L. De Visschere

Sociodemographic Determinants for Oral Health Risk Profiles

The present study aimed to explore the association between caries risk profiles and different sociodemographic factors . The study sample (n = 104) was randomly selected within an urban population in Flanders, Belgium. Caries risk was assessed by anamnesis, clinical examination, salivary tests, and a questionnaire. Age, gender, and socio-economic status were extracted from social insurance data files. Social indicators were “occupational status,” “being entitled to the increased allowance for health care interventions” and having access to the “Maximum Bill” (MAF), initiatives undertaken to protect deprived families. In the bivariate analysis there were significant differences in risk profiles between occupational groups (P < .001), between entitled and non-entitled individuals to the increased allowance (P = .02), and between access or no-access to the MAF (P < .01). The multiple logistic model showed a significantly higher chance of being in the low risk group for individuals with no-access to the MAF compared to those with access (OR:14.33–95% C.I. 2.14–95.84).

[The guideline Oral Health Care for dependent residents in long term care facilities, 2007: dire necessity!]

The guideline Oral health care for dependent residents in long term care facilities, 2007 : dire necessity!The oral health status of residents in Dutch nursing homes is rather poor, especially of those depending on caregivers for their oral health care. Moreover, when care dependency is rising, the provision of good oral health care becomes more difficult. With more elderly people still having (parts of) their natural teeth, the need for good oral health care is increasing even more.Therefore a specific guideline was developed. The ultimate aim of the guideline “Oral health care for dependent residents in long term care facilities” is to improve the oral health of nursing home residents. Oral health care needs to be incorporated in daily nursing home care routine and in the integral care plan of every resident. Attention is given to the importance of an adequate implementation of this guideline as well as to the necessity of research evaluating the effects of it’s implementation.SamenvattingHet is aangetoond dat de mondgezondheid van ouderen in Nederlandse verpleeghuizen vaak slecht is, vooral bij degenen die voor hun mondzorg afhankelijk zijn van anderen. Bij toenemende zorgzwaarte wordt het bovendien steeds moeilijker passende mondzorg te verlenen. Daarbij neemt de noodzaak van goede mondzorg nog eens extra toe doordat steeds meer ouderen over (een deel van) hun natuurlijke gebit blijven beschikken. Dit was de aanleiding om een Richtlijn Mondzorg te ontwikkelen. Het uiteindelijke doel van de in 2007 verschenen Richtlijn Mondzorg voor zorgafhankelijke cliënten in verpleeghuizen is de mondgezondheid van ouderen in verpleeghuizen te bevorderen. De mondzorg dient onderdeel te zijn van de dagelijkse zorg in verpleeghuizen en als zodanig te zijn opgenomen in het zorgplan van elke cliënt. Het belang van een goede implementatie en van nader onderzoek naar de effecten van de richtlijn op cliënt- en instellingsniveau worden onderstreept.

Risk of aspiration in care home residents and associated factors.

Pneumonia is a prevalent cause of death in care home residents. Dysphagia is a significant risk factor of aspiration pneumonia. The purpose of the current study was to screen for risk of aspiration in care home residents in the Netherlands and assess potential risk factors of aspiration. Five experienced speech-language therapists assessed 203 care home residents (115 primarily physically disabled, 88 primarily cognitively impaired) 60 and older in the first week after admission to a care home. In 43 (21.2%) residents, speech-language therapists assessed risk of aspiration and found no significant difference between physically disabled (26.1%) and cognitively impaired (14.8%) residents. After multivariate logistic regression analysis, the final prediction model for risk of aspiration showed Parkinsons disease as a significant factor (odds ratio = 5.11; 95% confidence interval [1.49, 17.52]) . The authors therefore conclude that risk of aspiration is a relevant care problem among Dutch care home residents and requires further assessment.

A pilot assessment tool of the need for oral health care and cost prediction in institutionalized elderly people.

OBJECTIVE To assess the dental treatment backlog and associated costs among institutionalized elderly people using a novel composite index, called the oral health index. BACKGROUND Despite numerous reports about oral health of old individuals, there is still lack of a systematic and practical method to estimate their treatment need covering all relevant aspects of oral health. In addition, little has been published on associated treatment costs and prediction of such costs. MATERIALS AND METHODS An observational study was performed on 143 dentate institutionalized elderly people, whereby several clinical parameters were registered. The collected data were included in the oral health index representing the need for oral health care. This covered the number of caries lesions, number of residual roots, periodontal health condition, plaque score and denture condition with a final score of 0-9. To investigate the validity of the index, the treatment costs were estimated using the measured clinical parameters and later compared with the actual expenditure of the patients for the following 2 years. RESULTS The average score of the index was 4.6 (SD 1.4) with 65.1% of the individuals having a score between 3 and 6 and 27.3% having a score of 6 and more, exhibiting medium and high need for oral health care, respectively. Only 30% of the patients underwent all the indicated treatments. The major reason of non-completion of the treatment was patients refusal. From the fully treated group, 61.5% of the subjects actually spent within the predicted range while 38.5% of them spent more than estimated. The underestimation was related to yearly calculus removals leading to repeated calculation of the same costs and newly emerging dental problems (33% developed new caries and 20% was confronted with tooth fracture within the 2-year period). CONCLUSION The novel index can be helpful to determine oral treatment needs and associated costs. Further research is needed to extend the clinical applicability of the index.

Tabaksgebruik en mondgezondheid (tobacco)

Er bestaan verschillende vormen van tabaksgebruik, waarvan ‘het roken van sigaretten’ het meest verspreid is. In Belgie rookt bijna een op vier. Er is een sociale gradient waarneembaar, waarbij de hoogst opgeleiden minder roken in vergelijking met de laagst opgeleiden. Het gebruik van tabak in welke vorm ook is de belangrijkste te vermijden doodsoorzaak, met longkanker als de belangrijkste aandoening. Daarom dient elke deugdelijke algemeen tandarts tabaksgebruik standaard op te nemen in de anamnese van elke patient. Het inwinnen van informatie omtrent het gedrag is belangrijk om samen met andere zorgverleners bij de patient en zijn omgeving aan gezondheidspromotie te doen in een gemeenschappelijke risicobenadering. Zo wordt in Belgie rookstopbegeleiding georganiseerd door (huis)artsen en erkende tabacologen of rookstopconsulenten. Daarnaast moet er door de zorgverleners regionaal en internationaal blijvend samengewerkt worden om de bevolking zo breed mogelijk voor te lichten over de schadelijke gevolgen van tabaksgebruik.