Aging and Oral Care: An Observational Study of Characteristics and Prevalence of Oral Diseases in an Italian Cohort

Background: Poor oral health is a common condition in
patients suffering from dementia. Several aspects of this
systemic pathology contribute to causing oral problems:
cognitive impairment, behavior disorders, communication
and, motor skills deterioration, low levels of cooperation
and medical-nursing staff incompetency in the
dental field. Objectives: The objectives of this study were
to evaluate the prevalence and the characteristics of oral
pathology in a demented elderly population, as well as
to check the association between the different degree of
dementia and the oral health condition of each patient.
Materials and Methods: In this observational study (with
cross-sectional design) two groups of elderly patients suffering
from dementia, living in two different residential
care institutions were recruited. The diagnosis of dementia
of each included patient was performed using the
Clinical Dementia Rating Scale. In order to evaluate the
oral health condition of the included subjects, each patient
underwent a physical examination of the oral cavity,
during which different clinical parameters were analyzed
(number of remaining teeth, oral mucosa, periodontal
tissues, bone crests). To each parameter, a score was assigned.
Spearman’s Rho test was used. Results: Regarding
the prevalence of oral pathology in elderly suffering from
dementia, it emerged that 20.58% of the included patients
had mucosal lesions and/or new mucosal formations (in
most cases undiagnosed and therefore untreated). The
prevalence of periodontal disease was equal to 82.35%
and a marked clinically detectable reabsorption of bone
crests was found in almost all patients (88.23%). 24.13%
of patients, who underwent the oral examination, had
totally edentulous maxillae and/or with retained roots,
without prosthetic rehabilitations. The correlation index
r showed the presence of a linear correlation (inverse relationship)
between the degree of dementia and the state
of health of the oral cavity of each patient. Conclusions:
Several factors contribute to poor oral health in the elderly
suffering from dementia: cognitive functions deterioration,
behavioral disorders and inadequate medical-staff
nursing training on oral hygiene. This study also demonstrated
that the lower the dementia degree is, the lower
tends to be the oral health status. In order to guarantee
a complete assistance to these patients, residential care
institutions should include in their healthcare program
specific dental protocols.