in-service training of nursing home personnel are also available. For more information, please write the senior author.
In an oral health survey, 1375 adults aged 85 and older were examined in North York, Canada. Only 31% of dentate nursing home residents and 47% of dentate independently living subjects had received dental care in the year previous to examination. The overall prevalence of edentulism was 66%, and about 80% of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated decay, and 47% of nursing home residents had untreated root decay. Regarding clinically defined treatment needs, high levels of unmet need were identified in subjects from both types of residences. Among nursing home residents, about 45% of dentate subjects required tooth extraction, and 56% required prosthodontic treatment. Although only 27% of dentate independently living residents required tooth extraction, over 60% needed restorative treatment. Higher prevalence of both untreated decay and unmet treatment needs was associated with lower utilization of dental care for dentate subjects. For edentulous subjects, prosthetic treatment was required by 70% of nursing home residents and by 51% of independently living subjects. These results indicate that, for both nursing home and independently living residents, dental diseases and treatment needs continue through out the lifespan.
The aim of this study was to evaluate the influence of an oral health education program (OHEP) on attitudes among the responsible nursing personnel toward performing oral health procedures for care receivers. A total of 2882 nursing personnel were offered participation in the OHEP, and the effect was evaluated by means of a questionnaire distributed pre-educationally as well as 1-2 months post-educationally. The nursing personnel were allocated, on the basis of nursing education, to either a "high level of health care education" group (HHCE), including registered and enrolled nurses, or a "low level of health care education" group (LHCE), including nursing assistants and home care aides. Statistical analysis was performed by means of descriptive and analytical statistics. After the OHEP, the nursing personnel estimated their ability to perform oral hygiene procedures for care receivers to be significantly increased. Post-educationally, a significant shift in importance was observed from knowledge regarding the diseased oral cavity to knowledge regarding the healthy oral cavity. It was also observed that, in the LHCE group, the OHEP favored practical procedures, while in the HHCE group, theoretical considerations were favored. This indicates that, when oral health education programs are designed, due attention should be paid to the nursing personnel's education level.
In 1993, nursing home care was a $70 billion industry. Since oral diseases are intertwined with declining health, it is important to achieve a better understanding of oral health care in nursing homes. The purpose of this paper is to present basic information regarding the nature of dental care from the 1995 US National Nursing Home Survey. Data include general availability of dental services, a description of types of dentists' and dental hygienists' services, and numbers of full-time equivalent dentists and dental hygienists. SUDAAN software was used to adjust for the complex, multistage sample design. Of the estimated 16,700 nursing homes in the contiguous US in 1995, between 14,000 and 15,000 offered some level of dental services. About 15,600 nursing homes provided assistance for oral hygiene, while some 7720 nursing homes had dental hygienists' services available. Approximately 60% of nursing homes either did not have services of dentists at all, or had them only on call or only off-site. Availability of dental services varied by characteristics of nursing homes. Examination of the nature of dental care raises questions about whether the intent of the Federal standards for dental care in Medicare and Medicaid are really being met. As more elderly remain dentate, and as the oral comorbidities of chronic diseases become more recognized, appropriate oral health services for individuals in long-term care settings likely will increase as public health issues.
Numerous studies have demonstrated that many older adults have problems chewing, pain, difficulties in eating, and problems in social relationships because of oral disorders. However, it is not clear if these functional and psychosocial outcomes affect broader psychological well-being and life satisfaction. Consequently, this paper begins to address the question, 'Does poor oral health compromise the quality of life?'. Initial cross-sectional analyses used data derived from the seven-year follow-up of the Ontario Study of the Oral Health of Older Adults. As at baseline and three-year follow-up, oral health was measured by self-ratings of oral health and five oral health indices. Psychological well-being and life satisfaction were assessed according to the Morale Index, the Perceived Life Stress Questionnaire, The Life Satisfaction Scale, and the General Health Questionnaire. All oral health variables were significantly associated with scores from the first three of these measures in the expected direction. These associations remained after we controlled for other potential influences on the quality of life. In addition, prospective analysis indicated that self-perceived oral health at three years had a significant independent effect on psychological well-being and life satisfaction at seven years. These results suggest that poor self-perceived oral health and relatively poor quality of life co-exist in the same subgroup of older adults.
