Knowledge, attitudes, and practices of dentists toward geriatric health and nutrition: A pan-India cross-sectional questionnaire-based study☆

This review explores the economic and behavioral dimensions of oral health in India, emphasizing the economic burden, treatment-seeking behaviors, and policy-level interventions needed to improve oral health outcomes. A mixed-method approach was employed, integrating primary data from the Oral Health Observatory (OHO) project (2016-2020) and a systematic review of secondary literature. The OHO project surveyed dental clinic patients using mobile app questionnaires, focusing on oral health behaviors, barriers, and outcomes. Secondary data were analyzed from PubMed, MEDLINE, and Embase databases to assess the economic implications of oral health care in India. The OHO data revealed a steady decline in routine dental visits after the age of 35-44 years, while emergency visits persisted across age groups. Gender disparities were observed, with men reporting higher dissatisfaction, greater oral pain, and work disruptions compared to women. Only 44.7% of participants brushed twice daily, and 36.7% brushed before bed. Secondary findings reveal that untreated oral diseases have a higher economic impact than preventive measures. This highlights the need for consumer awareness, strategic policies, and sustainable healthcare frameworks. India faces significant challenges in oral health due to low awareness, insufficient infrastructure, and economic barriers. Strengthening preventive strategies, increasing public-private partnerships, and integrating oral health education into primary care can dramatically reduce costs and improve population outcomes. A shift from reactive to preventive care is essential for ensuring equitable and sustainable oral health solutions.

S3: Geriatric mental health care and training in India – A critical review of progress and future directions

Nutrition plays a key role in oral and dental health. Similarly, oral health affects nutrition status and diet intake. Consumption of much cariogenic nutrients such as sugar affects dental and gum health. The awareness of dietary practices that affect the oral health is an essential component in the dental care system. The knowledge of the dietary factors that affect the oral health is a major component in the treatment plan. In this vein, this study was conducted to determine the level of awareness of nutrition information affecting oral health among dental patients who visit the private and university dental clinics in West Bank, Palestine. A total of 169 patients were invited to join the study and signed the consent form. A pretested questionnaire was used to collect the required data which included patients' sociodemographics, medical history, oral care practices, dietary practices, and oral health-related nutritional awareness. Face and content validity were verified, followed by a pilot study to determine the questionnaire reliability alpha, and the data were collected from October to November 2018. The Construct Validation was done using the Rasch measurement model, and the descriptive statistical analysis was done to determine the level of awareness and the difference among the groups using SPSS version 21. The total mean score of the nutrition awareness was (9.3 ± 2.8), with higher level of nutrition awareness among females, and the highest score was 16 out of 17. The good oral health condition was reported among 44%, fair 32%, poor 16%, and bad 10% while excellent oral health was reported among only 5% of the participants. There was no significant relationship between level of nutritional awareness with economic status, level of education, or area of living. For oral health, females showed significantly better oral and gum health levels (p < 0.05). The overall level of nutrition knowledge among the participants is insufficient. These results point to the need for oral health and nutrition educational courses and programs to improve oral and nutritional awareness and knowledge among Palestinian people and dental patients in particular. Improving the dietary habits and oral practices with lifestyle changes should also be encouraged.

Valuing oral health: Accomplishments and challenges

Dental Surgeons working in public sector have an important role to play in school dental health pro-gram to reinstitute the oral and dental health of growing population of India. Even though the oral health policy was drafted in India in 1995, it was not implemented till this date (1). It is im-portant to enhance the knowledge about good oral health in teachers and parents by caring out workshops and seminars on oral and dental health by dental Surgeons working in public health sector. Dental surgeons working in public health sector should carry out oral screening to improve the future of oral health care in India (2). Mobile den-tal unit is an effective method to render oral and dental health-care in the public sector and it should be implemented in school set up in multi-ple situations such as educating school children regarding oral and dental health, screening of school children for various oral diseases, school and community dental health program(3).In an interventional study conducted among rural school children in Nalgonda district to assess the oral health promotion, it was interfered that the School teachers may be utilized as good medium for oral health promotion among school children in India and other developing countries(4). The following recommendations should be incor-porated in school health program in India. The government should incorporate dental surgeons in school health programs to give lecture on oral health, oral hygiene, plaque control, oral and den-tal diseases, oral cancer or smokeless tobacco use and hazards counseling and topical fluoride appli-cation. The government should incorporate oral and dental health related topic in School curric-ulum. Compulsory fitness regarding oral and den-tal health should be made mandatory for class promotion. Dental Surgeons play an important role in recognizing child abuse in school set up (5). Dentists should evaluate child abuse cases and child abuse cases will present clinically as physical abuse, neglect, sexual abuse and emotional abuse (6). The straight path to accomplish the above goals is achieved through strong support from policy makers and professional support from den-tal surgeons working in public and private sector in India.

