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What are the barriers experienced by dentists when delivering oral health care to older people? A systematic literature review

This summary is based on the article published in Community Dentistry and Oral Epidemiology: Barriers of delivering oral health care to older people experienced by dentists: a systematic literature review (April 2014)

Bots-VantSpijker PC, Vanobbergen JNO, Schols JMGA, Schaub RMH, Bots CP, de Baat C.

Context 

Old age is associated with a higher incidence of disease, such as cardiovascular diseases, dementia, orthopaedic diseases and neurological diseases. These chronic diseases may increase the risk of developing oral diseases (1, 2).

Also, physical, cognitive and functional alterations accumulate while ageing and may lead to increasing care dependency. Increased dependency may cause problems to maintain good oral health (3, 4).

Over the last three decades, a very rapid overall decline in the rate of edentulism has occurred (5).  Having their own dentition, these people inevitably present many oral healthcare needs and are a risk group for oral diseases, especially caries, periodontal disease as well as tooth wear (3, 6).  Consequently, older people are in need of both preventive and curative oral health care continuously (7).

However, it has been shown that older people in general use professional oral healthcare services less frequently than younger people (8, 9).

Purpose of the Review

The review aims to systematically review the current literature to identify barriers of delivering oral health care to older people as experienced by dentists.

Key Findings

  • In care homes, lack of adequate dental equipment, unavailability of a treatment room and inadequate reimbursement were identified as the most common barriers (10, 11, 12–14).
  • Inadequate reimbursement for delivering oral health care in a care home was another identified common barrier. In a review (15), the availability of oral health care, the organization of oral healthcare providers and reimbursement for oral health care in Europe as well as in the United States were identified as important factors influencing access to oral health care for older people.
  • The negative attitude towards oral hygiene care and a lack of oral health knowledge of care home nurses was reported as a barrier (12, 16).
  • Dentists’ personal opinions about and inaccurate perceptions of older people: 
    • The strongest self-reported concern was that these patients rarely follow their recommendations. (14)
    • Dentists significantly overestimated their older patients’ reluctance to receive oral health care. (17)
    • In general, dentists had inaccurate perceptions of facts on ageing.
    • More experienced dentists and those who had larger numbers of self-paying older people in their practice held fewer negative stereotypes.
  • Lack of training and experience of dentists in delivering oral health care to older people are mentioned as a barrier. (18-22) 

References

  1. Lally F, Crome P. Understanding frailty. Postgrad Med J 2007; 83:16–20.
  2. Griffin SO, Barker LK, Griffin PM, Cleveland JL, Kohn W. Oral health needs among adults in the United States with chronic diseases. J Am Dent Assoc 2009; 140:1266–74.
  3. Ettinger RL. Oral health and the aging population. J Am Dent Assoc 2007; 138:5S–6S.
  4. Scully C, Ettinger RL. The influence of systemic diseases on oral health care in older adults. J Am Dent Assoc 2007; 138:7S–14S.
  5. Carlsson GE, Omar R. The future of complete dentures in oral rehabilitation. A critical review. J Oral Rehabil 2010; 37: 143–56.
  6. Kiyak HA. Successful aging: implications for oral health. J Public Health Dent 2000; 60: 276–81.
  7. Pyle MA, Stoller EP. Oral health disparities among the elderly: interdisciplinary challenges for the future. J Dent Educ 2003; 67:1327–36.
  8. Fiske J, Gelbier S, Watson RM. Barriers to dental care in an elderly population resident in an inner city area. J Dent 1990; 18: 236–42.
  9. Borreani E, Jones K, Scambler S, Gallagher JE. Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care. Gerodontology 2010; 27: 11–8.
  10. MacEntee MI, Weiss RT, Waxler-Morrison NE, Morrison BJ. Opinions of dentists on the treatment of elderly patients in long-term care facilities. J Public Health Dent 1992; 52: 239–44.
  11. Nitschke I, Ilgner A, M€uller F. Barriers to provision of dental care in long-term care facilities: the confrontation with ageing and death. Gerodontology 2005; 22: 123–9.
  12. Antoun JS, Adsett LA, Goldsmith SM, Thomson WM. The oral health of people: general dental practitioners’ beliefs and treatment experience. Spec Care Dentist 2008; 28: 2–7.
  13. Hopcraft MS, Morgan MV, Satur JG, Wright FA. Dental service provision in Victorian residential aged care facilities. Aust Dent J 2008; 53: 239–45.
  14. Chowdhry N, Aleksej[1]unien_e J, Wyatt C, Bryant R. Dentists’ perceptions of providing care in long-term care facilities. J Can Dent Assoc 2011; 77: b21.
  15. Holm-Pedersen P, Vigild M, Nitschke I, Berkey DB. Dental care for aging populations in Denmark, Sweden, Norway, United Kingdom, and Germany. J Dent Educ 2005; 69: 987–97.
  16. de Baat C, Bruins HH, van Rossum GMJM, Kalk W. Oral health care for nursing home residents in The Netherlands – a national survey. Community Dent Oral Epidemiol 1993; 21:240–2.
  17. Wilson MC, Holloway PJ, Sarll DW. Barriers to the provision of complex dental treatment for dentate older people: a comparison of dentists’ and patients’ views. Br Dent J 1994; 177:130–4.
  18. Kuthy RA, McQuistan MR, Heller KE, Riniker-Pins KJ, Qian F. Dental students’ perceived comfort and future willingness to treat underserved populations: surveys prior to and immediately after extramural experiences. Spec Care Dentist 2010; 30: 242–9.
  19. Habibian M, Seirawan H, Mulligan R. Dental students’ attitudes toward underserved populations across four years of dental school. J Dent Educ 2011; 75:1020–9.
  20. Wilkinson TJ, Gower S, Sainsbury R. The earlier, the better: the effect of early community contact on the attitudes of medical students to older people. Med Educ 2002; 36:540–2.
  21. Weaver RG, Haden NK, Valachovic RW, American Dental Education Association. Annual ADEA survey of dental school seniors: 2002 graduating class. J Dent Educ 2002; 66:1388–404.
  22. Weaver RG, Chmar JE, Haden NK, Valachovic RW. Annual ADEA Survey of Dental School Seniors: 2004 Graduating Class. J Dent Educ 2005; 69:595–619.

 

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1 Comment

  1. Harley Todd June 10, 2014

    Oral diseases can affect both the hard tissues like teeth and soft tissues of the mouth at any age. The primary disease that affects hard tissues is tooth decay, while soft tissues are affected by periodontal diseases, most often gingivitis and periodontists. Older people are also at increased risk for oral cancers and precancerous lesions. In such cases i will suggest you always go for a prior test in dentists clinic or else concern any specialist.

    Reply

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