Public Health England (London), London, UK.
Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, London, UK.
Gerodontology. 2022 Jun;39(2):131-138. doi: 10.1111/ger.12543. Epub 2021 Feb 14.
There is strong evidence for managing the risk of dental caries, notably dose-dependent use of fluoride based on risk. Specific guidance is lacking on higher fluoride use in older people in care homes and prevention is often omitted from dental care plans.
To introduce a risk-based preventative approach to existing routine dental care for older people in care homes.
Three mixed residential and nursing care homes for the frail and elder (>65 years) were selected to participate. All residents were risk assessed based on dependency, dentition status and self-care abilities and consequently placed on the appropriate evidence-based intervention (2800 ppm high dose fluoride toothpaste and/or quarterly fluoride varnish placement). Full mouth ICDAS dental examinations were completed at baseline, 6 months and 12 months.
At baseline, 127 risk assessments were completed in which most dentate residents (58.2%, n = 74) were assessed as Risk Level 2/3 (mod/high) whilst edentulous residents were all Risk Level 1 (low) (41.7%, n = 53). Only 13 (26.5%) of the 49 eligible residents completed the 12-month preventative programme. There was a significant difference in root caries (P < .0001), with 17 (51.5%) root lesions changing from active at baseline to arrested at 12 months.
The findings provide early indication of fluoride efficacy, especially on root caries in this vulnerable group, and highlight the challenges of delivering programme's in these complex, changing environments.
有强有力的证据表明，需要根据风险来管理龋齿风险，尤其是要根据风险使用依赖剂量的氟化物。针对养老院中老年人的更高氟化物使用的具体指导意见尚缺乏，并且预防措施通常在牙科护理计划中被忽略。
为养老院中的老年人引入一种基于风险的预防性常规牙科护理方法。
选择了三家混合居住和护理养老院（脆弱和老年人> 65 岁）参加。所有居民均根据依赖性、牙齿状况和自理能力进行风险评估，然后接受相应的基于证据的干预措施（使用 2800ppm 高剂量氟化物牙膏和/或每季度涂氟漆）。在基线、6 个月和 12 个月时完成全口 ICDAS 牙科检查。
在基线时，完成了 127 次风险评估，其中大多数有牙居民（58.2%，n=74）被评估为风险级别 2/3（中/高），而无牙居民均为风险级别 1（低）（41.7%，n=53）。只有 13 名（26.5%）符合条件的居民完成了为期 12 个月的预防计划。根龋有显著差异（P<.0001），基线时活动性病变的 17 个（51.5%）根病变在 12 个月时转为静止。
这些发现初步表明氟化物具有疗效，特别是对该脆弱人群的根龋，并且突出了在这些复杂、不断变化的环境中实施计划所面临的挑战。
