Changes In Oral Health Status Research Articles

The effects of professional oral health care on patients in the subacute stage of emergent neurosurgical disorders

This study evaluated the effectiveness of professional oral health care (POHC) on patients who were in the subacute stage of neurosurgical disorders. Forty subjects (26 male, 14 female) with acute cerebrovascular disorders or neurotrauma were randomly divided into two groups. The intervention group (n = 21) received POHC treatment by dental hygienists, and the control group (n = 19) did not. To evaluate the change in oral health status of the subjects, an oral examination was carried out at baseline and four weeks later. For the subjects in the intervention group, periodontal condition, oral hygiene status, and oral function improved statistically significantly. The detection rate for methicillin-resistant Staphylococcus aureus (MRSA) was statistically significantly lower in the intervention group than in the control group. These results suggest that POHC performed by dental hygienists in collaboration with nurses plays an important role in the promotion not only of oral health but also of general health.

Effects of an oral health education program targeting oral malodor prevention in Japanese senior high school students

Objective. Previous research has suggested that oral malodor could be a useful motivational tool for increasing the awareness of oral health in adolescents and improving their oral health behaviors. Hence, the aims of this research were: (1) to develop an oral health education program that included oral malodor prevention and (2) to test the effects of the program in Japanese senior high school students by comparing the changes of oral health outcomes between the intervention and control groups. Materials and methods. Subjects were 163 Grade 1 and 135 Grade 2 senior high school students in Tokyo, Japan. A novel oral health education program, which incorporated prevention of oral malodor, was developed and conducted on all Grade 1 students (intervention group). Grade 2 students (control group) did not receive the program. Changes in oral health status from baseline to 1-year follow-up were compared between the intervention and control groups. Results. The intervention group, compared with the control group, had a significantly higher proportion of students who improved or maintained good oral health status (i.e. dental plaque, gingivitis, tongue coating and oral malodor). Among students in the intervention group, the change was more evident in subjects with detectable oral malodor at the commencement of the program. Conclusions. An oral health education program focusing on the prevention of oral malodor is effective for promoting oral health among Japanese senior high school students. Therefore, embedding such a program in the school oral health curriculum would be beneficial for adolescents.

Trends in oral health by poverty status as measured by Healthy People 2010 objectives.

Poverty is a significant social determinant for oral health, yet Healthy People 2010 (HP 2010) does not monitor changes in oral health status by poverty. We assessed recent trends for six HP 2010 oral health objectives by poverty status. We used data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys to analyze trends for HP 2010 age-specific objectives relating to caries experience, untreated tooth decay, dental sealants, periodontal disease, tooth retention, and complete tooth loss by poverty status. Dental caries significantly increased from 19% to 24% for children aged 2-4 years, but when stratified by poverty, caries only increased significantly for non-poor 2- to 4-year-old children (10% to 15%) (Objective 21-1a). The largest percentage point increase in dental caries was for non-poor boys (9% to 18%). The use of dental sealants continues to grow in the U.S. The largest percentage point increase in sealant use (Objective 21-8) between the two survey periods was for all poor children aged 8 years (3% to 21%). Among adults aged 35-44 years, periodontal disease significantly declined in the U.S. from 22% to 16% (Objective 21-5b) and more adults retained all of their natural teeth (30% to 38%) (Objective 21-3). However, the increase in tooth retention was significant only for non-poor adults, particularly non-poor men (34% to 48%). Overall, the oral health status of Americans as measured by HP 2010 objectives mostly showed improvement or remained unchanged between 1998-1994 and 1999-2004. However, some changes in oral health status for some traditionally low-risk groups, such as non-poor children, may be reversing improvements in oral health that have consistently been observed in previous decades. These results suggest that poverty status is an important factor for planning and monitoring future national oral health goals.

