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AIMS: Edentulism is an incapacitating condition, and its prevalence is unequal among different population groups in the United States (US) despite its declining prevalence. This study aimed to investigate the current prevalence, apply Machine Learning (ML) Algorithms to investigate factors associated with complete tooth loss among older US adults, and compare the performance of the models. METHODS: The cross-sectional 2020 Behavioral Risk Factor Surveillance System (BRFSS) data was used to evaluate the prevalence and factors associated with edentulism. ML models were developed to identify factors associated with edentulism utilizing seven ML algorithms. The performance of these models was compared using the area under the receiver operating characteristic curve (AUC). RESULTS: An overall prevalence of 11.9% was reported. The AdaBoost algorithm (AUC = 84.9%) showed the best performance. Analysis showed that the last dental visit, educational attainment, smoking, difficulty walking, and general health status were among the top factors associated with complete edentulism. CONCLUSION: Findings from our study support the declining prevalence of complete edentulism in older adults in the US and show that it is possible to develop a high-performing ML model to investigate the most important factors associated with edentulism using nationally representative data.
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Boca Edêntula, Perda de Dente, Humanos, Estados Unidos/epidemiologia, Idoso, Adulto, Pessoa de Meia-Idade, Perda de Dente/epidemiologia, Perda de Dente/etiologia, Boca Edêntula/epidemiologia, Estudos Transversais, Fatores de Risco, Fumar, Prevalência, AlgoritmosRESUMO
AIMS: A longer life and the growing population of older adults are the achievements of the 20th century. The World Health Organization considers ageism an important barrier to age-appropriate care for older adults. The aim of this study was to translate and validate the ageism scale for dental students in Iran (ASDS-Persian). METHODS: The 27-question ASDS was translated from English into Persian (Farsi) and completed by 275 dental students from two universities in Isfahan, Iran. Principal component analysis (PCA), internal consistency reliability, and discriminant validity were estimated. Furthermore, in this study we conducted an analytical cross sectional study among dental students of Isfahan province (two universities) with the aim of proving data regarding their ageism beliefs and attitudes. RESULTS: PCA revealed an 18-question, four-component scale with acceptable validity and reliability. The four components are 'barriers/concerns on dental treatment in older adults', 'opinions about older adults', 'practitioner's perspective,' and 'older adults' perspective'. CONCLUSION: This preliminary validation of ASDS-Persian produced a new 18-question scale with four components with acceptable validity and reliability. This instrument could be further tested in larger samples in Farsi speaking countries.
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Etarismo, Estudantes de Odontologia, Humanos, Idoso, Inquéritos e Questionários, Irã (Geográfico), Reprodutibilidade dos Testes, Estudos Transversais, PsicometriaRESUMO
Background: Ageism persists in many different societies as it is innate and subconscious in nature. Negative effects such as loneliness, mistreatment, and occupational discrimination are frequently present due to ageism. The dental students in our study were wary of the possible benefits of expensive dental care because ageism is rife in their field. There is no validated and reliable ageism scale to assess how dental students perceive ageism in India. The current study was carried out to validate the ageism scale for dental students in the Indian context. METHODS: This was a cross sectional analytical study carried out among both males and females in Manipal College of Dental Sciences, Mangalore in which the instrument was 27-item Ageism scale for dental students. Content validity was done by six subject experts. The final version was administered to 213 students/Residents of dental school. The factorability of data was confirmed with KMO = 0.61 and Bartlett's Test of Sphericity resulting in p < 0.001. RESULTS: Final PCA model resulted in 15 items and six components that together accounted for 70.37% of overall variance. The six components had reliability ranging from marginal 0.51 (Component 6) to a high of 0.81 (Component 3). As per the gender differences by component females showed less ageism than men in "non-compliance" (-0.9(-1.66-0.14), p<0.05) and "practitioner perspective" (1.43 (0.84, 2.03), p<0.01). Statistical significance was seen in Barriers/concerns in dental treatment of elderly where residents showed reversed (1.4 (0.41, 2.38), p<0.01). Urban group showed more ageism for component 'time restraint' (-0.79 (-1.57, -0.02), p<0.05. CONCLUSION: Preliminary validation resulted in 15 item scale with six components with acceptable validity of the ageism scale and could be further tested in large samples. This scale will help recognize ageism in Indian context and provide necessary information to make changes in the curriculum as required.
