Table 2.
Main characteristics of the articles included in the systematic umbrella review.
| References, review design | Aim or objective | Search strategy | Type of studies: total number + design | Setting of participants. Total number of participants (if available) | Study outcomes related to holistic health |
|---|---|---|---|---|---|
| Nutrition | |||||
| Algra et al. (34) Systematic review | To examine the association between malnutrition and oral health in older people. | Databases: 4, PubMed, CINAHL, DOSS, and Embase. Langue: limited to English and Dutch. Date: from January 2000 to May 2020. |
10 studies: 9 cross-sectional studies + 1 longitudinal cohort study | Nursing homes, dental clinics, community community-welling older people, or hospital units (acute care units or rehabilitation). Total N = 9,093. |
The association between malnutrition and oral health, the state of hard and soft tissues of the mouth, salivary flow, and xerostomia |
| Hussein et al. (28) Systematic review and meta-analysis | To evaluate whether poor oral health is associated with a higher risk of malnutrition based on MNA or MNA-SF in older adults. | Databases:4, PubMed, Web of Science, Cochrane Library and EMBASE. language: English. Date: up to June 2020. |
33 studies: 28 cross-sectional studies + 5 cohort studies | Community-dwelling older adults, interviewed at home or in emergency rooms or hospital wards, institutionalized older adults, living in nursing homes or assisted living facilities. Total N = 27,559 |
MNA or MNA-SF |
| Tada and Miura (35) Systematic review | To assess the association of mastication with food and nutrient intake in the community dwelling elderly. | Databases:4, PubMed, Web of Science, Cochrane Library, and Scirus. Langue: English. Date: between 1991 and 2013. |
35 studies: 28 cross-sectional studies + 7 intervention studies | Community dwelling elderly (Non-institutionalized healthy elderly, dental school hospitals.) Total N not reported. |
Food intake or nutrient intake |
| Toniazzo et al. (36) Systematic review and meta-analysis | To compare the nutritional status and oral health in older individuals. | Databases:3, Medline-Pubmed, Scopus and EMBASE. Language: no restrictions. Data: up to October 28th 2016. |
26 studies: 23 cross-sectionals + 1 case-control + 1 cohort + 1 clinical trial | Non-institutionalized older adults. Total N = 13,257. |
The malnutrition or risk of malnutrition related with oral health |
| Van Lancker et al. (37) Systematic review | To determine whether an association exists between oral health and malnutrition in the elderly in a long-term care facility. | Databases:3, Medline, CINAHL and Cochrane Library. Language: in English, Dutch, French, or German. Date: between January 1985 and May 2011. |
16 cross-sectional studies | Long-term care facility. Total N not reported, number of included patients varied between 40 and 3,088. |
The association between oral health status and malnutrition |
| Zelig et al. (38) Systematic review and meta-analysis | To determine the association between tooth loss and nutritional status by the validated nutrition screening or assessment tool. | Databases:5, PubMed, Scopus, CINAHL, Web of Science, and MEDLINE. Language: English. Date: between January 2009 and December 2019. |
7 studies: 6 cross-sectionals and 1 cohort | Adults living in the community and institutions. Total N = 7,897. |
Associations between tooth loss and nutritional status |
| Age-related oral changes | |||||
| Affoo et al. (39) Systematic review and meta-analysis | To determine whether salivary flow decreases as a function of aging. | Database:7, PubMed, EBSCOhost, Web of Science, Cochrane library, EMBASE, Dissertations and Theses, and Scopus databases. Language: English. Date: up to June 2013. |
47 cohort studies | All general elderly. Total N not reported, number of included patients varied between 15 and 1,427. |
The aging process is associated with reduced salivary flow in a salivary-gland. |
| Pina et al. (40) Systematic review and meta-analysis | To determine the prevalence of hyposalivation in older people. | Database:6, Embase, LILACS, Medline, PubMed, Web of Science and Google Scholar. Language: no restrictions. Date: up to February 2019. |
13studies: 10 cross-sectional studies + 3 cohorts | All general elderly. Total N = 3,885 |
The prevalence of hyposalivation |
| Ruiz-roca et al. (41) Systematic review | To ascertain the oral health status of older people patients admitted to institutions or hospitalized for a long period of time. | Database: 2, PubMed and Cochrane Library. Language: English and/or Spanish and/or Portuguese. Date: 1 January 2014 to 1 January 2019. |
