Gunhild Vesterhus Strand

Psychometric properties and the prevalence, intensity and causes of oral impacts on daily performance (OIDP) in a population of older Tanzanians

BackgroundThe objective was to study whether a Kiswahili version of the OIDP (Oral Impacts on Daily Performance) inventory was valid and reliable for use in a population of older adults in urban and rural areas of Tanzania; and to assess the area specific prevalence, intensity and perceived causes of OIDP.MethodA cross-sectional survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. A two-stage stratified cluster sample design was utilized. Information became available for 511 urban and 520 rural subjects (mean age 62.9 years) who were interviewed and participated in a full mouth clinical examination in their own homes.ResultsThe Kiswahili version of the weighted OIDP inventory preserved the overall concept of the original English version. Cronbachs alpha was 0.83 and 0.90 in urban and rural areas, respectively, and the OIDP inventory varied systematically in the expected direction with self-reported oral health measures. The respective prevalence of oral impacts was 51.2% and 62.1% in urban and rural areas. Problems with eating was the performance reported most frequently (42.5% in urban, 55.1% in rural) followed by cleaning teeth (18.2% in urban, 30.6% in rural). More than half of the urban and rural residents with impacts had very little, little and moderate impact intensity. The most frequently reported causes of impacts were toothache and loose teeth.ConclusionThe Kiswahili OIDP inventory had acceptable psychometric properties among non-institutionalized adults 50 years and above in Tanzania. The impacts affecting their performances were relatively common but not very severe.

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.

Clinical and socio-behavioral correlates of tooth loss: a study of older adults in Tanzania

BackgroundFocusing 50 year olds and above, this study assessed the frequency, extent and correlates of tooth loss due to various reasons. Frequency and correlates of posterior occluding support was also investigated.MethodA cross-sectional household survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. One thousand and thirty-one subjects, mean age 62.9 years participated in a clinical examination and completed interviews.ResultsThe prevalence of tooth loss due to any reason was 83.5 %, due to caries 63.4% and due to other reasons than caries, 32.5%. A total of 74.9% had reduced number of posterior occluding units. Compared to subjects having less than 5 teeth lost due to caries, those with 5 or more lost teeth were more likely to be females, having decayed teeth, confirming dental attendance and to be among the least poor residents. Compared to subjects who had lost less than 5 teeth due to reasons other than caries, those who had lost 5 or more teeth were more likely to be of higher age, having mobile teeth, being males, being very poor and to disconfirm dental attendance when having problems. Predictors of prevalence of tooth loss (1 or more lost tooth) due to various reasons and reduced number of occluding units followed similar patterns of relationships.ConclusionThe results are consistent with prevalence and extent of tooth loss due to caries and due to reasons other than caries being differently related to disease- and socio- behavioral risk indicators. Caries was the principle cause of tooth loss and molar teeth were the teeth most commonly lost.

Long-term effect of an oral healthcare programme on oral hygiene in a nursing home

This article reports on the long-term effect of an oral healthcare programme aimed at improving and maintaining the oral hygiene of elderly residents in a nursing home. The method was based on (i) motivation and oral-care training of the nursing staff, (ii) production of picture-based oral-care procedure cards, (iii) distribution of adequate oral-care equipment, (iv) practical implementation of new routines, and (v) assessment of results attained. The level of oral hygiene in the nursing home was assessed using the mucosal-plaque score (MPS) index. Overall evaluation was made before the start of the study, after 3 months, and eventually after 6 yr. Before implementation of the oral healthcare programme, 36% of the residents had an acceptable score. Six years later, the proportion was 70%. The evaluation showed that the introduction of such an oral healthcare programme significantly improved the oral hygiene of the residents on a long-term basis. However, 30% of the residents did not achieve an acceptable score because they were very ill or dying, aggressive or wanted to brush their teeth themselves.

