Accepted Manuscript Title: Risk indicators associated with root caries in independently living older adults Author: Martina Hayes Cristiane Da Mata Margaret Cole Gerald McKenna Francis Burke Finbarr Allen PII: DOI: Reference:
S0300-5712(16)30092-6 http://dx.doi.org/doi:10.1016/j.jdent.2016.05.006 JJOD 2621
To appear in:
Journal of Dentistry
Received date: Revised date: Accepted date:
23-4-2016 15-5-2016 17-5-2016
Please cite this article as: Hayes Martina, Da Mata Cristiane, Cole Margaret, McKenna Gerald, Burke Francis, Allen Finbarr.Risk indicators associated with root caries in independently living older adults.Journal of Dentistry http://dx.doi.org/10.1016/j.jdent.2016.05.006 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Risk Indicators associated with root caries
Risk indicators associated with root caries in independently living older adults
Authors; Martina Hayes, Restorative Dentistry, University College Cork Cristiane Da Mata, Restorative Dentistry, University College Cork Margaret Cole, College of Medicine and Health, University College Cork Gerald McKenna, Centre for Public Health, Queen's University Belfast Francis Burke, Restorative Dentistry, University College Cork Finbarr Allen, Restorative Dentistry, University College Cork
Corresponding author; Martina Hayes, Restorative Dentistry, Cork University Dental School and Hospital, Wilton, Cork, Ireland Email
[email protected]
Keywords: root caries; dental caries; gerodontology; aged; epidemiology; risk factors
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Risk Indicators associated with root caries
Risk indicators associated with root caries in independently living older adults Abstract Objective: To determine the risk indicators associated with root caries experience in a cohort of independently living older adults in Ireland. Methods: The data reported in the present study were obtained from a prospective longitudinal study conducted in a cohort of independently living older adults (n=334). Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and other clinical variables. Questionnaires were used to collect data on oral hygiene habits, diet, smoking and alcohol habits and education level. A regression analysis with the outcome variable of root caries experience (no/yes) was conducted. Results: A total of 334 older dentate adults with a mean age of 69.1 years were examined. 53.3% had at least one filled or decayed root surface. The median root caries index was 3.13 (IQR 0.00, 13.92). The results from the multivariate regression analysis indicated that individuals with poor plaque control (OR 9.59, 95%CI 3.8424.00), xerostomia (OR 18.49, 95%CI 2.00-172.80), two or more teeth with coronal decay (OR 4.50, 95% CI 2.02-10.02) and 37 or more exposed root surfaces (OR 5.48, 95% CI 2.49-12.01) were more likely to have been affected by root caries. Conclusions: The prevalence of root caries was high in this cohort. This study suggests a correlation between root caries and the variables poor plaque control, xerostomia, coronal decay (≥2 teeth affected) and exposed root surfaces (≥37). The significance of these risk indicators and the resulting prediction model should be further evaluated in a prospective study of root caries incidence. Clinical Significance: Identification of risk indicators for root caries in independently living older adults would facilitate dental practitioners to identify those who would benefit most from interventions aimed at prevention.
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Risk Indicators associated with root caries
1.
Introduction
In many industrialised countries, as birth rates fall and life expectancy increases, the proportion of older adults within the general population is increasing. This trend is predicted to continue at pace in the twenty first century [1]. While the prevalence of chronic medical conditions is high in this cohort, large longitudinal population studies into ageing have shown that an increasing number of older adults are independently living, mobile and active in their communities [2-4]. With increasing numbers of patients retaining natural teeth into old age, the challenge of providing oral healthcare for the ageing population is undoubtedly going to increase. An increase in exposed root surfaces in the over 65 age group predisposes this group to a higher prevalence of root caries than younger populations [5]. Estimating the prevalence of root caries can be challenging as loss of teeth confounds the data and diagnostic criteria and methods of reporting the data differ between studies [6-8]. A 2010 systematic review [9] on the risk indicators of root caries suggested that future research should focus on variables which they found to be significant across a number of studies. These included age, gender, number of teeth at baseline, plaque index, lactobacilli counts, mutans streptococci counts, smoking, saliva flow rate, saliva buffer capacity, dental visit pattern, race/ethnicity, interdental cleaning, attachment loss, partial denture wearing, and gingival recession. The main objective of the present study was to investigate the relationship between root caries in a cohort of independently living older adults and the variables outlined above. 2.