5 studies: 2 cross-sectional + 2 cohorts + 1 case-control study | Older hospitalized for long term at least 7 days. Total N = 773 |
Poorer results in patients institutionalized in the periodontal index score |
| Chan et al. (42) Systematic review | To provide an update on caries prevalence in older adults around the globe. | Database: 5, PubMed, Scopus, Embase/Ovid and Web of Science, Google Scholar. Language: English. Date: January 2016 to March 2021. |
39 (8 additional) cross-sectional surveys | Community, residential homes, and hospitals. Total N not reported. |
Caries prevalence |
| López et al. (43) Systematic review | To review the burden of caries and periodontitis in the elderly, changes with age that can explain this burden, and the vulnerability to disease of elderly populations. | Database: 2, PubMed, Medline. Language: NA. |
18 studies | All general elderly. Total N not reported. |
Caries and periodontitis burden |
| Quality of life | |||||
| van de Rijt et al. (44) Systematic review | To identify oral health factors associated with OHQoL in the elderly and to give a comprehensive overview of the body of literature for each oral health factor separately. | Databases:5, PubMed, Embase, EBSCO/CINAHL, EBSCO/PsycINFO, and Wiley/ Cochrane Library. Language: no restrictions. Date: up to April 3, 2019. |
68 studies: 9 RCTs (randomized clinical trials) + 6 cohort studies + 53 cross-sectional studies | In community or in institutional care. Total N = 47,770. |
OHQoL |
| Wong et al. (45) Systematic review | To describe recently reported oral health levels, the OHRQoL and the associated factors. | Databases:6, Cochrane Library, JBI, MEDLINE, EMBASE, CINAHL, Google Scholar. Language: English. Date: between July 2009 and June 2019. |
25 studies: 22 cross-sectional studies + 3 case-control studies | Institutionalized homes, long-term care, nursing homes and residential homes. Total N = 10,958. |
OHQoL |
| Azami-Aghdash et al. (46) Systematic review and meta-analysis | To assess oral health- related quality of life in older people. | Database: 7, PubMed, EMBASE, Scopus, SID, MagIran, Cochrane Library, google scholar. Language: English. Date: from 1st Jan 2000 to 30th Jan 2017. |
40 studies: The type of included studies was not mentioned | All general elderly. Total N = 22,416. |
OHQoL |
| Baniasadi et al. (47) Systematic review and meta-analysis | To determine the relationship between poor OHRQoL and oral health determinants. | Database: 4, PubMed, Scopus, Cochrane Library and Web of Science. Language: English. Date: before 1 December 2019. |
19 studies: 18 cross-sectional studies + 1 cohort study | All general elderly. Total N not reported. |
The association between poor OHRQoL and oral health. |
| de Medeiros et al. (48) Systematic review | To evaluate whether treatment with new complete dentures improves quality of life in elderly patients. | Database: 6, MEDLINE/PubMed, Scopus, LILACS, SciELO, Web of Science, and Cochrane Library. Language: in English, Spanish, Portuguese. Data: up to March 2018. |
7 studies: 6 RCTs + 1 cohort study | Residential or nursing homes, sheltered accommodations, private homes, or hospitals. Total N = 618. |
Quality of life in elderly patients with new complete dentures |
| Ming et al. (49) Systematic review and meta-analysis |
To increase understanding of OHRQoL among patients with AD and explore factors that may affect OHRQoL. | Database: 6, PubMed, Cochrane Library, Medline, EBSCO, ProQuest, and EMBASE. Language: English. Date: until August 30, 2018. |
6 studies: 5 cross-sectional designs + 1 nRCT | All general elderly. Total N = 632. |
The association between OHRQoL and AD |
| Respiratory diseases | |||||
| Azarpazhooh et al. (50) Systematic review | To investigate evidence for a possible etiological association between oral health and pneumonia or other respiratory diseases. | Database: 9, Ovid MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Cochrane library, Database of Abstracts of Reviews of Effects, EMBASE, Health and Psychosocial Instruments, HealthSTAR, PubMed, and Google Scholar. Language: English. Date: from the earliest record until July 2005. |
10 studies: 9 case-control + 1 cohort study | In nursing homes and especially in ICUs. Total N not reported. |
Outcomes related to respiratory diseases |
