Dental Caries Prediction Based on a Survey of the Oral Health Epidemiology among the Geriatric Residents of Liaoning, China

Background. Dental caries is one of the most common chronic diseases observed in elderly patients. The development of preventive strategies for dental caries in elderly individuals is vital. Objective. The objective of the present study was to construct a generalized regression neural network (GRNN) prediction model for the risk assessment of dental caries among the geriatric residents of Liaoning, China. Methods. A stratified equal-capacity random sampling method was used to randomly select 1144 elderly (65-74 years) residents (gender ratio 1 : 1) of Liaoning, China. Data for the oral assessment, including caries characteristics, and questionnaire survey from each participant were collected. Multivariate logistic regression analysis was then performed to identify the independent predictors. GRNN was applied to establish a prediction model for dental caries. The accuracy of the unconditional logistic regression and the GRNN early warning model was compared. Results. A total of 1144 patients fulfilled the requirements and completed the questionnaires. The caries rate was 68.5%, and the main associated factors were toothache history, residence area, smoking, and drinking. We randomly divided the data for the 1144 participants into a training set (915 cases) and a test set (229 cases). The optimal smoothing factor was 0.7, and the area under the receiver operating characteristic curve for the GRNN model was 0.626 (95% confidence interval, 0.544 to 0.708), with a P value of 0.002. In terms of consistency, sensitivity, and specificity, the GRNN model was better than the traditional unconditional multivariate logistic regression model. Conclusion. Geriatric (65-74 years) residents of Liaoning, China, have a high rate of dental caries. Residents with a history of toothache and smoking habits are more susceptible to the disease. The GRNN early warning model is an accurate and meaningful tool for screening, early diagnosis, and treatment planning for geriatric individuals with a high risk of caries.

Implementation of Proton Pump Inhibitor Deprescription Protocol in Geriatric Residents

Background: Deprescribing is a recommended intervention to reduce morbidity and mortality caused by polypharmacy in older residents. However, a lack of definite deprescription guidelines and evidence of clinically meaningful outcomes complicates or precludes the practicality of such an approach. Objective: The objective of the present pilot study is to establish and implement a stepwise taper protocol that can potentially minimize overuse of proton pump inhibitors in a safe, effective, and feasible manner in the nursing home. Methods: Proton pump inhibitor dosage was reduced by half every 3 weeks until the lowest dose was reached; thereafter, the frequency was changed to every other day for 3 weeks, if tolerated. Subsequently, histamine receptor antagonists replaced proton pump inhibitors and followed the same deprescription regimen until discontinuation. Patient-specific interventions also included reassessment of therapeutic agents and dosage forms for more tolerable alternatives to facilitate deprescription efforts and minimize gastric ulceration or discomfort. Results: The pilot study enrolled 10 patients (average age 65.6 years, medication burden 16.8 units, and antisecretory duration 37.5 months). Physicians accepted >95% of interventions, and 90% of patients achieved cessation at 12 weeks. Post cessation, none of the patients needed antacid, prokinetic, or antisecretory agents at 4 weeks. Difficulties in order interpretation and transcription among nurses as well as order entry and calculations among pharmacists were noted. Conclusions: The present pilot study added to the growing body of evidence that gradual deprescription of antisecretory medications is feasible. Nonetheless, the pilot design precludes any conclusions about safety and efficacy of the intervention.

Major Oral and Dental Health Problems among Geriatric Residents of Nursing Homes in a defined Population in Iran

ABSTRACT Introduction Increase in life expectancy implies the need for more attention to the health of the elderly population, and oral health is not an exception. This study determined the frequency of major oral and dental health problems among institutionalized elderly adults in Qazvin, Iran. Materials and Methods In this cross-sectional study, 112 residents of geriatric nursing homes participated. History of systemic diseases and oral symptoms was asked and recorded; then, participants undertook a clinical intra- and extraoral examination. Examination consisted of oral mucosa, periodontal and dental assessment, and temporomandibular joint (TMJ) assessment. Results In total, 93 women and 19 men with an average age of 74.9 (±14.7) and 71.6 (±11.3) years respectively, were examined. A total of 73 patients were completely edentulous. Examination of the oral mucosa showed that 48 patients (42%) had changes in their oral mucosa. Pale mucosa and fissure tongue had the most frequency. However, denture stomatitis was the most prevalent disorder related to the denture. Xerostomia was the most frequent complaining symptom (67.8%) followed by dysphagia (53.7%) and dysgeusia (25.8%). A total of 26 patients (23.2%) had abnormal “clicking” sounds during TMJ assessment. Decayed, missing, and filling teeth (DMF) index in 39 dentate patients revealed 89.7% had decayed teeth, 100% had missing, and 2.6% had filling teeth. Community Periodontal Index of Treatment Needs (CPITN) revealed more than half of the participants had deep or shallow pockets. Conclusion Oral and dental health of elderly people in this study was not acceptable. They should be persuaded that there are continual needs for oral health care. Oral examination should be performed as part of development programs for older adults. How to cite this article Mojabi KB, Azimi S, Khansari M. Major Oral and Dental Health Problems among Geriatric Residents of Nursing Homes in a defined Population in Iran. J Contemp Dent 2016;6(2):125-128.