CHALLENGES IN STUDIES OF AGEING AND ORAL … Vilnius 2017 challenges.pdf · CHALLENGES IN STUDIES OF AGEING AND ORAL HEALTH ... Gostemeyer, wendicke, F. (2017) Aging, dental caries

CHALLENGES IN STUDIES OF AGEING AND ORAL HEALTH

Prof. Dr. Jacques Vanobbergen, 9th of June 2017

DEPARTMENT COMMUNITY DENTISTRY AND ORAL PUBLIC HEALTH

RESEARCH GROUP GERODONTOLOGY

• Introduction - focus

• Burden of caries and periodontal disease over

lifetime

• Assess the evidence for age-adequate

effective strategies to prevent and treat caries

and periodontal disease.

CONTENT



lifetime




CONTENT

• Some

interesting

results of

recent studies.

• Looking for

some

evidence?

CONTENT

• What do we have?

• What are the

methodological

challenges?

• What do we need?

• Discussion

section of

reports

• Published in

the last 10

years

• Weaknesses

and limitations

of reported

studies

• Searching until

saturation

• Priorities for

further reserach

INTRODUCTION

• Focus:

• Challenges in studies of ageing related to

oral public health

Joint EFP/ORCA workshop on the bounderies between

caries and periodontal diseases.

Group 4: .. In the ageing population

November 2016

Parador De La Granja - Spain

INTRODUCTION

• Focus:

• Challenges in studies of ageing related to

oral public health

Joint EFP/ORCA workshop on the bounderies between

caries and periodontal diseases.

Group 4: .. In the ageing population

Parador De La Granja - Spain

Demographic changes drive the need to learn more

about the burden of oral diseases (in particular

caries and periodontal diseases) in older populations.

More research is needed to provide the foundation for

better prevention and management of these

diseases in older populations.

• Tonetti, M. S., Bottenberg P, Conrads G, Eickholz P, Heasman P, Lopez R, Madianos P, Müller F, Needleman I, Nyvad B, Preshaw PM, Pretty I, Renvert S,

Schwendicke F, Trombelli L, vd Putten GJ, Vanobbergen J, West N, Young A, Paris S. Dental caries and periodontal diseases in the ageing population: call to

action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA

workshop on the boundaries be. Journal of Clinical Periodontology 44, S135–S144 (2017).



lifetime




BURDEN OF CARIES AND PERIODONTITIS OVER LIFETIME

• Damage due to both periodontitis and caries is largely

irreversible and therefore cumulative over the lifetime

• with age the exposure to risk factors for both

periodontitis and caries changes

disease experience is certainly increasing with

age, but not necessarily due to age

• Lopez, R., Smith, P. C., Gostemeyer, wendicke, F. (2017) Aging, dental caries and periodontal diseases. Journal of

Clinical Periodontology 44:S18, 145–152.

• Tonetti, M. S. et al. Dental caries and periodontal diseases in the ageing population: call to action to protect and

enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of

the joint EFP/ORCA workshop on the boundaries be. Journal of Clinical Periodontology 44, S135–S144 (2017).


BURDEN OF CARIES OVER LIFETIME

• Sheiham, A. et al. BMC Public Health 14, 863 (2014).

• Petersen, P. E. et al. Community dental health 27, 257–67 (2010).

• National Institute for Health and Disability Insurance (NIHDI). PBN:

Pilootproject Mondzorg voor Personen met Bijzondere Noden 2011.

• Janssens, B. et al. Community dental health (2017).

USA







80-89 +89

Based on 28 teeth

Random sample care dependent persons

WHO 65+

AmericasWHO 65+

Europe







Max 32

75-84 85-94 +95

1275 nursing home

residents Belgium

BURDEN OF PERIODONTITIS OVER LIFETIME

Eke, P. I. et al. Journal of Periodontology 1–18 (2015).

8.9% (12% EFP) of adults (30-80 years) had severe periodontitis during 2011 to 2012

More prevalent among adults age ≥ 50 years

Petersen et al. Community dental health 27, 257–67 (2010).