Understanding the attitudes and perceptions about oral health in nursing assistants (NAs) may facilitate efforts to improve daily oral care in long-term-care settings. By exploring the attitudes of individuals charged with daily oral care, we may gain insight into the level of care provided for the residents. To explore motivation for oral care by NAs, we developed a 28-item survey. The survey included descriptive information and a 20-item Likert-type instrument dealing with oral care for self-care and dependent individuals. Factor analysis was used to test the validity of the constructs intended to be measured by the survey items. The results indicated favorable responses to knowledge items and items related to the importance of oral health in general. However, the responses to questions related to amount of time to perform mouth care, the risk of being bitten by a resident, resident cooperation, and myths about oral health in aging revealed significant variation by NAs descriptive variables. An understanding of the implications of NAs' perceptions, values, and knowledge may provide impetus for new strategies for improving oral health and daily care in long-term-care facilities.
The numbers of dentate elderly are growing rapidly in all industrialized countries, and epidemiological information about their oral health is urgently needed. Our study is part of the population-based Helsinki Ageing Study (HAS), and this paper describes the periodontal health status as well as the need for periodontal treatment among the dentate elderly born in 1904, 1909, and 1914 and living in January, 1989, in Helsinki, Finland (n = 175). The dental examinations were carried out during 1990 and 1991 at the Institute of Dentistry, University of Helsinki, Finland. The subjects' periodontal health was recorded by the CPITN (Community Periodontal Index of Treatment Needs) method. The mean number of remaining teeth was 15.1 among men and 14.0 among women, with the mean number of remaining sextants 3.7 and 3.5, respectively. Healthy periodontal tissues (CPI = 0) were found in 7% of the subjects. Bleeding on probing (CPI = 1) was recorded in 6%, and calculus and/or overhanging margins of restorations (CPI = 2) in 41% of the subjects, as the worst finding. Altogether, 46% of the subjects had deep periodontal pockets, 35% with at least one 4- to 5-mm pocket (CPI = 3), and 11% with at least one > or = 6-mm pocket (CPI = 4). Overall, 93% of the subjects required oral hygiene instruction, 87% scaling and root planing, and 11% complex periodontal treatment. The periodontal treatment need was significantly higher in men than in women; however, no significant differences were observed among the three age cohorts. The need for complex periodontal treatment was unexpectedly low, probably explained by the fact that there were many missing teeth, especially molars, perhaps lost due to poor periodontal health.
To investigate the relationship between the oral hygiene practices of dentate elderly people living in residential homes, their requests for assistance and their oral health status.
164 people (81.2+/-7.4 years) participated in an interview and oral examination, and provided a stimulated saliva sample.
The mean number of coronal decayed surfaces (CDS) was 2.4+/-5.9, stimulated salivary levels (log(10)cfu/ml) of mutans streptococci, lactobacilli and yeasts were 1.6+/-2.1, 3.0+/-2.2, 2.1+/-1.7, respectively, and 53% had root decayed surfaces (RDS). Plaque (PI) and gingival (GI) Indices were 2.3+/-0.7 and 1.6+/-0.4 and denture debris scores (DDS) were high. 31% of the population cleaned their mouths twice daily without requesting help and they had significantly fewer yeasts, RDS, restorations on root surfaces, lower PI, GI (P<0.005) and DDS (P<0.0001) than the 69% who cleaned less often. 50% of those who cleaned less frequently requested assistance with oral hygiene but only 5% said that their carers supported them. Those residents who requested help had significantly higher levels of yeasts, lactobacilli (P<0.001), retained roots, DDS, RDS (P<0.005), PI and GI (P<0.0001).
The elderly residents' perceived need for assistance with oral hygiene was related directly to oral hygiene status and to clinical indicators of mucosal and dental diseases.
The effect of an oral health care education programme (OHCE) upon nursing home caregivers was assessed in a randomised controlled trial.
A self-administered questionnaire assessed oral health care knowledge and attitudes at baseline among 369 caregivers working in 22 nursing homes. Homes were randomly allocated to two groups. The intervention was a workplace OHCE. Caregivers assessed the value of the presentations. Questionnaires were re-administered 1 month (time 2) and 6 months (time 3) after the OHCE was delivered. The knowledge and attitude score means of the groups were compared. Open-ended questions solicited qualitative data.