Geriatric oral health issues in the United Kingdom

Malnutrition could profoundly affect older adults' oral health and quality of life, whereas oral health might, in turn, impact dietary intake and nutritional status. The present study aimed to investigate the association between general and oral health and nutritional status among older adults attending nutrition clinics at two main medical centers in Riyadh, Saudi Arabia. A cross-section study was carried out among adult patients (≥60 years) who attended a geriatric clinic or nutrition clinic at King Khalid University Hospital or King Abdulaziz Medical City, Riyadh. A validated clinician's Mini Nutritional Assessment Short-Form (MNA-SF), Oral Health Impact Profile-5 (OHIP-5), and 36-Item Short Form Survey (SF-36) were collected from each participant. A total of 261 participants with a mean age of 72.14 (±8.97) years were recruited. Diabetes (71%) and hypertension (80%) were present in the majority of patients. The overall MNA-SF score was (10 ± 3). Based on the categorization of the MNA-SF score, 65.9% were classified as malnourished or at risk of malnutrition. Participants with OHIP-5 scores higher than the median (>5) were more likely to be malnourished than those with scores at or lower than 5 (p < 0). The adjusted odd ratio for the MNA-SF score categories indicated that for a one-unit increase in the total SF-36 score, the odds of the malnourished category are 0.94 times less than the risk of malnutrition and normal nutritional status, with OR 0.97 (95% CI 0.94-0.95). Malnutrition or being at risk of malnutrition is likely associated with poor general and oral health. Healthcare providers need to incorporate dietitians into care plans to promote the nutritional health of older adults.

ABSTRACTIntroduction:Oral health is a critical concern for elderly patients, especially those with cognitive impairment residing in long-term care facilities. Cognitive decline often leads to difficulties in maintaining oral hygiene, resulting in poor oral health outcomes. This study aims to evaluate the oral health challenges faced by these individuals and propose management strategies to address these issues.Methods:The study employed a systematic literature review method, focusing on articles from PubMed and related databases. Three key parameters were assessed: (1) oral health status of elderly patients with cognitive impairment, (2) the role of caregivers in oral hygiene maintenance, and (3) strategies for improving oral health outcomes.Results:The findings revealed a significant correlation between cognitive impairment and deteriorating oral health. The use of caregiver-assisted interventions and regular dental check-ups improved oral health outcomes. Two statistical tables are included to highlight the impact of interventions.Conclusion:Effective management of oral health in cognitively impaired elderly patients requires collaborative efforts between healthcare providers, caregivers, and dental professionals. Timely interventions can significantly enhance oral health outcomes.

