Literature Review Oral Health

Literature Review Oral Health

Literature Review Oral Health

Synthesis of the Literature

Oral Health

A lot of literature is dedicated to the study of oral health problems and promotion to improve the quality of life in older adults who live independently. Such close attention to this topic is associated with the fact that the population is aging, which is a real problem in many countries. According to Bianco et al. (2021), aging is considered one of the most severe problems of the 21st century for many countries. In 2000, the number of people aged 60 and older was around 605 million while, by 2050, it is estimated to increase to almost 2 billion (Mittal et al., 2019). Moreover, Shokouhi et al. (2019) state that the increase in the elderly population requires close attention to various needs of this age group affecting their quality of life, which is a measure of social development. Old age has a connection with certain physiological alterations, eating problems, and dental and oral issues, for instance, difficulty swallowing and chewing food and tooth loss, which is followed by various diseases (Shokouhi et al., 2019). The authors indicate that chronic diseases tend to increase with age (Shokouhi et al., 2019). The presence of chronic illnesses is exacerbated by the decline in the normal functioning of the aging body, isolation, dependency on others, disability, and the decline in the quality of life (Shokouhi et al., 2019). The aging population increases the burden of different chronic diseases including oral problems.

The elderly experiences a high prevalence of different dental diseases and conditions. They include tooth loss, periodontal disease, plaque buildup, caries, unmet oral care needs, and worsening quality of life (Schensul et al., 2019). Apart from this, Dhama et al. (2021) state that dry mouth, dental caries, and precancerous/cancerous lesions are the most common oral and dental conditions observed in the elderly. Oral health is related to chronic disease and systemic health problems in older age (Malekpour et al., 2022). For instance, cognitive decline, dementia related to serum Porphyromonas gingivalis, high levels of immunoglobulin G, and xerostomia from multiple medications, as well as diabetes and cancer treatments relate to high levels of decay, insufficient oral hygiene, edentulism, and loss of teeth (Schensul et al., 2019). Periodontal disease is related to stroke and heart attack while periodontal treatment can have a positive impact on diabetes control (Schensul et al., 2019). Furthermore, insufficient oral health has an adverse effect on the oral health quality of life (Schensul et al., 2019). Therefore, many older adults experience oral health problems, which is why oral health promotion is of paramount importance to improve the quality of life of this group of people.Literature Review Oral Health

Further, a lot of literature is dedicated to the study of various indexes and scales to measure oral health-related quality of life. Nowadays, the Geriatric/General Oral Health Assessment Index (GOHAI) is commonly applied in order to assess oral health-related quality of life. It is grounded on three assumptions, namely, a) an individual can measure oral health through self-assessment; b) levels of oral health and hygiene vary from person to person, which can be demonstrated by applying measures grounded on an individual’s self-perception; c) self-perception has been determined as a predictor of oral health (Ortíz-Barrios et al., 2019). These indexes determine and measure problems associated with oral health in respondents with the 12-item questionnaire that assesses oral health problems in the last three months (Ortíz-Barrios et al., 2019). GOHAI is extremely useful since it assesses the severity of psychosocial consequences related to different oral diseases. GOHAI serves as a valuable tool for the evaluation of the outcomes of oral care services and programs (Ortíz-Barrios et al., 2019). The data provide the basis for efficient policies for an individual segment of the population, for instance, the elderly.

Moreover, Bianco et al. (2021) describe a positive side of using GOHAI. The authors mention that Atchison and Dolan elaborated the Geriatric/General Oral Health Assessment Index in 1990 (Bianco et al., 2021). The index explores the psychological, physical, and physiological needs of the elderly, therefore complementing clinical care. It evaluates three measures of quality of life-related to oral health, which include physical functions involving swallowing, speaking, and chewing; psychosocial functions, such as attitudes towards dental health, irritation from impressions, self-limitation of social contacts because of dental problems, and insecurity about oral health; discomfort or pain, including the mouth discomfort or use of medications (Bianco et al., 2021). Bianco et al. (2021) indicate that GOHAI attaches great importance to the functional state and discomfort. Moreover, Zhi et al. (2021) state that the index places more emphasis on subjective oral health with less clinical alteration and direct clinical aspects. In turn, Bianco et al. (2021) describe one more index related to oral health — OIDP, which was developed by Adulyanon in 1996. OIDP represents one of the characteristics of oral health-related quality of life scales (Wong et al., 2021). These instruments evaluate psychometric features admissible to the elderly (Wong et al., 2021). It consists of nine items that assess the severity and prevalence of problems with dentures or teeth found in the last six months and what effect they have had on older people’s daily activities as per Zhi et al. (2021). In such a way, the source examines GOHAI and OIDP as well as studies how these scales evaluate the impact of oral hygiene and health on quality of life.

