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Published in: BMC Geriatrics 1/2018

Open Access 01-12-2018 | Research article

Oral health and orofacial pain in people with dementia admitted to acute hospital wards: observational cohort study

Authors: Liza J. M. van de Rijt, Roxane A. F. Weijenberg, Alexandra R. Feast, Victoria Vickerstaff, Frank Lobbezoo, Elizabeth L. Sampson

Published in: BMC Geriatrics | Issue 1/2018

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Abstract

Background

Orofacial pain in people with dementia is difficult to detect, and often under-treated. Our aim was to investigate the prevalence of orofacial pain in people with dementia in acute hospitals in the UK. Secondary aims were to examine oral health status and explore associations between orofacial pain and oral health factors.

Methods

This cross-sectional observational study was carried out in two UK hospitals. Using the Orofacial Pain Scale in Non-Verbal Individuals (OPS-NVI) to identify orofacial pain, 101 participants with dementia, admitted to acute medical wards, were observed for at least 3 min during rest and chewing. Verbal participants were then asked about presence of orofacial pain, using self-report pain scales. Finally, a brief oral assessment was performed.

Results

Orofacial pain, assessed with the OPS-NVI, was present in 11.9% (95% C.I. 5.9, 18.8) of participants at rest and 21.9% (95% C.I. 14.6, 31.3) whilst chewing. Participants who were no longer able to self-report pain were significantly more likely to experience orofacial pain. Oral health in both dentate and edentate participants was poor. Brush frequency, indication of chewing quality, consistency of the food, presence of extra-oral abnormalities, person who performed mouth care, and oral hygiene in dentate participants were significant predictors for the presence of orofacial pain.

