Poor dental hygiene and periodontal health in nursing home residents with dementia: an observational study

Abstract

Poor oral health conditions are well documented in the institutionalized elderly, but the literature is lacking research on relationships between dementia and periodontal health in nursing home residents. The purpose of this cohort study, therefore, was to assess whether dementia is associated with poor oral health/denture hygiene and an increased risk of periodontal disease in the institutionalized elderly. A total of 219 participants were assessed using the Mini Mental State Examination (MMSE) to determine cognitive state. According to the MMSE outcome, participants scoring ≤20 were assigned to dementia group (D) and those scoring >20 to the non-dementia group (ND), respectively. For each of the groups D and ND, Gingival Bleeding Index (GBI) and Denture Hygiene Index (DHI) linear regression models were used with the confounders age, gender, dementia, number of comorbidities and number of permanent medications. To assess the risk factors for severe periodontitis as measured by the Community Index of Periodontal Treatment Needs, a logistic regression analysis was performed. Statistical analysis revealed no significant differences of GBI as well of DHI for demented and healthy subjects (p > 0.05). Severe periodontitis was detected in 66 % of participants with dementia. The logistic regression showed a 2.9 times increased risk among demented participants (p = 0.006). Oral hygiene, denture hygiene and periodontal health are poor in nursing home residents. The severity of oral problems, primarily periodontitis, seems to be enhanced in subjects suffering from dementia. Longitudinal observations are needed to clarify the cause-reaction relationship.

Carers’ education improves oral health of older people suffering from dementia – results of an intervention study

“…Plaque-positive areas were separately counted for each denture and divided by ten (total possible sites) to give a score, which could range from 0% to 100%. Compare Zenthöfer et al13…”

“…With regard to people with and without dementia, the mean CPITN scores and the number of natural teeth were different at baseline ( P <0.05). More detailed baseline characteristics are presented elsewhere 13. At follow-up examination after six months in the intervention group, a mean (SD) PCR value of 70.1 (26.1), a mean (SD) GBI value of 40.2 (29.3), a mean (SD) DHI value of 57.8 (27.9) and a mean (SD) CPITN value of 2.9 (0.6) were observed, indicating significant improvements in PCR and DHI ( P <0.001).…”

“…In analysis of GBI and CPITN, no significant improvements could be measured over the study period, albeit a substantial trend to improvement was observed. One should keep in mind that GBI can be affected by anticoagulative medications, which were present in ~40% of the participants 13. Furthermore, 89% of the participants had periodontitis in at least one sextant (see CPITN).…”

“…A further limitation of adequate oral hygiene provision is care-resistant behavior, which can be frequently observed in people suffering from dementia 9. Previous studies indicated poor oral hygiene in subjects with dementia in comparison to those without cognitive impairments, namely, more caries increments and worse periodontal conditions,10–13 and the prevalence of cognitive and motor impairments in nursing homes is likewise high (~50% of institutionalized elderly). However, maintaining a lifelong good oral health is important for both oral function (nutrition) and its impact on general health such as cardiovascular diseases, stroke, diabetes mellitus and pneumonia 14–16.…”

Longitudinal evaluation of periodontitis and development of cognitive decline among older adults

“…Recent systematic reviews suggest that older people with dementia have multiple oral health problems (Delwel et al., ; Gusman et al., ; Leira et al., ; Maldonado, Laugisch, Burgin, Sculean, & Eick, ). However, studies on the relationship between periodontitis and cognitive decline are few but indicate an association (Gil‐Montoya et al., ; Syrjala et al., ; Zenthofer et al., ). One possible explanation may be related to changes in daily functioning, associated with cognitive decline, affecting oral hygiene routines, resulting in higher plaque and bleeding index (Gil‐Montoya, Sanchez‐Lara et al., ; Zenthofer, Schroder, Cabrera, Rammelsberg, & Hassel, ).…”