Renato José De Marchi

Association between oral health status and nutritional status in south Brazilian independent-living older people.

OBJECTIVE Evidence suggests that older people with partial tooth loss and edentulism change their diet and lack specific nutrients, but few studies have assessed whether poor oral status is associated with risk of malnutrition and malnutrition in independent-living older people. We evaluated if poor oral status was associated with risk of malnutrition and malnutrition in this population. METHODS A random sample of 471 south Brazilians > or =60 y of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behavioral, general, and oral health data; nutritional status assessment, according to the Mini-Nutritional Assessment (MNA); and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prostheses. Correlates of risk of malnutrition/malnutrition according to the MNA were assessed by means of multivariate logistic regression. RESULTS Participants who reported dissatisfaction with their gingival health and edentulous persons wearing only one denture were more likely to be at risk of malnutrition, according to the screening MNA. Dissatisfaction with gingival health was a risk indicator, whereas having one to eight natural teeth was protective against the risk of malnutrition/malnutrition according to the full MNA. CONCLUSION In the present study, older people with a compromised oral status had higher odds for risk of malnutrition. The maintenance of a few teeth had a crucial role in increasing the chance of maintaining an adequate nutritional status in the studied population. In cases where edentulism was present, complete dental prosthetic use was associated with better nutritional status.

Resilience and Self-Perceived Oral Health: A Hierarchical Approach

OBJECTIVES: To determine whether positive self‐perceived oral health is associated with sociodemographic health variables, with an emphasis on resilience, in community‐dwelling older adults in southern Brazil.

Four-year incidence and predictors of tooth loss among older adults in a southern Brazilian city

BACKGROUND Tooth loss is still prevalent among older adults and may negatively affect their health and well-being. Previous evidence has shown that oral disease-related factors are the more consistent predictors of tooth loss. Although certain models have considered oral health behaviour as a key construct in explaining oral health inequalities, others have favoured the role of social structure and the social environment in determining oral health outcomes. OBJECTIVE To determine the tooth loss incidence and its predictors among community-living older adults in a southern Brazilian city. METHODS A cohort study was conducted using a simple random sample of 388 older people evaluated in 2004. The follow-up was carried out during 2008, with 273 older persons examined. Interviews and oral examinations were conducted. The incidence of tooth loss was modelled through a conceptual framework with the use of negative binomial regression. RESULTS Some 67.8% of people lost one or more teeth, whereas 12.5% became edentulous during the follow-up period. In the multivariate model that controlled for baseline predictors, older age; male gender; living in a rural area; being married; less schooling; current smoking; and dissatisfaction with the access to health services were associated with tooth loss. Among the clinical variables, the use of partial dentures and gingival bleeding index were predictors, whereas higher saliva flow rate was a protective factor for the outcome. DISCUSSION As proposed in the conceptual framework, demographic factors; primary determinants of health; behavioural; and clinical variables were predictors of tooth loss. These results are important, because understanding the causal association between lifestyle practices such as oral hygiene or smoking with tooth loss does not elucidate why individuals and communities engage in such practices. CONCLUSION Interventions aiming to reduce tooth loss and edentulism in the elderly should account for social and environmental factors, in combination with clinical and behavioural components.

Vulnerability and the Psychosocial Aspects of Tooth Loss in Old Age: A Southern Brazilian Study

Extensive tooth loss and edentulism can have a negative impact on the general health and quality of life of older adults. The extent to which psychological and social factors affect an individual’s decision to undergo tooth extraction and mouth clearance (extraction of all teeth), and the theoretical relationships between social structure, social life and oral health can be unraveled through qualitative research. This study aimed to explore the social and psychological factors involved in tooth extraction and mouth clearance within a historical perspective among rural Southern Brazilian older adults. It is based on qualitative data gathered via a series of eight focus groups among 41 older adults. Underlying the focus group discussions of different levels of health risks and resources for prevention of disease was the concept of vulnerability. Participants’ responses illustrated that tooth loss and mouth clearance were related to a lack of public dental health policies and programs, were influenced by social norms (including values pertaining to gender), and were associated with a low level of oral health knowledge. The social and program-dependent contexts of vulnerability were shown to have played a major role in the development of norms and values towards tooth extraction and mouth clearance. Vulnerability must be reduced in order to prevent disease particularly among rural populations. The influence of fatalistic beliefs about the inevitable loss of teeth with age may negatively influence the acceptance of dental treatment and predilection for oral health self-care.

