Oral Health has improved in recent decade with an increasing proportion of people maintaining their natural teeth. Although edentulousness is still prevalent and associated with socio-economic status. Dental caries remains a problem into older age when natural teeth are present and oral health problems and oro-facial pain are also considered to increase with age. Dementia is a common problem with the risks increasing as you get older.

The aim of this review was to provide an overview about oral health and oro-facial pain in older people with dementia, compared to older people without dementia.

Methods

Searches were carried out in the PubMed, CINHAL and Cochrane Library databases. Studies about oral health or disease in older people with dementia providing usable data were considered. Study selection was carried out independently by a dentist and neuropsychologist. Study quality was assessed using the Newcastle- Ottawa Scale (NOS). Data was abstracted by a single reviews and checked by two reviewers.  The principal summary measures used were percentages and means, including standard deviation.

Results

• 37 studies (1 RCT, 11 cohorts, 6 case controls, 19 cross-sectional) were included.
• In total 3770 patients with dementia and 4036 without dementia were included.
• 9 studies were considered to be of high quality.
• Only 7 studies considered oro-facial pain
• A simple summary of the range of findings for each variable assessed is show in the table below.

	With dementia	No dementia
Edentulousness	11.6 to 72.7 %	14.0 to 70.0 %
Denture utilization	5.0 to 100.0 %	17.0 to 81.8 %
Teeth present	1.7 to 20.0	2.0 to 20.2
DMFT index	14.9 to 28.0	19.7 to 26.1
Decayed	0.0 to 2.9	0.3 to 6.0
Missing	10.2 to 27.3	9.3 to 28.2
Filled	0.8 to 23.9	0.7 to 25.7
Oro-facial pain	7.4 to 21.7 %	6.7 to 18.5 %

 

Conclusions

The authors concluded

this systematic review found that older people with dementia have worse overall oral health than older people without dementia, including coronal caries, root caries, and retained roots. In contrast, they had an equivalent number of teeth present, similar rate of edentulousness, and equivalent decayed missing filled teeth index. Unfortunately, few studies have focused on oro-facial pain in older people with dementia. Oral health, and specifically orofacial pain in older people with dementia, is in dire need of further attention.

Comments

The limited quality of the original studies identified for this review is highlighted by the authors. They also point out that not all the studies report on all the variables and many did not report standard deviations. However, the review does helpfully summarise the available data. It is worth noting that there is considerable overlap between the older people with and without dementia although the authors note that oral health was worse in those with dementia in particular this was more noticeable in studies that included those with more advanced dementia. While this review suggests that oral health is poorer in those with dementia it also highlights the need to maintain and improve oral health in older people general for maintaining good oral health for all older people will simplify the challenges of providing care for those who suffer from dementia.

Links

Primary paper

Delwel S, Binnekade TT, Perez RS, Hertogh CM, Scherder EJ, Lobbezoo F. Oral health and oro-facial pain in older people with dementia: a systematic review with focus on dental hard tissues. Clin Oral Investig. 2017 Jan;21(1):17-32. doi:10.1007/s00784-016-1934-9. Review. PubMed PMID: 27631597; PubMed Central PMCID:PMC5203832.

Other references

Dental Elf – 10th Oct 2016

Oral Health in nursing homes: education for staff and residents