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Etarismo, Masculino, Feminino, Humanos, Idoso, Estudos Transversais, Estudantes de Odontologia, Reprodutibilidade dos Testes, Inquéritos e Questionários, ÍndiaRESUMO
INTRODUCTION: Minimal sedation (Anxiolysis) is used in dentistry to reduce stress, manage anxiety, and improve patient comfort during treatment. The oral route of minimal sedation is safe and convenient, but there is limited literature assessing the efficacy of this mode of patient care. This paper aims to evaluate the outcomes of oral sedation use for patients treated in a dental school setting using a retrospective cohort analysis of electronic health record data. METHODS: A total of 6872 patient records were selected after screening through the selection criteria. Demographic and treatment variables were obtained and analyzed. The appointment status was identified as a success or failure depending on the treatment codes assigned for that appointment. A multivariate logistic regression was used to evaluate relationships between appointment status and the obtained variables. RESULTS: Less than 3% patients had a 'failure outcome' when this data set was evaluated. Being treated in multiple clinics and being seen by multiple providers were both factors that increased the odds of success. CONCLUSION: Oral anxiolytics should be considered as a noteworthy option for patient management based on the outcomes reflected in this study. There is some evidence that seeing multiple providers improves the success rate of completing dental procedures carried out under oral sedation.
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As the world population ages, the need for age friendly care increases. In dentistry, age friendly care requires an appropriate comprehension of multiple factors that can be categorized in socio-economic circumstances, systemic health problems, and oral health conditions. In addition to the understanding of these factors and its relationships among each other, the future dental workforce should also be aware of unconscious and pervasive societal stereotypical perception of older persons, aging, and being old, which results in ageism and ageist attitudes. Dental schools can play an important role on raising ageism awareness and combating ageism in healthcare, thus preparing the future of the dental workforce to provide compassionate age friendly care. This paper will discuss ageism in dental schools and learning strategies used to combat it and increase compassionate care delivery for older adults.
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Etarismo, Estudantes de Odontologia, Humanos, Idoso, Idoso de 80 Anos ou mais, Inquéritos e Questionários, Atitude, EmpatiaRESUMO
The world's population is aging. Older adults are at risk for multiple chronic medical problems as they age. The management of these diseases requires these people to take a variety of medications, which may have undesired side effects. These medical issues can impact oral healthcare and result in a precipitous decline in oral health. A standardized teaching model has been developed to help novice dental practitioners learn how to access and treat oral health problems in older adults. This model is called rapid oral health deterioration (ROHD) risk assessment. The model has four steps for assessment and four categories of risk. This paper describes the components of the ROHD risk assessment, and how it can be used to prevent, diagnose and treat ROHD among older adults.
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OBJECTIVES: To investigate the association between self-reported periodontitis and the senses of taste and smell among employees of one Danish and two American universities. MATERIALS AND METHODS: Data were collected through a digital survey. A total of 1239 individuals from Aarhus University - Denmark, the University of Iowa, and the University of Florida - USA were included. Self-reported periodontitis was the exposure. The perceived senses of taste and smell were the outcomes and were measured through a visual analog scale (VAS). Self-perceived halitosis was the mediator. Confounders were age, sex, income, education, xerostomia, COVID-19, smoking, body mass index, and diabetes. The total effect was decomposed into direct and indirect using a counterfactual approach. RESULTS: The total effect of periodontitis on an impaired sense of taste was OR 1.56 (95% CI [1.02, 2.09]), of which 23% was mediated by halitosis (OR 1.13; 95% CI [1.03, 1.22]). Additionally, individuals with self-reported periodontitis had a 53% higher chance of having impaired smell (OR 1.53; 95% CI [1.00, 2.04]), with halitosis mediating 21% of the total effect (OR 1.11; 95% CI [1.02, 1.20]). CONCLUSION: Our findings suggest that periodontitis is associated with distorted senses of taste and smell. Additionally, this association appears to be mediated by halitosis.
