Anna‐Maija H. Syrjälä

Locus of control beliefs predicting oral and diabetes health behavior and health status

Our study evaluates the correlation between dental and diabetes locus of control beliefs and the potentiality of locus of control beliefs in predicting oral health behavior, dental status, diabetes compliance, and HbA1c level by using situation-specific locus of control scales and considering the value dimension. Data were collected by means of a quantitative questionnaire, a clinical oral examination and patient records. The research population comprised 149 insulin-dependent diabetics who had teeth of their own. Variables were the frequencies of tooth brushing and dental visiting, oral indexes, diabetes adherence, and HbA1c level. Dental and diabetes locus of control beliefs correlated with each other. Dental locus of control associated with frequency of dental visiting, plaque index, decayed surfaces, and with root caries, but diabetes locus of control associated only weakly with adherence with diabetes self-care regimens and not at all with HbA1c level. Correlations between dental locus of control and oral indexes were stronger among those having high value for dental care. Although there were correlations between dental and diabetes locus of control beliefs, only dental locus of control beliefs are practicable for determining health behavior and health status. It is therefore concluded that locus of control beliefs are health behavior specific.

Dementia and oral health among subjects aged 75 years or older.

OBJECTIVE  To study the association between diagnosed dementia and oral health, focusing on the type of dementia, among an elderly population aged 75 years or older. BACKGROUND Elderly people with dementia are at risk from oral diseases, but to date, only a few studies have analysed the association between type of dementia and oral health, and their results are inconclusive. MATERIALS AND METHODS This cross-sectional study is based on the Geriatric multi-disciplinary strategy (Gems) study that included 76 demented and 278 non-demented subjects. The data were collected by means of an interview and an oral clinical examination. The type of dementia was diagnosed according to DSM-IV criteria. Poissons and logistic regression models were used to determine relative risks (RR), odds ratios (OR) and 95% confidence limits (CI). RESULTS Our results showed that patients with Alzheimers disease and those with other types of dementia had an increased likelihood of having carious teeth, teeth with deep periodontal pockets, and poor oral and denture hygiene, compared with non-demented persons. The results showed that the type of dementia does not seem to be an essential determinant of oral health. CONCLUSIONS Among the elderly aged 75 years or older, patients with Alzheimers disease or other types of dementia are at increased risk of poor oral health and poor oral hygiene.

Relationship between cognitive impairment and oral health: results of the Health 2000 Health Examination Survey in Finland

Objective. The aim was to study oral health in relation to cognitive impairment in the general population. Material and Methods. The study population comprised 2320 persons aged 55 years or older who participated in a nationally representative Health 2000 Health Examination Survey in Finland. The data were collected by interviews and clinical oral examinations. Cognition was assessed using a shortened version of the Mini-Mental State Examination (score 0–16). Poisson regression models were used to estimate the relative risk (RR) for continuous variables and logistic regression models to estimate the odds ratio (OR) for dichotomized variables. Results. The results show that individuals with cognitive impairment have more carious teeth (MMSE 11-10: RR: 1.3, CI: 0.9–1.7, MMSE 9-0: RR: 1.5 CI: 1.0–2.4) than healthy persons. Furthermore, compared to cognitively healthy subjects, those with MMSE 9–0 more often have no teeth and no dentures (OR: 5.2, CI: 1.0–26.6) and less often good denture hygiene (OR: 0.4, CI: 0.2–0.7). Conclusion. Cognitively impaired subjects among older adults in Finland have more carious teeth, are more often edentulous without using a denture, and have poorer denture hygiene than cognitively healthy persons.

Metabolic control as a modifier of the association between salivary factors and dental caries among diabetic patients.

The aim here was to analyze the role of metabolic control as a modifier of the association of salivary factors with dental caries among diabetic patients. Cross-sectional data were gathered from 149 insulin-dependent diabetes mellitus patients by means of clinical examination, a quantitative questionnaire and patient records. Dental caries was measured as the number of decayed surfaces. The data were analyzed using negative binomial regression models. HbA1c level appeared not to be associated with dental caries. Of the salivary factors, only high levels of mutans streptococci (MS) and lactobacilli were associated with dental caries. Among the subjects with HbA1c ≧8.5, the presence of dental caries was more distinctly associated with higher levels of MS (RR = 3.86, CI: 1.39–11.96) and lactobacilli (RR = 3.59, CI: 1.44–9.33) compared to those with HbA1c <8.5. It can be concluded that poor glycemic control strengthens the positive association of MS and lactobacilli with dental caries.

Oral health intervention among community-dwelling older people: a randomised 2-year intervention study.

OBJECTIVE The aim of this study was to investigate the effects of a 2-year oral-health-promoting intervention on oral health behaviour and oral health among people aged 75 years or older. MATERIALS AND METHODS In a 2-year randomised intervention study, 279 community-dwelling older people completed the study: 145 persons in an intervention group and 134 in a control group. Interviews and clinical oral examinations were performed at the beginning of the study and at a 2-year follow-up. Changes in oral health behaviour and oral health were used as outcomes. INTERVENTION Oral health intervention included individually tailored instructions for oral and/or denture hygiene, relief of dry mouth symptoms, decrease of sugar-use frequency, use of fluoride, xylitol or antimicrobial products, and professional tooth cleaning. RESULTS More participants in both the intervention and control groups had better dental and denture hygiene and were free of oral diseases or symptoms at the 2-year follow-up than at the baseline. The differences in changes in outcomes between the intervention and control groups were not statistically significant. CONCLUSION The results of this study showed that oral health of community-dwelling older people could be improved. Oral health improved in both groups, more among the participants in the intervention group compared with control group, but the effect attributed to oral-health-promoting intervention remained small.

