Showing papers in "Gerodontology in 2016"

Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients.

Abstract: Objective The aim of this study was to describe relationships between oral status, dysphagia and malnutrition in a hospitalised older people. Background Undernutrition in older people is a major concern in geriatric hospital wards. Different factors can modify nutritional status like dysphagia or oral status. Materials and methods About 159 consecutive inpatients (108 women, 51 men) were examined. Comprehensive gerontological data at baseline and nutritional status according to BMI, MNA and serum albumin concentration, dependency according to ADL scores, dietary intake, swallowing capacities and oral status were collected. Swallowing capacities and dietary intake were reassessed 1 week after. Results Mean age was 85.28 (SD 5.68). Seventy-seven patients were malnourished (MNA) and 34 had dysphagia. Oral treatment was necessary in 142 patients (89.30% of all population). Candidiasis was present in 17 patients and salivary flow reduction in 50. Patients with dysphagia had the lowest dietary intake. After 1 week, patients with dysphagia were retested and dysphagia had abated in three of them. Dysphagia and undernutrition were associated (p < 0.001), and both were related to candidiasis (p < 0.001 and p < 0.01). Dysphagia was also related to salivary hypofunction (p < 0.001), loss of posterior occluding pairs (POPs; p = 0.014), oral self-care dependency (p < 0.001) and self-feeding dependency (p < 0.001). Salivary hypofunction was related to candidiasis (p < 0.001) and loss of POPs (p < 0.05), and candidiasis to loss of POPs (p < 0.01). Conclusion Although no causality can be demonstrated, poor oral health was strongly associated with malnutrition, emphasising the importance to develop oral care strategies and to incorporate a dental examination into comprehensive gerontological assessment.

Effect of a denture base acrylic resin containing silver nanoparticles on Candida albicans adhesion and biofilm formation

Abstract: Objective The objective of this study was to evaluate the effect of denture base resin containing silver nanoparticles (nano-silver) on Candida albicans adhesion and biofilm formation. Background Epidemiological studies report that approximately 70% of removable denture wearers suffer from denture stomatitis. Candida albicans adhesion and biofilm formation are regarded as essential prerequisites for denture stomatitis. Materials and methods The bioactivity and biomass of C. albicans biofilm, which was incubated in a series of twofold dilutions of nano-silver suspension at 37°C for 24 h, were determined using XTT reduction and crystal violet assays, respectively. The denture base resin specimens containing nano-silver were then used in C. albicans adhesion (37°C; 90 min; n = 9) and biofilm formation assays (37°C; 72 h; n = 9). Confocal laser scanning microscopy was used to evaluate the architectural properties of average thickness and live/dead cell ratio in the different biofilm stages that developed on the specimens. Results The bioactivity and biomass of C. albicans biofilm successively decreased with increasing nano-silver solution concentration. Denture base resin containing nano-silver had no effect on adhesion at low concentrations, but it exhibited anti-adhesion activity at a high concentration (5%). For 72 h biofilm formed on the resin specimens, the thickness and live/dead cell ratio were successively reduced with increasing nano-silver concentrations. Conclusion Nano-silver had antifungal activity and inhibited C. albicans biofilm formation. Antifungal activity and an inhibitory effect on adhesion and biofilm formation by denture base resin containing nano-silver were discovered, especially at a higher concentration.

Prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people in Japan.

Abstract: Objective This study investigated the prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people. Background Xerostomia and hyposalivation are common symptoms in the older population. Materials and methods This study included with 894 community-dwelling, Japanese older people (355 men, 539 women; age 65–84 years) who participated in a comprehensive geriatric health examination, which included questionnaires and interviews regarding medical history, medications, Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), depressive condition. The Zung Self-Rating Depression Scale (SDS) was used to evaluate depression. Resting salivary flow rate was evaluated by the modified cotton roll method. Results In this study, 34.8% of the participants (mean age, 73.5 ± 5.0 years) complained about xerostomia, while the prevalence of hyposalivation was 11.5%. Multiple regression analysis revealed hypnotics use [odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.13–2.61], SDS (OR = 1.05, CI = 1.04–1.07) and TMIG-IC total points (OR = 0.87, CI = 0.76–0.99) to be significantly associated with xerostomia. In contrast, female gender (OR = 2.59, CI = 1.55–4.31) and the use of agents affecting digestive organs (OR = 1.78, CI = 1.11–2.86) were associated with hyposalivation. Conclusion Our findings showed that the prevalence of xerostomia and hyposalivation were approximately 1 in 3 and 1 in 10 respectively. The factors associated with psychological factors and high-level functional competence, while hyposalivation was associated with medications and gender, as well as systemic and/or metabolic differences. It is important to consider these multidimensional factors associated with xerostomia and hyposalivation.

