Showing papers in "Gerodontology in 2009"

Oral status and its association with obesity in Southern Brazilian older people

Abstract: Background and objective: The loss of a functional dentition imposes eating difficulties and food avoidance, which may be detrimental in terms of nutritional status and health. The objective of this study was to investigate whether tooth loss and edentulism that were not rehabilitated with dental prostheses were associated with obesity among elderly in Southern Brazil. Materials and methods: A random sample of 872 independently living elderly was evaluated by means of a cross-sectional study. Socio-demographic, medical history and behaviour data were assessed using a standardised questionnaire. Two trained dentists assessed the number of teeth and use of prostheses in accordance with the WHO criteria. Height and weight were assessed and used to generate body mass index (BMI = weight (kilos)/height (cm)2) data. Participants were categorised into non-obese (BMI ≤ 30) or obese (BMI > 30). Multivariate logistic regression was used to model the relationship between number of teeth and use of dental prostheses with obesity adjusting for confounders. Results: Multivariate logistic regression revealed that edentulous persons wearing only upper dentures (OR = 2.34, 95% CI 1.18–4.27) and dentate participants with one to eight teeth wearing 0-to-1 prosthesis (OR = 2.96, 95% CI 1.68–5.19) were more likely to be obese. Conclusion: The results show that a poorer oral status, represented by having fewer teeth that were not replaced by dental prostheses, was associated with obesity in Southern Brazil older people, suggesting a close relationship between poor oral status and systemic conditions that may have important clinical implications.

A longitudinal study of the relationship between diet intake and dental caries and periodontal disease in elderly Japanese subjects.

Abstract: Objective: We hypothesise that a difference in nutrition influences dental caries and periodontal disease. There are few previous studies especially longitudinal ones which have evaluated this hypothesis. This study investigated the relationship between nutritional intake, including milk and milk products (MMP), and dental disease, controlling for several confounding factors. Material and methods: A group of 600 subjects aged 70, randomly selected for this study, included approximately the same number of male and female subjects. The number of teeth on which root caries had occurred or where there was a periodontal event over a 6-year period was measured. To determine quantitative food intake at baseline, a semi-quantitative food frequency questionnaire was used during face-to-face interviews by dieticians. The stepwise method of multiple linear regression analysis was used to identify independent predictors of the number of root caries or periodontal disease events during the 6 years. Intake of the six food groups includes (i) fish, shellfish, meat, beans and eggs; (ii) MMP; (iii) dark green and yellow vegetables (DYV); (iv) other vegetables and fruits; (v) cereals, nuts and seeds, sugar and sweeteners, confectioneries (CNSC) and (vi) fats and oils. The alcohol, gender and anthropometric evaluation including measurements of weight and height for the calculation of body mass index, educational level, the number of family members and the number of remaining teeth were used as independent variables. Results: According to stepwise multiple regression analysis, two variables (quantity of MMP, and gender) were negatively associated with the number of root caries events during the 6 years. The standardised coefficients were −0.14 (p = 0.035) and −0.17 (p = 0.007) respectively. In addition, DYV were negatively, and three other variables (CNSC; alcohol; and the number of remaining teeth at baseline) were positively associated with the number of periodontal disease events during the 6 years. The standardised coefficients were −0.16 (p = 0.001), 0.11 (p = 0.042), 0.10 (p = 0.041) and 0.58 (p < 0.001) respectively. Conclusion: Our results suggest that the intake of MMP in this elderly population correlated with root caries events. In addition, intake of vegetables negatively correlated, and intake of ‘CNSC’ positively correlated with periodontal disease events.

Effect of repeated cycles of chemical disinfection on the roughness and hardness of hard reline acrylic resins

Abstract: doi:101111/j1741-2358200900282x Effect of repeated cycles of chemical disinfection on the roughness and hardness of hard reline acrylic resins Objective: The aim of this study was to assess the effect of repeated cycles of five chemical disinfectant solutions on the roughness and hardness of three hard chairside reliners Methods: A total of 180 circular specimens (30 mm × 6 mm) were fabricated using three hard chairside reliners (Jet; n = 60, Kooliner; n = 60, Tokuyama Rebase II Fast; n = 60), which were immersed in deionised water (control), and five disinfectant solutions (1%, 2%, 525% sodium hypochlorite; 2% glutaraldehyde; 4% chlorhexidine gluconate) They were tested for Knoop hardness (KHN) and surface roughness (μm), before and after 30 simulated disinfecting cycles Data was analysed by the factorial scheme (6 × 2), two-way analysis of variance (anova), followed by Tukey’s test Results: For Jet (from 1874 to 1386 KHN), Kooliner (from 1409 to 872 KHN), Tokuyama (from 1257 to 828 KHN) a significant decrease in hardness was observed irrespective of the solution used on all materials For Jet (from 009 to 011 μm) there was a statistically significant increase in roughness Kooliner (from 036 to 026 μm) presented a statistically significant decrease in roughness and Tokuyama (from 015 to 011 μm) presented no statistically significant difference after 30 days Conclusions: This study showed that all disinfectant solutions promoted a statistically significant decrease in hardness, whereas with roughness, the materials tested showed a statistically significant increase, except for Tokuyama Although statistically significant values were registered, these results could not be considered clinically significant