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When caring for the oral health of frail and functionally dependent older adults, it is important to understand their general health and oral health problems to make a diagnosis. There are multiple treatment strategies available to care for their needs; many may not be evidence based. Dental treatment planning for older adults is as much art as science and requires clinicians to understand how patients are functioning in their environments and how oral health care fits into their needs and lifestyle. This article discusses a variety of treatment planning techniques and illustrates the problem with a longitudinal case history.
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Atenção à Saúde, Saúde Bucal, Humanos, Idoso, Planejamento de Assistência ao Paciente, Assistência OdontológicaRESUMO
OBJECTIVE: Age cohorts such as the baby boomers are influenced by historical experiences and the socio-dental events during their lifespan. These events/experiences have impacted their health behavior and consequently, their systemic and oral health. As the baby boomer population is aging, and the majority of them are retaining some of their natural teeth for longer, only fewer are becoming edentulous. This paper discusses the demographics and the social determinants of health of the early baby boomers (1945-1955), as well as the late boomers (1956-1964). METHODS: We have used data from the literature to describe the events which might have impacted these cohorts' attitudes and expectations towards the utilization of health care and dental services. RESULTS: There are variations in the way different age groups perceive dentistry and use dental and other healthcare services, known as cohort differences. Nonetheless, because people are now keeping more of their natural teeth as they age, there is a greater demand for oral healthcare among the baby boomer generation. In order to provide specialized care that addresses their unique needs, there is a need for expanded training programs at both the undergraduate and postgraduate levels. CONCLUSION: A cohort is composed of numerous individuals whose attitudes and behaviors are shaped by their personal life experiences and broader societal trends. Consequently, any information about a particular cohort can only offer generalizations. As healthcare providers, it is important to be aware of the general characteristics of a cohort, but also exercise caution when applying them to individual patients. We should interpret these characteristics in light of each patient's unique circumstances.
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Saúde Bucal, Determinantes Sociais da Saúde, Humanos, Crescimento Demográfico, EnvelhecimentoRESUMO
PURPOSE: The aim of this study is to investigate the literature to evaluate dental students' attitudes regarding the treatment of older adults. METHODS: A scoping review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses/PRISMA guidelines to identify articles from four electronic databases: MEDLINE via the PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Gray literature searches were also performed in Scopus, Web of Science, and ProQuest Dissertations and Theses-Health and Medicine. RESULTS: Eleven articles were assessed. The majority (72, 72%) were published between 2011 and 2020, evidencing various contexts of dental students, such as different countries and cultures, and levels of education. The most commonly used tool/instrument to survey dental students' attitudes was the Aging Semantic Differential Scale. Student age, race, and marital status did not seem to interfere with dental students' attitudes regarding the treatment of older adults. CONCLUSIONS: Dental students tend to have a positive attitude toward older people. In this context, female students, students who interact with older people, and clinical students have more positive attitudes than male and nonclinical students.
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Estudantes de Odontologia, Estudantes de Enfermagem, Idoso, Feminino, Humanos, Masculino, Atitude, EscolaridadeRESUMO
BACKGROUND: Empathic care is considered extremely important by patients and providers alike but there is still an ample need for assessing empathy among healthcare students and professionals and identifying appropriate educational interventions to improve it. This study aims to assess empathy levels and associated factors among students at different healthcare colleges at the University of Iowa. METHODS: An online survey was delivered to healthcare students, including nursing, pharmacy, dental, and medical colleges (IRB ID #202,003,636). The cross-sectional survey included background questions, probing questions, college-specific questions, and the Jefferson Scale of Empathy-Health Professionals Student version (JSPE-HPS). To examine bivariate associations, Kruskal Wallis and Wilcoxon rank sum tests were used. A linear model with no transformation was used in the multivariable analysis. RESULTS: Three hundred students responded to the survey. Overall JSPE-HPS score was 116 (± 11.7), consistent with other healthcare professional samples. There was no significant difference in JSPE-HPS score among the different colleges (P = 0.532). CONCLUSION: Controlling for other variables in the linear model, healthcare students' view of their faculty's empathy toward patients and students' self-reported empathy levels were significantly associated with students' JSPE-HPS scores.
