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ABSTRACTA representative sample of 520 dentate older adults living in rural Iowa were examined in their homes for the presence of occlusal or incisal attrition. Enamel attrition was found in 84.2% of the population, dentinal attrition in 72.9%, and severe attrition in 4.2%. Approximately 25% of this population's teeth were affected with substantial attrition. Attrition was more prevalent in the anterior segments. The prevalence of substantial attrition was associated with the number of remaining teeth, gender, gingival bleeding, and the use of smokeless tobacco. The decision to treat occlusal attrition in these older people should be based on the etiology and progression of the condition and other factors specific to the individual. The treatment of choice is determined by the extent and severity of the condition and the amount of occlusal vertical dimension lost.

A volunteer patient was examined by five dentists experienced in caring for geriatric patients. The patient and dentist interaction was videotaped and reviewed to evaluate a previously generated hypothesis regarding the diagnosis process. This descriptive study suggests that dentists experienced in geriatric care did assess and evaluate a wide range of patient characteristics. However, they did not follow the previously hypothesized process in arriving at an appropriate treatment plan. Instead, they relied heavily on past experiences with similar situations. The possible implications of this process for treatment planning and teaching of geriatric dentistry are discussed.

A random sample of 1,016 subjects aged 65 and older were interviewed and examined in their own homes. The sample was stratified by race and place of residence. As part of the interview, the 821 dentate subjects were asked to rate their mouth appearance, chewing ability, and mouth health. Most subjects responded positively to these questions. The self‐perception of mouth health was most related to the presence of anterior teeth. Perception of chewing ability was most related to the number of anterior teeth present, total number of teeth present, and the need for extractions. Subjects also were asked about their perceived dental needs. A small proportion of subjects thought they needed restorations, periodontal treatment, or teeth replacement. Subjects generally were not able to define the extent of their treatment needs, but their self‐perceptions of mouth appearance, chewing ability, and mouth health had some relationship to their oral health.

ABSTRACTSince 1980, a mobile program has delivered dental care to 14 different long‐term care facilities that care for frail and functionally dependent older persons. These facilities lie within a 60‐mile radius of the University of Iowa College of Dentistry.This paper reports comparisons between characteristics of users versus nonusers of dental care in the program. Of the 853 residents in the long‐term care facility who were screened, it was determined that 66% would benefit from some type of dental care. When the residents and their families were approached for treatment permission, 48% of those recommended permitted treatment; treatment was completed on 38% of those persons recommended for treatment. No differences were observed in the distribution or diagnoses of major medical problems for the users versus nonusers of care. Recommended treatment was similar for users and nonusers in nursing homes. The majority of non‐users refused treatment because they or their families did not perceive a need for dental care.

Prevalence and indicators of medication use with potential oral health implications among 4,163 people horn the Duke Established Populations for Epidemiologic Studies of the Elderly were studied. Medications were grouped into seven potential oral adverse drug reaction (POADR) Categories. Eighty percent of participants were taking at least one medication from any of the seven categories. Drugs with the potential to cause xerostomia were taken by 56.1%, abnormal hemostasis by 51.7%, soft tissue reactions by 23.4%, taste changes by 11.0%, alteration In host resistance by 8.7%, gingival overgrowth by 5.0%, and movement disorders by 2.4% of participants. Race‐stratified analyses revealed that medication use with any POADR was significantly associated (p ≤ 0.001) with being female for both races Among nonblacks, being ≥ 75 years old was associated with higher POADR use. Blacks who had a dental visit in the previous six months were more likely to take medications with POADR than those who did not. POADR medication use was not related to place of residence. Elderly often take medications with potential oral health impact.

AbstractBackgroundSystemic health and physical, cognitive, and social function gradually decline at the end of life. How oral health change at the end of life in community‐dwelling older adults remains unknown, increasing the difficulty in treatment planning for these individuals.MethodsA total of 250 community‐dwelling decedents of a longitudinal study were included in the analysis. Decedents' clinical and interview data collected at baseline, 18, 36, 60, and 84 months were linked to their death dates and plotted on an inverted time scale to study their oral health changes in the 3 years prior to death. Mixed effect models with random intercepts and slopes of months from death and sociodemographic variables were used to model the subjective and objective oral health trajectories in the last 3 years of life. The association of the change in the outcomes with a linear trend of months from death were assessed using the F‐test.ResultsNumber of missing teeth was significantly associated with a linear trend of months from death. With every month in proximity to death, the expected number of missing teeth increased by 0.03 (SE = 0.004; p < 0.001), resulting in an average of 1.08 missing teeth in 3 years. Among subjective outcomes, the odds of good versus poor or "neither" self‐rated systemic health (p = 0.009) and mouth appearance (p = 0.008) significantly decreased as death approached.ConclusionAlthough other oral health measures remained relatively stable, tooth loss and dissatisfaction with mouth appearance steadily increased in community‐dwelling older adults as death approached. These changes were gradual and parallel the end‐of‐life general health decline.