A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review

Abstract: Sao Paulo State Univ, UNESP, Aracatuba Dent Sch, Dept Dent Mat & Prosthodont, BR-16015050 Aracatuba, SP, Brazil

Relationship between oral health, nutrient intake and nutritional status in a sample of Brazilian elderly people

Abstract: Objective: To evaluate the relationship between the oral health condition, the nutrient intake and the body mass index (BMI) in elderly people. Background: Impaired dentition has been associated with an inadequate consumption of key nutrients and with changes in nutritional status in elderly people. Materials and methods: The sample comprised 887 elderly people, aged 60 and over, of whom 816 underwent a clinical oral examination and were allocated into groups according to the numbers of teeth and number of posterior occluding pairs of natural teeth. Nutritional status was determined using the BMI. Dietary intake was assessed by a 24-h diet recall interview and the data from these records were converted to nutritional intake using DietPro software. Differences between means were evaluated using anova, together with the Tukey test or Dunnet test, according to the normality of the data. Associations between categorical variables were tested using chi-square analysis. Results: Ages ranged from 60 to 96 years (mean, 71.46 years), with 47% of the respondents in the 60-to 69-year-old group. A high DMFT index (mean, 27.81) was observed with the missing component accounting for 88.8% of the index. Significant differences were observed between the mean intake of nutrients and the number of posterior occluding pairs of natural teeth (p < 0.05). No significant differences were found between the number of teeth and BMI. Conclusion: Nutrient intake is associated with the oral health status as defined by clinical measures.

Implant overdentures for edentulous elders: study of patient preference.

Abstract: Background: Studies show that elders wearing implant overdentures have improved nutrition and quality of life. However, upfront costs of this therapy are high, and the income of elderly edentulous populations is low. Objectives: This study was designed (i) to measure the preferences of edentulous patients for mandibular two-implant overdentures using Willingness-To-Pay (WTP) and Willingness-To-Accept (WTA), (ii) to assess the effect of long-term financing on WTP and (iii) to assess the desired role of health care plans in financing dental prostheses. Methods: Edentulous elders (68–79 years; n = 36) wearing maxillary dentures and either a mandibular conventional denture (CD, n = 13) or a two-implant overdenture with ball attachments (IOD, n = 23) participated in this study. All had received their prostheses 2 years previously, as part of a randomised clinical trial. A three-part questionnaire was completed during a 20-min interview with a trained researcher. Results: Forty-six per cent (6/13) of the CD wearers and 70% (16/23) of the IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses. These percentages were increased to 77% (CD) and 96% (IOD) if participants could pay for implant overdentures in monthly instalments. Eighty-six per cent (31/36) of all participants in both groups (21/23 IOD; 10/13 CD) thought that the government should cover at least some of the cost of implant overdentures. Conclusions: This study shows that, the majority of elderly edentate individuals who have not experienced mandibular two-implant overdenture therapy are willing to pay the cost, particularly when payment can be made in monthly instalments.

Effect of oral hygiene education and motivation on removable partial denture wearers: longitudinal study.

Abstract: Sao Paulo State Univ, Araraquara Dent Sch, Dept Dent Mat & Prosthodont, BR-14801903 Araraquara, SP, Brazil

Evaluation of an oral function promotion programme for the independent elderly in Japan.

Abstract: Objectives: The purpose of this study was to provide an oral function promotion programme for the independent elderly and evaluate the changes in oral health status and oral function. Background: Few studies have scientifically analysed and evaluated the effectiveness of oral function promotion programmes provided for the independent elderly. Materials and methods: The subjects were independent elderly females (mean age: 74.6 ± 6.3) recruited from senior citizens’ centres in Tokyo. The intervention group (n = 79) received a 3-month oral function promotion programme, which included facial muscle and tongue exercises and salivary gland massages. The control group (n = 62) did not receive this programme. Results: In the intervention group, the tongue coating scores decreased and the organoleptic score of oral malodour fell. The amount of food debris in the oral cavity decreased and the tongue dryness improved. Furthermore, the salivary flow rate increased. The length of time for maintaining the tongue in the forward position increased from 11.2 s to 18.7 s, and the number of times for moving the tip of the tongue in a clockwise circular motion, counter-clockwise circular motion and side-to-side motion within 30 s, increased from 14.5 to 20.6, 14.5 to 20.2, and 17.2 to 23.3 respectively. The number of times for movement of the lips significantly improved from 23.0 to 28.8 and the pronunciation of words was observed to be clearer. Conclusion: An oral function promotion programme was effective in improving the oral health status and oral function of an independent elderly population.