Oral Health and Quality of Life

Oral health is essential to good overall health and well-being. The Surgeon General of the United States and the World Health Organization (WHO) have urged preventive public health practices and improved access to oral care (Schensul et al., 2021). The elderly experience great disparities in both mainly because of the limited access to quality dental care and insufficient opportunities to get preventive education that would assist in addressing such diseases as edentulism, periodontal disease, and caries (Schensul et al., 2021). Mittal et al. (2019) try to identify causes resulting in poor oral health among older adults. According to the authors, the use of dental services among the elderly is low due to multiple barriers (Mittal et al., 2019). At the same time, there is no single factor that serves as the biggest barrier to accessing dental services among the elderly. The location of the facilities, the cost of dental care, limited income, the lack of specialists, and the lack of awareness of the services provided are the most common barriers to the use of dental services by older adults (Mittal et al., 2019). In addition, the lack of perceived need for care, oral hygiene literacy, and disability are significant factors that have a substantial impact on dental visits by the elderly (Gunpinar & Meraci, 2022). Apart from this, Lee et al. (2022) claim that oral health literacy is influenced by various demographic factors, such as the level of education, age, diet, monthly income, and activities of daily living. Moreover, Assari and Bazargan (2019) pay attention to socioeconomic status, especially a high level of education. According to the authors, this status promotes access to dental services and protects against insufficient oral health (Assari & Bazargan, 2019). Nonetheless, all people should be as knowledgeable about their healthcare needs as their physicians (Denis et al., 2021). All the barriers mentioned above affect oral health-related quality of life.

Many sources focus on such a phenomenon as oral health-related quality of life (OHRQoL). For instance, Top et al. (2019) state that OHRQoL is applied as an important metric to evaluate and measure health outcomes and treatment management. Mouth and teeth diseases are considered an important public health problem today and OHRQoL can help to evaluate outcomes of oral services and care. Reisine et al. (2021(b)) state that much attention to the quality of life can be associated with the definition of health proposed by the WHO. According to the WHO, health can be defined as “a complete state of physical, mental, and social well-being and not just the absence of disease” (Reisine et al., 2021(a), p 2). Therefore, quality of life has been included in the professional framework for oral health, hence supporting the notion that, in order to assess oral health in people or the results of clinical trials, clinical indicators are not enough (Reisine et al., 2021(a)). The authors affirm that OHRQoL serves as a highly significant construct for determining oral health and is applied as an outcome measure in adult dental clinical trials (Reisine et al., 2021 (a). Zheng et al. (2021) indicate that OHRQoL can be applied for measuring and assessing the effect of oral hygiene and health on a people’s quality of life. It implies a subjective perception of the state of the oral cavity and a subjective assessment of the psychological function, physical function, and aspects of the social activity of oral health (Sermsuti-Anuwat & Pongpanich, 2021). In addition, OHRQoL has the potential to evaluate the association between overall health and oral health from experience and subjective perspectives (Zheng et al., 2021).

In contrast to Reisine et al. (2021(a)), Zheng et al. (2021) pay attention to college students and not the elderly. According to Zheng et al. (2021), college students should have a good quality of OHRQoL since they become future agents of social progress and play a highly important role in the future development of the country. If compare them with people of the middle age, college students are in a period of dynamic growth and their health, behavior, lifestyle, and social psychology are more likely to alter. In turn, poor OHRQoL can have an adverse impact on the state of the oral cavity in students and their general health and well-being in the future (Zheng et al., 2021). Even though the source focuses on young people rather than older adults, it is still highly useful since it describes the theory of knowledge, attitudes, and practices (KAP). It is a theoretical model applied to alter an individual’s behavior associated with health. According to this model, healthy knowledge serves as the basis for the formation of healthy behavior and positive attitudes, which are the motive power behind behavior alteration (Zheng et al., 2021). Apart from this, the KAP theory affirms that the promotion of healthy behavior is the most important purpose. The authors state that there is a direct relationship between practice, attitudes, and knowledge (Zheng et al., 2021). In contrast, a traditional multivariate statistical method can reveal factors that have an impact on practice, attitudes, and knowledge. At the same time, it cannot explain causal relationships engaged in this process. For comparison, structural equation modeling represents a more advanced statistical technique, thus compensating for the shortcomings of traditional statistical methods (Zheng et al., 2021). This method of multivariate statistical analysis can work simultaneously with measurement errors, observation indices, and potential variables. Moreover, it can quantify the indirect and direct impacts of variables and investigate causal relationships between potential variables (Zheng et al., 2021). Currently, structural equation modeling is widely applied in behavioral and social sciences, psychology, management, biomedicine, and other fields.