BURDEN OF PERIODONTITIS OVER LIFETIME



lifetime





• Selection bias

• Low response rates

• Exclusion of subjects

• Drop outs

• Survivor effect

• Information bias

• Examiner reliability

• Validity: Standardisation and comparability

• Difficulties in doing examination


• Selection bias

• Low response rates (informed consent)

• Exclusion of subjects


• Difficulties in obtaining informed consent

• Exclusion of subjects with cognitive

impairment

• Not sampling institutionalised persons• Chalmers, J.M., et al. Caries experience in existing and new nursing home residents in Adelaide,

Australia. Gerodontology (2002) 19, 30–40.

• Eke, P. I. et al. Journal of Periodontology 1–18 (2015).

• Heegaard, K.M., Holm-Pedersen, P., Bardow, A., Hvidtfeldt, U.A., Grøbæk, M., and Avlund, K. The

Copenhagen Oral Health Senior Cohort: Design, population and dental health. Gerodontology (2015)

28, 165–176.

• Selection bias

• Drop outs


• More pronounced in elderly population groups

because of worsening health or death.

• High dropout (70 years –>85 years) because

of mortality or morbidity

• 17% to 43% of baseline subjects were

deceased at one year follow up.

• Chalmers, J.M., et al. Caries experience in existing and new nursing home residents in Adelaide, Australia. Gerodontology (2002) 19, 30–40.

• Krustrup, U., et al. The overtime effect of social position on dental caries experience in a group of old-aged Danes born in 1914. Journal of

Public Health Dentistry . (2008) 68, 46–52.

• VdPutten GJ, et al. Effectiveness of supervised implementation of an oral health care guideline in care homes: a single-blinded cluster

randomised controlled trial. Clin Oral Inv (2013) 17:1143-1153

• Hoeksema, A.R., Peters, L.L., Raghoebar, G.M. et al. Oral health status and need for oral care of care-dependent indwelling elderly: from

admission to death Clin Oral Invest (2016).

• Selection bias

• Drop outs


• In most cases there is no information about

non-responding care-homes and residents

• Difficulties in responder-non-responder

analyses

• Replaced by healthier counterparts

• Hirotomi, T., Kocher, T., Yoshihara, A., Biffar, R., Micheelis, W., Hoffmann, T., Miyazaki, H., and Holtfreter, B. Comparison of periodontal

conditions among three elderly populations in Japan and Germany. Journal of Clinical Periodontology (2014) 41, 633–642.

• Karki, A.J., Monaghan, N., and Morgan, M. Oral health status of older people living in care homes in Wales. British Dental Journal (2015) 219,

331–334.

• Heegaard, K.M., Holm-Pedersen, P., Bardow, A., Hvidtfeldt, U.A., Grøbæk, M., and Avlund, K. The Copenhagen Oral Health Senior Cohort:

Design, population and dental health. Gerodontology (2015) 28, 165–176.

• Selection bias

• Survivor effect


• Premature death because of poor oral health: survivors are the

sample

• Healthy elderly people probably overrepresented in surveys

• Remaining teeth are ‘survivors’ without fillings, carious lesions or

periodontal disease.

• ‘Biological elite’ remains • Vilstrup, L., Holm-Pedersen, P., Mortensen, E. L., & Avlund, K. Dental status and dental caries in 85-year-old Danes. Gerodontology, (2007) 24(1), 3–

13.

• Krustrup, U., et al. The overtime effect of social position on dental caries experience in a group of old-aged Danes born in 1914. Journal of Public

Health Dentistry . (2008) 68, 46–52.

• Holmén, A., et al. Oral status in home-dwelling elderly dependent on moderate or substantial supportive care for daily living: Prevalence of edentulous

subjects, caries and periodontal disease. Gerodontology )2012).

• Hirotomi, T., Kocher, T., Yoshihara, A., Biffar, R., Micheelis, W., Hoffmann, T., Miyazaki, H., and Holtfreter, B. Comparison of periodontal conditions

among three elderly populations in Japan and Germany. Journal of Clinical Periodontology (2014) 41, 633–642.

• Karki, A.J., Monaghan, N., and Morgan, M. Oral health status of older people living in care homes in Wales. British Dental Journal (2015) 219, 331–

334.


• Examiner reliability


• Lack of calibration, sometimes because of frailty of

the patients

• Use of own dentist (trust and more informed consent)

• Intra-examiner agreement was not recorded due to

high age and length of examination

• Vilstrup, L., Holm-Pedersen, P., Mortensen, E. L., & Avlund, K. Dental status and dental caries in 85-year-old Danes. Gerodontology, (2007)

24(1), 3–13.

