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Dental caries is the major cause of tooth loss in elderly individuals with physical and mental disabilities. The diagnosis of caries in elderly individuals is difficult due to a complicated oral environment compounded by the prevalence of physical and mental barriers to care. The restoration of tooth structure and the replacement of teeth lost due to caries result in considerable economic and biological cost to both individuals and society. Decisions to remineralize, restore, or extract teeth depend largely upon the extent of the structural damage caused by the infection. Teeth with small lesions can be remineralized with fluorides, whereas teeth with large lesions may be restored or extracted. Caries risk assessment based on the history of previous infection, salivary parameters, and ingestion of sugar can be used as a basis for placing a patient on a caries‐preventive regimen. This paper discusses the patho‐physiology of caries to explain the appropriate diagnosis, prevention, and treatment of dental caries in elderly individuals with chronic disabilities.

Open‐ended interviews were conducted with 109 individuals. These included: administrators, staff, dental personnel, residents, and family members, associated with 12 long‐term‐care (LTC) facilities to contrast different human resource and organizational strategies for managing the delivery of oral health care to the elderly residents. A multiple case‐study analysis revealed that no particular organizational strategy was ideal, although three important components—oral hygiene, diagnostic assessments, and dental treatment—were common to all. The dental personnel everywhere believed that oral health in the midst of other conflicting priorities received inadequate attention, while the administrators and staff acknowledged that they were weak at recognizing oral disorders and assisting with oral hygiene. In all, the interviews offered a portrait of the conflicting priorities associated with LTC, and they provide practical insights to successful strategies of care in this population.

Increasing numbers of Institutionalized elders have very poor oral health. It has been suggested that ethical problems may influence dentists who attempt to provide oral care for these people, but little attention has been given to research in this area. A qualitative Interview method was used to Investigate the views and experiences of dentists working with institutionalized elders. Particular attention was given to the ethical difficulties encountered and how the dentists resolved them. Ten dentists experienced in long‐term care were interviewed individually by means of open‐ended questions. Thematic analysis identified ethical problems focused on the difficulty of identifying the wishes of patients or predicting the outcome of treatment. The participants reported few difficulties in making clinical decisions in this setting. However, analysis revealed that the ethical perspectives of the dentists varied substantially. Variation was notable, particularly in their preference for ideal or practical treatment and in their preference for autonomy or beneficence.

ABSTRACTThere is limited information regarding oral health status and other predictors of oral health‐related quality of life. An association between oral health status and perceived oral health‐related quality of life (OHQOL) might help clinicians motivate patients to prevent oral diseases and improve the outcome of some dental public health programs. This study evaluated the relationship between older persons' OHQOL and their functional dentition, caries, periodontal status, chronic diseases, and some demographic characteristics. A group of 733 low‐income elders (mean age 72.7 ISD=4.71, 55.6% women, 55.1% members of ethnic minority groups in the U.S. and Canada) enrolled in the TEETH clinical trial were interviewed and examined as part of their fifth annual visit for the trial. OHQOL was measured by the Geriatric Oral Health Assessment Index (GOHAI); oral health and occlusal status by clinical exams and the Eichner Index; and demographics via interviews. Elders who completed the four‐year assessment had an average of 21.5 teeth (SD=6.9). with 8.5 occluding pairs (SD=4.6), and 32% with occlusal contacts in all four occluding zones. Stepwise multiple regressions were conducted to predict total GOHAI and its subscores (Physical, Social, and Worry). Functional dentition was a less significant predictor than ethnicity and being foreign‐bom. These variables, together with gender, years since immigrating, number of carious roots, and periodontal status, could predict 32% of the variance in total GOHAI, 24% in Physical, 27% in Social, and 21 % in the Worry subscales. These findings suggest that functional dentition and caries influence older adults' OHQOL, but that ethnicity and immigrant status play a larger role.