Questionnaire response rates at the three time points ranged from 76.3% to 85.4%. Two-thirds of caregivers employed at the time of the intervention attended the presentations. The OHCE was favourably assessed in 79% of responses. The intervention group significantly improved their scores over the control group at times 2 and 3 for knowledge (P<0.003) and attitude (P<0.001). Analysed across both arms at baseline, the main predictors for knowledge and attitude scores were age and dental attendance pattern. Qualitative responses showed an acceptance of caregivers' roles in oral health care and criticism of existing provision within homes.
The OHCE was well received and resulted in improved oral health care knowledge and attitudes. When viewed with separately reported trial results of clients' oral health status, knowledge and attitude score improvements coincided with improved delivery of oral health care.
We investigated the association between glycemic control of type 2 diabetes mellitus (type 2 DM) and severe periodontal disease in the US adult population ages 45 years and older.
Data on 4343 persons ages 45-90 years from the National Health and Nutrition Examination Study III were analyzed using weighted multivariable logistic regression. Severe periodontal disease was defined as 2 + sites with 6 + mm loss of attachment and at least one site with probing pocket depth of 5 + mm. Individuals with fasting plasma glucose > 126 mg/dL were classified as having diabetes; those with poorly controlled diabetes (PCDM) had glycosylated hemoglobin > 9% and those with better-controlled diabetes (BCDM) had glycosylated hemoglobin <or= 9%. Additional variables evaluated in multivariable modeling included age, ethnicity, education, gender, smoking status, and other factors derived from the interview, medical and dental examination, and laboratory assays.
Individuals with PCDM had a significantly higher prevalence of severe periodontitis than those without diabetes (odds ratio = 2.90; 95% CI: 1.40, 6.03), after controlling for age, education, smoking status, and calculus. For the BCDM subjects, there was a tendency for a higher prevalence of severe periodontitis (odds ratio = 1.56; 95% CI: 0.90, 2.68).
These results provide population-based evidence to support an association between poorly controlled type 2 diabetes mellitus and severe periodontitis.
The author examined the relative effects of tooth loss and xerostomia on the oral health-related quality of life of an elderly, medically compromised population, living in a long-term care setting. Data were collected from 225 subjects (mean age: 83 years) via a questionnaire and review of dental charts. Oral health-related quality of life was assessed using self-ratings, satisfaction ratings, an index of chewing capacity, the GOHAI, and OHIP-14. Almost all participants had one or more chronic medical conditions and were taking prescribed medications. Two-thirds of the study group was dentulous with a mean number of 16 remaining teeth. One-third of the participants had scores on a xerostomia index indicating marked oral dryness. In bivariate and multivariate analyses, xerostomia index scores were significantly associated with all oral health-related quality of life outcomes. Dental status was associated with chewing capacity only. The results suggest that xerostomia has an important influence on the well-being and quality of life of this population.
The aim of this study was to describe the oral health status of older adults living in northeastern Germany.
Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross-sectional, population-based study. Data on 1446 subjects aged 60-79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss.
The prevalence of edentulousness varied from 16% in the 60-65-year-old group to 30% in the 75-79-year-old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60-65 years) to one in the oldest (75-79 years). Among subjects aged 60-69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70-79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70-79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60-69 years: 85% vs. 71% in 70-79-year-old men; women aged 60-69 years: 71% vs. 62% in 70-79-year-olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern.
It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.
The aim of this study was to increase the versatility and further validate the method reported by Smith et al. (2001) by testing the reliability of plaque measurement against two well-known dental plaque quantification methodologies using image analysis in a clinical trial.
The teeth of 40 subjects were disclosed before digital images of the labial and lingual surfaces of their upper and lower incisors were acquired. The amount of plaque present was quantified using a modification of the method described by Smith et al. (2001). The method was modified for obtaining images of the lingual surfaces by incorporating the use of orthodontic occlusal mirrors and 5-mm pieces of moistened blue articulating paper used to enable calibration. Plaque measurements were made from 320 upper and lower anterior teeth from the 40 subjects by two operators. Fliess' coefficient of reliability was used to assess intra- and inter-operator reliability and the independent sample t test was used to assess statistical significance between test and control groups after checking the data for normality. For validation, measurements were recorded using the Turesky et al. (1970) (modification of the Quigley & Hein (1962) plaque index and the Addy et al. (1983) plaque area index. The results were compared with the image analysis method using Pearson's correlation coefficient.