| Khadka et al. (13) Systematic review | To determine potentially pathogenic microorganisms in oral specimens of older people with aspiration pneumonia and the effect of POHC in reducing aspiration pneumonia risk. | Database:7, PunMed/MEDLINE, CINAHL, EMBASE, Cochrane library, PROQUEST, Google Scholar, and Web of Science. Language: English. Date: published between January 2001 and December 2019. |
12 studies: 4 cross-sectionals + 5 cohort + 3 interventions (9 observational studies included a followed-up period ranging from 6 months to 9 years or until participants were no longer living. | Older adults in residential care. Total N not reported. |
Aspiration pneumonia as an outcome and describing oral microorganisms. |
| Liu et al. (51) Systematic review and meta-analysis | To assess effects of oral care measures for preventing nursing home-acquired pneumonia in residents of nursing homes and other long-term care facilities. | Database: 6, Cochrane Library, MEDLINE Ovid, Embase Ovid, CINAHL, ClinicalTrails. Gov, WHO. Language: no restrictions. Date: up to 15 November 2017. |
4 RCTs | Residents of nursing homes and other long-term care facilities. Total N = 3,905. |
Outcomes related to home-acquired pneumonia. |
| Loeb et al. (52) Systematic review | To assess the effectiveness of prevention of AP in older adults: compensatory strategy/positioning changes, dietary interventions, pharmacologic therapies, oral hygiene, and tube feeding. | Database:5, MEDLINE, EMBASE, Cochrane Library, CINAHL, and HealthSTAR databases. Language: no restrictions. Date: from 1997 to 2001. |
8 RCTs | Older adults in nursing homes. Total N = 1,234. |
Primary outcome: AP; Secondary outcomes: related to the effects of aspiration that were assessed included dehydration, gross aspiration, nutritional intake, and death. |
| Scannapieco et al. (15) Systematic review | To determine if interventions that improve oral hygiene reduce the rate of pneumonia in high-risk population. | Database: 4, MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and Cochrane library. Language: English. Date: from 1966 through March 2002. |
30 studies: 21 case-control studies + cohort studies + 9 RCTs. | Elder patients or institutionalized patients in nursing homes. Total N = 3,172. |
Primary outcome: reduced rate of pneumonia or lung disease, Secondary outcomes: improved lung function. Patients-centered outcomes: quality life issues, Adverse outcomes: intraoral adverse effects, increased rate of pneumonia. |
| Sjögren et al. (53) Systematic review and meta-analysis | To compare the effect of intensified oral care interventions given by dental or nursing personnel on mortality in elderly adults in hospitals or nursing homes with the effect of usual oral care. | Database: 3, PubMed, Cochrane library, and HTA. Language: English, Danish, Norwegian, or Swedish. Date: published since January 1, 1996. |
5 RCTs | Elderly adults in hospitals or nursing homes. Total N not reported. |
The outcome was mortality from HAP |
| Sjögren et al. (54) Systematic review |
To investigate the preventive effect of oral hygiene on pneumonia and respiratory tract infection, focusing on elderly people in hospitals and nursing homes. | Database: 2, Medline, Cochrane library. Language: Dutch, English, German, and any of the Nordic languages (Danish, Finnish, Icelandic, Norwegian, Swedish). Date: from 1996 to 2007. |
15 studies: 5 RCTs + 10 nRCTs | Elderly people in hospitals and nursing homes. Total N not reported. |
Pneumonia and respiratory tract infection, death from pneumonia |
| van der Maarel-Wierink et al. (55) Systematic review | To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors. | Database: 5, PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL. Language: English. Date: January 2000 to April 2009. |
21 studies: 1 case-cohort + 12 cohort + 7 case-control + 1 cross-sectional design | Frail elder people in hospitalized, institutionalized, or frail home-dwelling. Total N not reported. |
The risks of aspiration pneumonia |
| van der Maarel-Wierink et al. (56) Systematic review |
To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia. | Database: 5, PubMed, Web of Science, Cochrane Library, EMBASE and CINAHL. Language: English. Date: from January 2000 to July 2010. |
5 RCTs | Hospitalized or institutionalized people. Total N not reported. |
The incidence of aspiration pneumonia |
| Frailty | |||||
| Slashcheva et al. (29) Systematic review | To updating the evidence for association between oral health characteristics and frailty status, identifying gaps in translational dental research and application of frailty assessment into clinical practice. | Database: 5, MEDLINE and Epub Ahead of Print, In- Process & Other Non-Indexed Citations and Daily, Embase, Cochrane library and Scopus. Language: English. Date: Until to 2 January 2020. |