Parkinson's disease and periodontitis – the missing link? A review

Abstract: Objective: In this article an attempt has been made to postulate a possible link between Parkinson’s disease and periodontal disease. Background: Various systemic diseases such as cardiac disease, diabetes, renal diseases, low birth weight and Alzheimer’s disease have been proposed to be linked with periodontal disease on the basis of systemic inflammation. Parkinson’s disease is a chronic progressive neurodegenerative disorder with multifactorial aetiology. Until now, periodontal disease and Parkinson’s disease has been linked only on the basis of poor motor and cognitive control in Parkinson’s patient which leads to poor oral health maintenance. Evidence now suggests that chronic neuroinflammation is consistently associated with the pathophysiology of Parkinson’s disease. Also, recently, systemic inflammation has been suggested as one of the contributing factors for neurodegeneration. Material and methods: Dental and medical literature especially those dealing with neurosciences were selected which highlighted the link between systemic inflammation and infection. Results: So far there is no direct evidence implicating an effect of periodontitis in the pathogenesis of Parkinson’s disease. To clarify this link, studies on population based case–control or cohort design are needed. This would be especially significant in the present era where there is paucity for preventive measures as far as a cognitive disorder such as Parkinson’s disease is concerned. Conclusion: We cannot cure Parkinson’s disease, but if in future this missing link is established, an attempt can be made to prevent it by tackling one of its possible contributors (periodontitis) for systemic inflammation by simple preventive oral hygiene measures.

Physical fitness and oral function in community-dwelling older people: a pilot study

Abstract: Objective The aim of the present study was to quantify the relation between physical fitness and oral function, including tongue and lip movements. Background Physical fitness and oral function influence quality of life and activities of daily living in older individuals. Occlusal contact and mastication performance are associated with physical fitness, but the association between tongue and lip movements and physical fitness is unclear. Material and methods Sixty-six independent community-dwelling older individuals (24 men, 42 women; mean age, 70.3 ± 5.9 years) participated in this study. Measures of physical fitness were the one-leg standing time with eyes open, the functional reach test, anteflexion, the timed up and go test, and grip strength. Measures of oral function were tongue pressure, lip pressure, tongue movement from side to side, the repetitive saliva-swallowing test (RSST), oral diadochokinesis and masticatory efficiency. Multiple regression analysis was used to quantify the relation between physical fitness and oral function. Results After adjustment for age, sex, BMI, exercise habits and number of remaining teeth, the tongue movement from side to side and/or oral diadochokinesis were chosen as significant factors in each physical fitness measurement. Furthermore, the lip pressure and masticatory efficiency were associated with handgrip strength. Conclusion Oral function, including tongue and lip movements, was associated with physical fitness in older people in this study. Tongue dexterity as characterised by tongue movement from side to side and oral diadochokinesis particularly associated with physical fitness.

Effect of an oral healthcare protocol in nursing homes on care staffs' knowledge and attitude towards oral health care: a cluster‐randomised controlled trial

Abstract: Results: At baseline, no significant differences were observed between the intervention and the control group for both knowledge ( p= 0.42) and attitude ( p= 0.37). Six months after the start of the intervention, significant differences were found between the intervention and the control group for the variable knowledge in favour of the intervention group (p < 0.0001) but not for the variable attitude ( p= 0.78). Out of the mixed model with attitude as the dependent variable, it can be concluded that age ( p= 0.031), educational level ( p= 0.009) and ward type ( p= 0.014) have a significant effect. The mixed model with knowledge as the dependent variable resulted in a significant effect of the intervention ( p= 0.001) and the educational level ( p= 0.009). Conclusion: The supervised implementation of an oral healthcare protocol significantly increased the knowledge of nurses and nurses’ aides. In contrast, no significant improvements could be demonstrated in attitude.