The results for reliability were within Fliess' range of "excellent" for both intra-operator repeatability and inter-operator reproducibility. Pearson's correlation coefficients showed highly significant values indicating the close similarity between all three methods.
This method for the measurement of dental plaque on lingual surfaces of anterior teeth proved reliable. The combined results from the labial and lingual surfaces of anterior teeth using image analysis produced trial conclusions comparable with the alternate plaque quantification methods used, with less clinician time and further producing a permanent database of images for future use.
Objectives:
This work consists in improving oral hygiene (OH) for elderly dependent people in long-term hospital care, in order to decrease the degree of colonization and the associated risk of developing oral candidiasis. As this population frequently suffers from such colonization and because it is difficult to install and practice OH care, a study protocol was designed at the request of geriatricians. The objective of the present study was to set up a programme of OH, applied by the care staff, and to monitor oral colonization of by Candida spp.
Basic research design:
We compared the levels of hygiene and Candida spp. colonization for a group of 110 long-term patients in geriatric departments at T1, when clinical data were collected and oral mycological samples taken before the OH protocol was applied, and at T2, during the postprotocol phase after 3 months of application, when the clinical data and sample collection were repeated.
Results:
During these 3 months 11 patients died. These patients were excluded from the results, which are presented for matched series of the 99 patients still present at T2. Statistical analysis comparing the clinical and biological parameters at T1 and T2 established that there had been an improvement in OH: the 'adequate' level was reached for 72.4% of patients at T2 compared with 41.8% at T1 (P < 0.001) and the 'very inadequate' level was observed for 9.2% at T2 compared with 27.9% at T1 (P < 0.01). A reduction was observed in the number of patients showing the highest degree of C. albicans and C. glabrata colonization (> 50 colony forming units) from 41.9% at T1 to 24.9% at T2 (P < 0.05) and from 56.4% at T1 to 13.0% at T2 (P < 0.05) respectively. The number of patients with candidiasis fell significantly from 43.2% at T1 to 10.2% at T2.
Conclusions:
The OH protocol led to an overall decrease in Candida spp. colonization, a significant reduction in the number of candidiasis and an improvement in the level of oral and denture hygiene but vigilance is still necessary concerning OH care and the initial training of staff in specific care of the mouth.
General health perceptions, usually measured by means of single-item indicators, are commonly included in health and oral health surveys. The aim of the study reported here was to assess the relationship between self-rated oral health and satisfaction with oral health in two studies of older adult populations.
Participants in Study 1 were aged 50 years and over, the majority of whom had multiple chronic medical conditions and disabilities and lived within a multi-level geriatric care setting. They were recruited when attending a clinic in that setting for their annual dental screening. Participants in Study 2 were somewhat healthier community dwelling individuals, also aged 50 years and older, who took part. They were originally recruited by means of a telephone survey based on random-digit dialing. For Study 1, data were collected by means of personal interviews and a review of dental clinic charts, while for Study 2 personal interviews, clinical examination and self-completed questionnaires were used. Measures included self-rated oral health, satisfaction with oral health, oral health-related quality of life (OHRQoL) and tooth loss.
Data were obtained from 225 persons in Study 1 and 541 in Study 2. In both studies there was a significant association between self-ratings of oral health and satisfaction with oral health. However, also in both studies there was a discrepancy between the measures: approximately 10% of those with favourable oral health ratings were dissatisfied while approximately half of those with unfavourable ratings were satisfied. Those with apparently discordant responses had significantly higher scores on OHRQoL measures such as the GOHAI and the OHIP-14 than those with concordant responses. In Study 2, a similar discrepancy between self-rated general health and satisfaction with general health was also observed.
There is degree of discordance between self-ratings of and satisfaction with both oral and general health status in the older adult populations studied here. This may be because of the expectations concerning health in later life. More needs to be known about the frames of reference people use in constructing their responses to questions designed to assess health perceptions.