• Gerritsen, P.F.M., Cune, M.S., Van Der Bilt, A., and De Putter, C. Dental treatment needs in Dutch nursing homes offering integrated dental

care. Special Care in Dentistry (2011) 31, 95–101

• Karki, A.J., Monaghan, N., and Morgan, M. Oral health status of older people living in care homes in Wales. British Dental Journal (2015) 219,

331–334.


• Validity and comparability: Standardisation


• Validity in one age group does not always mean

validity in an other age group

• Internal validity versus external validity

• Comparability of indices (CDC/AAP ~ EFP)

• DMFT not be the best indicator of dental caries

among the elderly

• Use of different periodontal probes.

• Moreira, R.D.S., Nico, L.S., and Tomita, N.E. Oral health conditions among the elderly in Southeastern São Paulo State. Journal of Applied Oral

Science (2009)17, 170–178.

• Hirotomi, T., Kocher, T., Yoshihara, A., Biffar, R., Micheelis, W., Hoffmann, T., Miyazaki, H., and Holtfreter, B. Comparison of periodontal conditions

among three elderly populations in Japan and Germany. Journal of Clinical Periodontology (2014) 41, 633–642.



• Difficulties in doing examination


• Examinations were largely done at (nursing) home, risk of

underestimation of pathology (caries – periodontal disease) –

position, lighting, ..

• Large amounts of debris en plaque hindered examination, time

spent removing debris diminished the residents’ cooperative time.

• Extreme difficulty of examining the frail and medically

compromised. – resistant behavior


• Peltola P, et al. Oral health and treatment needs of the long-term hospitalised elderly. Gerodontology (2004); 21(2):93-99.

• De Visschere, L.M., Grooten, L., Theuniers, G., and Vanobbergen, J.N. Oral hygiene of elderly people in long-term care institutions - a cross-sectional study.

Gerodontology (2006) 23, 195–204.

• Vilstrup, L., Holm-Pedersen, P., Mortensen, E. L., & Avlund, K. Dental status and dental caries in 85-year-old Danes. Gerodontology, (2007) 24(1), 3–13.

• Holmén, A., et al. Oral status in home-dwelling elderly dependent on moderate or substantial supportive care for daily living: Prevalence of edentulous subjects,

caries and periodontal disease. Gerodontology )2012).

Morley, J. E. European Geriatric Medicine 7, 285–288 (2016).

Also in dentistry!!!

PREVENTION

Caries

Periodontal disease

PREVENTION

The underlying evidence for prevention (primary and secondary) and treatment of caries

and periodontal disease, irrespective of age but focussing on age-dependent differences

in efficacy



lifetime




PREVENTION

Periodontal disease

PREVENTION

• Patient-performed control of the biofilm

• Professional mechanical plaque removal

(PMPR)

• Supportive periodontal treatment (SPT)

• Chemical control of the dental biofilm

• Active periodontal treatment (APT)

• Control/management of risk factors for

periodontitis such as smoking and diabetes.

Tonetti M, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, Lopez R, Madianos Ph, Müller F,

Needleman I, Nyvas B, Preshaw Ph, Pretty I, Renvert S, Schwendicke F, Trombelli L, van der Putten GJ,

Vanobbergen J, West N, Young A, Paris S. Dental caries and periodontal disease in the ageing population.

J Clin Periodontol 2017;44: S135-S144.

PREVENTION

• Patient adherence to both effective self-

performed plaque removal (or assisted in the

dependent individual) and recall attendance

during supportive periodontal therapy are key

elements for success.

• The teeth in the Regular Compliance group had

significantly less risk of being lost during SPT

than did the teeth in the Erratic Compliance

group. (pooled RRTL: 0.56 [CI: 0.38, 0.82], P <

0.01)

Lee C, Huang H, Sun T & Karimbux N. Impact of patient

compliance on tooth loss during SPT: a systematic

review and meta-analysis

J Dent Res 2015;4494: 777-786.

Periodontal disease

PREVENTION

• There is little value in providing PMPR without Oral

Hygiene Instructions to reduce gingivitis.

• Repeated and individually tailored OHI is the key

element in achieving gingival health.

Strength of recommendation: High, level of

evidence 1.