BackgroundThe oral health of refugees and asylum seekers is understudied. However, oral health has important implications for overall health and wellbeing. This study addresses this gap by characterizing oral health care utilization in Médecins du Monde (MdM) clinics across mainland Greece from 2016 – 2017.MethodsA retrospective cross-sectional study design was used to estimate proportional morbidities for caries, extraction, developmental, periodontal disease, preventive, and other oral health outcomes. The association between physical health conditions and consultations of interest – upper respiratory tract infections (URTIs) and reproductive health consultations – and oral health were compared using odds ratios (OR) and 95% confidence intervals (CIs). Oral health outcomes between Afghans and Syrians were compared using odds ratios and 95% CIs.ResultsCaries (39.44%) and extractions (28.99%) were highly prevalent in our study population. The utilization of preventive dental consultations (37.10%) was high, particularly among males. Individuals with at least one upper respiratory tract infection (OR = 1.52; 95% CI: 1.30 – 1.77; Or = 1.90; 95% CI: 1.53 – 2.36) and women and girls with reproductive health consultations (OR = 1.30; 95% CI: 1.03 – 1.66; OR = 2.03; 95% CI: 1.49 – 2.76) were more likely to have any dental or caries specific consultations. The observed patterns in oral health needs differed between Afghans and Syrians, with Afghans more likely to have preventive screenings and less likely to have caries, extractions, or other conditions.ConclusionsDisplaced populations utilizing MdM dental clinics had high levels of oral health needs, particularly for caries and extractions. The connection between oral and overall health was seen in the study population, and these findings reinforce the public health importance of oral health for improving health and wellbeing of displaced populations. Evidence-informed policy, practice, and programming inclusive of oral health are needed to address both oral and overall health of refugees and asylum seekers in Greece. Future research should investigate not only oral health care needs but also knowledge and beliefs that inform utilization patterns among displaced populations.

To assess the value of Smiles for Life: A National Oral Health Curriculum (SFL) in influencing oral health practices of primary care professionals (PCPs).The National Maternal and Child Oral Health Resource Center’s Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC) project is working with five project teams in Georgia, Illinois, Maryland, Michigan, and Rhode Island that are integrating interprofessional oral health core clinical competencies into primary care practice. The competencies were developed to facilitate change in the clinical practice of PCPs working with vulnerable or underserved populations that lack or have limited access to oral health care.An initial PIOHCPC project requirement was for PCPs (physicians, nurse practitioners, nurse midwives, nurses) to complete at least two SFL courses based on their project population of focus (eg, pregnant women, children, adolescents). The curriculum consists of the following courses: Course 1: Relationship of Oral and Systemic Health; Course 2: Child Oral Health; Course 3: Adult Oral Health; Course 4: Acute Dental Problems; Course 5: Oral Health for Women: Pregnancy and Across the Lifespan; Course 6: Caries Risk Assessment, Fluoride Varnish, and Counseling; Course 7: The Oral Exam; and Course 8: Geriatric Oral Health. Three months after completion of the SFL courses, a 10‐question feedback form was sent to PCPs.PCPs working in primary care settings (community health centers, local health department, medical center women’s health clinic) serving pregnant women, children, and adolescents who completed at least two SFL courses as part of the PIOHCPC project.Thirteen PCPs (three physicians, three nurse practitioners, three nurse midwives, four nurses) completed the feedback form. One hundred percent of respondents strongly agreed/agreed that SFL courses (1) reinforced the importance of oral health to a patient’s overall health and well‐being, (2) increased their awareness of and familiarity with oral health issues in their patients, and (3) increased their confidence in integrating oral health care into primary care. Seventy‐seven percent of respondents strongly agreed/agreed that SFL courses helped reduce barriers to incorporating oral health care into primary care. Sixty‐two percent of respondents strongly agreed/agreed that integrating oral health care into primary care improved their patients’ oral health outcomes. The majority (ranging from 85 to 100 percent) of PCPs strongly agreed/agreed that SFL courses helped them integrate the interprofessional oral health core clinical competencies into primary care.Three months after completing SFL courses, PCPs indicated that the curriculum had a positive influence on oral health practices in the primary care setting. These findings are consistent with a 2017 study that examined SFL influence on clinical practice and found that the curriculum positively influenced oral health practices in the primary care setting. Additional feedback could be gathered 1 year post‐training to assess retention of PCPs’ practices related to integrating oral health care into primary care.Oral health training is essential for enhancing PCPs’ knowledge and practices related to integrating oral health care into primary care. To respond to the need to integrate oral health care into primary care, SFL should be considered as a training for PCPs.Health Resources and Services Administration.