Evaluation of an oral function promotion programme for the independent elderly in Japan

The purpose of this study was to provide an oral function promotion programme for the independent elderly and evaluate the changes in oral health status and oral function. Few studies have scientifically analysed and evaluated the effectiveness of oral function promotion programmes provided for the independent elderly. The subjects were independent elderly females (mean age: 74.6 +/- 6.3) recruited from senior citizens' centres in Tokyo. The intervention group (n = 79) received a 3-month oral function promotion programme, which included facial muscle and tongue exercises and salivary gland massages. The control group (n = 62) did not receive this programme. In the intervention group, the tongue coating scores decreased and the organoleptic score of oral malodour fell. The amount of food debris in the oral cavity decreased and the tongue dryness improved. Furthermore, the salivary flow rate increased. The length of time for maintaining the tongue in the forward position increased from 11.2 s to 18.7 s, and the number of times for moving the tip of the tongue in a clockwise circular motion, counter-clockwise circular motion and side-to-side motion within 30 s, increased from 14.5 to 20.6, 14.5 to 20.2, and 17.2 to 23.3 respectively. The number of times for movement of the lips significantly improved from 23.0 to 28.8 and the pronunciation of words was observed to be clearer. An oral function promotion programme was effective in improving the oral health status and oral function of an independent elderly population.

A 5‐year follow‐up of older adults residing in long‐term care facilities: utilisation of a comprehensive dental programme

This study will compare the clinical outcomes of 139 elders residing in long-term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years. Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care. A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition. Eighty-three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70-73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56-72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, chi(2) = 7.9, df = 2). Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.

Commentary: Munro CL et al. (2006). Oral health status and development of ventilator‐associated pneumonia: a descriptive study

AbstractBackground: Ventilator‐associated pneumonia (VAP) is a significant cause of morbidity and mortality and may be influenced by oral health.Objective: To describe the relationship between VAP and oral health status, changes in oral health status during the first 7 days after intubation and microbial colonization of the oropharynx and trachea.Methods: A total of 66 patients were enrolled within 24 h of intubation and were followed up for up to 7 days. Data on oral health measures and the clinical pulmonary infection score (CPIS) were collected at baseline, day 4 (n = 37) and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4.Results: Dental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < 0·001), baseline salivary lactoferrin and day 4 plaque (P = 0·01), and lower salivary volume and higher day 4 CPIS (P = 0·02). Potential pathogens were identified in oral cultures for six patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = 0·007), day 4 salivary volume (P = 0·02), interaction of APACHE II score and day 1 CPIS (P < 0·001), and interaction of day 1 CPIS and plaque (P = 0·01).Conclusions: Higher dental plaque scores confer greater risk for VAP, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk. Abstract reprinted from American Journal of Critical Care, volume 15, Munro CL et al., ‘Oral health status and development of ventilator‐associated pneumonia: a descriptive study.’, pages 453–460. © 2006, reproduced with permission from American Association of Critical Care Nurses.

Using Personal Digital Assistants to improve self-care in oral health

We conducted a pilot project to evaluate the potential of Personal Digital Assistant (PDA) technologies to improve the oral health of people with mild to moderate intellectual disabilities, chronic health problems and a long-standing history of poor oral health self-care. Oral health video and audio materials were prepared and transferred to PDAs. Patients were trained in the use of the PDAs at a regular dental appointment and the utilization of the PDA and any change in oral health status was tracked over the next six months. More than half of the 36 patients reported problems in keeping the PDAs functioning properly (mainly problems of keeping the batteries charged) for the duration of the project and 11 patients dropped out of the study. Ten of the remainder (40%) achieved improvement in at least three areas of oral health. The pilot project potentially brings a range of health promotion activities within the reach of people with limited health literacy which may produce better self-management of chronic health conditions.

