Impaired Oral Health in Older Orthopaedic In-Care Patients: The Influence of Medication and Morbidity

Abstract

Introduction

Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication.

Material and Methods

The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy.

Results

Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy.

Conclusion

The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.

Keywords:

• oral health
• orthogeriatric patients
• risk factors
• DFT
• medication
• comorbidity

Acknowledgments

We are grateful for the skilled collection of oral health data performed by dental hygienists Elisabeth Fagerström, Folktandvården Skåne and Sladjana Critén, Kristianstad University.

Abbreviations

AC, anticholinergic acting drugs; ACE, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; COPD, chronic obstructive pulmonary disease; DFT, decayed, filled teeth; PPI, proton pump inhibiting drug.

Data Sharing Statement

Data compiled for the study and published in this manuscript are available from the corresponding author at request.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there are no conflicts of interest in this work.