Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland

doi: 10.1111/j.1741‐2358.2011.00529.x Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland Introduction: This audit reports on the oral and general health of patients who were treated in a dental consultation clinic of a geriatric hospital. Material and Methods: Dental and medical records were obtained from 112 female and 80 male patients (mean age, 83.7 ± 8.2 years) who attended a dental consultation. Data analysis included the general health [American Society of Anesthesiologists (ASA) classification, number of diagnoses, cognitive function] and dental state in the age strata 60–69, 70–79, 80–89 and 90–99 years. Results: Seventy‐four per cent of patients were aged over 80 years. The prevalence of ASA‐P4 and P3 varied between age groups. Most patients (>86%) had more than three chronic diseases. Cognitive impairment was present in almost half of both older age cohorts (43 and 50%). Half of the patients (52%) were edentulous. In dentate patients, the average number of teeth was 12 ± 6 and differed in the maxilla significantly between age groups (p = 0.005). There was no significant association between dental state, ASA classification and systemic conditions. Conclusions: The profile of this cohort reflects a poor oral and general health status. The results underline the importance of an interdisciplinary consultation in a geriatric ward where oral health care is an integral part.     

The mental health clinic: a new model

The role of psychiatrists into public mental health clinics has been hampered by a perceived restriction of the psychiatrist''s role to prescribing and sign-ing forms, limiting opportunities to engage in the kind of integrated care that attracted many physicians to this specialty. We propose a revision of the current model in a direction that maximizes the expertise of this specialist as well as other clinicians in the health care team. The basic unit would consist of a psychiatrist (with adequate background both in psychopharmacology and psychotherapy), an internist and four clinical psychotherapists, who may provide evidence-based treatment after the initial evaluation of the psychiatrist. Its functioning would emphasize repeated assessments, sequential combi-nation of treatments, and close coordination of team members. Re-invigorating the role of the psychiatrist in the context of a team in which role assign-ments are clear could result in better outcomes and enhanced recruitment of psychiatrists into the public sector.     

The uptake of dental services by elderly Germans

Objective: The aim of the study was to assess the uptake of dental services by the old and very old population within the scope of the Berlin Aging Study (Berliner Altersstudie BASE ). Design: A multi‐disciplinary structured interview was performed on 928 subjects, aged from 70 to 103 years of whom 516 persons volunteered to take part in a 14‐session intensive protocol. Six representative study groups were matched for age and gender. Subjects were asked to recall the timing of their most recent dental visit. Data were validated by sending for dental records and compared with all study participants from the multi‐disciplinary intake assessment. Data were related to age group, dental state, dementia and education. Results: Reported last contact with dental services ranged from 2 weeks to 52 years (median 18 months) with a higher time lapse in the study groups aged 85 and older. Dentate subjects had seen their dentist more recently than edentate subjects. Higher education correlated with an increased dental utilisation. Subjective memory on the time lapse since the last dental appointment coincided in 13% of the subjects with available dental records (n=84), was misjudged between one and six months in 55%, and by more than six months in the remainder. Moderately or severely demented subjects who remembered their last dental appointment (n=48 of 70) showed no consistently different utilisation to healthy or mildly demented studs participants. Conclusion: Edentate old and very old subjects show the least frequent utilisation of dental services. Data on motivation and barriers to care are needed to develop strategies to improve the use of dental services and thus promote oral health in late life.     

Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders

doi: 10.1111/j.1741‐2358.2010.00402.x Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders Background: Most research on older people’s oral health has been quantitative. A need for more in‐depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. Objective: To explore experiences and perceptions of oral health and oral health care among an ethnically‐mixed sample of older New Zealanders. Methods: In‐depth interviews were conducted with 24 older people in two communities in New Zealand’s South Island. Thematic analysis of transcribed data was undertaken. Results: Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. Conclusions: We identified a number of shared experiences which affect older people’s ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received.     

Culture,dental professionals and oral health values in multicultural societies: measuring cultural factors in geriatric oral health research and education

Culture has significant impacts upon professional practice and patient health behaviours, especially in multicultural societies. This paper introduces the concept of culture and examines how it may be of importance to dental health professionals. Using the Dental Impact Profile and other dental social science measures, dental researchers and students can be engaged in studying cultural values and characteristics as a way of dealing with cultural differences.     