Dentition, nutritional status and adequacy of dietary intake among older residents in assisted living facilities

Abstract: Objective We examined the relationships between dentition, nutritional status and dietary intakes of energy, protein and micronutrients among older people in assisted living facilities in Helsinki. Background Poor dentition is associated with malnutrition. Less is known about how dentition is associated with detailed nutrient intakes in institutionalised older people. Materials and methods This cross-sectional study assessed 343 participants (mean age 83 years). Dentition was assessed by trained ward nurses and divided into edentulous participants without dentures (group 1), edentulous participants with removable dentures (group 2) and those with any natural teeth (group 3). Nutritional status was assessed by Mini Nutritional Assessment (MNA). The energy, protein and nutrient intakes were calculated from detailed 1-day food diaries and compared with the recommendations of the Finnish National Nutrition Council as a measure of dietary adequacy. Assessment included also participants' cognitive and functional status. Results Of the participants, 8.2, 39.1 and 52.8% were in groups 1, 2 and 3, respectively. Altogether 22% were malnourished according to MNA. Group 1 had the poorest nutritional status. A large proportion of participants consumed less than the recommended amounts of energy, protein or micronutrients. Half of the participants consumed <60 g/day of protein. The intake of protein was significantly lower in group 1 than in other two groups. Conclusion Malnutrition and inadequate protein intake were very common and associated with dentition among older people with multiple disabilities in assisted living facilities. Assessment of dental status should be part of good nutritional care in long-term care.

Digital panoramic radiographs are useful for diagnosis of osteoporosis in Korean postmenopausal women

Abstract: Objective The purpose of this study was to determine whether digital panoramic radiographs could be used for the diagnosis of osteoporosis through evaluation of the radiographs based on the correlation with bone mineral density (BMD). Methods One hundred and ninety-four post-menopausal women were selected from participants who had participated in the Dong-gu study. Panoramic radiographic indices measured are mental index (MI), mandibular cortical index (MCI) and simple visual estimation (SVE). BMD at the lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry (DXA). The Pearson's correlation test was performed to analyse the correlation between MI and age and BMD at the lumbar spine, femoral neck and total hip. Multiple linear regression analysis was performed to analyse the association of MI, MCI and SVE with BMD after adjusting for age, height and weight. To determine the optimal cut-off point of MI for the diagnosis of osteoporosis, the receiver operating characteristic analysis was performed. Results The MI was positively correlated with BMDs: lumbar spine: r = 0.36, femoral neck: r = 0.59 and total hip: r = 0.58 (p < 0.001). As age increased, MI decreased (r = −0.46). BMD at the lumbar spine and total hip were significantly lower in participants with reduction of mandibular width, thinning and resorption of mandibular cortex by the MI, SVE and MCI, respectively. The optimal cut-off value of MI for the diagnosis of spinal osteoporosis was 2.22 mm. Conclusion Thickness and morphological changes of mandibular inferior cortical bone are associated with BMD, independent of age, height and weight. These results suggest that MI, MCI and SVE may be useful indices for the diagnosis of osteoporosis in a Korean population.

Biocompatibility of a titanium dioxide-coating method for denture base acrylic resin.

Abstract: Objectives Ease of denture cleaning is of paramount importance in geriatric patients and those with limited dexterity. We have previously investigated methods of coating dentures with titanium dioxide (TiO2) and reported the effects (self-cleaning and antibacterial) of such treatments in in vitro studies. This study was to verify the biocompatibility of a TiO2-coated acrylic resin produced by the new coating method with spray-coating technique. Methods Specimens were prepared from denture base acrylic resin and polished up to grit #1000. The TiO2-coating agent was sprayed onto the specimens using an airbrush gun. Specimens were then divided into ‘polymethyl methacrylate (PMMA)’, ‘primer-coated PMMA’ and ‘TiO2-coated PMMA’ groups to be evaluated for biological safety using a hamster oral mucosa irritation test, a guinea pig skin sensitisation test and a rabbit intracutaneous test. The biological reaction was scored. Results Reaction scores were considerably <1.0, the acceptable limit set by the ISO, in all three tests. Indeed, in most samples, there was no deleterious effect at all. Conclusion These results tested on animals demonstrate that denture base resin coated with TiO2 by this method does not cause irritation or sensitisation of the oral mucosa, skin or intracutaneous tissue and is therefore good biocompatibility for use in close proximity to oral mucosa and skin.

