Dr Pei Yuan Chan’s helps clinicians treat aging patients

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Researcher from Singapore offers guidance for treating elderly dental patients

In addition to increasing oral health awareness in the general population, Dr Pei Yuan Chan seeks to educate clinicians on how to provide the best care as their patients get older. (Image: Drazen Zigic/Shutterstock)

SINGAPORE: Culture meets science in a recent study by oral health researchers in Singapore. The findings indicate that, in Singapore, clinicians need to address patient expectations regarding the deterioration of their oral health with age and implement reasonable interventions to mitigate that decline. Dental Tribune International spoke with lead researcher Dr Pei Yuan Chan about what dental clinicians globally could learn in order to better help their ageing patients.

Dr Pei Yuan Chan. (Pei Yuan Chan)

Dr Chan, what inspired your team to investigate the relationship between the number of functional occlusal units (FOUs) and oral health-related quality of life (OHRQoL) in older adults? How do you see this research benefiting everyday dental practice?
Our team was inspired by the success of the 8020 Campaign in Japan, which highlighted the pivotal role of maintaining at least 20 teeth for optimal oral health and function, particularly in older adults. Recognising how important this is, we sought to investigate the relationship between the number of FOUs and OHRQoL in older adults.

By conducting this research, we aim to shed light on the crucial link between FOUs and overall oral health outcomes. We envision that our findings will directly benefit everyday dental practice by providing clinicians with valuable insights into the importance of preserving FOUs in older adult patients. By incorporating our findings, dental professionals can tailor their treatment approaches more effectively, prioritising interventions that promote the retention of FOUs and enhance the overall well-being of older adults.

Based on your findings, what specific dental interventions would you recommend to preserve or enhance the number of FOUs in older adults? How can dentists prioritise treatments to maximise the impact on patients’ quality of life?
One of the challenges is that oral health awareness is generally low in Singapore. Many individuals do not prioritise regular dental visits, often seeking dental care only when experiencing pain. Moreover, there persists a misconception among older adults that dental issues and tooth loss are inevitable consequences of ageing. Therefore, there is a critical need to raise awareness about the preventable nature of oral diseases such as dental caries and periodontal disease, which can lead to tooth loss if left untreated.

Encouraging regular dental screenings is vital for early detection and management of oral disease, ultimately contributing to the preservation of at least 20 teeth beyond the age of 80. Preventive measures like fluoride treatments, the maintenance of good oral hygiene practices and the adoption of healthy dietary habits play a pivotal role in preventing caries and periodontal disease, both of which can have an impact on occlusal function and overall oral health.

Efficient management of periodontal disease is essential for preventing tooth loss and preserving occlusal units. Additionally, restorative treatments like dentures or implants can help replace missing teeth, ensuring adequate occlusal function and maintaining oral health. By emphasising the importance of preventive measures and early intervention, we can work towards improving oral health outcomes and promoting a better quality of life for individuals in Singapore.

To maximise the impact on patients’ quality of life, dentists can adopt a patient-centred approach, beginning by engaging with patients in order to understand their specific concerns and preferences regarding oral health and function. This allows for the development of comprehensive treatment plans that address both immediate needs and long-term goals, considering the patient’s overall health status and lifestyle factors.

In prioritising treatments, dentists should focus on addressing the functional needs of their patients, such as restoring or replacing missing teeth to improve occlusal function and enhance OHRQoL. Collaboration with other healthcare professionals, such as geriatricians or dietitians, can help address systemic issues that may have an impact on oral health and occlusal function.

Regular monitoring of patients’ progress is essential, allowing for adjustments to treatment plans as needed to ensure optimal outcomes and patient satisfaction. By adopting a tailored approach that considers individual needs and preferences, dentists can effectively prioritise treatments to maximise the impact on patients’ quality of life.

“Older adults should be involved in treatment decisions to ensure that their needs and goals are met.”

