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BDS3 Special Care Dentistry > OHRQoL > Flashcards

OHRQoL Flashcards

1
Q

4 aspects of human rights

A
  • Accessibility to services
    • Non-discrimination
    • Physical access
    • Economic
    • Information
  • Acceptability of health facilities/ goods/ services
    • Ethics
    • Culturally appropriate
  • Availability
    • Facilities
    • Effective public health
    • Preventative programme
    • Goods and services
  • Good quality service
    • Restructured to meet needs of older people
    • Robust and routine evidence
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2
Q

sustainable development and economics

A
  • Significant proportion of the population will be older
  • Older people contribute through food production and raising future generations
  • Development enhances an equitable society, well-being and productivity
  • Development needs to be inclusive
  • Economics
    • Minimise expenditure whilst maximising contributions
      • Flawed models based on old age being 65
  • Older people contribute to economy through consumption
    • Greater proportion of wealth in UK
  • Older people are an investment not a cost
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3
Q

biological Vs chronological age

A
  • Depends on factors influencing person on where they are on the biological scale
    • Biological model may be better than chronological model for old age
  • Some factors are changeable (behaviours, lifestyle, personal characteristics)
  • and some are non-changeable (physical environment, genetics, socio-economic status – can change but increasingly harder)
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4
Q

defining oral health

A
  • multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.
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5
Q

basis of patient centred care

A

very few diseases have an absolute cure – most can be treated

change in clinician perspective – how does opt want to live their life

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6
Q

Oral health related quality of life

A
  • Multidimensional construct
  • Subjective
  • Individualised

“A multidimensional construct that reflects (among other things) people’s comfort when eating, sleeping and engaging in social interaction; their self esteem; and their satisfaction with respect to their oral health”

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7
Q

oral health related quality of life measures

A
  • geriatic/general oral health
  • dental impact profile
  • oral health impacts profile (long and short)
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8
Q

geriatric/general oral health measure QoL covers

A

Chewing, eating, social contacts, appearance, pain, worry, self-consciousness

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9
Q

dental impact oral health QoL measures

A

Appearance, eating, speech, confidence, happiness, social life, relationships

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10
Q

oral health impacts QoL measures

A

Functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability and handicap

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11
Q

what is the value of OHRQoL

A

aids:

clinical practice and policy

  • Assessment on entry to care homes
  • FiCTION trial
  • Caries management
  • Strategic targeting/public health interventions

Research and service

  • Surveys
  • Clinical trials
  • Cost utility analysis
  • Health services research
  • Population surveys
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12
Q

The Influence of Oral Health Factors on the Quality of Life in Older People: A systematic review

  • natural dentition
A

No clear consensus on being edentulous on OHQoL

  • More teeth you have the better OHQoL
  • Also, the more missing teeth you have the more negatively impacted your OHQoL is

Want to keep anterior teeth/fill anterior spaces for improved OHQoL

Occluding pairs – very important for all ages – the more pairs the more positive OHQoL

  • Key to find, store and maintain occluding pairs for function
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13
Q

The Influence of Oral Health Factors on the Quality of Life in Older People: A systematic review

  • caries
A

No clear consensus – so many variables to measure caries

  • Carious lesions (active)
  • Restored teeth
  • Root caries

Would think caries would have a negative impact but when merge all the data together = no consensus

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14
Q

The Influence of Oral Health Factors on the Quality of Life in Older People: A systematic review

  • periodontal
A

Too many variables to produce a statistical significance overall

But (like caries) if you look at each domain individually then can see negative impact

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15
Q

The Influence of Oral Health Factors on the Quality of Life in Older People: A systematic review

  • prosthetic
A

RPD - mixed

Poor dentures negative impact of OHQoL

  • Ulcer, bad breath, non-functional

Fixed better than Removable

Implant retained prostheses = better OHQoL

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16
Q

oral health related factors that can impact QoL

A
  • natural dentition
  • caries
  • periodontal status
  • prosthodontic status
  • xerostomia
  • hyposalivation
  • clinical symptoms of dry mouth
  • orofacial pain
  • chewing ability
17
Q

shortened dental arch with resin retained bridges Vs full RPD

A
  • SDA/RRB
    • improved quality of life @ 24 months
    • improved cost effectiveness
  • RPD Group
    • initial improvement @ 6 months but diminished @24 months

argument that restoring to SDA over further restoring (unless have occluding pairs in posterior)

