Oral health and orofacial pain in people with dementia admitted to acute hospital wards: observational cohort study

Liza J M Van De Rijt,Frank Lobbezoo,Roxane A F Weijenberg,Elizabeth L Sampson,Victoria Vickerstaff,Alexandra R Feast

doi:10.1186/s12877-018-0810-7

Abstract

BackgroundOrofacial pain in people with dementia is difficult to detect, and often under-treated. Our aim was to investigate the prevalence of orofacial pain in people with dementia in acute hospitals in the UK. Secondary aims were to examine oral health status and explore associations between orofacial pain and oral health factors.MethodsThis cross-sectional observational study was carried out in two UK hospitals. Using the Orofacial Pain Scale in Non-Verbal Individuals (OPS-NVI) to identify orofacial pain, 101 participants with dementia, admitted to acute medical wards, were observed for at least 3 min during rest and chewing. Verbal participants were then asked about presence of orofacial pain, using self-report pain scales. Finally, a brief oral assessment was performed.ResultsOrofacial pain, assessed with the OPS-NVI, was present in 11.9% (95% C.I. 5.9, 18.8) of participants at rest and 21.9% (95% C.I. 14.6, 31.3) whilst chewing. Participants who were no longer able to self-report pain were significantly more likely to experience orofacial pain. Oral health in both dentate and edentate participants was poor. Brush frequency, indication of chewing quality, consistency of the food, presence of extra-oral abnormalities, person who performed mouth care, and oral hygiene in dentate participants were significant predictors for the presence of orofacial pain.ConclusionImproving oral care in acute hospital patients with dementia, particularly those who cannot self-report pain, may significantly reduce pain and suffering in this population.

Highlights

Orofacial pain in people with dementia is difficult to detect, and often under-treated
Of the 44 patients that were approached, but not included in the study, 9 were excluded because they did not wish to participate, 17 were excluded because the personal consultee indicated that the patient should not participate, 3 were excluded because the personal consultee, who gave verbal agreement, did not return the signed consultee form, and 15 were excluded because they were discharged from hospital before they could be screened (See Fig. 1)
Orofacial pain The prevalence of orofacial pain, according to the OPSNVI, during rest in all 101 participants, was 11.9% (95% C.I. 5.9, 18.8)

Summary

Introduction

Orofacial pain in people with dementia is difficult to detect, and often under-treated. Our aim was to investigate the prevalence of orofacial pain in people with dementia in acute hospitals in the UK. The prevalence of dementia will double every 20 years, with an expected 115 million people with dementia by 2050 [1]. 50% of people with dementia experience pain daily [2]. This can be difficult to detect, and is often under-treated [3]. Orofacial pain is common in people aged 70 years or above and may be caused by teeth or their supporting tissues, the muscles and joints of the masticatory system, or other non-odontogenic tissues [4, 5]. The prevalence of orofacial pain in older people aged 60 years or above without dementia is 6.7–18.5% and the few studies reporting on orofacial pain in people aged 60 years or above with dementia give a prevalence between 7.4 and 21.7% [9,10,11]

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Results

Discussion

Conclusion