The study highlights the importance of maintaining at least 20 functional teeth or ten FOUs for better OHRQoL. What preventive strategies do you suggest dentists should prioritise to help their older adult patients preserve their teeth?
Oral frailty encompasses a multifaceted decline in physical, psychological and social functions, and oral health plays a significant role in each aspect. Research indicates that declining oral health quality and increasing frailty are linked to older age, making maintenance of oral health essential for prolonging healthy life expectancy in ageing populations such as that of Singapore. Oral frailty in older adults has been associated with adverse health outcomes, including overall frailty, sarcopenia, long-term care needs and premature mortality. A key component that contributes to oral frailty is the number of remaining teeth, as this affects a person’s ability to chew and speak.

A recent pilot study conducted in Singapore among 780 community-dwelling adults aged 40 years and above revealed that 17.4% were orally pre-frail or frail, emphasising the pressing need for proactive measures to address oral frailty and its associated health implications. Dentists can play a crucial role in screening for oral frailty beyond their traditional focus on controlling oral disease and providing curative interventions. Given the interconnection between oral health and overall health, dentists can integrate assessments for oral function decline into routine check-ups. This involves evaluating functions such as chewing, swallowing and speaking, which are essential for maintaining overall well-being.

To facilitate early detection of oral frailty, dentists can utilise screening tools such as the Oral Frailty Index-8, a questionnaire designed to assess oral health-related behaviours and indicators of oral frailty. By incorporating such tools into their practice, dentists can identify older adults at risk of oral frailty and initiate appropriate interventions, potentially improving their overall health outcomes.

Furthermore, dentists can collaborate with primary care providers and community health partners to implement comprehensive oral health assessments and interventions for older adults. This interdisciplinary approach ensures that older adults receive holistic care addressing both their oral and general health needs.

“Given the interconnection between oral health and overall health, dentists can integrate assessments for oral function decline into routine check-ups.”

Your study noted a need for further research on the impact of the number or location of FOUs on masticatory efficiency and OHRQoL. What specific areas of future research do you think are most critical for dental professionals to focus on, based on your study’s findings?
The study’s findings on how FOUs affect masticatory efficiency and OHRQoL highlighted several key areas for future research in dentistry: location of FOUs, quality of FOUs, functional adaptations, intervention studies, objective measures of masticatory efficiency, and patient-reported outcomes, specifically:

  • investigation of how FOUs’ placement within the dental arches has an impact on chewing ability and overall oral function;
  • exploration of the relationship between the quality of FOUs (e.g. occlusal surface morphology and tooth integrity) and masticatory efficiency and determination of whether the presence of well-functioning but minimally worn teeth provides similar benefits to OHRQoL as fully intact teeth;
  • examination of how individuals with fewer FOUs compensate for chewing deficiencies through changes in chewing patterns or dietary adjustments and evaluation of the effectiveness of these adaptations in maintaining oral function and quality of life;
  • assessment of the effectiveness of various dental interventions aimed at preserving or improving FOUs regarding masticatory efficiency and OHRQoL, including preventive measures, restorative treatments and prosthodontic interventions;
  • development and validation of objective measures of masticatory efficiency, such as chewing efficiency tests and bite force assessments, to quantify the functional impact of FOUs on oral health outcomes accurately; and
  • the use of patient-reported outcome measures to understand individuals’ subjective experiences regarding masticatory function and OHRQoL and incorporation of these measures into future research to comprehensively assess OHRQoL.

By addressing these areas in future research, dental professionals can deepen their understanding of the relationship between FOUs, masticatory efficiency and OHRQoL. This knowledge will ultimately inform evidence-based approaches to oral health promotion and treatment planning for older adult populations.

Is there anything else about this or related research that you would like our readers to know?
It is important to take a comprehensive approach to oral healthcare, especially for older adults. Prioritising interventions that maintain or enhance FOUs is essential for their well-being. Collaborating with fields like geriatrics and psychology provides valuable insights into the broader context of oral health in ageing populations.

Patient-centred care is crucial. Older adults should be involved in treatment decisions to ensure that their needs and goals are met. Regular check-ups and education are vital preventive strategies to maintain good oral health and prevent issues like tooth loss.

Addressing disparities in oral health outcomes among older adults, including socio-economic and cultural factors, is essential. Implementing evidence-based interventions can significantly improve oral health and quality of life for older adults.

The study, titled “Functional oral status and oral health-related quality of life in community-dwelling older adults in Singapore”, was published online on 20 February 2024 in Community Dentistry and Oral Epidemiology, ahead of inclusion in an issue.

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