Mausbach K A, Velten J, Rehmann P, Kolb G, Wöstmann B
Zentrum für ZMK-Heilkunde - Poliklinik für Zahnärztliche Prothetik, Justus-Liebig-Universität Gießen, Schlangenzahl 14, 35392, Gießen, Deutschland.
Geriatrie und Rehabilitation, Bonifatius Hospital Lingen, Lingen, Deutschland.
Z Gerontol Geriatr. 2019 Nov;52(7):680-687. doi: 10.1007/s00391-018-1449-x. Epub 2018 Oct 2.
In the future there will be an increasing demand for professional care with simultaneous retention of the dentition in older people. Due to inadequate dental knowledge, it is often not possible for caregivers to adequately assess dental deficits.
The aim of the study was to develop and validate a simple tool (Mini Dental Assessment, MDA) to assess possible dental treatment needs (DTN) of residential geriatric facilities by nursing personnel.
In the study 169 patients (51 from the University Hospital Giessen, 118 from the Bonifatius Hospital Lingen) underwent a dental examination. The dental status was evaluated based on the California Dental Association (CDA) criteria and the DTN determined. In addition, the time since the patients last visit to a dentist (TLVD) and denture age (DA) were documented and a chewing function test (carrot eating test, CET) was carried out. In a second study 155 patients were examined (115 from the University Hospital Giessen, 40 from the Bonifatius Hospital Lingen) corresponding to the reference sample and including a further chewing function test (after Schimmel und Slavicek) and questionnaires on quality of life (Oral Health Impact Profile (OHIP), Denatl Impact on Daily Living (DiDDL)).
A total of 108 patients required dental treatment. The mean value (±SD) for the TLVD was 2.5 ± 3.8 years and 10.8 ± 8.9 years for the DA. There was a positive correlation (Spearman, P < 0.005) between the DTN and degree of comminution in the CET (3.4 ± 1.8 grade). Based on the results an assessment tool was developed using the variables CET, TLVD and DA weighted by the respective regression coefficients (10:3:1). The resulting mean total MDA score was 51.32 ± 28.14. A sensitivity/specificity analysis was conducted and a receiver operating characteristic (ROC) curve calculated (area under curve, AUC: 0.805; 95% CI: 0.738-0.873). The ROC curve from the follow-up study showed a good agreement with the ROC curve from the reference study (AUC 0.829, 95% CI: 0.751-0.907).
Based on the results of the study it could be shown that the MDA is a suitable instrument for making a valid statement on the assessment of DTN of patients in long-term care facilities. The validation study revealed the validity of the MDA in its originally developed form and the addition of two further chewing function tests did not significantly improve the validity of the MDA. Overall, the MDA appears to be an appropriate tool to help nursing home personnel to assess the necessity for nursing home residents to visit a dentist.
未来，老年人对专业护理并同时保留牙列的需求将不断增加。由于牙科知识不足，护理人员往往无法充分评估牙齿缺陷。
本研究的目的是开发并验证一种简单工具（迷你牙科评估，MDA），供护理人员评估老年护理机构中患者可能的牙科治疗需求（DTN）。
本研究中，169例患者（51例来自吉森大学医院，118例来自林根博尼法提乌斯医院）接受了牙科检查。根据加利福尼亚牙科协会（CDA）标准评估牙齿状况并确定DTN。此外，记录患者上次看牙医后的时间（TLVD）和假牙使用年限（DA），并进行咀嚼功能测试（吃胡萝卜测试，CET）。在第二项研究中，对155例患者（115例来自吉森大学医院，40例来自林根博尼法提乌斯医院）进行了检查，对应参考样本，并进行了另一项咀嚼功能测试（施密尔和斯拉维切克法）以及生活质量问卷调查（口腔健康影响量表（OHIP）、牙科对日常生活的影响（DiDDL））。
共有108例患者需要牙科治疗。TLVD的平均值（±标准差）为2.5±3.8年，DA为10.8±8.9年。DTN与CET中的粉碎程度（3.4±1.8级）之间存在正相关（斯皮尔曼相关性，P<0.005）。基于这些结果，使用变量CET、TLVD和DA，并根据各自的回归系数（10:3:1）加权，开发了一种评估工具。最终的MDA总平均得分为51.32±28.14。进行了敏感性/特异性分析，并计算了受试者工作特征（ROC）曲线（曲线下面积，AUC：0.805；95%置信区间：0.738 - 0.873）。随访研究的ROC曲线与参考研究的ROC曲线显示出良好的一致性（AUC 0.829，95%置信区间：0.751 - 0.907）。
基于研究结果表明，MDA是一种适用于对长期护理机构患者的DTN评估做出有效判断的工具。验证研究揭示了MDA原始形式的有效性，另外增加两项咀嚼功能测试并未显著提高MDA的有效性。总体而言，MDA似乎是一种合适的工具，可帮助养老院工作人员评估养老院居民看牙医的必要性。
