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This paper reports on the accuracy of tooth counts conducted in 22 subjects by 10 trained nurses as part of a large longitudinal study of a pharmacological agent. These nurses participated in a training course consisting of seminars, discussion, demonstrations, and practice examinations. Each of the nurses then counted the teeth of 22 subjects and recorded their findings independently. The counts of the nurses were compared with those of the dentists to assess the accuracy of the nurses' counts. We found that nurses and dentists were in perfect agreement for 86% of the patient counts conducted. Individual nurses' levels of agreement with dentists ranged from 73% to 100%, with pairwise kappa statistic values ranging from 0.70 to 1.00. In addition, both Pearson correlation and interclass correlation measures exceeded 0.98 for every comparison of dentist and nurse counts. The results of this study suggest that training nondental health care workers may be an accurate and low-cost way of obtaining tooth loss data and other oral health measures, particularly when oral health data are collected as part of larger, multi-disciplinary studies.

This investigation used retrospective methodology to examine the outcomes of previous dental treatment and the incidence of developing restorative and extraction needs, including dental caries, among nursing facility residents. Data were taken from treatment records of 48 dentate residents in 10 nursing facilities who received comprehensive dental treatment delivered through the Geriatric Mobile Unit (GMU) program operated by the University of Iowa College of Dentistry and were examined an average of 2.9 years after initial examination. Residents had a mean age of 84 years at the second exam, and 90% were female. About 18% of all previously placed restorations needed to be replaced, and an additional 11% of teeth that received a restoration needed to be extracted at follow-up. At follow-up, nearly 70% (33/48) of residents needed restorative care, while 44% (21/48) needed extractions. The mean incidence of teeth developing new treatment needs between the two visits was 2.7 teeth/person (14.9% of teeth) for restorative need and 1.1 teeth/person (6.6% of teeth) for extraction need. Results suggest that successful treatment outcomes can be achieved for nursing facility residents, but that dental disease and treatment needs develop at a high rate among these residents.

Several studies have reported the prevalence of medical conditions or investigated the relationships between the oral health status and general health conditions in the elderly. However, the relationship between medical conditions and oral health among the elderly is not well-described. Previous studies have not clearly identified a consistent association between medical conditions and oral health, specifically edentulism and tooth loss. The purpose of this study was to investigate the relationships between medical conditions and oral health, as assessed by edentulism and missing teeth, in an institutionalized elderly population. A systematic sample (n = 175), stratified by age and sex, was drawn from nursing home patients treated by the University of low' as Geriatric Mobile Unit (GMU) team. Data were extracted from GMU dental records, regarding history of medical conditions, medications, dental history, dentate status, and tooth-by-tooth conditions. Mean numbers of missing teeth were significantly higher among those who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease. Subjects who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease were more likely to be edentulous than subjects who did not have a history of those diseases. The biological basis for these relationships between dentate status and systemic medical conditions is unclear and warrants further study.

Little is known about oral health care behaviors of community-dwelling, cognitively impaired elderly (CIE) persons. Few studies have been conducted regarding the actual provision of oral care for CIE persons or the attitudes and concerns about oral health among their caregivers. The CIE person's ability to perform self-care decreases over time, and the role of the caregiver in daily oral care becomes increasingly important. The purpose of this pilot study was to explore the attitudes toward oral health and identify related concerns among caregivers who care for community-dwelling CIE persons. Caregivers were surveyed by means of a self-administered, mailed questionnaire. To maintain confidentiality, an intermediary was used for recruitment and data collection. Overall, 148 caregivers were invited by an intermediary to participate in the survey; only 21 (14%) consented to participate and returned the questionnaire. This paper discusses some of the numerous methodological challenges identified when an attempt was made to survey care-givers' attitudes toward and barriers to providing oral care for a dependent CIE.

This study of 230 hospital geriatric clinic patients compared the oral health of individuals with dementias with that of persons with no dementing illnesses. Data collected included dental examinations, subject questionnaires and review of hospital records. There were few differences among groups of patients based on categorization into groups of those diagnosed with (1) no dementia, (2) dementia of the Alzheimer's type, and (3) other dementias. However, there were significant differences based on degree of cognitive impairment regardless of dementia diagnosis. Those with severe dementia had poorer gingival health and oral hygiene, but better self-perceived mouth health. There are numerous limitations and inherent difficulties in studies involving persons with dementia, and overcoming these in the future will likely require long-term, interdisciplinary approaches.

Nurses' aides provide the majority of direct care for nursing facility residents. This study investigated aides' self-reported oral care activities and personal, job, organizational, and resident factors associated with oral care. A 30-item questionnaire was completed by 488 aides, and interviews were conducted with 65 of these aides. Aides were performing oral care activities for residents. Associations between some of the four groups of factors proposed and aides' oral care provision were found. Aides' attitudes toward oral care, lack of time and staff to complete oral care, and behavioral and physical difficulties with residents may have affected the time spent by these aides in providing oral care. The study highlighted the need for further investigation and assessment of (1) aides' CNA training courses and (2) continuing oral health educational interventions in nursing facilities. Personal interview were found to be a useful qualitative instrument for conducting dental research in nursing facilities. Further investigation is needed of interviews and other methodologies, such as observation, to supplement self-report as a measure of aides' oral care activities.