Oral health and access to dental care: a qualitative investigation among older people in the community

Abstract: doi:10.1111/j.1741-2358.2009.00320.x Oral health and access to dental care: a qualitative investigation among older people in the community Objective: The aim of this study was to explore older persons’ beliefs and attitudes towards oral health and access to and use of dental care services. Background: As the proportion of dentate older people increases, the need and demand for dental services will rise (J Public Health Dent, 60, 2000, 276). Design: Focus groups and semi-structured interviews were used for data collection. Setting and subjects: The study participants included 63 older people in Perth, WA. Results: Five major themes emerged from the interviews – the need for information and knowledge; accessibility of services; cost and affordability of oral care; fear and anxiety regarding dental visits and relationships with dentists. Attitudes and behaviours were slow to change in this group. Conclusion: This investigation provided important perspectives regarding oral health and dental access for older people residing in the community and demonstrated the importance of understanding this group when considering provision and use of services.

European College of Gerodontology: undergraduate curriculum guidelines in gerodontology

Abstract: Effective undergraduate teaching of gerodontology to present and future dental students is important if good oral health care of older people is to be assured. A review of the undergraduate curriculum for gerodontology is presented and indicates the need for a knowledge base from which new graduates can develop a special interest in care of older patients. The aim is improved care of older patients, satisfaction for teaching staff involved and improved professional standing for Dentistry. Motivation of students could also be achieved by the positive match between rising patient awareness and ethical responsibility of the profession for those older patients. As it stands, the undergraduate curriculum should include topics on specific care for the elderly and other patient groups, which extend the competences already agreed by the Association for Dental Education in Europe (ADEE). The logistics of teaching these topics will need co-ordination of those staff with appropriate skill and interest, preferably as a development of existing curriculum content.

In vitro and clinical evaluation of specific dentifrices for complete denture hygiene

Abstract: Objectives: To study the physical properties of two experimental dentifrices for complete denture hygiene, their effect on denture biofilm removal and antimicrobial properties by means of a clinical trial. Materials and methods: The experimental dentifrices comprised two compositions. One was based on the addition of 1% chloramine T (D1) and the other on the presence of 0.01% fluorosurfactant (D2). Measurements of density, pH, consistency, rheological features and abrasiveness were conducted. Sixty complete denture wearers were randomly assigned to three groups and were instructed to brush their dentures with a specific toothbrush: (1) Water (control); (2) D1; or (3) D2. Each method was used for 21 days. Denture biofilm was disclosed by a 1% neutral red solution and quantified by means of digital photos taken from the internal surface. Microbiological assessment was conducted to quantify Candida sp. and mutans streptococci. Data were evaluated by one-way anova and Tukey HSD, or Kruskal–Wallis (α = 0.05). Results: Both dentifrices decreased biofilm coverage when compared with the control group. D1 was the most efficacious treatment to reduce mutans streptococci, whereas D2 showed an intermediate outcome (anova, p < 0.040). No treatment influenced Candida albicans or non-albicans species (Kruskal–Wallis, p = 0.163 and 0.746, respectively). Conclusion: It can be concluded that brushing complete dentures with the experimental dentifrices tested could be effective for the removal of denture biofilm.

A qualitative study of trends in patient preferences for the management of the partially dentate state.

Abstract: Objective: To identify factors influencing attitudes of partially dentate adults towards dental treatment in Ireland. Background: People are retaining more teeth later in life than ever before. Management of partially dentate older adults will be a major requirement for the future and it is important to determine factors which may influence patients’ attitudes to care. Methods: Subjects: A purposive sample of 22 partially dentate patients was recruited; 12 women and 12 men, ranging in age from 45 to 75 years. Data Collection: Semi-structured individual interviews. Results: Dental patients have increasing expectations in relation to (i) a more sophisticated approach to the management of missing teeth and (ii) their right to actively participate in decision making regarding the management of their tooth loss. There is some evidence of a cohort effect with younger patients (45–64 years) having higher expectations. Conclusions: The evidence of a cohort effect within this study in relation to higher patient expectations indicates that both contemporary and future patients are likely to seek a service based on conservation and restoration of missing teeth by fixed prostheses.