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Atitude do Pessoal de Saúde, Estudantes de Medicina, Humanos, Estudos Transversais, Empatia, Universidades, Inquéritos e QuestionáriosRESUMO
This case history follows the treatment of a 61-year-old edentulous woman over a period of 23 years. The patient was wearing complete dentures for 25 years prior to treatment, was in pain, and having difficulty eating. Many treatments were tried, including multiple soft liners, hydroxyapatite to improve her mandibular ridge, and finally an implant-supported-overdenture. However, in spite of using all the technical procedures and materials available to us at the time of treating the patient, we were unable to sustain the comfort and quality of life for this patient. This happened because of the severe resorption of her mandible, with an intolerance to occlusal loading, and the continuous deterioration of her systemic health.
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Boca Edêntula, Saúde Bucal, Feminino, Humanos, Pessoa de Meia-Idade, Resultado do Tratamento, Satisfação do Paciente, Qualidade de VidaRESUMO
PURPOSE/AIM: To investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care. MATERIALS AND METHODS: De-identified data was collected from electronic health records of 18-year-old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care. RESULTS: Sample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits. CONCLUSIONS: Only one in every three adults with autism had at least one preventive dental visit per year.
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Transtorno Autístico, Assistência Odontológica para a Pessoa com Deficiência, Odontologia Preventiva, Adolescente, Adulto, Feminino, Humanos, Masculino, Transtorno Autístico/complicações, Assistência Odontológica, Medicaid, Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To analyze student performance when using a sustainable teaching tool developed to guide learning toward interprofessional perspectives. METHODS: This study compiled data about D4 students' performance when using an interprofessional education (IPE) teaching tool reported previously in this journal, during their 5-week Geriatric and Special Needs Program rotation in the academic years 2018-2019 and 2019-2020. Ninety-two students were introduced to IPE concepts and teaching tools during their orientation. Students were then asked a question regarding the perspective of each healthcare team member and whether they would contact these healthcare team members for collaboration during the provision of oral care with regard to various patient cases. Students were scored on whether they answered the question about the perspective of each health care team member. The same two independent evaluators also noted whether the student thought each member of the health care team should be contacted. RESULTS: A majority (90.2%-95.7%) of dental students applied their knowledge to questions regarding each health care team member's perspectives. The profession that dental students most often indicated they wished to contact for collaboration was primary care providers (n = 70; 76.1%), followed by family caregivers (n = 54; 58.7%), and pharmacists (n = 46; 50.0%). The results of the interrater agreement between the two-faculty scoring students were between 86.7% and 100%. CONCLUSIONS: The teaching tool is sustainable and succinct. Students considered the perspectives of each health care team member at a rate above 90%, and the interrater agreement was high among the faculty evaluators. Students considered contacting primary care providers, family caregivers, and pharmacists more often than the other health care team members. We see this model as one approach to begin the articulation of learning outcomes for IPP.
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Tomada de Decisões, Relações Interprofissionais, Estudantes de Odontologia, Idoso, Seguimentos, Humanos, Aprendizagem, Equipe de Assistência ao PacienteRESUMO
In March 2020, the World Health Organization declared a global public health emergency due to the spread of COVID-19, and medical and dental elective care was suspended, disproportionally affecting persons with special needs. As many of the special needs population live in a communal environment, they were at higher risk of being infected with and dying of COVID-19. Consequently, their access to medical and dental services was limited to emergency care. A method of reaching these populations evolved by the expansion of telehealth, including dentistry, to provide diagnosis, management, prevention, and provision of psychosocial support for patients.