Improved dental services have increased the retention of natural teeth and prostheses, creating complex oral care needs among older adults. Care managers are key in overseeing residents' oral health; their perceptions can inform strategies to improve geriatric oral health in residential aged care facilities (RACFs). To explore care managers' perceptions of the oral healthcare experiences and needs of older adults in RACFs. A descriptive qualitative study, grounded in a constructivist paradigm, was conducted using the Socio-Ecological Model to guide data collection and analysis at individual, interpersonal, organisational, community and policy levels. Ten care managers were purposively sampled and interviewed online using a semi-structured guide. Data were analysed using reflexive thematic analysis following Braun and Clarke's framework. Participants (n = 10; age 28-59 years; mean age 41.7; 5 males, 5 females) were from urban and semi-urban areas of western India. Five themes were identified: (1) A Moral Duty to Care-Personal Beliefs and Emotional Drivers of Oral Health Practice; (2) Navigating Relational Complexities-Care Amidst Resistance, Trust and Support; (3) Systemic Gaps and Adaptive Practices in Resource-Limited Settings; (4) Disconnected Services and the Social Devaluation of Residents' Oral Health; and (5) Calls for Oral Health Care Delivery/Systemic Reforms-Embedding Oral Health in Aged Care Policy. Care managers perceived residents' oral health as often being deprioritized in RACFs due to competing general health demands. An interdisciplinary care team, including a dentist, stronger policy support, and targeted training for care managers and staff, was strongly recommended to improve older adults' oral health outcomes in residential settings.

BACKGROUND Oral health of nursing home residents is generally poor, largely due to age-related conditions that increase their vulnerability and make them more dependent on others for oral care. Poor oral health can significantly impact general health and well-being, highlighting the important role of caregivers in preventing, detecting, and addressing residents’ oral health problems in time. The interRAI Suite of instruments, widely used for comprehensive health assessments, offers the opportunity for non-dental caregivers to assess oral health as part of general health and well-being and facilitates the integration of oral health in general care planning. OBJECTIVE Based on interRAI data, this study explored the associations between oral health and general health outcomes of nursing home residents in Flanders (Belgium) and the Netherlands. METHODS This cross-sectional study included baseline interRAI assessments of 2362 Flemish and Dutch residents aged 65 years and older, collected by caregivers (e.g., nurses, nurse aids, etc.) between October 2020 and February 2024. Validated outcome scales (e.g., Activities of Daily Living Hierarchy scale, Cognitive Performance Scale, Depression Rating Scale), health conditions such as diabetes, low weight (BMI ≤19), as well as family support and participation in social activities, included in the interRAI instrument, provided information on residents’ general health and well-being. Oral health was defined according to the nine items of the optimized oral health section for inclusion in the interRAI instruments, the OHS-interRAI. Adjusted logistic regression models were used to explore the associations between oral and general health outcomes. RESULTS Oral health problems were interconnected, with conditions in one oral structure impacting the health of others. When controlling for confounding variables, dependency on others for personal care and hygiene was significantly associated with poor oral hygiene (OR 1.7, 95% CI 1.1-2.4), chewing difficulties (OR 2.2, 95% CI 1.3-3.5), compromised teeth (OR 1.7, 95% CI 1.1-2.5), and the need for dental referral (OR 1.8, 95% CI 1.4-2.3). Natural dentition and gender had a significant impact on oral health status. Low weight was associated with poor chewing function (OR 2.0, 95% CI 1.1-3.6) and dry mouth (OR 1.8, 95% CI 1.0-3.2), both associated with oral discomfort or pain (OR respectively 6.8, 95% CI 3.3-14.0 and 3.5, 95% CI 1.8-6.9). Family support was identified as a facilitator in mitigating oral health problems. CONCLUSIONS The interRAI instrument, including the OHS-interRAI, is a valuable tool for monitoring residents' health and identifying areas requiring additional support. The results demonstrated the importance of prioritizing oral health as an integral component of comprehensive care. Recognizing the interconnection between oral health and other health conditions, including indicators of well-being, can guide caregivers and other healthcare professionals in incorporating preventive and supportive oral care practices into daily care routines, contributing to improved resident health and well-being outcomes.