The efficiency of cleaning fissures with an air-polishing instrument

It is important to remove organic material before sealing fissures. The aim of this study was to evaluate the cleansing effect of an air-polishing instrument (Prophy Unit, 2000 Satelec). Nine pairs of newly erupted premolars were treated. One of the teeth was randomly selected for air-polishing; the contralateral one was cleaned with a rubber cup and a standardized solution of pumice. The teeth were immediately extracted and later photographed in a scanning electron microscope. The photos were mounted together, forming one large picture of each fissure. These pictures were split into pairs of contralateral sections, 22 pairs altogether. Three independent observers gave a score to the cleanest section within each pair. This evaluation was repeated after 7 weeks. The air-polished sections obtained 126.5 of 132 possible scores, whereas pumice was given only 5.5 (P = 0.0039). It is concluded that air-polishing is an effective pretreatment for fissure sealing of newly erupted teeth.

Caries increment and prediction from 12 to 18 years of age: A follow-up study

Aim: This was to determine the increment of caries from 12 to 18 years of age and to explore the possibility of predicting caries increment in this period based on the caries experience at age12 years. Study design: Prospective longitudinal survey. Methods: A sample of 12-year-old children (n =159) were examined in 1993 and 70% of them re-examined at 18 years of age. Bitewing radiographs were taken and a diagnostic system using five caries grades (D1−D5) was used at both ages. Children at risk were defined as those who developed manifest caries lesions (D3−5FS) on approximal surfaces during the follow-up period. Possible predictors were analysed by calculation of sensitivity, specificity, and actual proportion of the population at risk. Results: The mean caries increment (D1−5MFS) from 12 to 18 years of age was 4.2 (SD±9.1). The percentage of caries-free adolescents at 12 and 18 years of age was 10% and 1% respectively; 25% had either a reversal or no increment in caries experience while the D1−5MFS increased in 65% of the adolescents. Of the increment of manifest lesions (D3−5FS), 18% were located in incisors/canines, 40% in premolars, 26% in first molars and 16% in second molars. Premolars had the largest proportion of the approximal surfaces with manifest caries increment. The best predictors of children at risk of approximal caries increment (D3−5FS) were caries experience (D1−5FS) on the approximal surfaces of premolars and second molars at the age of 12 years. The individuals that developed four or more manifest lesions on approximal surfaces between 12 and 18 years were the easiest to predict (sensitivity + specificity = 175%). Conclusions: There was a considerable increment of manifest caries lesions from 12 to 18 years of age in all tooth groups. The best predictors for increment of manifest caries on approximal surfaces during the age period were approximal caries in premolars and second molars at the age of 12 years.

Oral care training in the basic education of care professionals

OBJECTIVE To investigate the quantity and quality of oral care training in the basic education of future long-term care (LTC) professionals in Norway. BACKGROUND The level of oral hygiene has often proved inadequate in LTC facilities. It has been maintained that this could be due to insufficient knowledge of oral care among care professionals. MATERIALS AND METHODS A self-administered questionnaire was sent to all 270 schools in Norway which offered basic education of LTC personnel in 2004/05. Information on theoretical and practical oral care training, scope of oral care in teaching material and curriculum, educational background of the teaching staff and schools opinion regarding adequacy of their training programme was collected. RESULTS Of the 203 respondents (75% response rate), 188 (participants) included oral care in their educational programme. Approximately two-thirds of the participating schools provided 3 h or more of oral care training and many of the important themes were presented in the textbooks that were recommended. Moreover, the practical exercises performed in practice placement supplemented the knowledge. CONCLUSION The results could not confirm that LTC professionals basic education concerning oral care was inadequate. There may therefore be other explanations for the poor oral hygiene in many LTC facilities.

Marginal ridge strength of tunnel-prepared teeth restored with various adhesive filling materials

This study evaluated the load required to fracture the marginal ridge of tunnel-filled teeth restored with various adhesive filling materials. Five test groups, each consisting of 20 extracted maxillary premolars, were filled with either composite resin or a conventional, a cermet, or two brands of resin-modified glass ionomer (polyalkenoat) cements. The tunnels were prepared with the occlusal access placed in the mesial fossa, leaving a relatively thin approximal wall. The teeth were subjected to incremental dynamic forces. A maximum absorbed energy index, quantifying the fracture resistance of the teeth, showed no statistically significant differences between the test groups with regard to marginal ridge strength, even though the elastic moduli of the materials varied. None of the adhesive materials restored the teeth to the strength of sound teeth.