Association between number of teeth, edentulism and use of dentures with percentage body fat in south Brazilian community-dwelling older people.

OBJECTIVE To evaluate if poor oral status was associated with percentage body fat in a representative sample of south Brazilian community-dwelling elderly. BACKGROUND Evidence suggests that elders with extensive tooth loss and edentulism present with compromised chewing function, which results in dietary changes. However, few studies have assessed whether poor oral status is associated with percentage body fat in community-dwelling elderly. MATERIALS AND METHODS A random sample of 471 south Brazilians =>60 years of age was evaluated. Measurements included a questionnaire to assess socio-demographic, behavioural, general, and oral health data. Percentage body fat was measured with a Tanita TBF 612 digital scale, which measures foot-to-foot bioelectrical impedance; and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prostheses. Correlates of risk of inadequate percentage body fat were assessed by means of multinomial logistic regression. RESULTS Edentulous participants were more likely to be underfat [OR: 3.11 (1.27-7.61)] or overfat/obese [OR: 1.82 (1.05-3.16)]. CONCLUSION The present study shows that edentulous older people had higher odds for inadequate percentage body fat. The maintenance of teeth had a crucial role in increasing the chance of having an adequate body fat percentage in the study population.

Assessing changes in oral health-related quality of life and its factors in community-dwelling older Brazilians.

OBJECTIVE To describe changes in oral health-related quality of life and to evaluate the associations of these changes in community-dwelling older people. MATERIALS AND METHODS In this longitudinal study a representative sample of 872 older people, living in Brazil, was evaluated during 2004. The follow-up was carried out during 2008, with 587 older persons evaluated. A questionnaire assessing socio-demographic information, health history, oral health-impact profile and number of natural teeth was used. Changes in oral health-related quality of life were categorized as improvement or deterioration. Data analysis was performed using a hierarchical approach based in a conceptual framework. A hierarchal approach was carried out using Poisson regressions. RESULTS Older persons living in rural areas, those who reported brushing once a day or less and older persons with fewer natural teeth had an increased chance of reporting deterioration in oral health-related quality of life. Women and participants who received a minimum wage of less than US

The prevalence of elder abuse in the Porto Alegre metropolitan area

219.50 were more likely to report improvement in oral health-related quality of life. CONCLUSION The results of this study suggest that changes in the oral health-related quality of life are influenced by many of the variables that were included in the conceptual framework.

Incidence and predictors of edentulism among south Brazilian older adults

Abuse of the elderly is a form of violence to come to the publics attention. Dental professionals are in an ideal position to identify physical abuse. The aim of this study was to assess the prevalence of elderly abuse and analyze the database of injury reports that can be identified by dental teams. A documentary analysis study developed by the Elderly Protection Police Station of Porto Alegre, Rio Grande do Sul, was carried out. The information used came from 2,304 complaints filed at the aforementioned institution between the years of 2004 and 2006. The records of abuse are categorized as injury, neglect, mistreatment, theft, financial abuse, threat, disturbing the peace, atypical fact, and others. The injuries that could be identified by the dental team were classified according to the injurys location in the area of the head, face, mouth and neck. Descriptive analysis was performed, and chi-square tests were used to evaluate the distributions of the types of elder abuse in relation to sex and age. The most frequent of the different types of abuse was theft, with a prevalence of 17.8%, followed by disturbing the peace at 11.8%. Disturbing the peace, threat, and bodily injury were significantly associated with women. Elder abuse among women and men declines with age. The prevalence of head injury was 25% of the total injuries, most often in females, and in those aged < 70 years. Based on these results, it is necessary that the dental team observe the elderly persons appearance for suspicious physical signs.

