Epidemiologic studies have shown that the oral health of residents in nursing homes is poor. This can be due to their impaired ability to maintain appropriate oral hygiene or to a lack of interest in oral care among those responsible for the care. The purpose of this study was to assess the attitudes of managers, caregivers, and physicians with regard to oral health care issues of their residents. A questionnaire sent to the managers of the 65 nursing homes in Geneva was returned by 47 (69%). According to the managers, 85% of the nursing homes organized transportation for the residents to a dental office; dental care with follow-up treatment was organized in 79% of the facilities; 68% of the facilities organized treatment for dental emergencies. Another questionnaire was distributed to 169 caregivers in 13 nursing homes. A majority had received no education in oral hygiene care of the residents. The caregivers did accept responsibility for oral hygiene care, but preferred to share it with a dentist responsible for the oral health care of the residents. Only 33% of the physicians indicated that they carried out a systematic examination of the oral cavity, and 20% agreed that the oral cavity might be an integrated part of the body. The majority of the physicians were in favor of more information on oral diseases and regular visits by a dentist; however, close collaboration with a dentist on oral health issues had a low priority.
Reduced chewing ability in community-dwelling older people is linked to the presence of removable dentures and having fewer than 20 natural teeth present. Compensation is provided by chewing longer and swallowing larger food particles. Replacement of posterior tooth loss by fixed or removable prostheses increases the activity of the masticatory muscles, and reduces chewing time and the number of chewing strokes until swallowing. In residents of nursing homes and long-term care facilities undernutrition is prevalent because of general medical problems, reduced appetite, and poor quality of life. Poor oral health and xerostomia are often present and may have a negative effect on masticatory function and nutrition, precipitating avoidance of difficult-to-chew foods. There is no evidence that the provision of prosthetic therapies can markedly improve dietary intakes; however, it might improve oral comfort and quality of life and avoid enteral alimentation.
Despite the marked placebo effect, the results indicate that occupational therapy is particularly useful to improve the oral and denture hygiene in dependent and cognitively impaired LTC residents and may promote their autonomy in the execution of activities of daily life such as denture brushing.
Indices used to evaluate periodontal health have been widely accepted in epidemiological studies, yet their reliability cannot be guaranteed. The aim of this study was to evaluate the reliability of periodontal indices applied on elders. 19 elderly subjects, 73-years-old on average, were examined at a 1st appointment by 2 independent examiners. They were re-examined 2 weeks later during a 2nd session. The examinations were performed in a dental chair with good illumination. Periodontal health was evaluated using the community periodontal index of treatment need, and tooth mobility was evaluated using 2 different indices. Inter and intra-examiner agreements were evaluated using kappa statistics. Taken as an overall measurement, the CPITN was a reliable assessment of periodontal treatment need in elders. Disagreement occurred mainly on the evaluation of bleeding and shallow pockets. The detection of fairly mobile teeth was reliable; however, the performance of the more sensitive scale was deceptive. it seems that, in the case of tooth mobility, a choice has to be made between sensitivity or reproducibility. It can be concluded that examiners should be trained carefully since the reliability of the CPITN and tooth mobility evaluation were good but close to a critical level for which an agreement is classified as poor.
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