Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care-dependent older people: An e-Delphi study.
care-dependent older adults
e-Delphi study
geriatric oral care
institutionalised older adults
Journal
Gerodontology
ISSN: 1741-2358
Titre abrégé: Gerodontology
Pays: England
ID NLM: 8215850
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
04
02
2020
revised:
27
08
2020
accepted:
12
09
2020
pubmed:
20
10
2020
medline:
17
2
2021
entrez:
19
10
2020
Statut:
ppublish
Résumé
This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels. Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet. The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1. A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative. Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people.
Sections du résumé
OBJECTIVES
OBJECTIVE
This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels.
BACKGROUND
BACKGROUND
Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet.
METHODS
METHODS
The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1.
RESULTS
RESULTS
A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative.
CONCLUSIONS
CONCLUSIONS
Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people.
Types de publication
Journal Article
Langues
eng
Pagination
41-56Subventions
Organisme : Université de Genève
ID : This study was entirely funded by public funds, allocated to the Division of Gerodontology and Removable Prosthodontics of the University of Geneva.
Investigateurs
Roy L Soiza
(RL)
Predrag Erceg
(P)
Jurate Macijauskiene
(J)
Sofia Duque
(S)
Adalsteinn Gudmundsson
(A)
Sandra De Breucker
(S)
Gabriel Gold
(G)
Soulis George
(S)
Tomasz Kostka
(T)
Nicola Veronese
(N)
Jukka Meurman
(J)
Alexander Schembri
(A)
Inger Wårdh
(I)
Päivi Siukosaari
(P)
Barbara Janssens
(B)
Närhi Timo
(N)
Vassiliki Anastassiadou
(V)
Marysette Folliguet
(M)
Joke Duyck
(J)
Gerry McKenna
(G)
Jacqueline Boss
(J)
Vigita Gapšienė
(V)
Yvonne Nyblom
(Y)
Eimear Mithen
(E)
Marketa Harantova
(M)
Anne-Claire van der Lans
(AC)
Informations de copyright
© 2020 Gerodontology Association and John Wiley & Sons Ltd.
Références
Cohen-Mansfield J, Lipson S. The underdetection of pain of dental etiology in persons with dementia. Am J Alzheimers Dis Other Demen. 2002;17(4):249-253.
Hoeksema AR, Peters LL, Raghoebar GM, Meijer HJA, Vissink A, Visser A. Oral health status and need for oral care of care-dependent indwelling elderly: from admission to death. Clin Oral Investig. 2017;21(7):2189-2196.
Andersson P, Renvert S, Sjogren P, Zimmerman M. Dental status in nursing home residents with domiciliary dental care in Sweden. Community Dent Health. 2017;34(4):203-207.
Imsand M, Janssens JP, Auckenthaler R, Mojon P, Budtz-Jorgensen E. Bronchopneumonia and oral health in hospitalized older patients. A pilot study. Gerodontology. 2002;19(2):66-72.
Heo SM, Haase EM, Lesse AJ, Gill SR, Scannapieco FA. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis. 2008;47(12):1562-1570.
Kossioni AE, Hajto-Bryk J, Janssens B, et al. Practical guidelines for physicians in promoting oral health in frail older adults. J Am Med Dir Assoc. 2018;19(12):1039-1046.
Mojon P, Thomason JM, Walls AW. The impact of falling rates of edentulism. Int J Prosthodont. 2004;17(4):434-440.
Schneider C, Zemp E, Zitzmann NU. Oral health improvements in Switzerland over 20 years. Eur J Oral Sci. 2017;125(1):55-62.
Merete V. Evaluation of an oral health service for nursing home residents. Acta Odontol Scand. 1990;48:99-105.
Sweeney MP, Williams C, Kennedy C, Macpherson LM, Turner S, Bagg J. Oral health care and status of elderly care home residents in Glasgow. Community Dent Health. 2007;24(1):37-42.
Chung JP, Mojon P, Budtz-Jorgensen E. Dental care of elderly in nursing homes: perceptions of managers, nurses, and physicians. Spec Care Dentist. 2000;20(1):12-17.
Kossioni AE, Hajto-Bryk J, Maggi S, et al. An expert opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European policy recommendations on oral health in older adults. J Am Geriatr Soc. 2018;66(3):609-613.
Baumgartner W, Schimmel M, Muller F. Oral health and dental care of elderly adults dependent on care. Swiss Dent J. 2015;125(4):417-426.
Wyatt CCL, Kawato T. Changes in oral health and treatment needs for elderly residents of long-term care facilities over 10 years. J Can Dent Assoc. 2019;84:i7.