• PMPR both supra-gingivally and sub-marginally as

deep as necessary to remove all soft and hard

deposits is required to allow good self-performed

oral hygiene.

Strength of recommendation: Good

Practice point.

• PMPR as the sole treatment modality is

inappropriate in patients with periodontitis.

Strength of recommendation: Good

Practice point.Needleman I, Nibali L, Di Iorio A. Professional mechanical plaque

removal for prevention of periodontal diseases in adults – systematic

review. J Clin Periodontol 2015;. 42: S12–S35

Conclusions: OH - PMPR

Periodontal disease



lifetime




PREVENTION

• Selection bias

• Dropout is always a concern!

• Exclusion of subjects (frail elderly – dementia)

• Very few studies

• More inclusive regarding the quality criteria

• Precision of the estimate (95% CI)

• Comparability

• study designs

• Age groups

PREVENTION

• Lee C, Huang H, Sun T & Karimbux N. Impact of patient compliance on tooth loss during SPT: a systematic

review and meta-analysis. J Dent Res 2015;4494: 777-786.

• Needleman I, Nibali L, Di Iorio A. Professional mechanical plaque removal for prevention of periodontal

diseases in adults – systematic review. J Clin Periodontol 2015;. 42: S12–S35


• Calibration of the examiners

• Blinding

• Examiner blinding

• Patient blinding

• Assessment of the compliance

• Difficulties to include all confounders

• E.g. motivation of patient / clinician who provides OHI

PREVENTION

• Lee C, Huang H, Sun T & Karimbux N. Impact of patient compliance on tooth loss during SPT: a systematic

review and meta-analysis. J Dent Res 2015;4494: 777-786.

• Needleman I, Nibali L, Di Iorio A. Professional mechanical plaque removal for prevention of periodontal

diseases in adults – systematic review. J Clin Periodontol 2015;. 42: S12–S35

PREVENTION



(PMPR)






Periodontal disease

PREVENTION

• Altogether, the data show that when daily oral

hygiene cannot be performed, CHX MW

(0,2%) is the first product of choice.

• A meta-analysis of the effect on ‘de novo’

plaque formation of CHX DF/gel versus CHX

MW resulted in a difference in means of 0.27

[95% CI: 0.14; 0.39] (P < 0.0001).

Supranoto S, Slot D and Van der Weijden G. The effect of chlorhexidine dentifrice or gel versus

chlorhexidine mouthwash on plaque, gingivitis, bleeding and tooth discoloration: a systematic

review. Int J Dent Hygiene 13, 2015; 83–92..

Periodontal disease



lifetime




PREVENTION – CHEMICAL CONTROL OF THE BIOFILM

• Selection bias

• Wide spread of age groups

• Only three studies could be included


• Low to moderate risk of bias

• Patient blinding not feasible

• Assessment of compliance?

PREVENTION – CHEMICAL CONTROL OF THE BIOFILM

Supranoto S, Slot D and Van der Weijden G. The effect of chlorhexidine dentifrice or gel versus

chlorhexidine mouthwash on plaque, gingivitis, bleeding and tooth discoloration: a systematic

review. Int J Dent Hygiene 13, 2015; 83–92..

PREVENTION



(PMPR)






Tonetti et al. J Clin Periodontol 2017;44: S135-S144.

Periodontal disease



lifetime




PREVENTION

PREVENTION

• Caries management (continuum of

preventive and treatment strategies)

• Primary prevention: caries onset

prevention

• Secondary prevention: arrest of

caries lesions

Rich history of

RCT’s and

Cochrane Reviews

involving

adolescents and

younger children

Caries

Tonetti M, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, Lopez R, Madianos Ph, Müller F,

Needleman I, Nyvas B, Preshaw Ph, Pretty I, Renvert S, Schwendicke F, Trombelli L, van der Putten GJ,

Vanobbergen J, West N, Young A, Paris S. Dental caries and periodontal disease in the ageing population.

J Clin Periodontol 2017;44: S135-S144.

PREVENTION

Takahashi & Nyvad Caries Res 2016;50:422–431.

Common aetiology for

coronal and root caries

More vulnerable to

demineralisation

More efficacious

preventive and

therapeutic

treatments are needed

Caries

PREVENTION



• Primary prevention:

• oral hygiene: daily brushing with FD

• Fluoride-based therapy

• Secondary prevention: non-operative

approach

There is robust evidence

suggesting that fluoride-based

therapies are efficacious.