The impact of oral health on body image and social interactions among elders in long-term care

Abstract: Objective The objective of this study was to explore how social interactions and body image are influenced by perceived oral health among older people who live in long-term care facilities. Background Social interactions among frail elders in long-term care (LTC) facilities are limited, but to what extent body image and oral health influence their social relations is poorly understood. A positive body image and the perception of adequate oral health are linked to increased social contacts, as well as improved health and well-being irrespective of age. However, as frailty increases, it is unclear whether appearance and oral health priorities remain stable. Materials and Methods Open-ended interviews were conducted with a purposefully selected group of cognitively intact, older men and women who exhibited varying degrees of frailty, social engagement and oral health conditions and lived in one of seven long-term care facilities. The interviews were analysed using a constant comparative technique, and a second interview with participants checked the trustworthiness of the analysis. Results Three major categories were expressed by the participants: (1) My mouth is fine; (2) It depends; and (3) Not that important. Within each category, there were several contributing and influencing factors. Conclusions Social interactions among residents in LTC may be negatively impacted by poor oral health, but only if other personal and social issues are less bothersome than conditions with the mouth.

Translation and validation of Hindi version of Geriatric Oral Health Assessment Index.

Abstract: Objective The aim of the study was to translate and validate the oral health-related quality of life assessment tool named Geriatric Oral Health Assessment Index (GOHAI) into Hindi language for use in the Indian population. Methodology The 12-item GOHAI questionnaire was translated into Hindi, back-translated and compared with the original English version. After pilot testing and appropriate changes, the Hindi version was administered to a group of 500 patients visiting the geriatric medicine clinic in All India Institute of Medical Sciences, New Delhi. The questionnaire was re-administered to 29 participants after a gap of minimum 7 days. The measures for reliability and validity were also assessed. Results Cronbach's α score (0.79) showed excellent internal consistency. Item-scale correlations varied from 0.06 to 0.75. Test–retest correlation on the 29 patients showed excellent results (ranging from 0.748 to 0.946). Lower GOHAI scores were associated with patient's self-perception of nutritional status, perceptive need for prosthesis, number of posterior occluding pair of teeth. Higher GOHAI scores were seen with patients with removable prosthesis than with edentulous or partially edentulous participants. Age group was also found to be a significant factor for GOHAI scores. Conclusion The Hindi version of GOHAI exhibits acceptable validity and reliability and can be used in the elderly Indian population as a measure of oral health-related quality of life.

Potential respiratory pathogens colonisation of the denture plaque of patients with chronic obstructive pulmonary disease

Abstract: Introduction The role of bacterial infections in acute exacerbations of chronic obstructive pulmonary disease (COPD) is widely examined. Denture plaque in patients with COPD is an example of bacterial and fungal biofilm, which is a reservoir of potentially pathogenic respiratory tract microorganisms. Poor denture hygiene might cause acute exacerbations of COPD. Objective Assessment of prevalence of respiratory tract pathogens in denture plaque in stable patients with COPD and it influence on oral ontocenoses depending upon the therapy. Materials and methods The study was based on the clinical assessment of oral mucosa and denture hygiene in 53 patients with COPD with mean age of 70 ± 18 years and 14 generally healthy participants with mean age of 65 ± 14 years. Microbiological and mycological tests were performed by culturing direct denture swabs. Results The study showcased the presence of potential pathogenic micro-organisms in denture plaque of 48 patients with COPD (90%) and nine healthy subjects (64.3%). Yeast-like fungi prevailed in denture surface swabs of 40 (75%) in patients with COPD and 8 (57%) in cases of control group. In 66% of patients, various degree of oral mucosa inflammation prevailed. Conclusions Denture plaque could be a potential source of bacterial and fungal infections in patients with COPD.

Oral health and depression in older Japanese people.

Abstract: Objective The aim of this study was to investigate the relationship between oral dysfunction and depressive symptoms in Japanese community-dwelling seniors. Materials and methods Participants included 351 community-dwelling seniors (189 men, 162 women) aged 77 years. During dental examination, teeth and periodontal condition, including number of teeth, number of dental caries, pocket depth and clinical attachment level, were assessed, and unstimulated and stimulated salivary flow rates were measured. The General Health Questionnaire 30 (GHQ-30) was used to assess depression. The Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence was used to assess activities of daily living. Results Multiple logistic regression analysis revealed that gender (odds ratio [OR] = 2.3), low unstimulated salivary flow rate (OR = 2.1), ‘Complaint of mouth pain’ (OR = 2.4), ‘Complaint of physical disorders’ (OR = 2.1), and the total TMIG Index of Competence score (OR = 2.0) were positively associated with the high GHQ-30 score. Conclusion Subjective and objective oral dryness and oral pain are associated with depressive symptoms.

Failure rates of class V restorations in the management of root caries in adults – a systematic review

Abstract: Objective The aim of this systematic review was to compare cumulative failure rates of different restorative materials in carious class V lesions on the root surfaces of adult patients. Background The prevalence of root caries is set to increase in the coming years as a result of ageing of the population and a concomitant reduction in levels of edentulousness. Evidence is needed to assist practitioners to select the most appropriate restorative material for use in these lesions. Methods A search of the literature was undertaken using the electronic databases of PubMed, Embase, CENTRAL and OpenSIGLE using keywords relevant to the search question. Two review authors conducted the electronic search independently, and any conflict was resolved by discussion. The references quoted in the full text articles extracted were hand searched for any further eligible studies. Results Sixty non-duplicate citations were screened. Following review of the titles, abstracts, texts and application of the pre-determined inclusion/exclusion criteria, five studies remained. Conclusion There is a need for more research in this area as many of the studies identified in this systematic review treated post-radiation, xerostomic patients which are not typical of the general population. Increased adherence to CONSORT guidelines for reporting is also advised to facilitate future systematic review and meta-analysis in this area.

The effects of the number of natural teeth and posterior occluding pairs on the oral health-related quality of life in elderly dental patients.

Abstract: Objectives To compare between the oral health-related quality of life (OHRQoL) of Thai elderly dental patients at the Faculty of Dentistry, Chulalongkorn University with at least 20 natural teeth (NT) and those with less than 20 NT, and between those with at least 4 posterior occluding pairs (POP) and those with less than 4 POP. Background Thai government recommended that elderly people should have at least 20 NT and 4 POP. Materials and methods The participants comprised 240 Thai elderly dental patients who were interviewed and had their OHRQoL determined using the Oral Impacts on Daily Performances Index (OIDP). Higher OIDP score indicates poorer OHRQoL. We counted the functional NT and POP in each participant. Results Participants with less than 20 NT or less than 4 POP had significantly higher OIDP scores than those with at least 20 NT or at least 4 POP. Moreover, when we evaluated one by one tooth loss, we found the first and the last significant differences between the OIDP scores in the participants with at least 23 teeth and with less than 23 teeth, and those in the participants with at least 5 teeth and with less than 5 teeth, in consequently. Conclusion Thai elderly participants with at least 20 NT or at least 4 POP had greater OHRQoL than those with less than 20 NT or less than 4 POP, and in our study sample, we observed that 5 teeth may be an important clinical threshold for Thai elderly dental patients' quality of life.

Does denture-wearing status in edentulous South Korean elderly persons affect their nutritional intakes?

Abstract: Gerodontology 2014; doi: 10.1111/ger.12125Does denture-wearing status in edentulous South Korean elderly persons affect their nutritionalintakes?Objective: The aim of this cross-sectional study was to determine whether denture-wearing status inedentulous South Korean elders affected their nutritional intakes, using the 2008–2010 data from theKorean National Health and Nutrition Examination Survey (KNHANES).Background: Good nutritional status is a requirement for healthy aging in the elders. Tooth loss is thekey to lead to low masticatory ability and alterative food choice, which may increase the risks of sys-temic disease. Therefore, denture treatment is important to improve general health of edentulous per-sons.Materials and methods: From KNHANES data, 1168 edentulous older people were selected as theparticipants of the present study. Nutrient intake data collected via participants’ 24-h dietary recalls wereused to determine the ratio of nutrient intake to the Recommended Dietary Allowance for Koreans, thepercentage of individuals with inadequate nutrient and the effects of denture wearing on the risk ofundernourishment.Results: The results showed that compared to denture wearers, edentulous persons without dentures hadlower intakes of potassium, niacin and vitamin C. In addition, the distribution of inadequate nutrientintake among participants without dentures was higher than among participants with dentures; the risk ofundernourishment was 1.89 times that of denture wearers. [Correction made on 21 March 2014, after firstonline publication: “[...] participants with dentures was higher than among participants without dentures”was corrected to “[...] participants without dentures was higher than among participants with dentures”]Conclusion: Denture wearing was seen to have a significant effect on the level of nutrient intake inedentulous elders.Keywords: dentures, edentulism, nutrition.Accepted 10 February 2014

Opinions of dentists on the barriers in providing oral health care to community‐dwelling frail older people: a questionnaire survey

