Approach to the most prevalent oral disorders among the elderly: an integrative review focusing on primary health care

Silva, Helena Pereira Rodrigues da; Koppe, Bárbara; Brew, Myrian Câmara; Sória, Giordano Santana; Bavaresco, Caren Serra

doi:10.1590/1981-22562017020.160199

Abstract

Objective:

an integrative review of the treatment of oral candidiasis, root caries and xerostomia among the elderly population, focusing on Primary Health Care, was carried out.

Method:

scientific articles were collected from the MEDLINE/PUBMED database using the keywords "Geriatric dentistry" and "Oral health", crossed with corresponding descriptors, together with specific terms for the pathologies studied, and with “the clinical trial” filter activated. The abstracts of the articles were read by three researchers.

Result:

oral candidiasis: six randomized clinical trials and one quasi-experimental design study, on the treatment of prosthetic stomatitis by medication and/or the disinfection of dentures by different techniques, were identified; root caries: three randomized clinical trials were included, which tested the use of mouthwash with chlorhexidine solution and oral hygiene instruction associated or otherwise with other drugs; and xerostomia: two articles were analyzed using various medications, and the functional massage of the salivary glands and associated muscles.

Conclusion:

The results demonstrate a variety of treatment options for the studied clinical situations, although these should be adapted to the characteristics of the services and the population, as standard treatment in Primary Health Care has not been established. Strategies based on soft technologies, such as health education, seem to provide good results. The present study provides additional knowledge for health professionals in search of more resolutive and qualified dental care for the elderly in primary health care.

Keywords:
Candidiasis; Oral. Root Caries. Xerostomia. Primary Health Care. Elderly.Oral Health

[1] Correspondence Caren Serra Bavaresco. E-mail: c_bavaresco@yahoo.com.br

Authors/Year/Country	Sample and Methodology	Results
Webb BC et al., 2005²⁰ (Australia)	60 patients with candida-associated denture stomatitis; Two test groups and one control group. Randomized clinical trial; Efficacy of two treatment methods.	The control group showed insignificant changes in the candida and aerobic bacteria counts on dentures. Both hypochlorite and microwave irradiation proved to be effective in combating candida-associated denture stomatitis.
Koray M et al., 2005⁴⁸ (Turkey)	61 patients; Three groups (fluconazole, hexetidine and fluconazole + hexetidine). Quasi-experiment; Efficacy of oral fluconazole and hexetidine	The three groups showed a significant reduction compared to pre-test. There were no significant differences between groups.
Catalán A et al., 2008³⁴ (Chile)	27 patients with stomatitis; nine per group (two tests and one control). Randomized clinical trial; Antifungal effect of melaleuca alternifolia	In vitro: melaleuca - total inhibition of candida. In vivo: two test groups - no statistical difference; test groups compared to control group - both reduced the signs of inflammation.
Neppelenbroek KH et al. 2008¹⁹ (Brazil)	60 patients; three test groups (Mw - micro-waves, Mz-miconazole and MwMz) and a control group. Randomized clinical trial; Effectiveness of disinfection of complete upper dentures through microwave irradiation.	Mw and MwMz had much better results than control and Mz. There was no significant difference between the Mw and MwMz groups
Meurman JH et al., 2009⁵⁰ (Finland)	194 patients, two groups (control group with placebo and test group with AmF-SnF2 solution). Randomized clinical trial; Antifungal effect of amine flouride-stannous fluoride combination (AmF-SnF2) in solution compared to placebo	The number of patients with high candida counts was lower in the test group than in the control group. Total bacterial count was lower in both groups. The use of the AmF-SnF2 solution did not significantly change the mean candida score but the median was reduced in this group, while there was an increase in the control group.
Khozeimeh F et al., 2010⁴⁹ (Iran)	30 patients from a geriatric sanatorium, two groups (topical ketoconazole group and ketoconazole tablet group). Randomized clinical trial, efficacy between topical ketoconazole 2% in orabase and ketoconazole tablet.	The treatments exhibited similar efficacy.
Mima EG et al., 2012³⁵ (Brazil)	40 edentulous patients with dentures; Two groups: Nystatin Group and PDT Group. Randomized clinical trial; Compares the action of photodynamic therapy (PDT) and topical antifungal treatment against denture stomatitis, in terms of fungus count. Identification of species of candida.	Nystatin success: 54%. PDT success: 45%. Both reduced fungal culture in 30 days (with no statistical difference between groups). There were recurrence rates of 75% (Nyst) and 78% (PDT) among successful cases.
Kraft -Bodi E et al. 2015³⁶ (Switzerland)	215 elderly residents in nursing homes, two analysis groups (group using two types of probiotics and a placebo group). Randomized Double Blind Two-Arm Clinical Trial; effect of probiotic use on the prevalence and counts of oral candida.	Significant reduction in the prevalence of Candida Albicans in both dental biofilm and saliva (p<0.05). There was no difference between gingival bleeding and dental biofilm levels.