Conclusion

Improving oral care in acute hospital patients with dementia, particularly those who cannot self-report pain, may significantly reduce pain and suffering in this population.
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Literature
1.
go back to reference International, A.s.D., The global impact of dementia 2013-2050. Policy brief for heads of government, 2013. International, A.s.D., The global impact of dementia 2013-2050. Policy brief for heads of government, 2013.
3.
go back to reference Sengstaken EA, King SA. The problems of pain and its detection among geriatric nursing home residents. J Am Geriatr Soc. 1993;41(5):541–4.CrossRefPubMed Sengstaken EA, King SA. The problems of pain and its detection among geriatric nursing home residents. J Am Geriatr Soc. 1993;41(5):541–4.CrossRefPubMed
4.
go back to reference Lobbezoo F, Weijenberg RA, Scherder EJ. Topical review: orofacial pain in dementia patients. A diagnostic challenge. J Orofac Pain. 2011;25(1):6–14.PubMed Lobbezoo F, Weijenberg RA, Scherder EJ. Topical review: orofacial pain in dementia patients. A diagnostic challenge. J Orofac Pain. 2011;25(1):6–14.PubMed
5.
go back to reference Renton T, Durham J, Aggarwal VR. The classification and differential diagnosis of orofacial pain. Expert Rev Neurother. 2012;12(5):569–76.CrossRefPubMed Renton T, Durham J, Aggarwal VR. The classification and differential diagnosis of orofacial pain. Expert Rev Neurother. 2012;12(5):569–76.CrossRefPubMed
6.
go back to reference Avlund K, Holm-Pedersen P, Schroll M. Functional ability and oral health among older people: a longitudinal study from age 75 to 80. J Am Geriatr Soc. 2001;49(7):954–62.CrossRefPubMed Avlund K, Holm-Pedersen P, Schroll M. Functional ability and oral health among older people: a longitudinal study from age 75 to 80. J Am Geriatr Soc. 2001;49(7):954–62.CrossRefPubMed
7.
go back to reference Rejnefelt I, Andersson P, Renvert S. Oral health status in individuals with dementia living in special facilities. Int J Dent Hyg. 2006;4(2):67–71.CrossRefPubMed Rejnefelt I, Andersson P, Renvert S. Oral health status in individuals with dementia living in special facilities. Int J Dent Hyg. 2006;4(2):67–71.CrossRefPubMed
8.
go back to reference Weijenberg RA, Scherder EJ, Lobbezoo F. Mastication for the mind-the relationship between mastication and cognition in ageing and dementia. Neurosci Biobehav Rev. 2011;35(3):483–97.CrossRefPubMed Weijenberg RA, Scherder EJ, Lobbezoo F. Mastication for the mind-the relationship between mastication and cognition in ageing and dementia. Neurosci Biobehav Rev. 2011;35(3):483–97.CrossRefPubMed
9.
go back to reference Delwel S, et al. Oral health and orofacial pain in older people with dementia: a systematic review with focus on dental hard tissues. Clin Oral Investig. 2017;21(1):17–32. Delwel S, et al. Oral health and orofacial pain in older people with dementia: a systematic review with focus on dental hard tissues. Clin Oral Investig. 2017;21(1):17–32.
10.
go back to reference Adam H, Preston AJ. The oral health of individuals with dementia in nursing homes. Gerodontology. 2006;23(2):99–105.CrossRefPubMed Adam H, Preston AJ. The oral health of individuals with dementia in nursing homes. Gerodontology. 2006;23(2):99–105.CrossRefPubMed
11.
go back to reference de Souza Rolim T, et al. Oral infections and orofacial pain in Alzheimer's disease: a case-control study. J Alzheimers Dis. 2014;38(4):823–9.PubMedCrossRef de Souza Rolim T, et al. Oral infections and orofacial pain in Alzheimer's disease: a case-control study. J Alzheimers Dis. 2014;38(4):823–9.PubMedCrossRef
12.
13.
go back to reference Binder EF, Robins LN. Cognitive impairment and length of hospital stay in older persons. J Am Geriatr Soc. 1990;38(7):759–66.CrossRefPubMed Binder EF, Robins LN. Cognitive impairment and length of hospital stay in older persons. J Am Geriatr Soc. 1990;38(7):759–66.CrossRefPubMed
14.
go back to reference Ni Chroinin D, et al. Oral health status is associated with common medical comorbidities in older hospital inpatients. J Am Geriatr Soc. 2016;64(8):1696–700.CrossRefPubMed Ni Chroinin D, et al. Oral health status is associated with common medical comorbidities in older hospital inpatients. J Am Geriatr Soc. 2016;64(8):1696–700.CrossRefPubMed
15.
go back to reference Delwel, S., Standard operating procedure orofacial pain scale for non verbal individuals. 2014. Delwel, S., Standard operating procedure orofacial pain scale for non verbal individuals. 2014.
16.
go back to reference Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.CrossRefPubMed Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.CrossRefPubMed
17.
18.
go back to reference Peck CC. Biomechanics of occlusion--implications for oral rehabilitation. J Oral Rehabil. 2016;43(3):205–14.CrossRefPubMed Peck CC. Biomechanics of occlusion--implications for oral rehabilitation. J Oral Rehabil. 2016;43(3):205–14.CrossRefPubMed
19.
20.
go back to reference Naing LW, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci. 2006;1:9–14. Naing LW, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci. 2006;1:9–14.
21.
go back to reference Hoffmann F, et al. Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls. BMC Geriatr. 2014;14:20.CrossRefPubMedPubMedCentral Hoffmann F, et al. Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls. BMC Geriatr. 2014;14:20.CrossRefPubMedPubMedCentral
22.
go back to reference Chalmers J, Pearson A. Oral hygiene care for residents with dementia: a literature review. J Adv Nurs. 2005;52(4):410–9.CrossRefPubMed Chalmers J, Pearson A. Oral hygiene care for residents with dementia: a literature review. J Adv Nurs. 2005;52(4):410–9.CrossRefPubMed
23.
go back to reference Terezakis E, et al. The impact of hospitalization on oral health: a systematic review. J Clin Periodontol. 2011;38(7):628–36.CrossRefPubMed Terezakis E, et al. The impact of hospitalization on oral health: a systematic review. J Clin Periodontol. 2011;38(7):628–36.CrossRefPubMed
24.
go back to reference Gibney JM, et al. The oral health status of older patients in acute care on admission and day 7 in two Australian hospitals. Age Ageing. 2017;46(5):852–6.CrossRefPubMed Gibney JM, et al. The oral health status of older patients in acute care on admission and day 7 in two Australian hospitals. Age Ageing. 2017;46(5):852–6.CrossRefPubMed
25.
go back to reference Jordan A, et al. Pain and distress in advanced dementia: choosing the right tools for the job. Palliat Med. 2012;26(7):873–8.CrossRefPubMed Jordan A, et al. Pain and distress in advanced dementia: choosing the right tools for the job. Palliat Med. 2012;26(7):873–8.CrossRefPubMed
26.
27.
go back to reference Shimazaki Y, et al. Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people. J Dent Res. 2001;80(1):340–5.CrossRefPubMed Shimazaki Y, et al. Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people. J Dent Res. 2001;80(1):340–5.CrossRefPubMed
28.
go back to reference Sjogren P, et al. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 2008;56(11):2124–30.CrossRefPubMed Sjogren P, et al. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 2008;56(11):2124–30.CrossRefPubMed
29.
go back to reference Wyatt CC. A 5-year follow-up of older adults residing in long-term care facilities: utilisation of a comprehensive dental programme. Gerodontology. 2009;26(4):282–90.CrossRefPubMed Wyatt CC. A 5-year follow-up of older adults residing in long-term care facilities: utilisation of a comprehensive dental programme. Gerodontology. 2009;26(4):282–90.CrossRefPubMed
30.
go back to reference Eaton KA, et al. Looking after the mouth - evaluation of a pilot for a new approach to training care home carers in Kent, surrey and Sussex. Br Dent J. 2016;221(1):31–6.CrossRefPubMed Eaton KA, et al. Looking after the mouth - evaluation of a pilot for a new approach to training care home carers in Kent, surrey and Sussex. Br Dent J. 2016;221(1):31–6.CrossRefPubMed
31.
go back to reference Fueki K, Yoshida E, Igarashi Y. A structural equation model to investigate the impact of missing occlusal units on objective masticatory function in patients with shortened dental arches. J Oral Rehabil. 2011;38(11):810–7.CrossRefPubMed Fueki K, Yoshida E, Igarashi Y. A structural equation model to investigate the impact of missing occlusal units on objective masticatory function in patients with shortened dental arches. J Oral Rehabil. 2011;38(11):810–7.CrossRefPubMed
32.
go back to reference Lobbezoo F, et al. Orofacial pain and mastication in dementia. Curr Alzheimer Res. 2017;14(5):506–11.CrossRefPubMed Lobbezoo F, et al. Orofacial pain and mastication in dementia. Curr Alzheimer Res. 2017;14(5):506–11.CrossRefPubMed
33.
go back to reference Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manag. 2006;31(2):170–92.CrossRef Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manag. 2006;31(2):170–92.CrossRef
Metadata
Title
Oral health and orofacial pain in people with dementia admitted to acute hospital wards: observational cohort study
Authors
Liza J. M. van de Rijt
Roxane A. F. Weijenberg
Alexandra R. Feast
Victoria Vickerstaff
Frank Lobbezoo
Elizabeth L. Sampson
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2018
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-018-0810-7

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