Thomas Reiber

Dental care of frail older people and those caring for them

AIMS AND OBJECTIVES To describe oral health utilisation patterns of frail older people and contrast these with attitudes and utilisation patterns of nursing staff who are caring for them. BACKGROUND In view of widespread poor oral health of frail older people in long-term care, staff attitudes have been identified as an area of interest. In addition to data on attitudes, the current study contributes a description of aspects of oral health related behaviour of staff and clients. DESIGN Cross-sectional study. METHODS Structured interviews of a random selection of long-term care staff (n=320) and frail older people (n=172), within the two groups of home-care services (HCS) and long-term care facilities (LTCF). RESULTS Of staff members, 55·3% attach the same importance to their own oral health compared to that of clients and 35·7% regard their own oral health as more important; 98·4% of staff attended two or more dental examinations per year; 3·4% of HCS and 37·1% of LTCF routinely arranged oral examinations. In 81·4% HCS and in 34·4% of LTCF, there was no routine dental service available. Patterns of oral health service attendance greatly differ between staff and clients. CONCLUSION The oral health awareness of the majority of long-term care staff did not translate into adequate oral health care for clients. A gap exists between attitudes supportive of oral health, adequate and prevention driven own oral health related behaviour of staff and actual oral health care delivered to clients. RELEVANCE TO CLINICAL PRACTICE To bridge the gap identified, a concept is suggested for nursing educators and managers of LTCF targeting educational measures while taking into account individual attitudes.

Häufigkeit, Bedeutung und Behandlungsbedarf kraniomandibulärer Dysfunktionen (CMD)

Epidemiologische Daten zu kraniomandibularen Dysfunktionen (CMD), d. h. Kiefergelenkgeräusche, Schmerzen in der Kaumuskulatur und im Kiefergelenk, Einschränkungen der Unterkieferbeweglichkeit, welche die Häufigkeit und Bedeutung sowie den hieraus resultierenden Behandlungsbedarfcharakterisieren, fehlen bisher in Deutschland. Die vorliegende Arbeit fasst ein lokales, ein regionales und ein nationales Forschungsprojekt mit einheitlichem Studiendesign zu einer Gesamtbeschreibung für Funktionsstörungen des Kausystems über den gesamten Altersbereich von Kindern bis zu Senioren zusammen. Studienkonzept und Umfang der Untersuchungen (4917 Probanden) lassen eine Verallgemeinerung der Ergebnisse für Deutschland zu.Anamnestisch traten Symptôme bei 25% der Kinder/Jugendlichen, 33% der Erwachsenen im arbeitsfähigen Alter und bei 16% der Senioren auf Klinische Symptome zum Zeitpunkt der Untersuchung waren häufiger (Kinder/Jugendliche: 45%, Erwachsene: 68%, Senioren: 59%). Orofaziale Schmerzen, die Kernsymptome für CMD, waren bei 10% der Erwachsenen vorhanden. Sie waren mitpsychologischer Beeinträchtigung (Depression, Somatisierung, Angst) und Funktionseinschränkungen des Kausystems, aber auch Verminderung allgemeiner Aktivitäten (Arbeit, soziale Kontakte zu anderen, Erholung) verbunden. Der aktuelle subjektive Behandlungsbedarfreichte von 3 bis 6% mit wesentlichem Schwerpunkt in der mittleren Erwachsenengruppe. Diese Patienten wurden in der überwiegenden Mehrzahl von Zahnärzten betreut, weniger von Fachärzten der Hals-Nasen-Ohrenheilkunde, Neurologic PsychiatricAbstractThe prevalence and treatment demand ofTMD are unknown in Germany due to a lack of supporting epidemiological data. The results of three population-based studies characterizing TMD in 4917 children/adolescents (10–11 years and 15–16years old), adults (20–60 years old) and seniors (65–74 years old) are presented. Subjects were examined according to the Research Diagnostic Criteria for Temporomandibidar Disorders. This diagnostic system contains physical findings from a clinical examination of the temporomandibular joints and the masticatory muscles and psychological questions about depression and somatization as well as pain related disability. Subjective TMD symptoms from the questionnaire were reported by 25% of the children/adolescents, 33% of the adults and 16% of the seniors, with orofacial pain being the most important symptom (10% one month period prevalence for all adults). TMD signs were more prevalent from the clinical examination (children/adolescents: 45%, adults: 68%, seniors: 59%). Orofacial pain was associated with a remarkably elevated depression, somatization and anxiety, and jaw disability. Usual activities at work, school, or housework and the ability to take part in recreational, social and family activities were also restricted in subjects which orofacial pain. Subjective treatment need (demand) was between 3 and 6% depending on the age group. The highest demand was observed in adults. As for the prevalence of orofacial pain, women expressed a higher demand compared to men. Most of the health care for TMD was delivered by dentists. General practitioners or specialized physicians were involved in TMD care to a much lower degree. For the first time, epidemiological data about prevalence, severity, and treatment demand of temporomandibular disorders especially orofacial pain are presented for Germany. The use of international diagnostic TMD criteria in population-based studies with an uniform research design showed an orofacial pain prevalence which is comparable with international studies, especially US-American. Based on these findings, an inclusion of basic TMD-diagnostics in routine dental evaluations and treatment is recommended. Inclusion of first psychological diagnostic is recommended for patients with persistent orofacial pain.

Zähneputzen – aber richtig

Zahn-, Mund- und Prothesenpflege - Immer mehr alte Menschen pflegen und erhalten ihre eigenen Zähne ein Leben lang. Damit ist die Pflege vermehrt gefordert, die Mund- und Zahngesundheit auch bei funktionell eingeschränkten Bewohnern zu gewährleisten. Mit gesunder Ernährung, einer exzellenten Mundhygiene und der regelmäßigen Zufuhr von Fluoriden ist dieses Ziel erreichbar.