Evidence from younger patient

cohorts in relation to coronal

caries is mirrored by evidence

examining fluoride use in root

caries in older adults

Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in adults. J

Dent Res. 2007 May;86(5):410-5

Caries

PREVENTION







approach

There is robust evidence

suggesting that fluoride-based

therapies are efficacious.

Evidence from younger patient

cohorts in relation to coronal

caries is mirrored by evidence

examining fluoride use in root

caries in older adults

Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in adults. SR

- J Dent Res. 2007 May;86(5):410-5

Caries

PREVENTION

Gibson G, Jurasic M, Wehler C, Jones J, Supplemental fluoride use for moderate and high caries risk

adults: a systematic review. J Public Health Dent. 71 (2011) 171–184.

Fluoride mouthrinse

NaF 0,05% (225 ppm)- 0,2%(1000 ppm)

(Europe) SnF and Amine F

Caries

PREVENTION







approach

boosting fluoride

concentrations for

improved control of root caries

in a non-operative approach

Caries

PREVENTION



Fluoride varnish

5% NaF (22,600 ppm)

Caries

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwij3Iin84_PAhVJK8AKHXN0CAQQjRwIBw&url=http://www.gceurope.com/products/detail.php?id%3D178&psig=AFQjCNFyX5M-vcpmq4mHG2a8aVdnD74xyQ&ust=1473978324310585

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwij3Iin84_PAhVJK8AKHXN0CAQQjRwIBw&url=http://www.gceurope.com/products/detail.php?id%3D178&psig=AFQjCNFyX5M-vcpmq4mHG2a8aVdnD74xyQ&ust=1473978324310585

https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjjs4TGoo_PAhVMAcAKHQZqC_4QjRwIBw&url=https://kleingoed.dentalair.nl/preventie/sealants-en-fissuurlakken/duraphat-ampullen-5x1-6ml.html&psig=AFQjCNEQ3xmjCw8Z05UrcuNW5qweNjDkzQ&ust=1473956624648597

https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjjs4TGoo_PAhVMAcAKHQZqC_4QjRwIBw&url=https://kleingoed.dentalair.nl/preventie/sealants-en-fissuurlakken/duraphat-ampullen-5x1-6ml.html&psig=AFQjCNEQ3xmjCw8Z05UrcuNW5qweNjDkzQ&ust=1473956624648597

PREVENTION



Fluoride DF/gel

1,1% NaF paste (5,000 ppm)

Caries

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiO9MCPja3SAhVLrRQKHfzCCEkQjRwIBw&url=http://www.colgateprofessional.com/products/colgate-prevident-5000-plus/overview&psig=AFQjCNGkkp1RQIVpN-wyloyXXcVPvedOdA&ust=1488175828385735


PREVENTION

Fluoride DF/gel

1,1% NaF paste (5,000 ppm)

Ekstrand KR, Poulsen JE, Hede B, Twetman S, Qvist V, Ellwood RP. A randomized clinical trial of the

anti-caries efficacy of 5,000 compared to 1,450 ppm fluoridated toothpaste on root caries lesions in

elderly disabled nursing home residents. Caries Res. 2013;47(5):391-8

Elderly disabled nursing home

residents who had their teeth

brushed by the nursing staff twice

a day

Intervention: 5000 ppm

Control: 1450 ppm

Caries



PREVENTION

Fluoride DF/gel

1,1% NaF paste (5,000 ppm) - risk ratio for not reversing

Wierichs, R. J. & Meyer-Lueckel, H. (2015) Systematic review on noninvasive treatment of root caries

lesions. Journal of Dental Research 94, 261–271.

Caries



PREVENTION

Silver Diamine Fluoride (SDF) 28%

• Tan HP, Lo EC, Dyson JE, Luo Y, Corbet EF. A randomized trial on root caries prevention in elders.

Journal of Dental Research 2010 Oct;89(10):1086-90.

