Showing papers in "Gerodontology in 2008"

Antimicrobial and mechanical properties of acrylic resins with incorporated silver-zinc zeolite - part I.

Abstract: Objective: The purpose of this in vitro study was to evaluate the antimicrobial activity of acrylic resins containing different percentages of silver and zinc zeolite, and to assess whether the addition of zeolite alters the flexural and impact strength of the resins. Background: The characteristics of acrylic resins support microorganism development that can threaten the health of the dentures user. Material and methods: A microwave-polymerised (Onda-Cryl) and two heat-polymerised (QC20 and Lucitone 550) acrylic resins were used. The materials were handled according to the manufacturers’ instructions. Fifty rectangular-shaped specimens (8 × 10 × 4mm) were fabricated from each resin and assigned to 5 groups (n = 10) according to their percentage of Irgaguard B5000 silver–zinc zeolite (0%– control, 2.5%, 5.0%, 7.5% and 10%). Flexural strength and Izod impact strength were evaluated. The antimicrobial activity against two strains of Candida albicans and two strains of Streptococcus mutans was assessed by agar diffusion method. Data were analysed statistically by one-way anova and Tukey’s test at 5% significance level. Results: The addition of 2.5% of Irgaguard B5000 to the materials resulted in antimicrobial activity against all strains. Flexural strength decreased significantly with the addition of 2.5% (QC20 and Lucitone 550) and 5.0% (Onda-Cryl) of Irgaguard B5000. The impact strength decreased significantly with the addition of 2.5% (Lucitone 550) and 5.0% (QC20 and Onda-Cryl) of zeolite. Conclusion: The addition of silver–zinc zeolite to acrylic resins yields antimicrobial activity, but may affect negatively the mechanical properties, depending on the percentage of zeolite.

Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years.

Abstract: Objectives: (i) Initially, to devise and examine the validity of a system for determining lesion activity on root surfaces, and (ii) compare the effectiveness of two preventive programmes in controlling root caries in elderly people using the devised system. Materials and methods: (i) Four clinical variables: texture, contour, location and colour of root caries lesions were selected to evaluate lesion activity. The intraexaminer reproducibility of the scoring system was assessed on 28 elderly patients. The accuracy was assessed on 10 of these persons using an impression material (Clinpro, 3M ESPE). (ii) Of total, 215 homebound 75+ year olds were randomly assigned to one of three groups: group 1, once a month a dental hygienist brushed the teeth of the participants and applied Duraphat vanish to active root caries lesions. The participants in groups 2 and 3 received 5000 and 1450 ppm F-toothpaste, respectively, to use twice a day. This study included an interview, a baseline examination and a final follow-up examination after 8 months. Results: (i) Intraexaminer reproducibility of the root caries scoring system was 0.86 (Kappa). The sensitivity and specificity was 0.86 and 0.81. (ii) Data from those 189 (88%) who completed the study disclosed that there were no inter-group differences at the baseline examination concerning relevant conditions. At the end of the study, the root caries status of participants in groups 1 and 2 had improved significantly when compared with group 3 (p < 0.02). No significant difference was observed between groups 1 and 2 (p = 0.14). Conclusion: The data suggest that the root caries scoring system is reliable. Both the intervention programmes controlled root caries development; the hygienist in eight of 10 persons, the 5000 ppm F-toothpaste in seven of 10. In contrast, five of 10 participants who only brushed with 1450 ppm F-toothpaste had root caries progression.

Denture contamination by yeasts in the elderly

Abstract: doi:10.1111/j.1741-2358.2007.00247.xDenture contamination by yeasts in the elderlyObjectives: The aim of this study was to investigate yeast carriage in healthy denture wearers by swab-bing and to evaluate the effect of denture hygiene habits.Materials and methods: Denture wearers (n = 87) without evidence of denture stomatitis or any otheroral disease were investigated by separately swabbing the fitting surface of the upper denture and thecorresponding palatal mucosa in contact with the appliance. In a group of volunteers, a gel without anyactive compound was spread on the palatal side of the denture once in every morning for 2 weeks.Results: Screening showed Candida colonisation of upper prosthesis in 75.9% of individuals. The mostfrequent species isolated were Candida albicans (77.9% of the positive cultures), Candida glabrata (44.1%)and Candida tropicalis (19.1%). Carriage of more than one yeast species was found in 48.5% of the con-taminated dentures. There was a statistically significant association between denture contamination andpalatal mucosa colonisation (chi-squared test: p < 0.0001). Repeated swabbings after 1 week as well asduring a weekly follow-up for 1 month confirmed the denture contamination and its degree of severity. Adaily gel application produced a yeast-count decrease to 10% of the initial value after 2 weeks (chi-squaredtest: p = 0.0134 and p = 0.2841 for prosthesis and palatal mucosa, respectively).Conclusion: This study documented the reliability of oral swabbing when investigating yeast carriage inhealthy denture wearers. Moreover, just a diagnostic tool, sampling upper dentures for Candida could bethe opportunity to verify the patient’s compliance to hygiene advice.Keywords: Candida, dentures, hygiene, yeast.Accepted 28 April 2008

Caries clinical trial of a remineralising toothpaste in radiation patients.

Abstract: Objectives: The purpose of this study was to determine the efficacy and safety of a specially formulated remineralising toothpaste in controlling caries in a high-risk population: head and neck radiation patients. Design: The study compared the performance of the remineralising toothpaste with a conventional fluoride dentifrice using double-blind randomisation. Materials and methods: Test products: The products compared contained equivalent quantities of fluoride (1100 p.p.m.). The dual-phase remineralising toothpaste, Enamelon®, also delivered soluble calcium and phosphate ions, essential components of teeth, from separate phases. Both groups had all caries restored at baseline and used a fluoride rinse daily. Subjects: Fifty-seven subjects who received radiation to the head and neck causing saliva hypofunction, entered the study, while 44 completed the 10–12 month visit. Measurements: Examinations included coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over a 1-year period. Results: The average net increment per year for root caries per subject was 0.04 (±.052) in subjects completing the study using the remineralising toothpaste and 1.65 (±0.51) for root caries in subjects completing the study using the conventional fluoride dentifrice. The difference was statistically significant (p = 0.03), suggesting lower net root surface increment/year for the remineralising toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces. Conclusion: The results indicate that the remineralising toothpaste provides a significant benefit in preventing and remineralising root caries in high-risk patients.

Evaluation of the clinical efficacy of a mouthwash and oral gel containing the antimicrobial proteins lactoperoxidase, lysozyme and lactoferrin in elderly patients with dry mouth--a pilot study.

Abstract: Objectives: To evaluate the clinical efficacy of a mouthwash and oral gel containing the antimicrobial proteins lactoperoxidase, lactoferrin and lysozyme, in a sample of elderly individuals with dry mouth. Material and methods: Twenty elderly institutionalised subjects with dry mouth and with a certain degree of independence for daily life activities were included in this pilot study. A randomised, double blind and cross-over design was used. The study variables comprised subjective dry mouth sensation, the severity of discomfort assessed by means of a visual analogical scale (VAS), the Oral Health Impact Profile (OHIP), the presence of signs and symptoms of dry mouth, sialometry and Candida albicans culture. All the variables were recorded before and after each of the two periods of the study. Results: The 20 selected subjects we made up of 16 women and four men, with a mean age of 81.3 years. Improvement was observed on analysing the data between the first and second intervention period in terms of the OHIP values, the presence of dry mouth, and the need to drink fluids to swallow. However, the improvement in certain variables before and after treatment did not take a positive course in all cases, and some subjects even improved with placebo. Conclusions: The evaluated mouthwash and oral gel improved some subjective and clinical aspects in elderly individuals with dry mouth, though a placebo effect cannot be entirely discarded.

Arabic version of the Geriatric Oral Health Assessment Index.

Abstract: Objectives: The purpose of this study was to translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into an Arabic version, and to test the validity and reliability of the translated instrument (GOHAI-Ar) for use among the elderly in Saudi Arabia. Methods: The 12-item GOHAI was translated into Arabic using the back-translation technique and performing a preliminary test to determine the comprehensibility and readability of the Arabic language version. A total of 156 elderly patients answered the questionnaire, and underwent a clinical examination by one calibrated dentist. Information on subjects’ socio-demographic background and oral health conditions was collected. Convergent validity was evaluated by identifying the associations between perceived oral health status, general health status, perceived need for dental care and GOHAI-Ar scores. Discriminant validity was examined by comparing the GOHAI-Ar scores and six oral health parameters. Internal consistency was measured by Cronbach’s alpha. Test–retest reliability was assessed by intra-class correlation coefficient (ICC) and weighted kappa. Factor structure of GOHAI-Ar was evaluated using principal component factor analysis. Results: The mean GOHAI-Ar was 32.1 (SD 12.2; range 11–59). Mean GOHAI-Ar scores were higher for the elderly who rated their oral and general health as good. Subjects with perceived dental treatment needs had a lower mean GOHAI-Ar score than those without any such needs. The caries experience, number of missing teeth, OHI-S score, number of pathologically mobile teeth and number of oral lesions were negatively correlated with the GOHAI-Ar score. The Cronbach’s alpha (0.93) indicated a high degree of internal consistency and homogeneity between items. The ICC for GOHAI-Ar was 0.95, the weighted kappa coefficient for individual items varied between 0.42 and 0.71, and the correlation coefficients for the 12 items were above 0.70. Factor analysis didn’t support the expected dimensions of the index, and only one factor was found at eigenvalue greater than 1. Conclusions: The findings suggest an excellent reliability and validity of GOHAI-Ar. Further research is needed to assess the value of this instrument in oral health-related quality of life studies in Arabic elderly population.

Major salivary gland output differs between users and non-users of specific medication categories.

Abstract: Background: The intake of medications is a major aetiologic factor of xerostomia. The purpose of this study was to investigate the selective influence of medication categories on flow rates of individual major salivary glands. Methods: The effect of each medication category on salivary flow rates was determined by dichotomy comparisons between users and non-users. A total of 246 patients were included, 79 males and 167 females aged 13–92 years (mean 63 years). Of these, 200 used medications, which were grouped according to their category. A comprehensive medical and oral examination was performed. Both unstimulated and stimulated saliva was collected separately from the parotid and submandibular/sublingual glands. Results: Parotid flow rate was decreased among users of tranquillisers and sedatives (unstimulated flow), cardiovascular drugs and gastrointestinal drugs (stimulated flow). Submandibular/sublingual unstimulated output was lower in patients taking cardiovascular drugs, antihistamines, tranquillisers/sedatives and antidepressants, while the stimulated flow, in those taking cardiovascular drugs, antihistamines, tranquillisers/sedatives and gastrointestinal drugs. Conclusions: Users of many common medication categories display significantly reduced unstimulated and/or stimulated salivary flow rate from the major salivary glands compared with non-users. A larger number of medication categories are associated with reductions in salivary flow rate from submandibular/sublingual glands than parotid glands.

Edentulous patients' knowledge of dental hygiene and care of prostheses

Abstract: Objective: The aim of this study was to analyse denture users’ oral care habits with regard to the use of their prostheses. Background: Rehabilitative treatment is only successful when patients are motivated and aware of correct prosthesis use and hygiene. Materials and methods: Questionnaires were distributed to 150 complete denture users at the Federal University of Bahia School of Dentistry, the Esmeralda Natividade Health Center, the Bahian Science Development Foundation and a Salvador nursing home. The questionnaire included information on gender, age, length of prosthesis use, cleaning methods and materials, etc. The data were analysed using EpiInfo version 6 software. The chi-squared test was used for statistical analysis, with a significance level of 5%. Results: Questionnaire results showed that 78% of the subjects, with an average age of 67.3 years, had used the same complete denture for over 5 years. 64% slept with their prostheses and 44% removed them from the mouth only for cleaning. None of the patients interviewed knew anything about brushes designed specifically for complete dentures. 37.3% had a restricted diet and 44% believed that a complete denture would last for more than 10 years. Conclusion: Within the limitations of this study, it was concluded that the edentulous patients surveyed had limited awareness of prosthetic hygiene and long-term oral care despite extended periods of denture use.

Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint.

Abstract: Objectives: The relationship of bony changes in the condylar surfaces in articular disc displacement without reduction in temporomandibular joint (TMJ) was investigated using diagnostic imaging. The study also evaluated whether the bony changes in the condylar surfaces limit disc and condyle motion, and produce pathological joint sounds. Materials and methods: Thirty-seven joints in 28 patients diagnosed with degenerative bony changes in the condylar surfaces radiographically and anterior disc displacement without reduction using magnetic resonance imaging (MRI) were studied. The bony changes were assessed by radiographic examination and classified into two types: pathological bone changes (PBCs) including erosion, osteophyte formation and deformity, and adaptive bone changes (ABCs) including flattening and concavity. MRI was performed on the TMJ to examine the configuration and position of the discs. Joint sounds in the TMJ were determined using electrovibratograghy with a joint vibration analysis. Results: The articular disc motion to the condyle in the PBC group was smaller than in the ABC group irrespective of the configuration of the disc, even though there were no significant differences between the two types of bony changes in the disc position during jaw closing. The joint vibration analysis of the TMJ showed that joint sounds with a higher frequency were observed in the PBC group than in the ABC group. High energy levels needed to produce the higher frequencies (over 300 Hz) were observed only in the PBC group.

Association of chronic stress, depression symptoms and cortisol with low saliva flow in a sample of south-Brazilians aged 50 years and older.

Abstract: Background: Few studies have evaluated the relationship between depression symptoms, chronic stress or physiological measures of stress such as cortisol levels and saliva secretion. Objective: To evaluate the association of low saliva flow with chronic stress, depression symptoms and cortisol in a population aged 50 years and older. Methods: Participants (n = 227) were recruited from community clubhouses and among dementia caregivers. Stress was assessed using the Lipp’s Stress Symptoms Inventory and salivary cortisol measurements. In addition, taking care of a relative with dementia was included as a proxy variable for chronic stress. Depression was assessed using the Beck Depression Inventory. Saliva flow rate was assessed by measuring unstimulated and chewing-stimulated saliva flow. Further saliva samples were collected (morning, noon, night) for cortisol analysis by means of radioimmunoassay. Results: Gender, being a dementia caregiver, self-reported diabetes and prescriptive medication intake were independently associated with a low stimulated saliva flow. Prescriptive medication intake was also associated with a low unstimulated saliva flow. Conclusion: Caregiving, a proxy of chronic stress, was associated with low stimulated saliva flow, indicating that stress may have a potential role in salivary gland hypofunction.

Predictors and correlates of edentulism in the healthy old people in Edinburgh (HOPE) study.

Abstract: Objectives: To determine the extent to which correlates of edentulism are explained by an association between tooth loss and cognitive ability Methods: Participants in the Healthy Old People in Edinburgh (HOPE) study aged 70 or more at baseline were assessed and health, cognitive, socio-economic and socio-environmental data collected on four consecutive occasions It was noted whether the participant had any retained teeth and if not, the age when the last tooth was lost Prior determinants of edentulism were investigated with binary logistic regression models At the 9-year follow-up, associations with edentulism were examined using general linear models with edentulism as an independent factor Results: 201 participants were adequately tested, of whom 104 (517%) were edentulous A logistic regression model that considered age, sex, education, social class, deprivation index of residence, objective distance from dentist, participant’s estimate of distance from dentist and NART-estimated IQ (NARTIQ) found age (p = 0032), occupational class (p = 0019) and NARTIQ (p = 0027) as significant predictors of edentulism Cox’s proportional hazards modelling found only NARTIQ (p = 0050) to be correlated Being edentulous was associated with poorer respiratory function but not hand grip strength (p = 023) Edentulous participants had lower self esteem scores (p = 0020) and poorer dietary assessment scores (p = 0028) Being edentulous was also associated with significantly lower mean scores on all cognitive testing, although these associations became non-significant after adjustment for NARTIQ and age Conclusions: In healthy older people, edentulism is associated with relative impairment of cognitive ability, although this association is explained by the fact that lower original intelligence predisposes to edentulism and poorer performance on cognitive tests in old age Once original intelligence is adjusted for, tooth loss is not related to cognitive ability Tooth loss is, however, associated with poorer status across a wide range of health measures: physical health, nutrition, disability and self-esteem Establishing the degree to which these health outcomes are causally related to edentulism could usefully be factored into cost–benefit analyses of programmes designed to prevent tooth loss

Ocular prosthesis: a brief review and fabrication of an ocular prosthesis for a geriatric patient.

Abstract: Objective: A review of literature for ocular prosthesis is presented along with a case report of a geriatric patient. Review of literature: The evolution of ocular prosthesis, materials and methods, fabrication techniques for custom and stock eye prosthesis, delivery and after care for the ocular prosthesis are reviewed. Case report: A 74-year-old female patient who had undergone enucleation of her right eye was restored with a stock ocular prosthesis. Conclusion: The use of stock ocular prosthesis of appropriate contour, size and colour can provide an acceptable aesthetic result.

Factors associated with negative self-perception of oral health among elderly people in a Brazilian community.

Abstract: Objective: Self-perception of oral health is an important measurement for assessing the health and quality of life of elderly people. The aim of this study was to analyse associations between negative self-perception of oral health and poor oral state, socio-demographic variables, depression and use of medications. Method: In this cross-sectional study, elderly people aged 60 to 74 years living in the urban zone of a city in southern Brazil were interviewed and examined. Functionally dependent individuals were excluded. Self-perception was measured using the General Oral Health Assessment Index, and scores of 30 points or less were considered to represent negative perception. The physical, social and worry dimensions of this indicator were also analysed. Results: Two hundred and sixty-seven elderly people (mean age 66.5 years, 59.9% female) were included in the study. Most of them had had little schooling. Negative self-perception was identified in 18.7%, although none of the poor oral state was associated with this variable. In multivariate analysis, negative self-perception was associated with female gender and depression. The women presented significantly lower means in the three dimensions analysed and individuals with depression, in the physical and social dimensions. Poor oral health (edentulism and absence of posterior occlusion) were associated with the physical dimension. Conclusion: Negative self-perception of oral health was associated with gender and depression, but not with poor oral health. Therefore, gender and the presence of depression are factors to be taken into account in assessments involving this age group.

Bond strength of denture teeth to acrylic resin: effect of thermocycling and polymerisation methods.

Abstract: Background: Failure of bonding between acrylic resin teeth and denture base material is a considerable problem for patients who wear complete dentures. Objective: The purpose of this study was to evaluate the bond strength between acrylic resins and resin denture teeth with different thermocycling and polymerisation methods. Materials and methods: Microwave-polymerised (Onda-Cryl), heat-polymerised (Classico) and autopolymerising (Jet) acrylic resins and resin denture tooth (Biotone) were used. The acrylic resins were polymerised according to the following: (A) microwave – fast cycle, Onda-Cryl; (B) microwave – long cycle, Onda-Cryl; (C) microwave – manufacturer’s cycle, Onda-Cryl; (T) water bath – long cycle, Classico; and (Q) bench polymerisation cycle, Jet. Twenty specimens were prepared for each polymerisation method. Ten were thermocycled, and 10 did not receive thermocycling. For the purpose of the study, a shear test was used. Data were analysed with the Kruskal–Wallis test and Dunn’s multiple comparisons test (p = 0.05). Results: Cycles B, C and T were similar (p > 0.05), and had statistically higher bonding values than cycles A and Q (p 0.05), except for cycle Q (p = 0.0038). Conclusion: Thermocycling decreased the bond strength, but not significantly for microwave and heat-polymerised cycles. Regarding the bond strength of denture teeth to acrylic resin, the fast microwave polymerisation cycle should be avoided when polymerising Onda-Cryl acrylic resin. In addition, Jet acrylic resin is not adequate for use in denture repair.

Relationship between chewing ability and high-level functional capacity in an 80-year-old population in Japan.

Abstract: Objectives: To evaluate the association between high-level functional capacity and chewing in a middle-old community-based population. Background: Although basic and instrumental activities of daily living are known to be associated with chewing ability in the elderly, an association between higher levels of competence and chewing ability has not been evaluated in the elderly. Materials and methods: The association between chewing ability using a number of different foods and high-level functional capacity by the Tokyo Metropolitan Institute of Gerontology was evaluated in 694, 80-year-old people residing in Fukuoka Prefecture, Japan. Results: A significant correlation was found, using multiple regression or logistic regression analyses adjusted for various confounding factors, between the number of total chewable foods, hard foods or moderately hard foods, and total functional capacity, instrumental activity, intellectual activity or social role ability. In contrast, the number of slightly hard foods, easily chewable foods and remaining teeth were only partly related to total functional capacity and intellectual activity. Conclusion: High-level functional capacity including intellectual activity and social role in middle-old elderly was associated with the ability to chew hard foods than to chew easily chewable foods. Maintenance of chewing ability in elderly might result in better intellectual activity and social role.

Association between serum calcium and periodontal disease progression in non‐institutionalized elderly

Abstract: OBJECTIVE To assess the effect of baseline serum calcium on the progression of periodontal disease in non-institutionalized elderly. BACKGROUND Although a few studies have found some evidence of the role played by dietary calcium in periodontal disease process, there is a paucity of information pertinent to longitudinal assessment of serum calcium-periodontal relationships. MATERIAL AND METHODS Clinical attachment levels of 266 Japanese subjects aged 70 years were recorded at baseline and annually for six consecutive years. Progression of periodontal disease (PPD) was defined as the number of teeth that showed additional attachment loss of > or =3 mm during the 6 years. The number of PPD was calculated for each subject and categorised into four levels, namely, PPD(0), PPD(1), PPD(2) and PPD(3) where the number of teeth with additional attachment loss ranged from 0, 1-10, 11-20 and >20 respectively. The levels of serum calcium, albumin, random blood sugar, immunoglobulin (IgG, IgA and IgM), gender, smoking habits, education, gingival bleeding and the number of teeth present were obtained at baseline. RESULTS Serum calcium, IgA, smoking, gingival bleeding and teeth present were associated with PPD at p < or = 0.10 and were included in a multinomial logistic regression analysis. Serum calcium was the only variable that was significantly associated with PPD with relative risks of 100 at PPD(1) and PPD(2), respectively, and 1000 at PPD(3). CONCLUSION Serum calcium may be considered a risk factor for periodontal disease progression in non-institutionalized elderly.

Factors associated with oral health perception in older Brazilians

Abstract: Objectives: To investigate the self-perception of oral health in older people, aged 65–74, from the central region of southern Brazil. Methods: Cross-sectional population-based study using data from the Oral Health Conditions Survey of Southern Brazil, developed between the years 2002 and 2003, by the State Health Secretary (SHS) of Rio Grande do Sul (RS), Brazil. Socioeconomic and demographic variables, self-perception of oral health and clinical data, as well as dental pain were evaluated in 618 elderly people. Multinomial logistic regression was used to evaluate the effect of explanatory variables on the self-perception of oral health. Results: Almost half of the elderly were edentate and rated their oral health as good or very good. With regard to dental pain, 28.8% of the people declared that they had experienced dental pain in the 6 months before the interview. There was a significant relationship between dental pain and classification of oral health, and chewing ability. Following adjustment, the need for dental prostheses remained associated with the influence of oral health on establishing relationships. Similarly, personal income remained associated with the elderly's perception of their ability to talk. Finally, the level of education remained related to the influence of oral health status in people's relationships. Conclusion: Dental pain and the need for dental prostheses were the main factors that affected the self-perception of oral health of elderly people from southern Brazil.

A simplified caries risk test in stimulated saliva from elderly patients

Abstract: Objectives: To evaluate and compare lactobacilli species (LB) and mutans streptococci (MS) caries risk identification by means of a Caries Risk Test Bacteria (CRT Bacteria test), with a conventional laboratory test (CLT), as well as their correlation with the dental caries experience [(decayed-missing-filled teeth (DMFT index)] in subjects 60 years of age and older. Design: Cross-sectional study. Setting: Epidemiologic and Health Service Research Unit, Aging Area. XXI Century National Medical Center; Mexican Institute of Social Security (IMSS). Subjects: A total of 696 elderly subjects residing in southwestern Mexico City. Methods: The DMFT index was determined in 696 subjects and saliva collected by stimulation. This was processed with a CRT Bacteria test and a CLT (the gold standard) test. Subjects with high [≥105 colony forming units (CFU)/ml] and low caries risk (<105 CFU/ml) were assessed. Results: The CRT Bacteria test sensitivity (Sen) and specificity (Spe) were 0.97 and 0.86 for LB, respectively, with positive and negative predictor values of 0.92 and 0.95 respectively. For MS, Sen and Spe was 0.92 and 0.90, and 0.96 and 0.81 respectively. The receiver operating characteristic area under the curve (ROC area) in LB and MS was 0.94 and 0.89, respectively; thus, a correlation existed between the caries experience and the LB and MS caries risk, similar to that present with the CLT test. Conclusion: The CRT Bacteria test shows similar results to those of the CLT test in subjects 60 years of age and over.

Tooth loss, denture wearing and associated factors among an elderly institutionalised Brazilian population.

Abstract: Objective: This cross-sectional study assessed the prevalence and extent of tooth loss as well as denture wear and associated factors in institutionalised elderly in Brazil. Background: There is scarcity of research in Brazil concerning geriatric oral health issues. Material and methods: A sample of 335 individuals over 60 years of age, representative of the institutionalised elderly from Belo Horizonte, Brazil, were selected through a stratified sampling strategy. Data were collected from structured questionnaires, reviews of medical records and intra-oral examinations. Results: Edentulousness was observed in 74.9% of the elderly and was related to age, years of study, income, length of institutionalisation, systemic diseases and mini-mental score. Among the dentate subjects, 17.9% possessed 20 or more teeth. Approximately half the edentulous elderly (42.6%) and most of the partially dentate subjects (66.7%) did not wear dentures. The multivariate analysis showed that subjects that wear dentures were more likely to be female, possess higher incomes, be more functionally independent and married. Furthermore, the odds of wearing dentures among the elderly who had lost 13–32 teeth were 9.11 times higher than those who had lost up to 12 teeth. Conclusion: Tooth loss is highly prevalent in this institutionalised Brazilian population, and the prevalence of denture wear is low. The extent of tooth loss, income, functional status and marital status are important predictors for denture wear. The development of an oral health programme for these individuals should assist in their rehabilitation needs and promote in-home care or safe transport for the elderly to a health care location.

Retention of telescopic denture in elderly patients with maximum partially edentulous arch

Abstract: The telescopic denture is one possible solution for prosthetic rehabilitation for a partially dentate arch with few remaining teeth, which is the reason why it is usually considered in elderly patients. The system of double crowns consists of the male component of attachment or patrix, which is cemented to the abutment tooth, and the female component of attachment or matrix, which is the removable part of the restoration. Retention force represents resistance to those forces which tend to separate the partial denture and supporting tissue in the occlusal direction. Its optimal value is 5–9 N per each patrix and it should strictly be between these limits as a stronger or weaker force will endanger the functionality of the denture or damage the supporting tissue of the abutment teeth. Objective: The goal of this study was to establish the exact value of the individual and total retention force of the completed telescopic system. Method: The Bredent dynamometer was used for measuring these values. The study involved measuring the individual force of separation of 50 patrix–matrix components, and total force of 20 partial dentures of various designs retained by double crowns made in the Dental Laboratory of the Clinic for Prosthetic Dentistry, Faculty of Stomatology, Belgrade University. The research was carried out in the period from January 2006 to October 2006. Results and conclusion: The results showed different values of separation force – from very low values to those exceeding optimal limits. A reduction in the force of separation is necessary in the case of excessive tightness. If there was looseness between patrix and matrix, the cylindrical components of double crowns need to be lined by a suitable composite material.

The relationships between oral status, physical and mental health, nutritional status and diet type in elderly Japanese women with dementia

Abstract: Objectives: To suggest methods for maintaining an adequate nutritional status for elderly patients with dementia by evaluating the relationships between oral status, physical and mental health, and feeding conditions. Background: Feeding difficulties in dementia patients are related to food intake, and failure to eat may be associated with weight loss in long-term care facilities. The relationship between compromised oral function and diet is still unclear. Materials and methods: A cross-sectional study of 94 elderly women with dementia (mean age 89.6 ± 5.6 years) from a nursing home was undertaken to investigate their oral, physical and mental and nutritional status. Results: There were significant differences in serum albumin (p = 0.0284), N-ADL (p = 0.0005), NM scale (p = 0.0004) and HDS-R (p = 0.0004) between denture wearers and non-denture wearers. However, there were no significant differences in body mass index between denture wearers and non-denture wearers. Conclusion: A suitable type of diet and assistance with feeding could maintain the nutritional status of elderly patients with dementia if they are still feeding themselves. The nutritional support team will benefit from the participation of a dentist.

Utilisation of dental services in a university hospital palliative and long-term care unit in Geneva.

Abstract: OBJECTIVES: Dental care plays an important role in the multidisciplinary approach, which is used in palliative and long-term care to address the complex needs of terminally ill patients. The aim of this study was to assess the utilisation of dental services in a University Hospital Palliative and Long-term Care Unit. MATERIAL AND METHOD: Over an observation period of 13 months, structured questionnaires were filled in after each dental appointment. The survey covered three main topics: the initiation and incentive from the dental consultation, particular difficulties because of the patient's health or the hospital's organisation as well as the accomplished treatment. RESULTS: Two hundred and seventy-five questionnaires from a total of 102 patients were available for analysis. The patients' median age was 83 years (SD 10.3, range 49-101 years), 63 were female, 39 male. A majority of first appointments were initiated by a physician (n = 49 of 102), mainly because of pain (n = 62 of 275). 10.5% of the appointments were cancelled on the same day. Only one-fifth of the patients were able to reach the practice on foot. Six used a walking stick and 54 relied on a wheelchair. Eighteen patients needed to be seen in their bed. The most frequently performed procedures were extractions and removal of denture sore spots (n = 67 of 275) followed by the manufacturing of new dentures (n = 38 of 275). In more than 17% of the appointments, no particular treatment was performed. CONCLUSION: The utilisation of dental services in terminally ill and severely compromised elderly patients shown justifies a dental service in a palliative care or geriatric hospital setting. The particular dental work profile requires a practitioner with empathy and professional experience.

Effect of inorganic polyphosphate in periodontitis in the elderly.

Abstract: Aim: Inorganic polyphosphate exists as chains of phosphate molecules and is distributed in osteoblasts, and regulates osteoblastic cell differentiation and bone matrix calcification. The purpose of this study was to clarify the effects of inorganic polyphosphate on periodontitis. Material and methods: Subgingival local irrigation with inorganic polyphosphate was studied in a randomised double-blind study of 33 patients with periodontitis. Scaling and root planing were performed 1 week after the initial examination. Results: No significant differences between the inorganic polyphosphate group and control were detected in each item except IL-1β. Patients in whom both the bleeding on probing and gingival index at 1 week had improved were significantly older in the inorganic polyphosphate group than in the control group (p < 0.05). Bone regeneration was seen in one case of the inorganic polyphosphate group. Conclusions: Inorganic polyphosphate was useful in the treatment of periodontitis in the elderly, indicating a probable effect of anti-ageing, with similar bone regenerations occurring in both groups.

Radiographic changes in alveolar bone height on overdenture abutments: a longitudinal study.

Abstract: Objective: Stabilisation of partial dentures is an important part of prosthodontic treatment, particularly in patients with an excessive reduction in alveolar bone supporting their abutment teeth. In these cases, overdenture prostheses are one possible treatment choice. Background: The aim of this study was to evaluate the effects of overdentures on the condition of alveolar bone of the remaining teeth, and to evaluate the overdenture concept in the prosthetic treatment of partially edentulous patients. Materials and methods: The investigation was conducted on 22 patients during observation periods of 6 and 10 years. After preparation, all abutment teeth were provided with either amalgam restorations or gold copings. An overdenture in the lower jaw was fabricated for every patient. A special film holder was used to repeat the X-ray procedure in every patient in the same manner. The radiographs were evaluated using the grid scale. The alveolar bone level of all remaining teeth was evaluated on dental films by measuring the distance between the root apex and coronal border of the alveolar bone. Results: A statistically significant difference (p < 0.01) was calculated 6 years after delivery stage between distal alveolar bone levels of experimental abutments under overdentures and the remaining teeth of the control group. Alveolar bone of abutment teeth was considerably preserved, particularly in seven patients observed 10 years after provision of their dentures. Conclusion: Within the limitation of this study, the validity of the overdenture treatment in partially edentulous patients is concluded. Good oral hygiene was crucial for the success of treatment with overdentures.

The role of candidal histolytic enzymes on denture-induced stomatitis in patients living in retirement homes.

Abstract: Material and methods: Fifty nine elders wearing complete dentures and living in retirement homes in Curitiba (southern Brazil), were divided into two groups: group #1, 26 patients with denture-induced stomatitis and group #2, 33 patients without denture-induced stomatitis. The two groups were evaluated in relation to the degree of denture-induced stomatitis, salivary fungal loads, and secretion of some histolytic enzymes. Results: Patients from group #1 showed higher degrees of colonisation by Candida albicans (p = 0.031). Candida krusei, Candida tropicalis, and Candida parapsilosis were also isolated, but there were no differences between the groups (p > 0.05). Secretory aspartyl protease (Sap) and chondroitinase did not show significant differences among the isolated Candida spp. in the two groups. Phospholipase secretion rates were higher among the strains of C. albicans from group #2 (p = 0.036). The same behaviour was not detected for non-albicans Candida species. Conclusions: The results could infer that differences in the secretion rates of candidal histolytic enzymes should not be imputed as imperative for the progress of denture-induced stomatitis.

Perceptions of oral health adequacy and access in Michigan nursing facilities

Abstract: Objective: To determine practices and perceived access barriers (facility resources, attitudes and professional dental involvement) related to oral health by surveying directors of nursing (DONs) in Michigan nursing homes (NHs). Background: DONs are crucial to NH practice and policy, so understanding their perceptions of oral health care is vital. Methods: A 27-item questionnaire exploring aspects of oral health was mailed to all 402 Michigan NH. Descriptive statistics were calculated for response items. Results: Facility response rate was 32% (n = 129). Sixty-three per cent of facilities had a written dental care plan primarily co-ordinated by nursing staff and social workers. Stationary dental equipment was available in 3% of facilities. Thirty-eight per cent stated an examination by a dentist was provided to new residents. Seventy-five per cent of residents identified as needing dental treatment were likely to receive it. Of the 28% of residents receiving dental treatment beyond an examination in the past year, 28% received emergent care. Over 50% of responding DONs indicated satisfaction with how oral hygiene needs were met in their facilities. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or their private offices as well as financial concerns of the resident and/or family. Generally, greater resources were available in urban facilities, but substantial barriers to care were uniformly perceived. Conclusion: Oral health policies and practices within Michigan NH vary, as measured by resources, attitudes, and the availability of professional care. Dental involvement in policy creation, provision of consultation, and service is limited.

