Development of a prognostic index to predict tooth survival for older adults

Oral health is a significant issue for demented older adults because of its relationship to quality of life, as well as systemic health and well-being. Research has shown that demented patients encounter more oral diseases compared to those without dementia. However, little is currently known about tooth survival among those with dementia. Due to lack of information and clear clinical guidelines for care, clinical decision-making for demented elderly are primarily based on the experience of dentists and remain somewhat arbitrary. Therefore, non-beneficial or even harmful treatments could be provided to this vulnerable population, potentially diminishing their quality of care and life. This study was conducted to explore the patterns of tooth loss for demented patients and to develop a computerized prognostic index to help dental professionals predict risk of tooth loss for older adults. A retrospective design was applied in this study. Propensity score matching was used to control the impact of confounders on tooth survival. Cox, Poisson and Negative Binomial (NB) regressions were developed to explore the patterns of tooth loss in demented patients. A computerized prognostic index was then developed based on the NB model. A face validity test was also conducted to preliminarily evaluate the impact of the prognostic index on clinical decision making. Analysis indicated that oral health in demented patients was poor. More than one quarter of the remaining teeth of demented subjects were decayed at first arrival. Risk of tooth loss was high in these patients and nearly 40% of the subjects lost at least one tooth in five years. However, the patterns of tooth loss were not statistically different between demented and non-demented patients. Age, number of decayed/broken teeth, number of filled teeth, use of dental prosthesis, anticholinergic burden of medications and physical mobility strongly associated with tooth survival. The face validity test showed the prognostic index could influence clinical decision of dental professionals. Based on these results, it was concluded dementia was not associated with tooth survival in older adults. The prognostic index could potentially benefit treatment decisions of dental professionals, but the impact of this instrument needs to be further evaluated.