My BEST Dentists Journal


Tooth loss may affect ability to carry out everyday tasks

Older adults with more natural teeth are better able to perform everyday tasks such as cooking a meal, making a telephone call or going shopping, according to researchers from UCL and the Tokyo Medical and Dental University.

The study published in the Journal of American Geriatrics Society, analyzed data from 5,631 adults from the English Longitudinal Study of Aging (ELSA) aged between 50 and 70.

Previous studies have shown the link between tooth loss and reduced functional capacity but did not establish a causal link. In this study the research team wanted to investigate the causal effect of tooth loss on someone's ability to carry out daily activities. After considering factors such as participants' socioeconomic status and poor general health, they still found there was an independent link between tooth loss and the ability to carry out everyday tasks.

For the study, participants were asked how many natural teeth they had, with older adults usually having up to 32 natural teeth that are lost over time. Then, using data collected in 2014-2015, the researchers measured the effect of tooth loss on people's ability to carry out key instrumental activities of daily living (IADL). The activities included preparing a hot meal, shopping for groceries, making telephone calls, taking medications, doing work around the house or garden, or managing money.

Senior author, Professor Georgios Tsakos (UCL Institute of Epidemiology and Health), explained: "We know from previous studies that tooth loss is associated with reduced functional capacity, but this study is the first to provide evidence about the causal effect of tooth loss on the instrumental activities of daily living (IADL) among older adults in England. And this effect is considerable.

"For example, older adults with 10 natural teeth are 30% more likely to have difficulties with key activities of daily living such as shopping for groceries or working around the house or garden compared to those with 20 natural teeth.

"Even after taking in factors such as participant's education qualification, self-rated health and their parent's education level for example, we still found a positive association between the number of natural teeth a person had and their functional ability."

The team of researchers note that having more natural teeth is associated with delaying the onset of disability and death and that tooth loss can also hamper social interactions, which is linked to poorer quality of life. They also suggest tooth loss could be linked to having a poorer diet with less nutrients.

The researchers say the results must be interpreted with caution because of the complex design and further studies are needed to investigate the casual relationship between tooth loss and functional ability.

First author, Dr. Yusuke Matsuyama (Tokyo Medical and Dental University) said: "Preventing tooth loss is important for maintaining functional capacity among older adults in England. Given the high prevalence of tooth loss, this effect is considerable and maintaining good oral health throughout the life course could be one strategy to prevent or delay loss of functional competence.

"The health gain from retaining natural teeth may not be limited to oral health outcomes but have wider relevance for promoting functional capacity and improving overall quality of life."

by UCL

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Preparing for the year ahead at UCL Eastman

Professor Albert Leung looks at how UCL Eastman has been preparing for the year ahead in the face of COVID-19.

COVID-19 posed unprecedented challenges by shutting down face-to-face teaching at UCL very abruptly. Fortunately, at UCL Eastman we were already used to delivering comprehensive online teaching. Virtual classes began less than 24 hours after the university lockdown, keeping the momentum going, to the delight of many of our students.

Since then, we have developed a sophisticated range of online teaching and assessment methods, building on our existing distance-learning expertise.

As well as continuing to deliver our degree programmes, we have developed and delivered bespoke CPD webinars on laser dentistry, periodontology, oral health in sport, dental nursing and restorative dentistry.

A suite of guest lectures on advanced aesthetics was hosted. We moved taster days online, so that prospective students could continue to sample our renowned programmes.

Challenging but exciting

In May, oral health experts from across the world joined UCL Eastman Director Professor, Stephen Porter, as well as representatives from Eastman Institutes in Sweden and New York, for the first international webinar on dentistry and COVID-19.

As Head of CPD, part of my role has been to oversee the delivery of the above – it has been challenging but really exciting. If you told me five months ago this is what I would be doing as Professor of Dental Education, I would not have believed you.

But at the same time our online service was already in place and we simply expanded it to meet the new circumstances. .