The theme of the Elders' Oral Health Summit is older adults' access to dental care and how this situation can be improved for future cohorts. A major question is whether older adults today, as well as baby boomers who will be entering their seventies within the next decade, will demand dental care as part of their overall well-being. The current cohort of elders varies widely in its use of dental services, from regular preventive users to non-users who report that they have not been to a dentist in more than twenty years. In 1999, 53.5 percent of older adults reported that they had visited a dentist, the lowest rate of any age group beyond eighteen. This article examines some determinants of older persons' dental service utilization, both barriers and enablers, as a means of understanding why some people continue seeking preventive dental care throughout their lives while others are lifelong irregular users and still others discontinue regular use after retirement or relocation to a new community or long-term care facility. Based on the epidemiological and psychosocial literature available on this topic, barriers and enablers include cohort and age, race and ethnicity, income and education, availability of dental and medical insurance, urban vs. rural residence, physical access to a dental office, and systemic and functional health. Attitudes toward oral health and dental care and other psychosocial variables may override some of these demographic and structural variables. Research in medical and dental service utilization offers insights into the relative predictive ability of these variables. Dental providers can also be potent enablers or barriers to older adults' access to dental care. Each of these factors plays a role in older adults' use of dental services. Under different situations some serve as both barriers and enablers.
To evaluate the validity and reliability of photographic examinations for developmental defects of enamel (DDE) in maxillary and mandibular incisors and canines using a standardized process.
The anterior teeth of 257 children were examined 'wet', both clinically and photographically for DDE, using the modified Federation Dentaire Internationale (FDI) (DDE) Index. A series of five standardized photographs were taken for each child: a frontal view perpendicular to the four incisors; two lateral views, each showing the lateral incisors and canines on each side of the dental arch; and the superior and inferior views, retaking of the frontal view with the camera held at approximately 30 degrees above and below the horizontal plane. The photographs taken for each child were viewed as three different sets; the 'five-view' (frontal, two lateral views plus superior and inferior views), 'three-view' (frontal and two lateral views), and 'one-view' (frontal view only) slide sets.
Using 'one view' slides, 91.7% of teeth could be examined photographically. Whereas using multiple views 99.9% of teeth could be assessed. At the subject level, agreements between clinical diagnoses (gold standard) and photographic examinations were substantial to almost perfect (k = 0.73-0.86). At the tooth level, agreement was best for incisors (k = 0.71 or higher). The intra-examiner reproducibility was high for the photographic assessments at both subject and tooth levels (k = 0.71-0.95).
Multiple-view photographic slides of 'five-view' and 'three-view' are valid and reliable for assessing DDE on the 12 anterior teeth, while a 'one-view' (frontal) was acceptable to study only the incisors.
The aim of the present study was to evaluate the impact of dry mouth conditions on oral health-related quality of life in frail old people, residents at community care centers. Further, reliability and validity of a visual analogue scale (VAS) for dry mouth symptoms were determined within the study cohort.
In old people functional, social and psychological impacts of oral conditions are associated with an overall sense of well being and general health. Subjective dry mouth and reduced saliva flow are common disorders in old people caused by disease and medication. Thus, dry mouth conditions may be determinants for compromised oral health-related quality of life in old people.
In total, 50 old people living at service homes for the old people were asked to answer questionnaires on subjective dry mouth (VAS) and Oral Health Impact Profile (OHIP14) for oral health-related quality of life. Saliva flow was estimated by absorbing saliva into a pre-weighed cotton roll.
The final study cohort comprised 41 old people (aged 83-91 years). Significant associations were identified between both objective and subjective dry mouth and overall or specific aspects of oral health-related quality of life.
Dry mouth (objective and subjective) is significantly associated with oral health-related quality of life strengthening the value of monitoring dry mouth conditions in the care of frail old people.
The purpose of this study was to describe the actual daily oral care provided by certified nursing assistants (CNAs) for dentate elderly nursing home (NH) residents who required assistance with oral care. The study was conducted in five nonrandomly selected NHs in upstate New York using real-time observations of CNAs providing morning care to residents, retrospective chart review, and CNA screening interviews. Oral care standards developed and validated by a panel of 10 experts (dentists, dental hygienists, registered nurses) to be appropriate for dentate NH residents were used to evaluate the oral care provided by 47 primary dayshift CNAs to a convenience sample of 67 residents. CNAs were blinded to the study's specific focus on oral care. Adherence to individual standards was low, ranging from a high of 16% to a low of 0%. Teeth were brushed and mouths rinsed with water in 16% of resident observations. One resident had her tongue brushed.