Number of teeth and selected cardiovascular risk factors among elderly people

OBJECTIVE To produce evidence on an association between the number of teeth and selected cardiovascular risk factors among an elderly population. MATERIALS AND METHODS The study population comprised of 523 community-living elderly people who participated in the population-based Kuopio 75+ study. The data for each subject were collected using a structured clinical health examination, an interview and laboratory tests. Linear regression models were used to estimate adjusted mean values and confidence limits. RESULTS Edentulous persons and persons with a small number of teeth had lower serum HDL cholesterol and higher triglyceride, leucocyte and blood glucose levels and a higher body mass index (BMI) compared with subjects to a large number of teeth. CONCLUSION The study showed that, in the Finnish home-dwelling population aged 75 years or older, those with a large number of teeth were less likely to have cardiovascular risk factors such as a low serum HDL cholesterol level, a high triglyceride level and a high BMI than did subjects with a small number of teeth or who were edentulous.

Salivary flow rate and risk of malnutrition – a study among dentate, community-dwelling older people

OBJECTIVE To analyse the relation between unstimulated and stimulated salivary secretion and the risk of malnutrition among home-dwelling elderly people. BACKGROUND Saliva has an important role in eating. Despite this, there are only a few studies on the role of salivary secretion in the development of malnutrition among elderly people. MATERIALS AND METHODS The study population consisted of 157 subjects aged 75 or older. This was a part of GeMS study carried out in Kuopio, in eastern Finland. The data used in this study were collected by means of interviews and geriatric and oral clinical examinations. The risk of malnutrition was measured using the Mini Nutritional Assessment Short-Form. Logistic regression models were used to estimate odds ratios (OR) and their 95% Confidence Intervals (CI). RESULTS Subjects with a low unstimulated salivary flow rate (<0.1 ml/min) or stimulated salivary flow rate (<1.0 ml/min) had no statistically significant increase in risk of malnutrition, OR: 1.3, CI: 0.5-3.9, OR: 1.5, CI: 0.5-4.2, respectively, when compared with those with a normal unstimulated and stimulated salivary flow rate. CONCLUSION Our results do not support the concept that low salivary secretion is an important risk factor for malnutrition among community-dwelling elders.

Associations of instrumental activities of daily living and handgrip strength with oral self‐care among home‐dwelling elderly 75+

OBJECTIVE To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self-care among dentate home-dwelling elderly people in Finland. MATERIALS AND METHODS The study analysed data for 168 dentate participants (mean age 80.6 years) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004-2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry. RESULTS Study participants with high IADL (scores 7-8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1-6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8-5.2) and for having good oral hygiene of 2.8 (CI 1.0-8.3) when compared with participants with low IADL (scores ≤6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4-1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4-1.8) and for good oral hygiene of 1.1 (CI 0.5-2.4) in comparison with the study subjects in the lowest tertile of handgrip strength. CONCLUSION The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self-care among the home-dwelling elderly.

Determinants for preventive oral health care need among community-dwelling older people: a population-based study.

The aim was to study the determinants of preventive oral health care need among community-dwelling old people. The study population consisted of 165 participants, a subpopulation in the Geriatric Multidisciplinary Strategy for Good Care of Elderly People (GeMS) study. Fifty-five percent of the edentate participants with full dentures and 82% of the dentate had a need for preventive oral health care. In the total study population, the need for preventive care was associated with co-morbidity (measured by means of the Modified Functional Co-morbidity Index) odds ratios (OR) 1.2 (confidence intervals [CI] 1.0-1.5), being pre-frail or frail, OR 2.5 (CI 1.2-5.1), presence of natural teeth, OR 4.8 (CI 2.2-10.4), and among dentate participants, the use of a removable partial denture, OR 12.8 (CI 1.4-114.4). Primary care clinicians should be aware of the high need for preventive care and the importance of nonoral conditions as determinants of preventive oral health care need.

Sedative load and salivary secretion and xerostomia in community-dwelling older people

OBJECTIVE The aim was to investigate how sedative load and the total number of drugs used are related to hyposalivation and xerostomia among 75-year-old or older dentate, non-smoking, community-dwelling people. MATERIALS AND METHODS The study population consisted of 152 older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations during 2004-2005. Sedative load, which measures the cumulative effect of taking multiple drugs with sedative properties, was calculated using the Sedative Load Model. RESULTS The results showed that participants with a sedative load of either 1-2 or ≥3 had an increased likelihood of having low stimulated salivary flow (<0.7 ml/min; OR: 2.4; CI: 0.6-8.6 and OR: 11; CI: 2.2-59; respectively) and low unstimulated salivary flow (<0.1 ml/min; OR: 2.7, CI: 1.0-7.4 and OR: 4.5, CI: 1.0-20, respectively) compared with participants without a sedative load. Participants with a sedative load ≥3 had an increased likelihood of having xerostomia (OR: 2.5, CI: 0.5-12) compared with participants without a sedative load. The results showed that the association between the total number of drugs and hyposalivation was weaker than the association between sedative load and hyposalivation. CONCLUSION Sedative load is strongly related to hyposalivation and to a lesser extent with xerostomia. The adverse effects of drugs on saliva secretion are specifically related to drugs with sedative properties.