BackgroundOral Health Literacy (OHL), defined as an ability to obtain, understand, and apply information related to oral health, plays a crucial role in promoting effective oral health outcomes and behaviors. Given the pressing need to enhance oral health among older adults, this scoping review aims to summarize the impact of OHL on oral health behaviors and outcomes in this population.MethodsThe authors performed an electronic search up through July 22, 2024. Among the 2,226 articles identified, the authors included studies in which the investigators evaluated the association between OHL and oral health behaviors or outcomes restricted to individuals aged 60 years and older. Thematic analysis was used to develop the domain for oral health behaviors or outcomes.ResultsAmong the 10 studies analyzed, significant correlations were identified between OHL and various oral health indicators, including periodontitis, the number of remaining teeth, dental prosthesis use, oral hygiene, oral health-related quality of life among men, as well as dissatisfaction with oral health (p < 0.05). However, the results were conflicting across the studies, indicating variability in the strength and nature of these associations. Additionally, OHL was shown to significantly influence oral health-related behaviors, especially the tooth brushing frequency (p < 0.05).ConclusionsThis review highlights a scarcity of studies addressing OHL in older populations, suggesting that OHL has been deprioritized in efforts to improve oral health for this vulnerable group. Key gaps include the need for age-appropriate OHL assessment tools, stronger evidence linking OHL to specific oral health behaviors and outcomes, and the integration of OHL into broader health initiatives and research in older group. These areas are critical to advancing our understanding and improving oral health outcomes among older adults.

BackgroundOral health literacy (OHL) might have an impact on oral health outcomes. Currently, relatively few related studies have been conducted among older people. The aim of this study was to explore the impacts of OHL on oral health outcomes in older adults in a cross-sectional design.MethodsFrom November to December 2023, through the utilization of the cluster sampling approach, a questionnaire survey was carried out among elderly patients visiting the Prosthodontics Department of West China hospital of Stomatology. Data were collected through the general information questionnaire, the Chinese version of the Oral Health Literacy Scale, the Geriatric Oral Health Assessment Index, and oral examinations. Descriptive statistics, binary logistic regression, and poisson regression were used to analyse the data.ResultsA total of 407 valid questionnaires were recovered, with an effective retrieval rate of 98.79%. After adjustment for sociodemographic, economic and oral health behaviours, the results of the binary logistic regression indicated that the correlations between OHL and self-rated oral health were not statistically significant, while OHL was a predictor variable for dental expenditures within the past year (OR = 0.591; 95%CI: 0.371–0.939), and the poisson regression revealed that OHL was a predictor variable of the quality of life (PR = 1.062, 95%CI: 1.030–1.084) and the number of lost teeth (PR = 0.917, 95%CI: 0.865–0.972).ConclusionsThis study showed that OHL was closely associated with recent dental expenditure, oral health-related quality of life and the number of lost teeth. These findings could contribute to the planning and development of oral health education programs aimed at enhancing the OHL among the elderly population.

BackgroundOral health is an essential component of overall well-being, yet it remains a neglected public health area in many low- and middle-income countries. Teachers play a vital role in shaping students’ oral health behaviours, making their knowledge and practices crucial for school-based oral health promotion. This study assessed the knowledge, attitudes, and practices (KAP) regarding oral health among primary school teachers in Mchinji District, Malawi, to evaluate their readiness to support oral health education.MethodsA cross-sectional survey was conducted among 316 primary school teachers using a structured questionnaire. Descriptive statistics summarized demographic and KAP variables, while chi-square tests and Cramér’s V measured associations between demographic characteristics and oral health knowledge and practices.ResultsAmong participants, 60.0% were male, 61.4% were aged 30–45 years, and 61.9% had more than 10 years of teaching experience. While 63.6% demonstrated average oral health knowledge and 29.4% showed good knowledge, awareness of preventive dental procedures such as dental scaling (26.7%) and flossing (14.2%) was low. Most teachers (82.2%) exhibited average oral hygiene practices, and only 10.2% had good practice scores. Although positive attitudes were widespread, with over 90% recognizing the importance of oral health and regular dental visits, only 26.4% had received oral health training, and 68.5% identified limited knowledge as a barrier to teaching oral health. Age was significantly associated with knowledge level (p = 0.007, Cramér’s V = 0.152), while gender and teaching experience were not.ConclusionPrimary school teachers in Mchinji District hold positive attitudes toward oral health but display knowledge and practice gaps. Strengthening teacher training through structured oral health capacity-building programs could enhance school-based health education and inform policies that integrate oral health into Malawi’s primary school curriculum.