Materials and Methods
2.1
Study design
The data reported in the present study were baseline recordings obtained at the beginning of a prospective longitudinal study conducted on the risk factors associated with root caries incidence in a cohort of independently living older adults. The study protocol was submitted and given full ethical approval by the Clinical Ethics Committee of the Cork Teaching Hospitals (ECM 4 Y 06/12/11). The study was conducted in compliance with the principles of the Declaration of Helsinki and written informed consent was obtained from each participant. Eighty-five of the Page 3 of 23
Risk Indicators associated with root caries
individuals whose data are included in this report were also subsequently enrolled in a randomised controlled clinical trial comparing restorative materials in the operative treatment of root caries [10].
2.2
Recruitment
Adults aged over 65 years of age with any of their remaining natural dentition were invited to attend Cork University Dental School and Hospital for a free dental examination. Advertisements were placed in local shopping centres, community centres and the local press over a period of three months. Telephone contact details of the study co-ordinator were provided and patients were allocated appointments provided they were the appropriate age, and confirmed they had some of their natural dentition remaining.
All of the patients recruited to the study were
independently living older adults. No financial rewards were offered to patients. Recruitment commenced in October 2012 and was completed in November 2013.
2.3
Inclusion and exclusion criteria
The inclusion criteria for entering this study were:
Aged 65 or over
Present a minimum of one natural tooth
Living independently in the community
Have sufficient cognitive ability to understand consent procedures
The exclusion criteria for this study were:
2.4
Those living in nursing home facilities
Individuals requiring antibiotic prophylaxis for periodontal probing
Data collection and oral examination
Each participant was interviewed by a research assistant prior to the dental examination. During this, the research assistant completed a data collection form which recorded age, gender, education level, medical history, fluoride exposure, oral Page 4 of 23
Risk Indicators associated with root caries
and denture hygiene practices, smoking and alcohol consumption, and diet information. The medical history form used was the standard form used throughout the dental hospital and the remaining questions were selected from the National Survey of Adult Oral Health 2000 – 2002 General Health Questionnaire [11]. The subject’s health was classified into one of four categories based on a system developed by the American Society of Anaesthesiologists (ASA). In this classification:
ASA 1 is a normal healthy patient without systemic disease.
ASA 2 is a patient with mild to moderate systemic disease.
ASA 3 is a patient with severe systemic disease that limits activity but is not incapacitating.
ASA 4 is a patient with severe systemic disease that limits activity and is a constant threat to life.
A single trained and calibrated examiner performed a baseline oral exam in a standard dental operatory equipped with a dental light and air-water syringe. Patients were advised to avoid eating, drinking, smoking, chewing gum, tooth brushing, or mouthwashes for one hour prior to their appointment. Saliva was collected over a period of five minutes following one minute of stimulation by having the participant chew a paraffin pellet. Xerostomia was defined as a stimulated saliva flow rate of < 0.7 ml saliva/min. The CRT® Caries Risk Test (Ivoclar-Vivadent, Schaan, Liechtenstein) was used to record the salivary buffer capacity and counts of mutans streptococci (MS) and lactobacilli (LB). The buffer capacity of stimulated saliva was determined using CRT Buffer® (Ivoclar-Vivadent). The test field of the buffer strip was wetted entirely with stimulated saliva using a pipette. After 5 minutes of reaction, a coloured chart provided by the manufacturer was used to record the buffer capacity as low, medium or high. The MS and LB counts per millilitre saliva were recorded using CRT Bacteria® (Ivoclar-Vivadent). The agar surfaces were wetted with stimulated saliva and incubated at 37 °C (99 °F) for 48 hours. The MS and LB counts were scored in two categories:
