Discussion

Questionnaire survey by post mail had been said to be low retrieval rate, but it was considered to be suitable for information response of many clinics and hospitals. In this research, a questionnaire survey was conducted for representative members or dental specialists of three academic societies who are likely to understand the significance of the research and are thought to be engaged in implant treatment or home-visit dental care. Therefore, the questionnaire retrieval rate of this survey was close to other similar questionnaire survey, and it might have little confusion of question contents of the questionnaire. Further considerations are to further improve the response rate of the questionnaire and the actual situation of visiting dental practice other than this subject.

The present study found that no less than 30% of the dentists had patients who were admitted to the hospital or became bedridden at home after receiving implant treatment at their clinic and that 22% of the dentists had been consulted about the implants. Dentists who had provided continued post-operative implant care through home-visit dental care accounted for approximately 80%, whereas 40% of the dentists did not know the post-implantation status of their implant patients. Moreover, because the dentists who answered “I have no patients that were admitted to the hospital or became bedridden at home” (27%) are likely to include those who were not aware of such patients, it can be inferred that a larger number of dentists do not know the status of their implant patients after placement of the implants, which suggests the need to facilitate an understanding of the post-implantation status of patients.

Approximately 3% of the patients seen in home-visit dental care had implants. Lantto et al. reported a lower proportion of having implants among older adults receiving long-term care compared to healthy controls. Meanwhile, the rate of having implants among older adults that was calculated based on the results of the Survey of Dental Diseases is approximately 3%, which is largely consistent with the results of the present study among the older adults receiving long-term care. However, as the results of the present study and the Survey of Dental Diseases were mostly examined by visual inspection, it could not deny the possibility that have failed to detect potentially more implants, it is necessary to investigate the actual situation in the future. Fifty-six percent of the patients with implants were unable to perform oral self-care, which is lower compared to 77% in patients without implants. The outcome may be attributable to a high level of interest in the oral condition seen in patients with implants as well as the difference in the general condition such as age, cognition function, and cerebrovascular disease between the two groups, which is a subject for future research. However, the percentage, 56%, in itself is a high level as the proportion of patients incapable of oral self-care, and hence, it is important to provide them with professional care/management despite the issue of manpower. Moreover, some case, it is difficult for elderly patients or carers to clean their implant-supported prosthesis, so it is important to elucidate how the position or number of implants influences the complexity of care. Therefore, it might be necessary to promote a unified and standardized implant card describing necessary and sufficient implant information.

In addition, the number of patients with implants placed at the dentist’s own clinic accounted for only one third, suggesting that the remaining two thirds of the patients had the implants placed at other dental clinics. Ideally, this implies a great need for the standardization on size and shape of screw or driver used for implants, which would likely be useful to ensure continued post-operative implant care. It will be necessary to encourage implant manufacturers to do so through academic societies and dental associations. However, since basic research on mechanical performance is also necessary, it is difficult to promptly promote it, so it seems realistically to promote standardized implant cards. Even the dentists who do not offer implant treatment clearly recognized the need for implant cards, as Visser et al. [8] suggested the necessity for an “implant passport”. In actuality, however, more than 50% of the dentists offering implant treatment do not use the implant card and, even in cases where it is used, most of the cards are not standardized ones. Thus, we strongly hope that a systematized implant card will gain widespread use.

It is necessary in the future to elucidate implant-related problems arising in home-visit dental care and how they are actually addressed.

Within the limitation of low response rate to the questionnaire in this preliminary study, we concluded that many of practitioners including specialists indicated the need of universal record of implant for dependent elderly cares.