Standards never met were brushing teeth at least 2 minutes, flossing, oral assessment, rinsing with mouthwash, and wearing clean gloves during oral care. Most residents (63%) who received oral care assistance were resistive to CNA approaches. For most observations, oral care supplies were not evident. Actual oral care provided to residents contrasts sharply with CNAs' self-reported practices in the literature and suggests that NH residents who need assistance receive inadequate oral health care.
A combination of poor oral hygiene and dry mouth may be hazardous to the oral health status. However, systematic assessments in order to detect oral health problems are seldom performed in the nursing care of the elderly. The aims of this study were to investigate the occurrence of oral health problems measured using the Revised Oral Assessment Guide (ROAG) and to analyse associations between oral health problems and age, gender, living conditions, cohabitation, reason for admission, number of drugs, and functional and nutritional status. One registered nurse performed oral health assessments using ROAG in 161 newly admitted elderly patients in rehabilitation care. Oral health problems were found in 71% of the patients. Thirty per cent of these patients had between four and eight problems. Low saliva flow and problems related to lips were the most frequent oral health problems. Problems in oral health status were significantly associated with presence of respiratory diseases (problems with gums, lips, alterations on the tongue and mucous membranes), living in special accommodation (low saliva flow, problems with teeth/dentures and alterations on the tongue), being undernourished (alterations on the tongue and low saliva flow) and being a woman (low saliva flow). The highest Odds ratio (OR) was found in problems with gums in relation with prevalence of respiratory diseases (OR 8.9; confidence interval (CI) 2.8-27.8; P < 0.0005). This study indicates the importance of standardised oral health assessments in order to detect oral health problems which can otherwise be hidden when the patients are admitted to the hospital ward.
The aim of this review was to retrieve data describing the oral health status of individuals with dementia living in special facilities.
A literature search on the MEDLINE database (Entrez PubMed) was performed. The literature search yielded 208 papers, of which seven publications were selected for evaluation. Results: From the available studies poorer oral hygiene, decreased saliva flow rates and a higher caries incidence were reported in individuals with dementia living in special facilities when compared with healthy individuals. Oral health problems were more pronounced in the severe stage of the disease.
There is limited scientific data describing the oral health status of individuals with dementia living in special facilities. However, available data indicate that individuals with dementia living in special facilities have more oral health problems than individuals without dementia.
To assess oral health status and oral health-related quality of life (OHRQoL) of residents in an extended care facility and to assess the care providers' oral health attitudes and knowledge.
Participants included 137 residents (58.1% female, age range 32-94 years, 91% African-American) and 22 care providers. Residents received an oral examination and completed the Oral Health Impact Profile (OHIP-14), an OHRQoL questionnaire. Care providers completed an oral health knowledge (OHK) questionnaire before and after the on-site geriatric oral health education and training programme.
Oral examinations showed that 58% of the residents had extensive oral health needs. On the OHIP-14, the mean severity was 9.2 (SD=12.0), extent (number of items rated as 'fairly often' or 'often') was 1.2 (SD=2.6) and prevalence (participants rating at least one item at least 'fairly often') was 37.8%. Most prevalent negative impact items were about 'oral pain', 'appearance' and 'self-consciousness'. Regarding OHK, caregivers' knowledge improved following instruction from 65% correct on the pre-test to 90% correct on the post-test (p<0.05). Subsequent to the eight in-service workshops, providers reported that physical limitations, fear of getting bitten and time constraints were barriers to providing oral hygiene to their residents.
Examination data showed a high level of dental needs among the majority of residents, accompanied by significantly reduced OHRQoL. Although care providers' OHK improved following the geriatric service programme, they reported specific barriers regarding their provision of oral hygiene care to the residents.
To assessing the oral hygiene and treatment needs of a geriatric institution in southern France.
For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments.
From 2003 to 2004, a cross-sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated.
The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment.
The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly.
A POWERPOINT presentation entitled ‘ELDERS-Oral Health Care for Persons in Residential Care’ Canadian Intellectual Property Office Copywrite
- Wyattccl Macenteemi
Interdental brush in Type I embrasures: examiner blinded randomized clinical trial of bleeding and plaque efficacy
- Imai PH