Oral health care for the ageing population in Brazil: Trends and potentials in the public health system

OBJECTIVE To identify socioeconomic, demographic, behavioural and clinical predictors of the 8-year incidence of edentulism in south Brazilian older adults. METHODS Cohort of a representative sample of older persons in Carlos Barbosa, a south Brazil city. A cohort study was conducted using a simple random sample of 392 older people evaluated in 2004, with follow-ups in 2008 and 2012, when 199 participants were evaluated. Interviews and oral examinations were conducted. The baseline assessment was carried out in 2004, with follow-ups in 2008 and 2012. To evaluate the predictors of edentulism, Poisson regression models with robust variance were carried out. The outcome was modelled through the use of a hierarchical approach based on the conceptual framework proposed by Andersen and Davidson. RESULTS Some 11.5% of the participants had become edentulous after 8 years. Higher income, use of partial removable dentures and low salivary flow were associated with the incidence of edentulism. CONCLUSIONS Maintaining a good salivary function may be essential for the prevention of the incidence of edentulism in this age group. Furthermore, our findings suggest that rehabilitations with partial removable dentures may be detrimental to long-term oral health.

Four‐year incidence and predictors of coronal caries in south Brazilian elderly

© 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd The national public health system of Brazil (Sistema Único de Saúde or SUS) is based on the principles of integrating health promotion, protection and rehabilitation for everyone.1 It offers primary, secondary and tertiary care, including oral health care at each level. The family health strategy (FHS), as a means of delivering care, was introduced in 2011 to administer multidisciplinary teams of physicians, nurses, auxiliary nurses, community health workers and occasionally dentists. The teams are organised geographically to cover populations of up to 1000 households each focused on communitybased care with domiciliary visits.1 Through this strategy almost 100 million Brazilians (~50% of population) of all age groups get dental care annually with a high level of satisfaction.2,3 Geriatric dentistry became a speciality recognised by the Brazilian Dental Council in 2001 and, in 2016, there were 271 registered dental geriatricians. In 2016, there were more than 279 000 general dentists in Brazil, mostly working in private practice, and in the heavily populated South and Southeast regions.4 On the other hand, the Sistema Único de Saúde also has dental specialist (prosthodontists, oral/maxillofacial surgeons, endodontists, periodontists, oral medicine and stomatologists) that provide services at the second and tertiary level of care. However, there are only 34 dental geriatricians working for the public system, whereas presumably the other 237 geriatricians work in private practice. Therefore, most of the population has to look for a dentist on a private service in order to get specialised treatment, and it can be expensive especially for people with low incomes. Brazil has Telessaúde, a telehealth programme offering webbased consultations and education for all primary care professionals in Brazil.4 Dentists appreciate this service (satisfaction rate is about 95%) for the advice it provides, which is predominantly now on pharmacological interactions, oral pathology and temporomandibular joint problems. It is a popular service administered by the SUS because patients are saved the time, travel and costs associated with referrals to second and third levels of care at major centres, and physicians and dentists can consult quickly and directly with specialists.5 Unfortunately, the telehealth programme does not yet include dental geriatricians. The 34 specialists in dental geriatrics on the FHS teams work solely in primary care clinics. In summary, Brazil has only a few dentists with special training in dental geriatrics to manage the oral health care of older people. But at least the specialty of dental geriatrics is a recognised specialty in the country. Unfortunately, the skewed distribution of dentists restricts the services accessible to most of the older people across the country. A new dental curriculum proposed in 2002 for the 220 dental schools in Brazil aims to produce dentists with an effective balance of technical and social competencies for the needs of an ageing population.6 We suggest that it should prepare new graduates to use Telessaúde as an effective way to communicate and consult with the dental geriatricians and other specialists, presuming, of course that dental geriatricians are part of the telehealth programme. This, we believe, will place Brazil at the forefront of dental geriatrics globally, and provide guidance to other countries with similar social and geographical challenges.