18
Q

2 models for translating QoL into clincal practice

A
  • prevention
  • delivery of clinical care
19
Q

life course and prevention

A
  • Equal or equitable
    • Reduction in care as life course progress – but need to address – need preventative strategies in place throughout life course

“medicine is failed prevention” Sir Michael Marmot

20
Q

Caring for smiles

A
  • Scotland’s national oral health promotion, training and support programme
  • Education and Training Programme
    • Lectures to carers, upskill carers
  • Adults who move into a care home have their mouth care needs assessed on admission
    • First set of principles - OHQoL
  • Adults living in care homes have their mouth care needs recorded in their personal care plan
    • Develop a care plan based on assessment
    • Unique to them
  • Adults living in care homes are supported to clean their teeth twice a day or undertake daily oral care for dentures
21
Q

issue for elderly dental care in scotland

A

Systematic review highlight that existing training programmes

  • Improve knowledge and influence attitudes
  • No change in oral hygiene
  • “If you always do what you have always done you will always get what you have always got”*
  • Henry Ford
22
Q

potential model to improve OH of elderly

A

Fluoride Varnish Programmes for Older people in caring environments

A randomised feasibility study

  • Pilot work undertaken 2014-2015
    • Sample size – 13 of 78 residents
      • Enormous drop – death, ill, change in consent capacity

Complexity of systems and delivery highlighted

  • How to get in, delivery, where in care home

Significant finding on arresting caries roots

  • F varnish beneficial for root caries, but 50:50 for teeth whether restored or extracted
    • More results in 2021 - COVID impact

Innovation

  • Need to remove biofilm in theory
23
Q

3 trajectories in end of life

A
  • Top – cancer
  • Middle – chronic heart/lung, gradual decrease with sudden dips of hospital
  • Bottom – long slow decline - extended life
24
Q

to treat or not to treat

A
  • Older people’s end of life trajectory tends to be longer
    • Average 2-3 years when admitted to care home (bell shaped curve so varies)
  • Predicting how long this person is going to live is hugely challenging
  • If dentists know the person is in the end stages of life they conform to a more conservative approach
  • There is however a risk of overtreatment
    • 67% of older people received “usual care” of which 62% died within 3 month

HPT, RPD, restorations, paying money, visiting dentist regularly

25
Q

what do we need to manage to improve oral health

A
  • Report OHRQoL as good yet, oral health is remarkably poor
  • “Secondarisation of oral problems” (medical or social)
    • Other more complex issues which affect them at this stage of life
    • Lack of input from dentists in the team approach (in end of life care)
  • Major complaints are:
    • Dry mouth
    • Ulceration
    • Infection and Pain
26
Q

barriers to oral health care for elderly

A

more how than who - Clinical support, education and training is not a panacea

Numerous barriers:

  • Integrated working between health and social care
  • Mutual decisions improve outcomes
  • Nominated care lead
  • Sharing in planning interventions and flexibility
    • Current health care systems are flexible enough
27
Q

oral health improvement plan scotland - 3 parts related to elderly

A
  • Domiciliary Care Provision
    • Upskill care workers
  • Enhanced Skills – Gerodontology specialism?
    • More services being able to be provided in primary high street setting for them
      • Reduce OH inequality
  • Partnership between health and social care
28
Q

domicillary care

A

Lower societal cost when compared to fixed clinic – Swedish Population

controversial in UK

  • Believed to be expensive – study shows not

Safety

  • Limited in what you can do in care homes in Scotland

Overall not significant risk to health to provide domiciliary care

29
Q

positive impact on OHRQoL

A
  • Increased number of teeth, anterior teeth and occluding pairs of teeth have a positive impact on OHRQoL for older people
  • We need to consider stage of life course and integration of disciplines in how we manage our patients across health and social care
  • Further education and research is essential to shape how we move forward in the care of older people

BDS3 Special Care Dentistry (21 decks)

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