• Wierichs, R. J. & Meyer-Lueckel, H. (2015) Systematic review on noninvasive treatment of root caries


CHX varnish 1% 3-monthly

NaF varnish 5% 3-monthly

38% SDF yearly

No intervention was significantly superior to the other

Caries

https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiqtdnEhcDTAhVJPBQKHfWDBcoQjRwIBw&url=https://cced.cdeworld.com/courses/4990-Clinical_Use_of_Silver_Diamine_Fluoride_in_Dental_Treatment&psig=AFQjCNF3cizqgMeN_Z_s1GmaYkk76-E8OA&ust=1493224638842367

https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiqtdnEhcDTAhVJPBQKHfWDBcoQjRwIBw&url=https://cced.cdeworld.com/courses/4990-Clinical_Use_of_Silver_Diamine_Fluoride_in_Dental_Treatment&psig=AFQjCNF3cizqgMeN_Z_s1GmaYkk76-E8OA&ust=1493224638842367

PREVENTION

Chlorhexidine varnish

• Slot D.E., Vaandrager N.C., Van Loveren C., Van Palenstein Helderman W.H., Van der Weijden G.A. The

Effect of Chlorhexidine Varnish on Root Caries: A Systematic Review. Caries Res. 2011;45:162–173.

• Wierichs, R. J. & Meyer-Lueckel, H. (2015) Systematic review on noninvasive treatment of root caries


Conclusion

Within the limitations of this review, it may be concluded

that in the absence of regular professional tooth cleaning

and oral hygiene instructions, CHX-V may provide a

beneficial effect for patients in need of special care.

The strength of this recommendation is graded as ‘weak’.

Caries

PREVENTION

Conclusion

Heasman PA, Ritchie M, Asuni A, Gavillet E, Simonsen JL, Nyvad B. Gingival recession and root caries

in the ageing population: a critical evaluation of treatments. J Clin Periodontol. 2017 Mar;44 Suppl

18:S178-S193.

• Root caries lesion development can be controlled at the population level by brushing the teeth

twice a day with conventional fluoride toothpaste (1000-1500 ppm F).

• Active root caries lesions can be converted into inactive lesions by twice daily brushing with

conventional fluoride toothpaste (1000-1500 ppm F), combined with professional applications of

5% NaF varnish or 2% NaF solution 3-4 times a year.

• Alternatively, lesion arrest might be obtained by brushing lesions twice a day with high-F

toothpaste (5000 ppm F).

• Fluoride interventions should be combined with meticulous dental hygiene and sugar control to

optimize the caries-controlling effect.

• Daily use of a fluoridated mouth-rinse may help in controlling root caries lesion development in

the elderly medically compromised patient.

• Chlorhexidine has no additional effect in combination with regular use of fluoride.

Caries



lifetime




PREVENTION

• Drop out (70 years -> 85 years (mortality/morbidity)

• Case definition (e.g. activity of RCL)

• Paucity and poverty of evidence

• Quantity and quality of studies on fluoride

effectiveness among adults!

• Poor compliance (difficult to control and measure)

• Patient/examiner blinding is limited

• Follow-up times rather short

PREVENTION

• Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in adults. J Dent Res. 2007 May;86(5):410-5

• Tan HP, Lo EC, Dyson JE, Luo Y, Corbet EF. A randomized trial on root caries prevention in elders. Journal of Dental Research 2010

Oct;89(10):1086-90.

• Gibson G, Jurasic M, Wehler C, Jones J, Supplemental fluoride use for moderate and high caries risk

• adults: a systematic review. J Public Health Dent. 71 (2011) 171–184.

• Ekstrand KR, Poulsen JE, Hede B, Twetman S, Qvist V, Ellwood RP. A randomized clinical trial of the anti-caries efficacy of 5,000 compared to

1,450 ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing home residents. Caries Res. 2013;47(5):391-8

• Wierichs, R. J. & Meyer-Lueckel, H. (2015) Systematic review on noninvasive treatment of root caries lesions. Journal of Dental Research 94,

261–271.

• Drop out (70 years -> 85 years (mortality/morbidity)

• Case definition (e.g. activity of RCL)

• Paucity and poverty of evidence

• Quantity and quality of studies on fluoride

effectiveness among adults!

• Poor compliance

• Patient/examiner blinding is limited

• Follow-up times rather short

PREVENTION


• Tan HP, Lo EC, Dyson JE, Luo Y, Corbet EF. A randomized trial on root caries prevention in elders. Journal of Dental Research 2010

Oct;89(10):1086-90.

• Gibson G, Jurasic M, Wehler C, Jones J, Supplemental fluoride use for moderate and high caries risk

• adults: a systematic review. J Public Health Dent. 71 (2011) 171–184.

