Is Cognitive Status Related to Oral Hygiene Level and Appropriate for Determining Need for Oral Hygiene Assistance?
- Autores: Patricia Anca Steinmassl, Otto Steinmassl, Gabriela Kraus, Herbert Dumfahrt, Ingrid Grunert
- Localización: Journal of periodontology, ISSN 0022-3492, Vol. 87, Nº. 1, 2016, págs. 41-47
- Idioma: inglés
- Enlaces
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Resumen
Background: With declining general health, the maintenance of oral health becomes increasingly difficult. Unfortunately, health care resources are limited. An assessment tool for detecting a patient’s need for oral health care assistance would promote its adequate distribution. The aim of this study is to evaluate if the Shulman clock-drawing test score is a suitable assessment tool for determining the need for oral hygiene assistance.
Methods: Data collected from recent dental checkups of 126 inhabitants of five Austrian residential care facilities were analyzed. The Shulman clock-drawing test score was used as a measure for cognitive abilities and related to tooth and denture hygiene indices, which were assessed using the approximal space plaque index (API) and the denture plaque index (DPI).
Results: Shulman score values were distributed almost evenly in the study population. The mean API was 83.6% (SD 20.2%) for the maxilla and 94.9% (SD 15.6%) for the mandible. The mean DPI was 43.9% (SD 31.4%). Cognitive impairment was not statistically related to the dental or denture hygiene index.
Conclusions: A high Shulman clock-drawing test score indicates the need for oral hygiene assistance, but it is not suitable as a single tool to assess this need. Patients with other disabilities might equally qualify for assistance. Dentures, however, can be cleaned quickly and efficiently independently of patient compliance; therefore, cleaning the patients’ dentures should be part of nursing personnel’s daily care routine for every patient.
Because of the rising percentage of elderly people,1 there is an increased need for treatment and prevention of oral diseases in this group.2 The basis of primary prevention in dental health is individual oral hygiene. Adequate motor and cognitive abilities are required for performing adequate oral hygiene. Reduced manual dexterity, impaired vision, and other associated conditions often impede older people from taking care of their oral hygiene.3 In addition, dependent elderly often show a diminished desire and ability to communicate,4 which might cause them to refrain from seeking assistance. Oral care assistance also seems to be perceived as more disagreeable for caregivers than other nursing activities—even more disagreeable than changing sanitary pads.5 In spite of being an undesirable task, effective oral hygiene is a necessity for the maintenance of oral health. This applies to both dentate and edentulous patients: whereas dental plaque is well known to promote diseases of the teeth and gums and potentially has an impact on general health, denture plaque has also been shown to promote oral diseases such as candidiasis and denture stomatitis and diseases of residual teeth such as caries and periodontitis.6 Because of aspiration and ingestion of microorganisms colonizing the dentures, denture plaque enhances the risk of infections,6 most importantly pneumonia.7,8 Its control, therefore, is beneficial for general health6,9,10 and influences general health–related quality of life.10,11 Enabling dental visits for institutionalized patients is often difficult and requires logistic and often financial efforts. Therefore many patients are not regularly seen by a dentist, who could assess oral health and hygiene level and determine whether a patient is in need of assistance with oral hygiene. A standard assessment tool for determining the need for oral hygiene assistance among institutionalized patients could enable adequate distribution of such assistance in residential care facilities. Upon admission to a long-term care facility in Austria, each patient’s need for care is assessed by a medical examination evaluating the patient’s general health, motor abilities, and cognitive status, which is often assessed by the Shulman clock-drawing test.12 The assessment of associations between cognitive impairment and level of oral hygiene may help with detecting those people particularly dependent on assistance with oral hygiene without the need to see a dentist first. The results provided by this study present substantial information for health care planning and are valuable for the development of oral health care programs.