26 studies: 17 Cross sectional studies + 9 longitudinal studies | All general elderly. Total N = 37,925. |
Association between oral health characteristics and frailty status |
| Tôrres et al. (57) Systematic review | To assess the relationship between frailty or one of its components and poor oral health. | Database: 5, PubMed, EMBASE, Cochrane library, LILACS, and SciELO. Language: English, Spanish, or Brazilian Portuguese. Date: from 1991 to July 2013. |
12 studies: 7 cross-sectional + 5 cohort studies. | The frail elderly. Total N = 7,884. |
Different oral health predictors and covariates that are associated with frailty or its components. |
| Hakeem et al. (58) Systematic review | To systematically review longitudinal studies on the association between oral health and frailty indicated by any validated scale or index. | Database: 3, MEDLINE, EMBASE and LILACS. Language: no restriction. Date: up to July 2018. |
5 longitudinal studies | No considerations were given for the recruitment settings (nursing or care homes, hospitals, community dwelling), nor the general health status. Total N not reported. |
Association between oral health and frailty |
| Cognitive impairment | |||||
| Nangle et al. (59) Systematic review | To focus on how oral health relates to specific cognitive abilities in older adults. | Database: 4, PubMed, Scopus, PsychINFO, and Web of Science. Language: English. Date Until August, 2018. |
23 studies: 19 cross sectionals + 3 longitudinal + 1 interventional | NA Total N = 121,547. |
Relationship between oral health and cognitive decline in late adulthood |
| Lauritano et al. (60) Systematic review | To present a literature review of oral health status and the need for oral care in people with dementia, as compared to people without dementia and also of the relationship between periodontal disease and cognitive impairment. | Database: 3, PubMed, CINAHL, and Cochrane Library. Language: no restrictions. Date: within 2019. |
56 studies: 19 cohort + 9 case-control + 26 cross-sectional + 2 RCTs | Participants must have been diagnosed with dementia, and should be 60 years or older. Total N = 15,263. |
Role of tooth loss due to periodontal disease in progression of dementia. |
| Delwel et al. (61) Systematic review | To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues. | Databases: 3, PubMed, CINAHL, and the Cochrane Library. Language: Dutch, English, and German. Date: performed on 12 January 2017. |
36 studies: 14 cross-sectional studies + 10 case-control studies + 10 + cohort studies + 2 RCTs | Nursing homes, Community, Non-institutionalized, institutionalized, assisted living, acute bed geriatric hospital, psychiatric hospital, long-term care homes. Total N = 9,182. |
Oral hygiene and oral health status |
| Delwel et al. (62) Systematic review |
To provide a systematic overview including a quality assessment of studies about oral health and orofacial pain in older people with dementia, compared to older people without dementia. | Database: 3, PubMed, CINAHL, and the Cochrane Library. Language: no restrictions. Date: up to now. |
37 studies: 11 cohort + 6 case-control studies + 19 cross-sectional + 1 RCT | All general elderly. Total N = 7,806. |
Oral health status |
| Wu et al. (63) Systematic review | To systematically review longitudinal studies examining the association between oral health and cognitive decline. | Database:3, PubMed, Medline, CINAHL. Language: English. Date: January 1993 and March 2013. |
56 studies: 40 cross-sectional studies + 16 longitudinal studies | All general elderly. Total N not reported. |
The risk of cognitive decline or incident dementia |
| Depression | |||||
| Cademartori et al. (64) Systematic review and meta-analysis | To systematically review the literature in order to investigate association between depression and oral diseases. | Database: 5, PsychInfo, PubMed, Scielo, Scopus, and Web of Science. Language: no restriction Date: until 20 April 2018 |
15 studies: 14 cross-sectional studies + 1 longitudinal study | All general elderly. Total N not reported. |
Dental caries/periodontal disease/tooth loss |
AD, Alzheimer's disease; AP, aspiration pneumonia; DOSS, Dentistry and Oral Sciences Source; MNA, mini nutritional assessment; MNA-SF, mini nutritional assessment short form; NA, not available; OHRQoL, oral health-related quality of life; POHC, professional oral hygiene care.