Denture loss: an 8-month study in a community dental setting

Objective: Lost dentures can be a frustrating scenario for both patients and clinicians. This study aimed to find out where dentures were being lost and the level of assistance patients received with denture care. Results: The results showed most dentures were lost in the hospital environment, and in many cases patients were not provided with pots in which to store their dentures or offered help or advice on denture care. The provision of new dentures to this patient group is complicated by the fact that in many cases the dentures were over ten years old and many of the patients were over eighty five years old. This makes adaptation to new dentures difficult. Conclusions: It is imperative that protocols are developed and staff trained to minimise the risk of lost dentures and improve the standard of denture care.     

The dental awareness of nursing home staff in Singapore - a pilot study

Objective: The aim of this pilot study was to assess the oral health knowledge among staff working in a local nursing home managed by a voluntary welfare organisation. Method: A self‐administered questionnaire was completed by 53 nursing staff working in a home with 270 residents. The questionnaire was structured to assess the staff's knowledge of dental caries, periodontal disease and the care and use of dentures. Results: 99.6% of the respondents felt that oral health care of the elderly was very important. However, only 45.3% of them attributed the cause of dental caries to the frequent intake of sugar. Bacteria in dental plaque was identified by 88.7% of them as the main cause of periodontal disease while 96.2% of them indicated that dentures should be cleaned at least once a day and rinsed after every meal. Conclusion: The staff of this nursing home demonstrated positive knowledge of periodontal disease and denture care. However, their knowledge of dental caries revealed substantial room for improvement. This could signal an area for future staff training and development. Such efforts would help establish a team of caregivers who can improve the oral health and quality of life for residents in the nursing home.     

Dental utilisation for older Americans aged 55–75

Objectives: The purpose of this study was to analyze a comprehensive nationally representative data set to determine the effect of economic and non economic determinants on the decision to seek care and the decision to select a specific number of dental visits. Design: The conduct of this study involved the examination and analyses of secondary data available from the National Health Interview Survey. A two-pan choice logistic regression model was utilized to first describe the decision to seek care and second to describe factors associated with the decision to select a specific number of dental visits as a function of income, education, family size, age, marital status, presence of teeth, employment status, health status, gender, race, insurance status, and reason for dental visit. Subjects: Data analysis focused on 5.327 non-institutional older adults between the ages of 55 and 75 who were not eligible for Medicaid. Results: Results provide supporting evidence that income, presence of dental insurance, presence of teeth, gender, family size, education race and age are associated with the decision to seek dental care and that income, presence of dental insurance, gender, family size, education, and race are associated with the number of dental visits among users even when the effects of other variables are controlled for. Discussion : Analyses suggest that employment may have a surprisingly limited effect on dental utilisation and that among explanatory variables there are differences in significance and magnitude between the decision to seek care and the decision to select a specific number of dental visits. In addition, in contrast with some prior studies, health status does not appear to be associated with the decision to seek care or associated with the number of dental visits among respondents.     

Methicillin-resistant Staphylococcus aureus (MRSA) screening of hospital dental clinic surfaces

We assessed the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains on surfaces of hospital dental clinics. Specimens were obtained from 5 clinically symptoms-free patients of five different specialties clinics (Implantology, Pediatric Dentistry, Prosthetics, Restorative Dentistry, and Oral Medicine) of the Dental Clinic Hospital of King Saud University before and after each patient. A Q-tip swabs were used from 10 surfaces in each clinic (Arm rest of dental chair, floor beneath dental chair, sink/faucet, towel dispenser, instrument table handle, light handle, X-ray viewer, paper dental records, head rest, and bench). Specimens were cultured in CHROMagar MRSA medium. Prevalence of MRSA colonization was compared between periods before and after patients visited each clinic for treatment. The results showed that the prevalence of MRSA was remarkably increased after patients visited the area. The results indicate that dental clinics should be considered as possible reservoirs of MRSA in the hospital setting.