Relative contribution of caries and periodontal disease in adult tooth loss among patients reporting to the Institute of Dental Sciences, Belgaum, India.

Abstract: Objectives: To examine the reasons for tooth loss in an adult population. Methods: Patients who reported to the department of prosthodontics in Institute of Dental Sciences, Belgaum, located in the north-western part of the state of Karnataka, in the southern region of India over a period of 2 months, with at least one missing tooth (excluding third molars) constituted the sample size. There were a total of 365 patients (185 females and 180 males) within the age group of 16–84 years (mean age 51.06 ± 16.47 years) who fulfilled this criterion. Socio-demographic profile was recorded along with a clinical examination for assessing the number and pattern of tooth loss. The reasons for tooth loss were recorded according to the history reported by the patient. Results: In the present study of 365 patients, 58.9% of the patients were completely edentulous, 41% were partially dentate, of which 20.8% had lost their teeth from caries, 11% from periodontal disease and 9.3% from a combination of reasons. More females had lost their teeth because of dental caries whereas more males had lost their teeth because of periodontal disease, this being statistically significant. (χ2 = 16.53, p = 0.001). Highly significant results were obtained for age and reasons for tooth loss. (χ2 = 150.39, p < 0.001). Irrespective of the socio-economic status, dental caries was the most common cause for tooth loss in partially dentate patients though it was not statistically significant (χ2 = 13.62, p = 0.325). Mandibular first molars were the teeth most frequently lost due to dental caries. The maxillary left central incisor was most frequently lost due to periodontal disease, followed by the maxillary right central incisor. Conclusions: Since both dental caries and periodontal disease contributed to tooth loss at different ages, risk indicators need to be identified.

A review of the effectiveness of oral health promotion activities among elderly people.

Abstract: A review of the effectiveness of oral health promotion activities among elderly people Objectives: This study aimed to review the effectiveness of oral health promotion studies conducted among elderly people between 1997 and 2007. Methods: Four electronic databases were searched and papers were rated for level of evidence and scientific quality. Key findings of the papers were summarised. Results: Thirteen thousand nine hundred and four papers were retrieved and 17 studies (18 papers) met the criteria for the review: 13 were randomised controlled studies, three were quasi-experimental studies and one was a pre-/post-single group intervention study. According to the Levels of Evidence, 11 studies could be categorised as 1b and six studies could be categorised as 2b. The quality of the evidence of the 17 studies ranged from 12 to 19; 13 of the studies had a score of 15 or above; four of the studies ranged from 12 to 14. Evidence from oral health promotion activities aimed at preventing caries, improving periodontal health and altering oral health behaviours were reviewed. The use of fluoride, antimicrobial agents and health-care provider education has important roles within oral health promotion activities for elderly people. Studies have tended to be of short-term duration and rely on surrogate outcome measures of oral health. Conclusion: In the last 10 years, increasing attention has been paid to oral health promotion activities among the elderly population and high quality evidence has emerged. However, there is a need for even higher-quality research to provide more definitive guidelines on oral health promotion practices for elderly people.

Biofilm formation of Candida albicans on the surface of a soft denture‐lining material

Abstract: Background: Soft denture lining-materials are more susceptible to microbial adhesion than hard denture base acrylic resin. Poor oral hygiene and Candida albicans infection are common among elderly denture wearers as these patients usually have difficulty in keeping them clean. Purpose: To evaluate the influence of the oral hygiene methods on the formation of a biofilm over a soft denture-lining material. Material and methods: Twenty volunteers were randomly separated into two groups: G1 and G2. Ten volunteers performed daily hygiene of the prostheses with a soft toothbrush and toothpaste. The G2 performed a treatment identical to G1 but also immersed the prostheses in sodium hypochlorite 0.5% for 20 min, once a week. Quantification of the mean score values of biofilm formation at different times were statistically analysed using analysis of variance and Tukey’s test (α = 0.05). Results: G1 (0.65 ± 0.52) showed the lowest mean score values of biofilm formation. There was statistical difference between G1 and G2. The highest mean score values were found at 6 weeks (1.3 ± 1.08) and were statistically different from other times. Conclusion: The oral hygiene methods had a significant effect in the formation of the biofilm over a soft denture-lining material.

The potential benefits of dental implants on the oral health quality of life of people with Parkinson's disease.