Change in oral health status among the institutionalized Norwegian elderly over a period of 16 years

Objective. To assess the oral health status of elderly residents living in nursing homes, and to determine whether there have been any changes between 1988 and 2004. Material and methods. The dental, periodontal, prosthetic, and oral mucosal status was recorded for 155 elderly long-term residents in five nursing homes. The results were compared with those of an identical cross-sectional study from 1988, using the same nursing homes, examination procedures, and evaluation criteria. The participation rate was 89.6%. Results. Edentulism was less frequent in 2004 (43%) than in 1988 (71%), and the mean number of teeth among the dentate participants had increased from 10.7 to 14.6. The proportion of subjects with decayed teeth increased from 55% in 1988 to 72% in 2004, and the mean DMFT (decayed, missing, and filled teeth) increased from 19.4 to 23.2. The frequency of subjects with periodontal pockets of 4 mm or more increased from 43% to 65% during the 16-year period. More participants had crowns or bridges. Of the denture-wearing subjects, more were affected by stomatitis in 2004 than in 1988; however, a decrease in the degree of severity was evident. Conclusions. As more people retain their own teeth throughout life and the prevalence of oral diseases increases among the institutionalized elderly, their objective need for dental treatment is even greater than before. This underscores the necessity for developing effective and oral care programs for the elderly.

Oral Health Status and Development of Ventilator-Associated Pneumonia: A Descriptive Study

Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health. To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea. A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4. Dental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P<.001), and interaction of day 1 CPIS and plaque (P=.01). Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.

The effectiveness of out-of-hours dental services: I. pain relief and oral health outcome

To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. Two health authorities in South Wales, UK. A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.

Pain relief from out-of-hours dental services?

Objective To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. Basic design Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. Setting and subjects Two health authorities in South Wales, UK. A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. Results For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30–40% and 23–38% respectively). Although the 'rotas for all' — a telephone-access GDP-provided service for both registered and unregistered patients — achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. Conclusions Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.

Changes in dental status over 10 years in 80-year-old people: a prospective cohort study.

The aim of the present study was to follow-up the condition of the teeth over a sufficiently long period. Dental examinations were a part of a multidisciplinary 10-year cohort study on the elderly. These examinations were made in 1990 (n = 226), 1995 (n = 90) and 2000 (n = 65) for the entire population born in 1910 and living in Jyväskylä, Finland. The subjects were divided into two categories, dentate (one tooth or more) and edentulous. The results showed that men had more intact teeth and lower DMF scores than women, but the differences diminished during the follow-up period. The number of remaining and filled teeth of those women who took part in all three phases of the present study was higher than that of those who died during the follow-up. In men the DMF scores showed the opposite trend. The most significant deterioration during the 10-year follow-up was found in the number of teeth and DMF scores in men and in the number of remaining and filled teeth in women. Among men, in particular, significant changes in oral health status could be seen even between 80 and 90 years of age. Hence, regardless of advanced age, a subject should be motivated by the oral health care team to seek regular dental treatment.

Study on Annual Changes in Oral Health Status in Female Primary School Children

Study on Annual Changes in Oral Health Status in Female Primary School Children

Acculturation and dental health among Vietnamese living in Melbourne, Australia.

To describe the relationship between acculturation and oral health status, oral health knowledge and frequency of dental visits in subjects of Vietnamese background, 18 years or older, living in Melbourne, Australia. Oral health status was measured using the DMFS index. Oral health knowledge was estimated by responses to six specific oral preventive measures: brushing, flossing, use of fluorides, diet, and dental visits. Dental visits was measured by the number of visits in the 12 months prior to the survey. Acculturation was measured along two dimensions, psychological and behavioural, using the Psychological-Behavioural Acculturation Scale. Data were analysed using multivariate analysis to identify the combined effect of eight predictors (age, gender, occupational status, education, reason for migration, proportion of life in the host country, behavioural acculturation and psychological acculturation) against the dependent variables. The analysis was conducted on a sample of 147 subjects and showed significant interactions between the acculturation variables and three outcome measures: dental caries, knowledge of preventive measures and dental visits. Results indicated that acculturation was an important intervening variable. Psychological acculturation was strongly related to the three oral health outcomes, although the effect of behavioural acculturation was also apparent regarding dental status. This study offers several insights for understanding the mechanisms by which acculturation impacts oral health status. Interventions that simplify the cultural influence of immigrant groups by focusing on socio-demographic differences and even immigration variables to define risk groups might not produce predicted changes in oral health status.