Oral Health and Interventions

The use of indexes and scales mentioned earlier are part of oral health promotion programs. Oral health promotion programs are highly effective for older adults (Seo & Kim, 2019). In terms of health promotion and prevention, oral health promotion programs should be implemented before oral dysfunction and oral health problems emerge (Seo & Kim, 2019). Thus, these programs should be provided at an early stage before oral problems develop. Scheerman et al. (2020) state that people should follow an oral hygiene regimen involving the use of fluoride toothpaste and rinses, which could prevent the development and progression of dental problems. For example, doctors recommend different mechanical methods, such as flossing, brushing, and other interdental cleaning devices, to control the accumulation of plaque biofilm (Milleman et al., 2022). Moreover, Bosma et al. (2022) pay particular attention to flossing, hence claiming that it is a highly useful component of recommended daily oral care regimens. According to Bosma et al. (2022), the Food and Drug Administration classifies dental floss as a Class I medical device aimed at removing food particles between teeth and plaque for reducing caries. Nonetheless, the authors state that patients tend to find this component difficult to perform effectively on a regular basis (Bosma et al., 2022). A great majority of older adults prefer toothbrushing (Bosma et al., 2022). At the same time, flossing together with toothbrushing is considered more effective compared to toothbrushing only in reducing plaque and interproximal bleeding (Bosma et al., 2022). Adherence to oral hygiene regimens is extremely low, in particular among older adults living independently (Scheerman et al., 2020). Further, Gallie (2019) states that many older adults who live alone neglect oral hygiene. This fact points to the necessity for interventions aimed at improving oral health behavior. According to Scheerman et al. (2020), different functions of mobile phones make them useful for health promotion programs. They provide an opportunity to introduce behavioral programs into significant real-life contexts, involving people’s health decisions and the obstacles they experience while changing behavior (Saxena & Gunjal, 2021). Mobile health can be applied as an additional component to improve oral hygiene and gain oral health knowledge (Scheerman et al., 2020). However, the use of mobile phones for different health promotion programs may be difficult for older adults, in particular those living independently.

Practice Recommendations

Based on the literature review, the older adult population living alone needs to improve practices of maintaining oral health. The oral health education program will encourage this target group to change its attitude, behavior, knowledge, and perception of oral health (Scheerman et al., 2020). Evidence suggests oral health promotion program is efficient for the target population since it influences the quality of life. The approach has shown positive results in helping the older adult population to navigate some of the challenges they experience in old age. It is a method that can have a considerable impact when offered by trained health care personal, nurses, assistants and other healthcare personal in small groups following the HBM framework. Keyong et al. (2019) state that oral health education programs impact the older adult population’s understanding of disease severity and oral health risk. Furthermore, studies of caretakers’ post-oral health intervention programs indicate improvement in fluorides, denture care, oral hygiene, and the importance of dental checkups (Janto et al., 2022). In this project, oral health education programs will be implemented based on recommendations to improve the quality of life among the older population living independently.

One of the recommendations is to provide participants with in-person teachings, show audiovisual material as well as written information for them to keep to instruct them in the proper and effective way to provide oral care to themselves and improve their quality of life. Other recommendation is to apply mobile health reminders through Remind Application, to keep participant information confidential, as additional components in the oral health education program (Scheerman et al., 2020). The mobile reminders are an ideal choice for this intervention since they are easy to use. Nowadays, mobile devices are portable and widespread even among the older population. Moreover, educational material, and training videos can be shared to them to support the learning without place or time constraints. Saxena & Gunjal (2021) state that mobile applications offer an opportunity to incorporate behavioral programs into the real-life contexts of older adults. In addition, the mobile reminders could be used to improve their health decisions. Thus, mobile reminders are a perfect tool for assisting in the implementation of the oral health promotion program.