Abstract: Objective: To investigate how dental implants impact on the oral health quality of life of people with Parkinson’s disease (PD). Background: PD is a progressive neurological disorder that can result in a number of oral health care challenges, including denture difficulties. Lack of evidence related to use of implants in PD prompted this study to investigate their use in this group of people. Materials and methods: Nine people with PD were provided with either fixed or removable prostheses using Astra-Tech implants. Participants completed the socio-dental questionnaire, ‘The Dental Impact on Daily Living Assessment’ (DIDL) prior to implant surgery, and at 3 and 12 months after provision of the final prosthesis. DIDL comprises two components – the Oral Health Quality of Life Inventory (OH-QoL) and the Self-Reported Assessment of Oral Health and Functional Status (SROH). Results: Nine people (with an age range of 54–77 years) had implants placed. The implant success rate was 85 and 81% in the maxilla and mandible, respectively. The OH-QoL and SROH results (analysed using the one-way analysis of variance and pairwise multiple comparisons) demonstrated a significant improvement in the domains of eating and satisfaction with the prosthesis after 3 months, which was maintained at the twelve month review. The OH-QoL indicated a gradual improvement in oral well-being over the 12-month period. Conclusion: The oral health quality of life of people with PD was improved by the use of dental implants, indicating this as a viable treatment option.

Trends in NHS primary dental care for older people in England: implications for the future.

Abstract: Objective: To examine trends over time in the National Health Service (NHS) dental service provision for older people in England and consider the implications for future care. Background: The number and proportion of older people in the population nationally are increasing and their oral health needs are changing as more people retain teeth into older age. Materials and methods: Descriptive analysis of routinely collected activity data for primary dental care in England was undertaken over the 6-year period, 1999/2000–2004/05. Data were cleaned, grouped into age bands for analysis. Activity rates per head of population were calculated for key aspects of care. Population forecasts and national survey data were used to inform future predictions of care required. Results: There was an increase in absolute terms of total items (14.4%) and items per capita (10.7%) between 1999/2000 and 2004/05, with a peak of 15.7 million items claimed in 2003/04. Over the 6-year period, increases per capita were seen for dental examinations (11.3%), periodontal treatments (8.9%), fillings (1.9%), crowns (14.3%) and extractions (4.9%) amongst older people as a group. In contrast, there was a marked decrease in the episodes of care involving domiciliary care ()46.4%) and upper complete dentures ()32.9%) per capita over this period, items that were most commonly provided for the oldest ageband (85 years and over). Apart from complete dentures, the demand for care is predicted to increase. Conclusion: The volume of primary dental care provided for older people has been increasing at a rate which exceeds population growth, but remains low. Planners and commissioners should urgently review the provision of dental care of older people to ensure that their oral health needs are being met particularly in relation to dentures and domiciliary care.

Effect of monomer treatment and polymerisation methods on the bond strength of resin teeth to denture base material

Abstract: Background: The fracture between acrylic denture base material and artificial teeth is a common clinical occurrence in dental prosthodontic practice. Objective: To evaluate the bond strength between acrylic resins and resin denture teeth when submitted by two protocols of monomer liquid application on the tooth surface and using different polymerisation methods. Material and methods: Microwave-polymerised (Onda-Cryl), heat-polymerised (Classico) and autopolymerising (Jet) acrylic resins and a brand of resin denture teeth (Biotone) were used. The acrylic resins were polymerised according to the cycles: (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. Thirty specimens were prepared for each polymerisation method; 10 were packed with acrylic resin after 60 s of monomer liquid application on the tooth surface, 10 after 180 s and 10 without any monomer liquid application. For the purpose of the study, a shear test was used. anova and Tukey tests were performed to identify significant differences (α = 0.05). Results: The highest bond strength values were found for monomer surface treatments, regardless of the polymerisation cycles. The highest significant values were found for cycles B (15.4 ± 1.8 MPa), C (11.9 ± 4.9 MPa) and T (15.4 ± 2.6 MPa) for non-treated and 60 s methylmethacrylate treated groups. Comparing the monomer liquid treatment, they did not differ significantly (p > 0.05), except for cycle A (p < 0.05). Conclusion: Chemical treatment using monomer on the tooth surface prior to the acrylic resin packing improved the bond strength between resin denture tooth and acrylic resin, regardless of monomer liquid treatment protocols. The microwavable resin, polymerised by fast cycle and autopolymerising resin should be avoided for processing denture and denture repairs, respectively.

Impact of ageing and drug consumption on oral health.

Abstract: The impact of ageing on oral health and salivary flow is usually over-estimated possibly because of the high frequency of polypharmacy observed in this subset of patients. Understanding the physiological changes and treatment-related oral complications of older patients is essential to promote accurate management of symptoms and improve their quality of life. The current paper reviews age-related physiological chances in salivary glands and the effect of polypharmacy on oral health, focusing on xerostomia and hyposalivation.

