Gap in Dental Care Can Lead to Diabetes, Other Disease Conditions

Oral health of people with dementia

Case Study: Asphyxia Caused by Inspissated Oral and Nasopharyngeal Secretions

REVIEW QUESTION/OBJECTIVE The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia. More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth. INCLUSION CRITERIA Types of participants This review will consider studies that include residents with a formal diagnosis of dementia currently residing in permanent care in Residential Aged Care Facilities. This review will exclude participants that have not received a formal diagnosis of dementia as well as those who are not living as a permanent admission in Residential Aged Care Facilities. Studies conducted on community dwelling individuals with a formal diagnosis of dementia will be excluded. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the efficacy of professional oral health care performed by a dental hygienist. These studies involve professional oral health care performed by a dental hygienist using a toothbrush, interdental brushes, floss and hand scalers if necessary to remove plaque and food debris and in some instances hardened calculus or tartar. If there are studies involving the professional oral health care being performed by dentists or a combination of dentists and dental hygienists they will be included in the analysis. This review will exclude interventions involving staff training interventions and interventions performed by nurses/assistant nurses. TRUNCATED AT 250 WORDS

The Power of a Toothbrush

Generalized periodontitis is the most common form of periodontal pathology, especially in the second half of life. Nowadays, the problem of periodontal disease is relevant due to its high prevalence, tendency to progression, multifaceted influence on the dentoalveolar system and the whole organism as well as uncertain treatment. Therefore, there is a need to find optimal ways of prevention and treatment of this disease. Close relationships between periodontal pathology and systemic diseases, such as hypertension, which affects every 2nd-3rd adult were determined.The objective of the research was to determine the status of oral cavity hygiene in patients with generalized periodontitis of II degree and stage II hypertension.Materials and methods. The study included 30 patients with generalized periodontitis of II degree and stage II hypertension being treated in the Ivano-Frankivsk Regional Clinical Cardiology Dispensary; the average age ranged from 35 to 54 years (the main group). The control group included 10 patients of the same age without generalized periodontitis and somatic pathology .The status of oral cavity hygiene was determined using the Green Vermillion index. The diagnosis of periodontal disease was made on the basis of the classification proposed by M.F. Danilevskyi. The obtained results were subjected to variation-statistical analysis using statistical package “Stat Soft 6.0”; classical methods of variational statistics were applied; mean values and their reliability were evaluated.Results. The results of examination showed poor oral hygiene in almost all patients. The analysis of hygienic indices showed the following results: in patients of the main group, the Green Vermillion index was 1.99 ± 0.13 points (p<0.001) which corresponds to unsatisfactory level of oral hygiene. In patients of the control group, this index was 1.10 ± 0.17 points which corresponds to satisfactory level of oral hygiene. According to the index, 9 (30.0%) patients of the main group had satisfactory oral hygiene, 12 (40.0%) patients had poor oral hygiene, and in 9 (30.0%) patients, poor oral hygiene was observed.In the control group, 2 (20.0%) patients had good oral hygiene, 6 (60.0%) patients had satisfactory oral hygiene and in 2 (20.0%) patients, unsatisfactory oral hygiene was observed. There were no patients with poor oral hygiene. The analysis of the indicators of the Green Vermillion index showed that in case of the pathological process exacerbation the oral hygiene status in patients deteriorated.Conclusions. The level of oral hygiene in patients of both groups was low due to incorrect selection of personal hygiene products or their untimely replacement. In patients with generalized periodontitis of II degree and stage II hypertension, the level of oral hygiene was lower than in somatically healthy persons: the worse status of oral cavity hygiene – the more pronounced changes in the periodontal tissues. We can suppose that high blood pressure affects the status of the oral cavity, creates a higher risk and exacerbates the periodontal diseases.

Nursing home residents’ perspectives on oral health: An in-depth interview study

Overcoming Oral Hygiene Challenges in the Nursing Home

Do COVID-19 Control Guidelines for Long-Term Care Facilities Include Oral Healthcare Orientations?

Key summary pointsAimWe evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities.FindingsOnly one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL.MessageOral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities.

Older adults with serious illness are particularly vulnerable to oral disease due to worsened overall health, progressive functional loss and polypharmacy. Meanwhile, inability to communicate oral health needs, increased functional disability and psychological distress also hamper timely oral health care and lead to prolonged suffering and compromised quality of life. While many seriously-ill older adults with poor oral health receive no oral health care prior to death, unnecessary treatment is also common. In response to these issues, a new oral health care model is proposed to better address the oral health needs of older adults with serious illness. This model aims to promote comfort, maintain oral function and improve quality of life. End-of-life oral health trajectories and stage-appropriate oral health care strategies are also introduced to guide the care of these vulnerable individuals.