Pretty I, Ellwood R, Lo E, et al. The Seattle Care Pathway for securing oral health in older patients. Gerodontology. 2014;31:77-87.
Fiske J, Frenkel H, Griffiths J, et al. Guidelines for the development of local standards of oral health care for people with dementia. Gerodontology. 2006;23(Suppl 1):5-32.
Dalkey NC. The Delphi Method: An Experimental Study of Group Opinion. Santa Monica, CA: Rand Corporation; 1969.
Christina CA, Eric B. The Delphi technique as a method for increasing inclusion in the evaluation process. Can J Program Eval. 2005;20(1):272-279.
McKenna H, Hasson F, Keeney S, Surveys. Gerrish K, Lacey A, eds. The Research Process in Nursing (6th ed.). Chichester: Blackwell Publishing; 2010.260-272.
Likert R. A technique for the measurement of attitudes. Arch Psychol. 1932;140:1-55.
Matthias S, Vara T. Straightlining in Web survey panels over time. Surv Res Methods. 2015;9(2):125-137.
Mahler DA, Selecky PA, Harrod CG. Management of dyspnea in patients with advanced lung or heart disease: practical guidance from the American College of Chest Physicians consensus statement. Pol Arch Med Wewn. 2010;120(5):160-166.
Mahler DA, Selecky PA, Harrod CG, et al. American College of Chest Physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease. Chest. 2010;137(3):674-691.
Ramos D, Arezes P, Afonso P. Application of the Delphi Method for the inclusion of externalities in occupational safety and health analysis. DYNA. 2016;83:14-20.
Raskin MS. The Delphi study in field instruction revisited: expert consensus on issues and research priorities. J Soc Work Educ. 1993;30(1):75-89.
Kay RM, Hahn EJ. Building consensus using the policy Delphi method. Policy Polit Nurs Pract. 2000;1(4):308-315.
Warth J, von der Gracht HA, Darkow I-L. A dissent-based approach for multi-stakeholder scenario development - the future of electric drive vehicles. Technol Forecast Soc Chang. 2013;80:566-583.
Kumar RP, Sekhar SS. Productivity management in India: a Delphi study. Int J Oper Prod Manag. 1990;10:25-51.
Keeney S, Hasson F, McKenna H. The Delphi Technique in Nursing and Health Research. 6. Chichester: Wiley-Blackwell; 2011.
Williams PL, Webb C. The Delphi technique: a methodological discussion. J Adv Nurs. 1994;19:180-186.
Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008-1015.
Akins Ralitsa B, Homer T, Cole BR. Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. BMC Med Res Methodol. 2005;5(37):1-12.
Armstrong D, Marshall JK, Chiba N, et al. Canadian consensus conference on the management of gastroesophageal reflux disease in adults - update 2004. Can J Gastroenterol. 2005;19(1):15-35.
Powell C. Myths and realities of the Delphi technique. J Adv Nurs. 2003;41:376-382.
Razak PA, Richard KM, Thankachan RP, Hafiz KA, Kumar KN, Sameer KM. Geriatric oral health: a review article. J Int Oral Health. 2014;6(6):110-116.
Guessous I, Theler JM, Durosier Izart C, et al. Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study. BMC Oral Health. 2014;14:121.
Hopcraft MS, Morgan MV, Satur JG, Wright FA. Dental service provision in Victorian residential aged care facilities. Aust Dent J. 2008;53(3):239-245.
Decker SL. Medicaid payment levels to dentists and access to dental care among children and adolescents. JAMA. 2011;306(2):187-193.
Manski RJ, Macek MD, Moeller JF. Private dental coverage: who has it and how does it influence dental visits and expenditures? J Am Dent Assoc. 2002;133(11):1551-1559.
Gil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. Clin Interv Aging. 2015;10:461-467.
Deep P. Screening for common oral diseases. J Can Dent Assoc. 2000;66(6):298-299.
Gaszynska E, Szatko F, Godala M, Gaszynski T. Oral health status, dental treatment needs, and barriers to dental care of elderly care home residents in Lodz, Poland. Clin Interv Aging. 2014;9:1637-1644.
Beirne P, Clarkson JE, Worthington HV. Recall intervals for oral health in primary care patients. Cochrane Database Syst Rev. 2007;(4):CD004346.
Frame PS, Sawai R, Bowen WH, Meyerowitz C. Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines. Am J Prev Med. 2000;18(2):159-162.
Benn DK, Clark TD, Dankel DD 2nd, Kostewicz SH. Practical approach to evidence-based management of caries. J Am Coll Dent. 1999;66(1):27-35.