And online learning in the context of COVID-19 has actually been very effective. This is because the education paradigm has been shifted to practical delivery of programmes in the comfort of the participants’ own home. Learning takes place in a relatively relaxed, congenial and unthreatened environment.

There are of course issues, particularly in clinical dentistry, where practice and the practical application of skills are crucial. We are currently holding flexible, catch-up sessions for all our postgraduates; no student will be left without the vital, hands-on experience they require.

Respond flexibly

Now, as we approach a new term, and a potential second wave of infections, we are COVID-proofing our future plans.

We will continue to deliver most didactic and theoretical training online. There will be face-to-face clinical skills teaching in our new, state-of-the-art facilities wherever possible. The latter will be in small groups, enabling us to be mindful of any social distancing measures in place.

We are working to minimise the number of times students travel to campus each week.

Inevitably, we all need to be prepared to respond flexibly to changes in governmental advice. But we are excited to meet our new postgraduates and begin our journey with them.

Professor Albert Leung is director of CPD and restorative dentistry, and dean of the Faculty of Dentistry of the Royal College of Surgeons in Ireland.

by Albert Leung

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Simple oral health steps help improve elite athletes' performance

Elite athletes who adopted simple oral health measures, such as using high fluoride toothpaste and cleaning between their teeth, reported significantly reduced negative effects on performance related to poor oral health, finds a study led by UCL.

The new research, published in BMJ Open Sport & Exercise Medicine, is the latest in a series of studies led by the UCL Centre for Oral Health and Performance (COHP), based at UCL Eastman Dental Institute, which have found that elite athletes have substantial rates of oral disease, including tooth decay and gum inflammation, and these symptoms negatively affected their wellbeing and sporting performance.

To help address this, researchers at UCL COHP designed a behavioral change program aimed at better educating elite athletes about oral health and providing some simple interventions to improve their daily oral health routines.

Explaining the study, lead author, Dr. Julie Gallagher (UCL Eastman Dental Institute), said: "Poor oral health of elite athletes is common and is associated with negative performance. However, compared with other health and training pressures, oral health care is not a high priority in elite sport.

"We therefore wanted to develop a program which was aligned with the existing high-performance culture of the athletes and their teams. Underpinning the study was health behavior psychology, which included education, self-motivation, goal setting, and an easy to use toolkit, ensuring the athletes had a readily available opportunity to improve."

In total, 62 athletes from two Great Britain Olympic Teams, rowing and cycling, and one Premiership Rugby Club, Gloucester Rugby, were recruited to the study.

Athletes and support teams were asked to watch a 10-minute presentation which focussed on building motivation to improve oral health, and three 90-second information films, featuring GB rower Zak Lee-Green, which focussed on increasing oral health knowledge and skills to perform optimum oral health behavior.

In addition,each athlete received an oral health screening to check for diseases such as caries (tooth decay) and gingivitis (gum inflammation). They were then given a bespoke follow up report with tailored advice and an oral health toolkit, containing a manual toothbrush, prescription fluoride toothpaste and flosspicks. As a minimum, they were also asked to brush their teeth for two minutes twice a day, to include brushing before training in the morning and before bed in the evening.

In total 89% of athletes completed the four-month study. On completion athletes were asked to fill in an oral health knowledge questionnaire, undergo a follow-up gingival (oral disease) assessment and evaluate the oral health kit.

Dr. Nigel Jones, Head of Medical Services at British Cycling, said: "The topic of oral health amongst athletes is an important one, especially as it can be linked to performance. My role with the Great Britain Cycling Team is to ensure the holistic well-being of our cyclists, and as oral health can have a big impact on immune function as well as being important in its own right, I wanted to support this project. The learnings which the riders took from the study have been invaluable and will be deployed across the whole team as we ramp up our preparations for the Tokyo Olympic and Paralympic Games next year."

Researchers believe the bespoke model they have developed could be used for other health promotion needs in elite sport.

by University College London (UCL)

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