Oral and dental health in patients with diabetes mellitus (DM) requires special attention due to the bidirectional relationship between diabetes and oral health. Individuals with diabetes are more susceptible to oral health problems such as periodontal (gum) disease, dental caries (cavities), fungal infections like oral thrush, and delayed wound healing. These conditions can be exacerbated by poorly controlled blood glucose levels, which compromise the body’s ability to fight infections and heal tissues. Periodontal disease, in particular, is prevalent among diabetics and can worsen glycemic control, creating a vicious cycle that impacts overall health. Conversely, oral infections and inflammation from poor oral hygiene can contribute to insulin resistance, potentially aggravating diabetes management. Effective management of oral health in diabetes includes regular dental check-ups, meticulous oral hygiene practices (brushing, flossing, and using mouthwash), and timely treatment of dental issues. Dentists play a critical role in educating patients about the importance of oral hygiene and monitoring for early signs of oral complications. Collaborative care between dental and medical professionals is essential to ensure comprehensive management of both diabetes and oral health, thereby improving overall quality of life and reducing the risk of systemic complications.

ObjectiveThe primary objective of this research was to use qualitative methods to assess the knowledge, attitudes, and confidence of caregivers in their ability to provide oral hygiene assistance to residents. The secondary objective was to assess the knowledge and attitude of administrators on the provision of oral hygiene assistance for residents, and their confidence in caregivers’ ability to provide oral hygiene assistance to nursing home residents in San Antonio, Texas.MethodsA semi-structured interview guide was used to conduct face-to-face interviews with seven caregivers and twelve administrative staff from ten nursing homes in San Antonio, Texas. Employees in nursing homes who are caring for residents are referred to as caregivers and those whom they care for are referred to as nursing home residents. One survey instrument was developed for the caregiver’s knowledge, attitude, and confidence toward providing oral health care, and another to assess the administrator’s knowledge, attitude, and confidence in caregivers providing oral care for nursing home residents. The interviews were recorded, transcribed, and coded for thematic content.ResultsThe findings revealed that caregivers and administrators had adequate knowledge of the connection between oral and systemic health. The administrators were confident that caregivers were adequately trained to provide oral hygiene care for residents. Caregivers had a positive attitude toward the importance of good oral health. They regularly assessed the residents’ oral health, but due to time constraints, staffing shortages, and other competing tasks providing oral health care to the residents was challenging. Most caregivers were confident in their skills in providing oral care for the residents since 85.6% agreed. On the contrary, almost half of the administrators were confident that caregivers have the necessary skills to provide oral care for residents, while 41.7% were unsure.ConclusionsThe study gave a broader insight into the provision of oral care in nursing home residents from the perspectives of caregivers and administrative staff. Administrators must provide caregivers with adequate training and time so they can provide adequate oral health care for the residents.

Background and ObjectivesOral health of older adults in nursing homes is poor, which can negatively affect general health and well-being. Most oral health problems are preventable with good oral hygiene and regular dental check-ups. Caregivers can help improve residents’ oral health through regular oral health assessments. The interRAI instrument used in Long-Term Care Facilities to evaluate older adults’ health and well-being, has the potential to integrate oral care into general care planning. The recently optimized Oral Health Section for inclusion in the interRAI instruments (OHS-interRAI) enables nondental caregivers to identify residents requiring help with oral hygiene and/or a dental referral. This study reports the first data obtained using the OHS-interRAI, describing the oral health situation of older adults in Flemish and Dutch nursing homes.Research Design and MethodsIn this cross-sectional study, interRAI Long-Term Care Facilities data, including OHS-interRAI data, were collected from October 2020 to January 2023 and analyzed from 417 and 795 persons aged 65 years or older in Flemish and Dutch nursing homes, respectively.ResultsMost common oral health problems were poor oral hygiene and compromised teeth. Differences in oral health were found between Flemish and Dutch residents. Flemish residents had significantly more problems with chewing, dry mouth, oral and denture hygiene, and tongue condition than their Dutch counterparts. They also had a higher need for help with oral hygiene (19.4% vs 14.0%), and a dental referral (36.8% vs 20.9%). Older adults in Flemish nursing homes (20.3%) had significantly fewer dental check-ups than those in Dutch nursing homes (73.5%).Discussion and ImplicationsThe use of the OHS-interRAI by nondental caregivers identified at least one-third of the residents requiring help with oral hygiene and/or a dental referral. By means of trigger algorithms (Collaborative Action Points), the OHS-interRAI enables the integration of oral care into general care planning.