Wang NJ, Holst D. Individualizing recall intervals in child dental care. Community Dent Oral Epidemiol. 1995;23(1):1-7.
Wang NJ, Riordan PJ. Recall intervals, dental hygienists and quality in child dental care. Community Dent Oral Epidemiol. 1995;23(1):8-14.
Ramseier C, Fischer J, Fischer G, Schimmel M. Effect of age on bleeding on probing (BOP) as an indicator of periodontal inflammation in patients enrolled in supportive periodontal therapy. Oral Health Prev Dent. (in press)
Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol. 2006;77(9):1465-1482.
Navazesh M. Dry mouth: aging and oral health. Compend Contin Educ Dent. 2002;23(10 Suppl):41-48.
Seppi K, Weintraub D, Coelho M, et al. The movement disorder society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson's disease. Mov Disord. 2011;26(Suppl 3):S42-80.
DeBowes SL, Tolle SL, Bruhn AM. Parkinson's disease: considerations for dental hygienists. Int J Dent Hyg. 2013;11(1):15-21.
Avlund K, Holm-Pedersen P, Morse DE, Viitanen M, Winblad B. Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability. Gerodontology. 2004;21(1):17-26.
Wu B, Plassman BL, Liang J, Wei L. Cognitive function and dental care utilization among community-dwelling older adults. Am J Public Health. 2007;97(12):2216-2221.
Stiefel DJ. Dental care considerations for disabled adults. Spec Care Dentist. 2002;22(3 Suppl):26S-39S.
Atkinson JC, O'Connell A, Aframian D. Oral manifestations of primary immunological diseases. J Am Dent Assoc. 2000;131(3):345-356.
Manabe T, Teramoto S, Tamiya N, Okochi J, Hizawa N. Risk factors for aspiration pneumonia in older adults. PLoS One. 2015;10(10):e0140060.
Bramanti E, Arcuri C, Cecchetti F, Cervino G, Nucera R, Cicciu M. Dental management in dysphagia syndrome patients with previously acquired brain damages. Dent Res J (Isfahan). 2012;9(4):361-367.
Quagliarello V, Ginter S, Han L, Van Ness P, Allore H, Tinetti M. Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis. 2005;40(1):1-6.
Chalmers JM. Behavior management and communication strategies for dental professionals when caring for patients with dementia. Spec Care Dentist. 2000;20(4):147-154.
Cohen-Mansfield J, Thein K, Marx MS, Dakheel-Ali M, Freedman L. Efficacy of nonpharmacologic interventions for agitation in advanced dementia: a randomized, placebo-controlled trial. J Clin Psychiatry. 2012;73(9):1255-1261.
White SM. Including the very elderly in clinical trials. Anaesthesia. 2010;65(8):778-780.
Crosby G, Culley DJ, Marcantonio ER. Delirium: a cognitive cost of the comfort of procedural sedation in elderly patients? Mayo Clin Proc. 2010;85(1):12-14.
Lewis A, Wallace J, Deutsch A, King P. Improving the oral health of frail and functionally dependent elderly. Aust Dent J. 2015;60(Suppl 1):95-105.
Douglas H, Georgiou A, Westbrook J. Social participation as an indicator of successful aging: an overview of concepts and their associations with health. Aust Health Rev. 2017;41(4):455-462.
Levasseur M, Desrosiers J, St-Cyr TD. Comparing the disability creation process and international classification of functioning, disability and health models. Can J Occup Ther. 2007;74 Spec No.:233-242.
Bots-VantSpijker PC, Vanobbergen JN, Schols JM, Schaub RM, Bots CP, de Baat C. Barriers of delivering oral health care to older people experienced by dentists: a systematic literature review. Community Dent Oral Epidemiol. 2014;42(2):113-121.
Marino R, Tonmukayakul U, Manton D, Stranieri A, Clarke K. Cost-analysis of teledentistry in residential aged care facilities. J Telemed Telecare. 2016;22(6):326-332.
Torres-Pereira CC, Morosini Ide A, Possebon RS, et al. Teledentistry: distant diagnosis of oral disease using e-mails. Telemed J E Health. 2013;19(2):117-121.
Srinivasan M, Delavy J, Schimmel M, et al. Prevalence of oral hygiene tools amongst hospitalised elders: a cross-sectional survey. Gerodontology. 2019;36(2):125-133.
Wolden H, Strand GV, Gjellestad A. Caregivers' perceptions of electric versus manual toothbrushes for the institutionalised elderly. Gerodontology. 2006;23(2):106-110.
Claydon NC. Current concepts in toothbrushing and interdental cleaning. Periodontol. 2000;2008(48):10-22.
