Caries incidence and increments in community-living older adults with and without dementia

Abstract

Objectives: The Oral Health of Older Adults with Dementia was instigated in the late 1990s to quantify and compare coronal and root caries incidence and increments in community-living older Australians with and without dementia. Methods: A longitudinal design was used to conduct dental inspections at baseline and one-year, for two groups of randomly selected community-living older adults – one group of 116 people with dementia and a comparison group of 116 people without dementia. Results: At one-year there were 103 dementia and 113 (112 dentate) non-dementia participants. Coronal and root surface caries incidence was higher for dementia participants (p<0.05). Dementia participants had higher coronal and root caries adjusted caries increments (ADJCI) (p<0.01). Both coronal and root ADJCI were evident in half of dementia participants, compared with one-quarter of non-dementia participants. Dementia participants with higher coronal ADJCI were those who had visited the dentist since baseline, who were taking neuroleptics with high anticholinergic adverse effects, and whose carer had high carer burden score (p<0.01). Dementia participants with higher root ADJCI were those needing assistance with oral hygiene care and whose carers had difficulties with oral hygiene care (p<0.05). Baseline characteristics predictive in linear regression for: (1) coronal caries increments among all participants were - dementia participants, those with cognitive testing scores indicative of moderate-severe dementia, those with private health insurance; (2) root caries increments among all participants were - dementia participants, and those who had >1 decayed/filled root surface at baseline. Among dementia participants, being male was the baseline characteristic predictive in logistic regression for coronal caries increments, and having >1 decayed coronal surface was the baseline characteristic predictive for root caries increments. Conclusions: Coronal and root caries incidence and increments were significantly higher in the community-living older adults with dementia over the one-year follow-up period. Dementia participants had high levels of coronal and root caries increments; characteristics related to high caries increments included sex (males), dementia severity (moderate-severe), high carer burden, oral hygiene care difficulties, use of neuroleptic medication (with high anticholinergic adverse effects) and previous experience of caries.