The data of numerous studies show that there is a direct correla-tion between malocclusions and dental caries, periodontal dis-eases, poor oral hygiene, which is manifested by symptoms of mutual complication. The presence of orthodontic pathology (crowding of teeth, anomalies of the position of individual teeth, distal and deep bite) causes accumulation of dental plaque. Spe-cial attention in this aspect deserve children with malocclusions from boarding schools, as many of them are deprived of paren-tal attention, the opportunity to be “grafted” family culture atti-tude to their own health through hygienic oral care.The aim of our study is to detect the level of hygienic state of the oral cavity in children from boarding schools.Material and methods. Evaluation of the hygienic state of the oral cavity was carried out in 444 children of boarding schools with malocclusions using the Green – Vermillion hygienic index.The results of the study. Analysis of the obtained data showed that the average value of the Green-Vermilion index in the ex-amined children is 1.93±0.06 points, which corresponds to a poor level of hygiene. There were established some differences in the value of the index depending on the age of children. Thus, of 7 year-old children, its value was 1.99±0.07 points and up to 9 years of age it increases to 2.09±0.06 points, which indicates deterioration in the oral hygiene. In children of 12 years, the average value of this index is 1.91±0.08 points. It should be not-ed that the lowest index value was recorded in the group of 15-year-old children – 1.72±0.06 points.We decided to find out how the level of oral hygiene differs in the children of boarding schools with malocclusions depending on their residence. It was established that the worst oral hygiene was found in children of the boarding school of Sambir (premountain area). Thus, a poor level of hygiene was found in children 7 years old (2.44±0.06 points) and 15 years old (2.41±0.08 points). The rest children had a very bad level of hy-giene: 9-year-old and 12-year-old children - 2.71±0.03 points and 2.54±0.07 points, respectively. The children of boarding schools in Lviv and in Zhovtantsy (flat region) of all age groups had poorly care for the oral cavity. At the same time, it was found that the highest level of oral hygiene was in children of Strilki (mountainous region) (1.34±0.08 points) in comparison with other localities, which is explained by the quality educa-tional work of the children's dentist working in this educational institution. We also analyzed the effect of the presence of maloc-clusions on the state of oral hygiene in the examined children. It has been established that in all age groups the presence of or-thodontic pathology significantly affects the state of oral hy-giene. A detailed analysis showed that in 7-year-old children with malocclusions oral hygiene was poor (2.22±0.06 points), and in children without malocclusions - satisfactory (1.69±0.07 points). We also analyzed the indicators of the Green-Vermilion index in children with different types of malocclusions. The highest index values were found in children with anomalies of occlusion – 2.59±0.01 points. The average indexes in children with anomalies of dental arches were significantly lower: 2.38±0.03 points, which also correspond to poor oral hygiene. At the border of satisfactory and poor hygiene, the average val-ues of the index in children with anomalies of individual teeth were 1.89±0.01 points. Thus, the effect of the presence of malocclusions on the level of oral hygiene has been statistically confirmed. A difference was also found in the indicators of oral hygiene in children, depend-ing on the region of examination. With age, the motivation for caring for the oral cavity improves, which is manifested in im-proved hygiene. Also found a relationship between the presence of a dentist in boarding schools and compliance with the rules of oral hygiene, which indicates the role of the dentist in educating children in schools, especially boarding schools.

To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance worn for a minimum of 4.5 years. This retrospective study conducted in patients with healthy baseline periodontium recruited participants among consecutive sleep apnea patients treated with an oral appliance between 2004 to 2014. Eligible participants were recalled for a follow-up visit at which a periodontal examination was performed and a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit. Twenty-one patients enrolled with a mean treatment length of 7.9 ± 3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4 ± 0.5 mm, recession 0.6 ± 1.1 mm, and clinical attachment loss 0.8 ± 1.0 mm. Compared with baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1 degrees) with the continued use of an oral appliance. Gingival levels were maintained with clinically insignificant changes during the observation period. Inclination of the mandibular incisors increases significantly with the use of an oral appliance in patients with obstructive sleep apnea. Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession. Heda P, Alalola B, Almeida FR, Kim H, Peres BU, Pliska BT. Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2067-2074.