A prospective study on elderly patients with facial fractures in a developing country.

Abstract: Background: This paper describes the incidence, aetiology, treatment and complications of facial fractures seen among the elderly in a developing country. Methods: A prospective study evaluated 85 patients over 60 years of age who were diagnosed with facial fractures over a period of 12 months in 23 public hospitals nationwide. Results: The elderly accounted for 4.5% of the total number of patients seen with facial fractures during the study period. Elderly men outnumbered women by a ratio of 4.31:1. Of the elderly patients, 35.3% had at least one medical condition, the commonest of which was hypertension. Road traffic accidents were the main cause of injury. The fractures were treated in only 26.2% of cases. Complications were uncommon. Conclusions: With a low incidence, and conservative treatment often being practised, the healthcare burden of treating facial fractures among the elderly in Malaysia is at present still low. Language: en

Potential factors responsible for dryness of the dorsum of the tongue in elderly requiring care.

Abstract: Objective: This study explored potential factors in elderly requiring care that cause dryness of the dorsum of the tongue despite moisture retention in the sublingual mucosa. Materials and methods: Subjects were 224 elderly (mean age: 83.6 ± 7.4 years) living in a nursing home and requiring individual care. Measurement of moisture of the dorsum of the tongue and sublingual mucosa was performed using a wetness tester (L-SALIVO) with a measurement time of 10 s. Results: A significant difference in drying only of the dorsum of the tongue was noted depending on the degree of incapacity, level of consciousness, eating (oral ingestion or tube-feeding), and conversation. Multiple logistic regression identified the degree of incapacity in terms of eating (oral ingestion or tube-feeding) as a significant factor for dryness. The odds ratio for the degree of incapacity was 3.2 while that for eating was 11.226. Conclusion: Dry mouth of the dorsum of the tongue in elderly requiring care was associated with the degree of incapacity, tube feeding, and level of conversation.

A study of the prosthodontic and oral health needs of an ageing psychiatric population

Abstract: Background: Life expectancy has increased worldwide, with India (having 8% who are senior citizens), falling into the “Greying Country” category. This ageing population constitutes a high-risk oral health group, vis-a-vis impaired manual dexterity, cognitive deterioration and unmet treatment needs, which could be compounded by psychiatric morbidity. Objective: To assess oral health status and prosthodontic need of ageing psychiatric patients. Materials and method: One hundred and twenty-five patients, aged 50 years or above, admitted to the Department of Geriatric Mental Health, King George’s Medical University, Lucknow, Uttar Pradesh, India, were examined for prosthodontic, oral health status and need, the study population being divided into groups on the basis of Bristol Activities Scale of Daily Living. Results: Depressive symptoms (which increased with age) and psychiatric morbidity were found to be more in females. About 98% of the population showed probing depths of more than 3 mm, with mean number of decayed/missing teeth and inability to maintain oral/denture hygiene (p < 0.001) increasing in higher disability levels. While 91.3% of the population wearing a prosthesis required new dentures, 33.3% of the study population had unfulfilled partial denture need and 28.4% had unfulfilled upper/lower complete denture need. Conclusion: Ageing psychiatric subjects require dental education and treatment to meet their needs.

Two-dimensional finite element analysis of stresses developed in the supporting tissues under complete dentures using teeth with different cusp angulations

Abstract: Statement of problem The selection of appropriate teeth for complete denture occlusion is very important for long-term success, and adequate maintenance of the residual alveolar ridge. Purpose The purpose of this study was to determine the stress generated underneath the complete denture by altering the cuspal angulations of the denture teeth. Material and methods A two-dimensional finite element model of a coronal section of maxillary and mandibular complete dentures, mucosa and alveolar bone in the first molar region was designed. The occlusal aspect of the denture teeth was altered to make 33 degrees , 20 degrees , 0 degrees cuspal angulation. All the nodes at the bases of maxillary and mandibular alveolar bone of finite element analysis models were restrained in all directions. A functional occlusal load of 50 N was applied through the mandibular model base. To design these models and to analyse them, EMRC's NISA II finite element analysis computer software was used. In these models, the elements were selected (a, b, c, d, e, f) in the region where it was necessary to determine the stresses generated in both the maxillary and mandibular portions. Results The results were interpreted as Von Mises stresses and were observed in pre-defined areas. The stress patterns observed within model with each type of posterior occlusion, showed unique variations as well as some similarities. Conclusion Stresses of greater magnitude were observed in cuspal teeth, 33 degrees and 20 degrees respectively, where as 0 degrees teeth showed a slightly less magnitude of stress generated.