UNASSIGNED: Replacement of missing teeth is not a straightforward task in head and neck cancer (HNC) patients post-radiotherapy. There is debate regarding the best way to care for these patients as it has been reported that using dentures by HNC patients after receiving treatment with radiotherapy might initiate the development of osteoradionecrosis.
UNASSIGNED: This rapid review aimed to collate and compare the national and international guidelines for the use of dentures following radiotherapy for HNC patients.
UNASSIGNED: Three steps were included in data collection of this rapid review (first step; identification of dental and relevant non-dental associations/societies, second step, identification of national and international guidelines regarding the dental management of HNC patients, and third step; identification of recommendations about the replacement of missing teeth in HNC patients).
UNASSIGNED: In the 193 countries recognized by the United Nations, there were 238 relevant societies found, from those 175 confirmed that they do not have clear guidelines. Only 32 associations/societies (all in either Europe and North America) recommend guidelines for their dentists (N = 12 guidelines) about the dental management of HNC patients and show their position regarding the use of dentures for HNC patients after receiving treatment with radiotherapy.
UNASSIGNED: There are very few guidelines and those that do exist differ, lack detail, and rarely go beyond routine advice. Accordingly, clear, detailed, and evidence-based guidelines are required to inform the management of patients with missing teeth following radiotherapy for HNC patients.

Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulated via discussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group.

OBJECTIVE: The objective of this study was to assess the effectiveness of a supervised implementation of the \"Oral health care Guideline for Older people in Long-term care Institutions\" (OGOLI) in The Netherlands.
METHODS: A sample of 12 care homes in the Netherlands was allocated randomly to an intervention or control group. While the residents in the control group received oral health care as before, the intervention consisted of a supervised implementation of the OGOLI.
RESULTS: At baseline, the overall random sample comprised 342 residents, 52 % in the intervention group and 48 % in the control group. At 6 months, significant differences were observed between the intervention and the control group for mean dental as well as denture plaque, with a beneficial effect for the intervention group. The multilevel mixed-model analyses conducted with the plaque scores at 6 months as outcome variables showed that the reduction by the intervention was only significant for denture plaque.
CONCLUSIONS: Supervised implementation of the OGOLI was more effective than non-supervised implementation in terms of reducing mean plaque scores at 6 months. However, the multilevel mixed-model analysis could not exclusively explain the reduction of mean dental plaque scores by the intervention.
CONCLUSIONS: A supervised implementation of an oral health care guideline improves oral health of care home residents.

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OBJECTIVE: To compare a supervised versus a non-supervised implementation of an oral health care guideline in Flanders (Belgium).
BACKGROUND: The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline \'Oral health care in care homes for elderly people\' was developed to improve oral health of institutionalised elderly.
METHODS: A random sample of 12 nursing homes was randomly allocated to the intervention or the control group. Representative samples of 30 residents in each home were monitored during a 6-month study period. The intervention included a supervised implementation of the guideline.
RESULTS: At the 6-month follow-up, only a small but statistically significant (p = 0.002) beneficial effect (0.32) of the intervention was observed for denture plaque after adjustment for baseline value and the random effect of the institution. In the linear mixed regression models, including a random institution effect, difference in denture plaque level was no longer statistically significant at the 5% level.
CONCLUSIONS: Only denture hygiene has been improved by the supervised implementation, although with lower benefits than presumed. Factors on institutional level, difficult to assess quantitatively, may play an important role in the final result.

Maintaining oral health in the critically ill patient is imperative in reducing the risk of nosocomial infections and improving patient comfort and discharge outcomes. Critically ill patients are at great risk for poor oral health as many are elderly, undernourished, dehydrated, immunosuppressed, have a smoking or alcohol history, are intubated or on high-flow oxygen, and are unable to mechanically remove dental plaque. Many modalities for delivering oral care have been reported in the literature. The use of the toothbrush in the mechanical removal of plaque, even in the intubated patient, has been proven to be superior to the swab. Brushing of the gums in edentulous patients is of benefit. Although electric toothbrushes are preferable, their cost, size and the potential for cross-infection limits their use. Chlorhexidine has long been the gold standard for mouthwashes and provides up to 24 hours of antimicrobial activity; therefore infrequent applications are adequate. Sodium bicarbonate and hydrogen peroxide are of limited use due to lack of convincing evidence regarding their safety and antimicrobial effects in the critically ill population. Saliva stimulants or substitutes including lemon and glycerine are also inappropriate for moistening the oral cavity in the critically ill patient. Regular oral assessment and individualized oral care, along with the use of a standardised protocol for oral care (incorporating proven modalities) is vital for optimal oral care in the critically ill patient.

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