Oral health care issues in aged care facilities in Western Australia: resident and family caregiver views

Abstract: Objective: To investigate resident and family perceptions and attitudes towards oral health care and access to dental services for aged care facility residents Method: Focus groups and individual interviews with residents and family caregivers were conducted at aged care facilities in the Perth Metropolitan Area, Western Australia Results: There were 30 participants from twelve aged care facilities (21 residents and nine family caregivers) Five focus groups comprising both residents and family caregivers were conducted in addition to three face-to-face interviews with residents Both groups considered oral health very important to overall health and quality of life Family caregivers noted a lack of dental check-ups and specialised professional oral care, particularly in high-care facilities Low care residents were more likely to have regular dental check-ups or dental treatment and off-site dental visits were straightforward due to their mobility and family member assistance Family caregivers noted time limitations and lack of expertise in oral health care amongst staff in high-care facilities, and the challenges of maintaining oral care for residents with poor mobility or cognitive impairment It was considered important that staff and management liaise with family caregivers and family members in provision of oral care Conclusion: Regular oral care, assessment and treatment were considered limited, particularly for residents in high care There is a need for comprehensive, ongoing oral health programmes involving appropriately trained and empathetic dental health professionals and staff to improve oral health care in Perth’s aged care facilities

Complete removable prostheses: from expectation to (dis)satisfaction

Abstract: Objective: The purpose of this survey was to increase our knowledge on the experience and feelings of edentulous people, 6 months after having acquired and worn a pair of complete removable prostheses. Background: The incorporation of conventional, complete removable prostheses may be an appropriate treatment which can result in an improvement in the quality of life of people who have lost their teeth. Methods: The 12 patients of the sample were interviewed individually according to a semi-structured questionnaire so as to create an atmosphere for open conversation regarding the subject matter. For each participant, photographs, before dental treatment and after the use of the prostheses, were taken. The images of the prostheses were reviewed and impressions were collected. Results: The analysis of participant’s statements allowed one to verify if the complete removable prostheses improved the quality of life; however, difficulties encountered could lead users to abandon their prostheses. Conclusion: Appropriate investment on the part of health professionals, together with the clarification of information and the monitoring of patients, may well minimise these difficulties.

Geriatric patient - psychological and emotional considerations during dental treatment.

Abstract: Objective: The world’s population is ageing rapidly with an increase in the age related diseases and disabilities. With the increase in the life span, chronic diseases play a significant role and the dental diseases are the most prevalent chronic condition. Diagnosis and treatment planning for the elderly must include considerations of the biological, psychological, social and economic status of the patient in addition to the obvious dental problems. The aim of this article is to provide a review of the psychological and emotional factors involved in the dental treatment and the methods to develop a right dental attitude. Background: Authorities in dental medicine have long recognized a relationship between psychology and dentistry and have attempted to describe the factors that require consideration during the dental therapy. The theoretical approaches are now replaced by practical approach of patient management. Materials and method: The article reviews the literature regarding the etiology for the development of psychological and emotional disturbances, factors that influence the patient’s response and methods to develop the right dental attitude. Conclusion: The dentist is concerned with the emotional and psychological state of the patient, for it is an essential component of treatment and the success of the treatment often depends on the emotional state of the patient. It is thus important for the dentist to be aware of practical- problem- oriented approach that helps in patient management and in maintaining and improving dental health as part of total healthcare services available to the elderly.

Oral mucosal lesions and temporomandibular joint impairment of elderly people in the South East Local Government Area of Ibadan.

Abstract: Objective: To determine the prevalence of oral mucosal lesions, temporomandibular joint (TMJ) impairment and oral health-related habits in the elderly people in South East Local Government Area (SELGA) in Ibadan. Background data: SELGA is one of the largest local government areas in Oyo State, Nigeria and has a population of 225 800. Design: A cross-sectional survey. Methodology: A randomly selected sample of 690 elderly people from 23 wards in SELGA were examined by two trained and calibrated examiners using mirror, probe and natural light. Results: One hundred and fifty-five (22.46%) of the elderly examined had one or more oral pathology lesions, representing infection-related swelling, non-infection-related swelling, pre-malignant lesions, denture stomatitis, non-denture based ulcers, angular cheilitis, geographic tongue, scrotal tongue, lichen planus, hyper-pigmentation and TMJ impairment. Fifty-five (35.5%) of these pathologies were infection-related swellings. Six (3.9%) of the pathologies were denture-related stomatitis, 14(9.03%) were pre-malignant lesions, 14(9.03%) were non-infection-related swelling, while 27 (17.4%) were TMJ impairment. The rest of the lesions constituted the remaining 25.1%. Only 15.9% of the participants had tobacco-related habits, 10.7% drank alcohol, whilst 41.6% chewed kola nuts. Conclusion: Oral pathoses prevalence (22.46%) was similar to findings in developed countries (29.9%) but with a reversal of causal factors, infection-related swellings were more common, whereas pre-malignant lesions were less common. The infections were mostly complications from periodontal disease, which culminated in abscess formation. Tobacco-related habits were not highly prevalent among the elderly people in SELGA. However, oral pathoses resulting from nutritional deficiencies were the third most frequent lesions observed.