Another recommendation is, if they are available, involve the contribution of family and beloved ones in this project. Family can play a significant role in the oral health education program, hence allowing the older adult population support from them, and play an essential role in the oral health hygiene regimen by interacting with them and encouraging the older adults to follow different activities. They can follow up on the development of dental problems, processes of tooth brushing, flossing, and various interventions. The approach will encourage family involvement in the oral health promotion program, thus resulting in transparency and improved outcomes.

Project Setting

The project will take place in an Independent Residential Community in Miami Dade County. The clients will be tenants aged 55 to 62 years, both males and females. The health behaviors to look out for will be poor oral hygiene as well as psychosocial and physical functions.

The project will align with the mission of the Rental Community, offering remarkable living experiences for the older populations through community-inspired properties, exceptional customer service, and a passion-driven team (Richman Properties Services, n.d.). In addition, the project will align with the organization’s vision, which implies offering first-class residential services to everyone and putting the needs of the consumers first (Richman Properties Services, n.d). The organizational structure and culture will support the implementation of the project because the company has over 600 employees maintain a resident-focused culture from the landscape crew, maintenance staff, leasing agents, property manager, and housekeeping personnel. Thus, the project setting is ideal for the oral health promotion program (Richman Properties Services, n.d.).

The impact of the oral health education program on the quality of life will determine the organization’s need for the project. Project stakeholders will comprise older adult populations from Miami-Dade County, Florida. The estimated number of seniors in the region is 440,203 out of the 2,153,471 adult populations (World Population Review, n.d.). Families, healthcare practitioners, staff, and property managers are other stakeholders. The proof of organizational support will be ensured through Glassdoor reviews. Plans for sustainability will be implemented at the beginning through consultations with stakeholders to include them throughout the project.

A SWOT analysis (appendix 1) will be utilized to assess the strengths and weaknesses, review opportunities, and ascertain the threats of the project. The strengths of the project setting include the significant portfolio of properties and the number of seniors participating in the oral health promotion program. Its weaknesses imply the privately owned properties and social surroundings. On the other hand, the threats comprise patients’ and families’. Finally, the opportunities are the availability of the internet and resident-focused culture among the personnel.

Project Vision and Mission

The mission of the project is to help older adults living alone improve their oral health by focusing on their overall good health and wellbeing (OHRQoL) and reduce the prevalence of different dental diseases and conditions, such as periodontal disease, tooth loss, caries, and plaque buildup. The vision is to change the older adult population’s behavior, perception, and attitude so they can find oral health easy to accomplish. Notably, the project will take place at Independent Senior Community owned by Richman Property Services and located in Miami Dade County.

The project’s mission and vision will align with the vision and mission of the residential community. The mission of the Independent Senior Community is to offer remarkable living experiences for the older populations living independently through community-inspired properties, exceptional customer service, and a passion-driven team. The vision is to provide first-class residential services to everyone and put the needs of the consumers first (Richman Properties Services, n.d). The project will accomplish its mission in the project setting by ensuring that the remarkable service equates to improving the overall good health, wellbeing, and quality of life of the older adult population. Accordingly, the project vision will be accomplished in the project setting by putting the health needs of the consumers first.

Project goals will be divided into short-term and long-term. The short-term objectives include awareness of the different mechanical methods recommended by healthcare professionals, such as brushing, flossing, and using interdental cleaning devices to minimize plaque accumulation. In addition, the project will aim to improve oral health in four weeks among the older adult population living independently. The long-term objectives are to reduce the occurrences of dental diseases and conditions, minimize the impact of the effects of oral health among the older adult population, improve the oral health-related quality of life (OHRQoL), and, in the long run, change the knowledge, attitudes, and behaviors.

There is not know any risks or discomforts for the participants in this research study, except fatigue or tiredness when completing the questionnaire, and/or the participants may experience stress from receiving information and thinking about it. But if at some point during the investigation process, the participant does not feel comfortable with the questions or information and decide not to continue being part of the study, the participant can leave the project at any time, without any retaliation or penalty.

Project Objectives

Literature Review Oral Health