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COVID-19, Assistência Odontológica para a Pessoa com Deficiência, Humanos, Saúde Bucal, Saúde PúblicaRESUMO
PURPOSE: To compare the outcomes of prosthodontic treatment for subjects wearing a complete maxillary denture opposing a root-supported mandibular overdenture (RSO) or an implant-supported mandibular overdenture (ISO). METHODS: A literature search was performed in seven electronic databases: MEDLINE via PubMed interface, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, and AgeLine. The search terms were developed by the primary investigators and the health sciences librarian, who then started with PubMed and adapted the original search strategy for the other databases. Included articles were those that compared the outcomes for mandibular RSOs and those with ISOs, for persons wearing a maxillary complete denture. RESULTS: Seven articles were included in the review. There were limitations in this review because of small sample sizes, short study durations, and different methodologies. Also, no comparative studies were identified for clinically important outcomes, such as survival rates of abutments, prosthodontics/maintenance problems, and longitudinal cost of care. For prosthodontic complications, patient satisfaction, and ability to clean, no differences were reported. For oral tactile sensibility, RSOs presented significantly improved sensibility, whereas ISOs had higher maximum bite force capability, but the difference was not statistically significant, except when subjects had a cross-bite or a lingualized occlusion. CONCLUSIONS: The results of this scoping review were not conclusive, except for maximum bite force, where ISOs seem to perform better than RSOs by the measured criteria. ISOs had higher survival rates than RSOs, and required less maintenance, but were more expensive. It was disappointing to find so few studies comparing these clinical treatment modalities, which suggests that either treatment may be clinically acceptable and depends upon a shared decision between patients and their dentists.
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Implantes Dentários, Revestimento de Dentadura, Humanos, Prótese Dentária Fixada por Implante, Prótese Total, Força de Mordida, Mandíbula, Satisfação do Paciente, Retenção de DentaduraRESUMO
PURPOSE: This study aimed to validate an ageism scale for dental students in Switzerland. METHODS: The original scale was first translated to German and then evaluated by 14 experts for relevance; four items were eliminated. Validation of the resulting questionnaire was performed at three Swiss dental schools. Principal component analysis (PCA) was performed; Cronbach's alpha (α) was used to assess the internal consistency reliability, and Pearson's coefficient to identify any correlations with demographic parameters (P < 0.05). RESULTS: PCA revealed 11 items among 4 factors (Overall: 11 items, α = 0.63, variance = 56.6%; Factor #1 (F1): items = 3, α = 0.64; Factor #2 (F2): items = 3, α = 0.42; Factor #3 (F3): items = 3, α = 0.35; Factor #4 (F4): items = 2, α = 0.37). F1 and F4 were correlated with clinical experience (F1: P = 0.042; F4: P = 0.006) and participation in a gerodontology course (F1: P = 0.021; F4: P = 0.004). F1 was correlated with experience of dealing with the elderly (P = 0.031), while residence locality was correlated with F3 (P = 0.047) and F4 (P = 0.043). F2 was correlated with the presence of elderly in the family (P = 0.047). CONCLUSION: The translated dental ageism questionnaire for Switzerland resulted in an 11-item scale with acceptable reliability.
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Etarismo, Idoso, Humanos, Psicometria, Reprodutibilidade dos Testes, Estudantes de Odontologia, Inquéritos e Questionários, SuíçaRESUMO
PURPOSE/AIM: To investigate factors associated with self-reported dry mouth (xerostomia) among older adults seeking dental care at a University clinic. MATERIALS AND METHODS: A query was performed in the electronic records database and de-identified data were collected from patients aged 65 + recorded on the date that the initial health history was entered. Among these patients, data about patients' medications, gender, age, BMI, tobacco use, alcohol addiction, diabetes, heart disease, joint replacement, allergies to medications, hypertension, and mental disorders were obtained. Evaluation of potential risk factors for dry mouth was performed using univariate and multivariable logistic regression analyzes (alpha = 0.05). RESULTS: A total of 11,061 subjects were included in the analysis, 51.5% of whom were women. The mean age in years was 74.2 ± 7.0, the median number of medications was 7 (IQR = 4-11), and 38.5% of the participants reported dry mouth. The multivariable logistic regression analysis revealed that the odds of xerostomia for subjects who took 11 +, 7-10, or 4-6 medications were 3.34, 2.07, or 1.38 times those of subjects who had took 0-3 medications, respectively. CONCLUSION: Number of medications showed a strong and dose-dependent association with xerostomia.