Loe H. Mechanical and chemical control of dental plaque. J Clin Periodontol. 1979;6(7):32-36.
Sambunjak D, Nickerson JW, Poklepovic T, et al. Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database Syst Rev. 2011;(12):CD008829.
Salzer S, Slot DE, Van der Weijden FA, Dorfer CE. Efficacy of inter-dental mechanical plaque control in managing gingivitis-a meta-review. J Clin Periodontol. 2015;42(Suppl 16):S92-105.
Christou V, Timmerman MF, Van der Velden U, Van der Weijden FA. Comparison of different approaches of interdental oral hygiene: interdental brushes versus dental floss. J Periodontol. 1998;69(7):759-764.
Jackson MA, Kellett M, Worthington HV, Clerehugh V. Comparison of interdental cleaning methods: a randomized controlled trial. J Periodontol. 2006;77(8):1421-1429.
Frascella JA, Fernandez P, Gilbert RD, Cugini M. A randomized, clinical evaluation of the safety and efficacy of a novel oral irrigator. Am J Dent. 2000;13(2):55-58.
Cutler CW, Stanford TW, Abraham C, Cederberg RA, Boardman TJ, Ross C. Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque. J Clin Periodontol. 2000;27(2):134-143.
Chapple IL, Van der Weijden F, Doerfer C, et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42(Suppl 16):S71-76.
Balenseifen JW, Madonia JV. Study of dental plaque in orthodontic patients. J Dent Res. 1970;49(2):320-324.
Kocak MM, Ozcan S, Kocak S, Topuz O, Erten H. Comparison of the efficacy of three different mouthrinse solutions in decreasing the level of streptococcus mutans in saliva. Eur J Dent. 2009;3(1):57-61.
Wigger-Alberti W, Gysen K, Axmann EM, Wilhelm KP. Efficacy of a new mouthrinse formulation on the reduction of oral malodour in vivo. A randomized, double-blind, placebo-controlled, 3 week clinical study. J Breath Res. 2010;4(1):017102.
Davies RM. The rational use of oral care products in the elderly. Clin Oral Investig. 2004;8(1):2-5.
Najafi MH, Taheri M, Mokhtari MR, et al. Comparative study of 0.2% and 0.12% digluconate chlorhexidine mouth rinses on the level of dental staining and gingival indices. Dent Res J (Isfahan). 2012;9(3):305-308.
DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996;109(6):1556-1561.
Gil-Montoya JA, de Mello AL, Cardenas CB, Lopez IG. Oral health protocol for the dependent institutionalized elderly. Geriatr Nurs. 2006;27(2):95-101.
Flotra L, Gjermo P, Rolla G, Waerhaug J. Side effects of chlorhexidine mouth washes. Scand J Dent Res. 1971;79(2):119-125.
Quirynen M, Avontroodt P, Peeters W, Pauwels M, Coucke W, van Steenberghe D. Effect of different chlorhexidine formulations in mouthrinses on de novo plaque formation. J Clin Periodontol. 2001;28(12):1127-1136.
Abdallah C. Perioperative chlorhexidine allergy: Is it serious? J Anaesthesiol Clin Pharmacol. 2015;31(2):152-154.
Deschepper M, Waegeman W, Eeckloo K, Vogelaers D, Blot S. Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study. Intensive Care Med. 2018;44(7):1017-1026.
Izumi M, Takeuchi K, Ganaha S, Akifusa S, Yamashita Y. Effects of oral care with tongue cleaning on coughing ability in geriatric care facilities: a randomised controlled trial. J Oral Rehabil. 2016;43(12):953-959.
Winnier JJ, Rupesh S, Nayak UA, Reddy V, Prasad Rao A. The comparative evaluation of the effects of tongue cleaning on existing plaque levels in children. Int J Clin Pediatr Dent. 2013;6(3):188-192.
Ariaudo AA, Arnim SS, Greene JC, Loe H. How frequently must patients carry out effective oral hygiene procedures in order to maintain gingival health? J Periodontol. 1971;42:309-313.
Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2005;33(2):81-92.
Srinivasan M, Schimmel M, Riesen M, et al. High-fluoride toothpaste: a multicenter randomized controlled trial in adults. Community Dent Oral Epidemiol. 2014;42(4):333-340.
Meyer-Lueckel H, Machiulskiene V, Giacaman RA. How to intervene in the root caries process? Systematic review and meta-analyses. Caries Res. 2019;53:599-608.
Nikawa H, Hamada T, Yamashiro H, Kumagai H. A review of in vitro and in vivo methods to evaluate the efficacy of denture cleansers. Int J Prosthodont. 1999;12(2):153-159.