• Ekstrand KR, Poulsen JE, Hede B, Twetman S, Qvist V, Ellwood RP. A randomized clinical trial of the anti-caries efficacy of 5,000 compared to

1,450 ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing home residents. Caries Res. 2013;47(5):391-8

• Wierichs, R. J. & Meyer-Lueckel, H. (2015) Systematic review on noninvasive treatment of root caries lesions. Journal of Dental Research 94,

261–271.

RECOMMENDATIONS (RANDOM ORDER)


• Ferreira, R.C., De Magalhães, C.S., and Moreira, A.N. Tooth loss, denture wearing and associated factors among an elderly institutionalised

Brazilian population. Gerodontology (2008). 25, 168–178.


• Heegaard, K.M., Holm-Pedersen, P., Bardow, A., Hvidtfeldt, U.A., Grøbæk, M., and Avlund, K. The Copenhagen Oral Health Senior Cohort:

Design, population and dental health. Gerodontology (2015) 28, 165–176.

• Assessment methods need to be converged, a gold

standard for periodontal recording is necessary.

• Qualitative research methods can be appropriate to

understand some complex relationships.

• Full mobile equipment will be useful.

• Using the shortest study duration reduces sample

bias

RECOMMENDATIONS (RANDOM ORDER)


• Palmer RF, Royall DR. Missing data? Plan on it! J Am Geriatric Soc (2010) 58:S343-S348.

• Previous studies can be useful to improve sampling

strategies.

• Recently evolved, statistically sound alternatives to

eliminating cases with missing data are now

accepted as state of the art.

• Full information likelihood procedure

• Multiple imputation methods

• Tonetti, M. S., Bottenberg P, Conrads G, Eickholz P, Heasman P, Lopez R, Madianos P, Müller F, Needleman I, Nyvad B,

Preshaw PM, Pretty I, Renvert S, Schwendicke F, Trombelli L, vd Putten GJ, Vanobbergen J, West N, Young A, Paris S. Dental

caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an

essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries be.

Journal of Clinical Periodontology 44, S135–S144 (2017).

FUTURE RESEARCH

There is an urgent need for epidemiological

surveillance of caries, periodontal diseases,

tooth loss and oral health-related quality of

life in older populations.






FUTURE RESEARCH





National oral health surveys need to include

representative samples of 65- to 74-year-olds and 75+

year-olds, including the very old (85 years and older)

and frail and/or care dependent elders, and older

people with multimorbidity and polypharmacy (e.g. by

oversampling).

Reporting of surveys need to follow standardized

formats in order to allow comparisons and data

synthesis.






FUTURE RESEARCH





Epidemiological evaluations in older populations

should include oral hygiene levels, tooth loss,

attachment level, pocket probing depths and

inflammation (bleeding on probing) as well as the

presence and number of coronal and root caries

lesions, their severity and activity.

Quality-of-life measures, salivary secretion rates and

(medical) risk factors should also be assessed.






FUTURE RESEARCH

Priorities should be placed on how preventive

and therapeutic regimens may preserve oral

health, quality of life and nutrition into older

age as comorbidities present unique

challenge to the delivery of intrinsically

efficacious and effective strategies.






FUTURE RESEARCH

Priorities should be placed on how preventive

and therapeutic regimens may preserve oral

health, quality of life and nutrition into older

age as comorbidities present unique

challenge to the delivery of intrinsically

efficacious and effective strategies.

To understand disease progression with age,

future long-term longitudinal studies recording

the disease extent and severity of both caries

and periodontitis in these age groups, as well as

a comprehensive set of preventive strategies,

are warranted.

ACKNOWLEDGMENT

• A valuable input from

Drs Barbara Janssens

Lynn Janssens

Ellen Palmers

!!

!

Prof. Dr. Jacques Vanobbergen

community dentistry and oral public health

E

[email protected]

www.ugent.be

www.gerodent.be

Ghent University

@ugent

Ghent University

thank you for your attention

Documents

CHALLENGES IN STUDIES OF AGEING AND ORAL … Vilnius 2017 challenges.pdf · CHALLENGES IN STUDIES OF AGEING AND ORAL HEALTH ... Gostemeyer, wendicke, F. (2017) Aging, dental caries