The degree of tongue‐coating reflects lingual motor function in the elderly

Abstract: Objectives: The aim of this study was to examine the relation between the degree of tongue-coating and oral function. Background: Tongue-coating is a moss-like deposit which forms over the tongue surface, and includes micro-organisms, food residues, and abrasive epithelia. It is considered that motor function of the tongue and lips and saliva secretion decrease in the aged and have some effect on the accumulation of tongue-coating. Although saliva secretion has been reported as a factor amongst these oral functions in contributing to tongue-coating, the correlation with the motor function of oral structures is unknown. Subjects and methods: The factors that contribute to the accumulation of tongue-coating were examined in 48 subjects of advanced age (mean age 80.8 ± 7.8 years) with no severe levels of periodontal disease. Changes in the degree of tongue-coating were also examined after oral functional training in these subjects. The frequency of oral cleaning, status of oral hygiene, motor function of the tongue, and masticatory performance were examined as potential factors associated with the degree of coating. Results: The results showed that tongue pressure and the frequency of oral diadochokinesis measured by pronouncing the single syllable ‘ka’ as an indicator were statistically significantly correlated with the degree of tongue-coating. Several factors in oral function improved with training, and also the degree of tongue-coating decreased in 27 subjects. Conclusion: These results suggest a correlation between the degree of tongue-coating and a reduction in lingual motor function and, in addition, possible improvement in level of coating by functional training of the tongue.

Comparison between complete denture and implant-retained overdenture: effect of different mucosa thickness and resiliency on stress distribution.

Abstract: Background: The effect of different mucosa characteristics on stress distribution of complete dentures and overdentures remains unknown. Objective: The aim of this study was to evaluate the effect of different mucosa thickness and resiliency on the stress distribution of complete dentures and implant-retained overdentures using a two-dimensional finite element analysis. Material and methods: Representative models of the edentulous mandible were constructed on AutoCAD software according to the groups’ characteristics. In group CD, a model of the edentulous mandible supporting a complete denture was obtained while in group IO, a model of edentulous mandible supporting an overdenture over two unsplinted implants with an o’ ring system was constructed. In each group, mucosa assumed three characteristics of thickness (1, 3 and 5 mm) corresponding to the resiliencies hard, resilient and soft respectively. Evaluation was performed on Ansys software with 100N vertical load applied on central incisor teeth. The principal stress was used as analysis criteria. Results: Group IO showed higher stress values than group CD regardless of mucosal thickness and resiliency. Stress decreased at the supporting tissues in both groups as the thickness and resiliency of mucosa increased. In relation to the supporting tissues, cortical bone showed the highest stress values. Conclusion: It was concluded that the use of an attachment system increases stress values and the thickness and resiliency of mucosa influence more on these values.

The prosthetic need WHO index: a comparison between self-perception and professional assessment in an elderly population.

Abstract: The purpose of this study was to consider the criteria for establishing the need for prosthesis, by comparing the need perceived subjectively by a patient (self-perception) with that assessed by an examiner according to the WHO diagnosis criteria. The proposed domiciliary sample comprised 270 elderly (aged 60 years or older) residents in a municipality in southern Brazil. The interviews and oral examinations were conducted by two dentists following a period of training and calibration. The criteria used conformed to the WHO and FDI standards. Statistical treatment of data included bivariate and multivariate analysis using SPSS 10.0. Only five patients identified the need for a prosthesis when not identified by the examiner. In the case of 172 elderly subjects, there was agreement in the self-perceived and observed treatment needs. The need for prosthesis was found in 93 elderly subjects who did not perceive any need for prosthetic treatment. The multivariate analysis showed that the variables age, gender, residential area and form of service most sought after during their lives were significantly associated with a better self-perception of oral health. The professional criteria based on WHO guidelines differed from the self-perceived need. Elderly male subjects who lived in a rural area and were 70 years of age or more, who did not participate in third age groups, and who had not sought dental services for most of their lives were the least likely to perceive the need for prosthetic treatment, thereby underestimating their oral health needs.

A 5-year follow-up of older adults residing in long-term care facilities: utilisation of a comprehensive dental programme.