Augsburger RH, Elahi JM. Evaluation of seven proprietary denture cleansers. J Prosthet Dent. 1982;47(4):356-359.
Kulak-Ozkan Y, Kazazoglu E, Arikan A. Oral hygiene habits, denture cleanliness, presence of yeasts and stomatitis in elderly people. J Oral Rehabil. 2002;29(3):300-304.
Paranhos Hde F, da Silva CH. Comparative study of methods for the quantification of biofilm on complete dentures. Braz Oral Res. 2004;18(3):215-223.
Duyck J, Vandamme K, Krausch-Hofmann S, et al. Impact of denture cleaning method and overnight storage condition on denture biofilm mass and composition: a cross-over randomized clinical trial. PLoS One. 2016;11(1):e0145837.
Ragher M, Prabhu UM, Ittigi JP, Naik R, Mahesh CS, Pradeep MR. Efficacy of denture cleansers on impact strength of heat polymerized acrylic resins. J Pharm Bioallied Sci. 2017;9(Suppl 1):S241-S245.
Keyf F, Gungor T. Comparison of effects of bleach and cleansing tablet on reflectance and surface changes of a dental alloy used for removable partial dentures. J Biomater Appl. 2003;18(1):5-14.
Cruz PC, Andrade IM, Peracini A, et al. The effectiveness of chemical denture cleansers and ultrasonic device in biofilm removal from complete dentures. J Appl Oral Sci. 2011;19(6):668-673.
Pires CW, Fraga S, Beck AC, Braun KO, Peres PE. Chemical methods for cleaning conventional dentures: what is the best antimicrobial option? An in vitro study. Oral Health Prev Dent. 2017;15(1):73-77.
de Sousa Porta SR, de Lucena-Ferreira SC, da Silva WJ, Del Bel Cury AA. Evaluation of sodium hypochlorite as a denture cleanser: a clinical study. Gerodontology. 2015;32(4):260-266.
de Souza RF, de Freitas Oliveira Paranhos H, Lovato da Silva CH, Abu-Naba'a L, Fedorowicz Z, Gurgan CA. Interventions for cleaning dentures in adults. Cochrane Database Syst Rev. 2009;(4):CD007395.
Ramage G, O'Donnell L, Sherry L, et al. Impact of frequency of denture cleaning on microbial and clinical parameters - a bench to chairside approach. J Oral Microbiol. 2019;11(1):1538437.
Iinuma T, Arai Y, Abe Y, et al. Denture wearing during sleep doubles the risk of pneumonia in the very elderly. J Dent Res. 2015;94(3 Suppl):28S-36S.
Bouattour Y, Kalberer N, Chebib N, Mojon P, Mehl A, Srinivasan M, Müller F. Effects of overnight storage conditions on conventional complete removable prostheses. International Journal of Prosthodontics. 2020. (In press)
Danser MM, Gomez SM, Van der Weijden GA. Tongue coating and tongue brushing: a literature review. Int J Dent Hyg. 2003;1(3):151-158.
Par M, Badovinac A, Plancak D. Oral hygiene is an important factor for prevention of ventilator-associated pneumonia. Acta Clin Croat. 2014;53(1):72-78.
Butler-Jones D. Report on State of Public Health in Canada 2010: Growing Older- Adding Life to Years. Ottawa, ON: Department of Public Health; 2010.
Sinha M. Results from General Social Survey: Portrait of Caregivers. Ottawa, ON: Statistics Canada; 2012.
Charles L, Brémault-Philips S, Parmar J, Johnson M, Sacrey L-A. Understanding how to support family caregivers of seniors with complex needs. Can Geriatr J. 2017;20(2):75-84.
Chen X, Chen H, Douglas C, Preisser JS, Shuman SK. Dental treatment intensity in frail older adults in the last year of life. J Am Dent Assoc. 2014;144(11):1234-1242.
Mulk BS, Chintamaneni RL, Mpv P, Gummadapu S, Salvadhi SS. Palliative dental care- a boon for debilitating. J Clin Diagn Res. 2014;8(6):ZE01-06.
Rak OS, Warren K. An assessment of the level of dental and mouthcare knowledge amongst nurses working with elderly patients. Community Dent Health. 1990;7(3):295-301.
Logan HL, Ettinger R, McLeran H, Casko R, Dal Secco D. Common misconceptions about oral health in the older adult: nursing practices. Spec Care Dentist. 1991;11(6):243-247.
Dharamsi S, Jivani K, Dean C, Wyatt C. Oral care for frail elders: knowledge, attitudes, and practices of long-term care staff. J Dent Educ. 2009;73(5):581-588.