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Liza van de Rijt is a general dentist and a PhD student at the Department of Orofacial Pain and Dysfunction at the Academic Centre for Dentistry Amsterdam (ACTA). This research is a collaboration with the Marie Curie Palliative Care Research Department of University College London. Here she discusses her Age and Ageing paper 'Prevalence and associations of orofacial pain and oral health factors in nursing home residents with and without dementia'.

The number of older people with dementia has increased substantially over the past few decades. Getting older and having dementia increases the risk of health problems and can make it hard for people to keep their mouth and teeth clean. As a result, more oral health problems occur. These oral health problems can lead to the development of orofacial pain (pain in the mouth or face, such as toothache). Unidentified orofacial pain can cause distress and may lead to challenging behaviour.  People without memory problems and dementia can recognise they are in pain and arrange their own dental care. For older people with severe dementia, self-reporting pain can become challenging or even impossible. In this case, careful observation is needed to identify pain. To assess orofacial pain in people who are no longer able to communicate and promote research in this field, a tool has been developed: the Orofacial-Pain Scale for Non-Verbal Individuals (OPS-NVI). We asked how common orofacial pain is in this population, which oral health factors contribute to the development of this pain, and whether this tool is valid to identify orofacial pain?

This study was conducted in four nursing homes in London. We investigated the prevalence of orofacial pain, using the OPS-NVI, in residents with dementia. Residents with dementia who were able to communicate, were asked about the presence of orofacial pain. Residents without dementia were also asked about the presence of orofacial pain. After the pain assessment, a brief oral examination was performed by a general dentist. We also collected information on dementia severity, general health, functional ability, quality of life, and nutritional status. Orofacial pain was significantly more prevalent in older nursing home residents with dementia (48.8%) than in those without dementia (14.8%). The oral health of residents with dementia was poorer than that of those without dementia. Having a soft diet, a dry mouth, having natural teeth, and poor oral hygiene were significant predictors for orofacial pain in residents with dementia. The validity of the OPS-NVI showed acceptable to outstanding outcomes.

We found that orofacial pain was more common in residents with dementia than in those without. Oral hygiene may be poor due to difficulty in cleaning their teeth. We recommend that oral health care should be included in the routine health care of nursing home residents, especially in those with dementia, to reduce the risk of developing orofacial pain. This may be challenging to implement in practice where care home staff have multiple demands on their time.

Read the Age and Ageing paper 'Prevalence and associations of orofacial pain and oral health factors in nursing home residents with and without dementia'.