Developing appropriate dental education systems: the impact of changes in oral health status and oral health care systems

Current education programmes for oral health care workers have failed to adapt to the changing oral health status and the changing demands made upon oral health care systems. In order to adapt, education systems need to recognise the forces that are influencing the demands on the oral health care system and identify the most appropriate solutions. The most logical solution is to develop programmes which reflect the Primary Health Care Approach (PHCA), and in particular emphasise inter-sectorial collaboration. The challenge for dental education systems is to identify mechanisms through which these principles can be applied.

Issues in measuring change in self-perceived oral health status.

An important goal of a health care intervention or system is to improve the health of an individual or a population. The challenge for health services research is to measure and explain this change. However, the issue of how changes in health status should be defined and measured has been given relatively little attention. This paper draws on the rather sparse literature to examine some issues involved in measuring changes in oral health status and illustrates these using data from a longitudinal study of the oral health of older adults. The paper draws a distinction between quantitative and qualitative change and the challenges involved with each. Four different ways of assessing change are reviewed and their strengths and weaknesses highlighted. Global transition judgements, although relatively simple measures of change, incorporate patients' values and avoid the statistical problems associated with measures such as change scores. Nevertheless, the measurement of change in oral health status is complex and controversial and no approach is universally accepted. Consequently, the decision as to which strategy to adopt is far from simple.

Statistical aspects of measuring change in oral health status of older adults

Statistical aspects of measuring change in oral health status of older adults

Statistical aspects of measuring change in oral health status of older adults

There are many statistical aspects involved in the measurement of change and some of these are discussed in this paper. First, a general overview of the three types of index, discriminative, predictive and evaluative, is presented. Each type of index should be developed in a different manner and this will depend on its use. For example, the reliability of an evaluative index is different from that of the other types of index and would depend on the observations on each individual remaining stable over time, and having a large change score when the dental status improves or deteriorates. Second, the issue of when we should be measuring change as opposed to just using the final measurement, or to using an analysis of covariance, is discussed. The final section of the paper looks at some of the fallacies which occur in the measurement of change and discusses whether or not we should try to correct for these.

Longitudinal Study on Oral Health in Subjects with Alzheimer's Disease

To examine longitudinal oral health changes in unmedicated, generally healthy subjects with Alzheimer's disease (AD) and compare them to age- and gender-matched healthy, unmedicated control subjects. Oral health parameters were evaluated over 2 to 3 years and the results compared between subjects with AD and controls. Clinical Center of the National Institutes of Health, Bethesda, Maryland. Twenty-one community-dwelling subjects with a clinical diagnosis of AD and 21 age- and gender-matched control subjects. Neither population was being treated for any other systemic condition nor taking any prescription medications. Unstimulated and stimulated major salivary gland flow rates were measured, and gingival, periodontal, dental, and oral mucosal tissues assessed. In general, subjects with AD demonstrated decreased salivary flow rates and diminished oral health, but most longitudinal changes in oral health status were not significantly different than controls. Patients with AD are susceptible to a variety of oral health problems, and progression of AD can lead to a deterioration in oral health and function. These patients require aggressive preventive care to maintain function for as long as possible, which necessitates close cooperation among numerous health care professionals.

Trends in dental caries in The Netherlands.

Until 1985, epidemiological studies in The Netherlands were focused on school-age children. Up to that year, few caries prevalence data for (young) adults in selected groups were available. In 1986, the first National Dental Survey of the adult population was carried out in The Netherlands. Lack of information made it impossible for trends in dental caries in adults to be studied on a scientific basis. However, with use of cross-sectional studies conducted on selected adult populations between 1970 and 1989, an indication of a trend in dental caries is described. Evident changes in the age-specific average DMFT scores took place in the younger age groups. In the older age groups, the average DMFT score has not changed. Changes in percentages of edentates in the period 1980-1990 probably reflect part of the changes in oral health status of Dutch adults.