Authors/Year/Country	Sample and methodology	Results
Wyatt CC et al., 2007²¹ (Canada)	1,101 elderly persons; Two groups: control group (placebo) - 551 elderly persons; CHX (chlorhexidine) test group - 550 elderly persons. Randomized double-blind clinical trial; tests the impact of regularly rinsing with 0.12% chlorhexidine solution on tooth loss.	Results showed that regular use of chlorhexidine mouthwash did not have a substantial effect on the preservation of dental structures among the elderly.
Tan HP et al., 2010²² (China)	306 elderly persons from 21 institutions; four groups: Individual hygiene instruction (IHI); IHI + application of chlorhexidine 1% varnish every three months; IHI + 5% sodium fluoride varnish application every three months; IHI + annual application of 38% silver fluoride diamine solution. Randomized clinical trial; to compare the efficacy of four methods of preventing new root caries.	Groups two, three and four had reduced carious surfaces in comparison to the IHI only group (reduction of relative risk of caries). There was no significant difference between groups. Reductions of 57%, 64%, and 71% respectively. Side effects or discomfort were not reported.
Zhang W et al., 2013²³ (China)	266 elderly persons; three groups: Group One: OHI annually; - Group Two: OHI and application of SFD annually; Group Three: OHI and SFD annually and another oral health education program (OHEP) every six months. Randomized clinical trial; To evaluate the effectiveness of silver fluoride diamine (SFD) and education on the prevention and paralysis of root caries lesions.	Group three had fewer new carious surfaces than group one. Group two and three had a greater number of paralyzed caries than group one.
Cruz Gonzalez AC, Marín Zuluaga DJ, 2015²⁴ (Colombia)	75 elderly people living in geriatric institutions; Two groups (ART and conventional technique) evaluated after six months. Randomized Clinical Trial; to compare the clinical performance of the ART technique in relation to the conventional technique on root surfaces	The ART group presented an 81.3% survival rate after 6 months while the conventional technique obtained a rate of 92.9%. Although the ART group had a higher rate of failure and less success in terms of treatment, the authors suggest that ART is a recommended technique for the treatment of root caries in the institutionalized elderly.
da Mata C.et al., 2015²⁵ (Ireland)	99 elderly persons, two groups (ART and conventional technique). Randomized Controlled Clinical Trial with two-year follow-up.	The cumulative survival rate of the restorations was 85.4% for ART and 90.9% for the conventional technique. Statistical analysis did not find a significant difference between groups.

Authors/Year/Country	Sample and methodology	Results
Gil-Montoya JÁ et al. 2008²⁶ (Spain)	20 institutionalized elderly; Two phases: Phase One: test group - Biotene mouthwash and Oral Balance gel and control group - two placebo products. Stage Two: after a break of 20 days, the products were changed. Pilot study. Randomized double blind clinical trial; to evaluate the clinical efficacy of a mouthwash and gel containing the antimicrobial proteins lactoperoxidase, lysozyme and lactoferrin in elderly patients with dry mouth.	Some symptoms improved with the test group and others with the placebo.
Hakuta C et al., 2009²⁷ (Japan)	141 elderly persons; Two groups: test group - underwent program and control group which did not undergo program. Randomized clinical trial; evaluate oral functionality promotion program for the elderly in Japan with facial and tongue exercises and massage of the salivary glands.	In the test group: the tongue coating scores decreased; the amount of food debris in the oral cavity was reduced and dryness on the tongue was improved; the increase rate of salivary flow was greater; the period of time of the tongue being maintained in the forward position increased and the number of times for moving the tip of the tongue increased; pronunciation of words was clearer.
Ohara Y et al., 2015²⁸ (Japan)	47 elderly patients with xerostomia; Two groups (the group that received the oral health education program and the control group). Randomized Clinical Trial; the intervention group consisted of oral hygiene instructions, muscular exercises and massage of the salivary glands; the control group received general information about oral health.	21 patients from the intervention group and 17 patients from the control group completed the study. The salivary accumulation tests were significantly better in the intervention group than the control group.