Abstract: Objective: This study will compare the clinical outcomes of 139 elders residing in long-term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years. Background: Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care. Material and methods: A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition. Results: Eighty-three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70–73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56–72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, χ2 = 7.9, df = 2). Conclusion: Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.

TMD and GOHAI indices of Brazilian institutionalised and community-dwelling elderly

Abstract: Rationale and objectives: Considering the controversy in the literature regarding several aspects of temporomandibular dysfunction (TMD) in elderly populations and the absence of reliable data on elderly Brazilians in this field, this study consisted of an evaluation of TMD prevalence and the self-perception of oral health among institutionalised and community-dwelling elderly in Sao Jose dos Campos, Brazil. Methods: Two hundred and fifteen community-dwelling and 185 institutionalised elderly people were evaluated by the Helkimo anamnestic (Ai) and clinical dysfunction (Di) indices and answered a questionnaire using the Geriatric Oral Health Assessment Index (GOHAI). Results: The major prevalence of TMD symptoms was for the Ai0 (symptom-free) group (69.5%), while the major prevalence of clinical signs was for the DiI (mild) group (56%). Women presented a higher AiII classification than men (χ2 test, p = 0.049). Community-dwelling elderly presented a significantly lower Ai0 classification than the institutionalised ones (Two ratios equality test, p < 0.001). There was no relationship between the institutionalised status and the clinical dysfunction index for Di0 and DiIII classification (Two ratios equality test, p = 0.194 and 0.535 respectively). The institutionalised elderly presented greater (One-way anova = 0.005) self-perception of oral health (33.45) than did the community-dwelling group (32.66). There were only weak Pearson’s correlations among the anamnestic (−33.0%) or clinical (−14.7%) findings by the TMD and GOHAI indices. Symptom-free (Ai0) institutionalised elderly presented better scores in all GOHAI dimensions and elderly representing an absence of clinical TMD signs (Di0) presented higher GOHAI physical dimension scores in both groups. Conclusions: The prevalence of TMD symptoms among this sample of elderly individuals was relatively low, self-perception of oral health was reasonable and a weak, inverse correlation was found between TMD signs and symptoms and elderly self-perception of oral health measured by the GOHAI index.

Understanding the 'epidemic' of complete tooth loss among older New Zealanders.

Abstract: doi:10.1111/j.1741-2358.2009.00306.x Understanding the ‘epidemic’ of complete tooth loss among older New Zealanders Objective: The aim of this study was to obtain a deeper understanding of the social factors driving New Zealand’s historic ‘epidemic of edentulism’ and how they operated. Method: In-depth, semi-structured interviews with 31 older New Zealanders were analysed using applied grounded theory. Results: Universal factors present in the data were: (a) the way in which New Zealand society accepted and indeed encouraged edentulism without stigma for those who had a ‘sub-optimal’ natural dentition; (b) how the predominant patterns of dental care utilisation (symptomatic and extraction-based) were often strongly influenced by economic and social disadvantage; and (c) the way in which lay and professional worldviews relating to ‘calcium theory’ and dental caries were fundamental in decisions relating to the transition to edentulism. Major influences were rural isolation, the importance of professional authority and how patient-initiated transitions to edentulism were ultimately facilitated by an accommodating profession. Conclusion: The combined effects of geography, economics, the dental care system and the professional culture of the day, in the context of contemporary (flawed) understandings of oral disease, appear to have been the key drivers. These were supported (in turn) by a widespread acceptance by the profession and society alike of the extraction/denture philosophy in dealing with oral disease.

Oral health care in private and small long-term care facilities: a qualitative study.

Abstract: Objective: Elderly people who are institutionalised receive qualified care. Among the services supplied, oral health care has not always been a priority. The aim of this study was to identify the characteristics of oral health care provided to the elderly residents in long-term care facilities (LTC) in Porto Alegre/RS city. Methods: Twelve private and small-size LTCs (less than 20 residents) participated in this study. All supervisors and 36 carers were interviewed. The data obtained were organised according to the offer of oral health under the following categories: responsibility for oral care, oral care routines, difficulties carrying out oral care routines. Results: The procedures used most often in order of frequency were tooth brushing, prostheses cleaning, use of mouthwashes, soaking of prostheses and cleaning of the tongue. Among the difficulties mentioned were the high cost of dental assistance, the lack of co-operation both by family members and by the elderly themselves, the oral and general health status of the elderly and the limited time available for carers to carry out the tasks. Oral care is conducted empirically, and the responsibility is left to the carers. Conclusions: Analysis of the statements given reveals that oral care does not follow any kind of protocol or standardisation. The persistence of this situation could lead to unsatisfactory oral health care in private and small LTC facilities.