Caries activity and associated risk factors in elderly hospitalised population – 15-months follow-up in French institutions

Only a few studies have been published concerning hospitalised elderly disabled people. Objectives: 1) to investigate the oral health status of elderly French patients hospitalised in the two main geriatric hospitals of Paris. 2) to describe the respective influences of general parameters (type of hospitalisation, pathologies and medication) on oral environment parameters. 3) to analyse the influences of these oral parameters on caries activity in Long-Term Care (LTCF) and in rehabilitation facilities (RF) patients and to study the incidence and the time-course of caries in these specific population. Subjects: 117 subjects (mean age=83.0 years, SD=7.8, range=64 to 102 years) were examined at baseline and 32 of the 50 LTCF subjects were reexamined 15-months later. Methods: The general parameters recorded were age, gender, type of hospitalisation, period of stay, removable prosthesis, general diseases, number of diagnoses, medications with hyposalivary side-effects. The oral environment parameters recorded were flow rate, buffer capacity, mutans streptococci and lactobacilli counts, measured at baseline by tests on stimulated saliva, and plaque index. Crown and root surfaces were recorded according to a modified caries activity index. Results: Among the polypathological subjects (85.5% of the population), the number of diseases ranged from 2 to 8. The LTCF patients had a significantly higher mean number of diagnoses (3.5; SD=1.5) than the RF patients (2.8; SD=1.4). 76.9% of patients were taking medications with hyposalivary side-effects. The stimulated flow rate ranged from 0.02 ml/min to 5 ml/min. Its mean was significantly lower for LTCF patients (0.67 ml/min; SD=0.51) than for RF patients (1.12 ml/min; SD=0.89). The plaque index was significantly higher in LTCF subjects and in patients with mental diseases. At baseline, 17,442 crown and root surfaces were examined. Flow rate was related to crown caries and buffer capacity to root caries. During the 15-months follow-up, the mean number of active root surfaces was significantly increased: from 0.148 (SD=0.116) at baseline vs. 0.250 (SD=0.174) at the second examination. Conclusions: The strongest relationship in the present study between oral parameters and caries activity was the negative relationship between buffer capacity and active root caries. This study confirms an association between the type of hospitalisation and both salivary parameters flow rate and plaque index. This investigation illustrates the critical need for hygiene and oral care, in this elderly disabled population.