This paper reports the results of a study that investigated changes in the medical and functional status of nursing facility residents over a 2.9 year period. Sixty-seven residents from 10 nursing facilities were included in the study, which demonstrated that the resident's medical and functional status deteriorated during this period. These changes adversely affected the residents' ability to receive recommended dental treatment, suggesting that early, definitive, and often aggressive treatment approaches be used in providing services to these individuals.

This study was undertaken to improve understanding of current oral hygiene care practices in intermediate care facilities. Questionnaires were sent to directors of nursing of all licensed intermediate care facilities in Iowa. Results show that an estimated 57% of residents needed direct oral hygiene assistance. In all intermediate care facilities, the majority of direct oral hygiene care was provided by aides. Oral hygiene care was often not provided at an optimal level, and the main reasons reported for this lack of care were uncooperative residents (82%), lack of perceived need by aides (68%), and inadequate time/personnel (49%). Development and promotion of oral hygiene care programs in intermediate care facilities must take into consideration the realities and problems involved. Otherwise, efforts to introduce or implement new or improved care programs will fail.

Many care-dependent elderly individuals live in nursing homes and must depend on nursing home aides for oral hygiene care. It is generally agreed that the level of oral hygiene care among care-dependent nursing home residents is less than optimal. Two reasons are time constraints and the difficulty involved in brushing other individuals' teeth. The identification of effective and efficient plaque-removal devices for use by care-providers should make it easier for nursing home aides to incorporate effective oral hygiene care into their daily routines. This pilot study was undertaken to determine the relative effectiveness of four plaque removal devices with different basic designs when used by a non-professional care-provider on 10 healthy volunteers. A brush with curved bristles on the lateral aspect of the brush head and short straight bristles in the center (Collis-curve) and an electric toothbrush with tufts that rotate reciprocally (Interplak) were the most effective, a conventional brush (Oral-B) was somewhat less effective, and a disposable foam brush (Abco) was least effective and similar to the prebrushing plaque score (baseline). All the volunteers reported that the Collis-curve was the most comfortable brush, and the care-provider reported that it was the easiest to use.

This paper reports on the comparison of 104 patient-provided medical histories and those provided by the patients' physicians. Patient-provided histories were obtained using a written health questionnaire with verbal follow-up. At the level of specific medical conditions, patients and physicians agreed only about half of the time, whereas there was better agreement by systemic disease category (average agreement 77%). Both patients and physicians reported systemic conditions not reported by the other, indicating that neither patients nor physicians can be relied on as the sole source of medical history information. Whenever there is a complex medical history or uncertainty about the completeness of the patient's knowledge and reporting of their medical history, contacts with the patient's physician(s) are indicated.

The institutionalized elderly use more drugs per capita than do other segments of the population and are more likely than other population groups to have adverse drug reactions. Many of these drugs could affect oral health or dental treatment. This paper provides data on the frequency with which a population of nursing home residents took medications with possible oral effects. Information regarding prescription and nonprescription drug use was obtained from nursing home records of 481 subjects. Nine medication effect categories of possible significance in dentistry were established. Dentists treating institutionalized patients must be knowledgeable about patient drug use because 94% of this institutionalized population were taking medications that could alter oral health or dental treatment.

Root surface caries is of growing importance because its prevalence increases with age, and the population of the United States is growing older while edentulism and tooth loss rates have declined. Few clinical studies have evaluated materials used for the restoration of active root caries lesions. This study evaluated a Type II glass ionomer cement and a microfilled composite resin, both placed in preparations without mechanical retention or acid etching of enamel, in the restoration of root caries. Fifty adult volunteers with active root caries received one or both materials with the material chosen randomly. Patients were recalled after 24 months to evaluate restorations for retention, additional caries, marginal integrity, and overall clinical acceptability. Seventy-seven restorations were available for reevaluation. Forty-five percent of the glass ionomer and 73% of the composite restorations were clinically acceptable after 24 months. Of the glass ionomers, 39% were fully retained compared with 73% of composite restorations. Among those partially or fully retained, 25% of the glass ionomer restorations had minimal loss of marginal integrity and 30% had extensive loss while 53% and 9% of composite restorations had minimal and extensive loss, respectively. Most restorations were clinically unacceptable because of restorative material loss. Substantial numbers of glass ionomer cement and composite resin restorations were lost. This may be the result of difficulties in maintaining isolation and obtaining a proper gingival seal. Thus, routine use of mechanical retention is still highly recommended to reduce the loss of restorative material.