Abstract: Objective: The aim of this study was to investigate to what extent dentists in the Netherlands experience barriers in providing oral health care to community-dwelling older people. Background: As most publications on the barriers in providing oral health care to older people consist of surveys on oral health care in care homes, it was decided to investigate the barriers dentists experience in their own dental practices while providing oral health care to community-dwelling frail older people. Material and methods: A representative sample of 1592 of the approximately 8000 dentists in the Netherlands aged 64 or younger were invited to respond to a questionnaire online. The dentists were asked to respond to 15 opinions concerning oral healthcare provision to community-dwelling frail older people aged 75 years or more who experience problems in physical, psychological and social areas, as well as possible financial problems. Results: The total response rate was 37% (n = 595; male=76%; average age 49). The majority of those who responded agreed that the reimbursement of oral health care to older people is poor. Two thirds of those who responded (66%) agreed that there are limited opportunities to refer the frail and elderly with complex oral healthcare problems to a colleague with specific knowledge and skills. Conclusion: Dentists experienced barriers in two domains; a lack of knowledge and practical circumstances. It was concluded that the dentist's gender, age, year of graduation and the number of patients aged 75 years or more treated weekly were in some respect, related to the barriers encountered.

Validation of the Spanish version of the oral health impact profile to assess an association between quality of life and oral health of elderly Chileans

Abstract: Gerodontology 2014; doi: 10.1111/ger.12124Validation of the Spanish version of the oral health impact profile to assess an associationbetween quality of life and oral health of elderly ChileansObjective: To validate the Spanish version of the OHIP-49 among elderly population.Background: Oral health, as a predictor of quality of life, can be evaluated using validated instruments.One of the most commonly used instruments worldwide is the Oral Health Impact Profile-49 (OHIP-49).This instrument has not yet been validated in Chilean older adults.Materials and methods: Interviews and clinical exams were performed in a convenience sample ofeighty-five elderly participants aged 60 or more years (mean 69.02 7.82 years). Socio-demographicand clinical variables were analysed: number of teeth, caries, periodontal and prosthetic treatment needsand prosthetic functionality.Results: High internal consistency values were obtained for both the OHIP-49 Sp instrument (0.990)and all of its dimensions (0.875–0.995). The average score of the OHIP-49 Sp was 62.54 43.73. Signif-icantly higher OHIP-49 Sp scores were observed in participants with caries (p = 0.01), in those needingcomplex periodontal treatment (p = 0.0001) and those in need of dental prostheses (p ≤ 0.0001).Conclusion: The OHIP-49 Sp proved to be a valid tool to assess oral health-related quality of life, whentested in Chilean older adults.Keywords: quality of life, oral health, oral health impact profile, validation studies as topic, aged, chile.Accepted 10 February 2014

Changes in cell density and morphology of selected cells of the ageing human dental pulp.

Abstract: Objectives The aim of this study was to determine the changes in cell density and morphology of selected cells of the ageing human dental pulp. Background Changes in cell density and morphology of dental pulp cells over time may affect their capability to respond to tooth injury. Materials and methods One hundred thirty-one extracted teeth were obtained from individuals between the ages of 6 and 80 years. The apical 1/3 of the root region was removed from all teeth prior to routine processing for producing histological slides. The histology slides were used to study the changes in cell density and morphology of selected pulp cells; odontoblasts, subodontoblasts and fibroblasts in the crown and root regions of the dental pulp. Student's t-test and one-way anova were used for statistical analyses. Results In all age groups, the cell density for all types of cells was found to be higher in the crown than in the root (p < 0.05). In general, the pulp cell density was found to decrease with age in both the crown and root regions. However, it was noted that the reduction of coronal odontoblasts occurred later in life (40–49 years) when compared to that of subodontoblasts or fibroblasts (30–39 years). Conclusions The density of the coronal pulp cells reduces and these cells undergo morphological changes with ageing of individuals and this may affect the pulp's ability to resist tooth injury.

Translation and validation of a Spanish version of the xerostomia inventory

Abstract: Objective The aim of this study was to validate a Spanish cross-cultural adaptation of the xerostomia inventory (XI). Materials and methods The original English version of XI was translated into Spanish, cross-culturally adapted and field tested. The Spanish version of XI (XI-Sp) was tested with a sample of 41 patients with xerostomia. The reliability of the XI-Sp was determined through internal consistency and test–retest methods. The construct validity of XI-Sp was determined by means of correlation between XI-Sp scores and salivary flow measurements. Results Overall XI-Sp scores were 40.8 (SD = 10) for the first application and 40.2 (SD = 9.5) for the second. Cronbach's alpha value for the XI-Sp was 0.89 and 0.87, respectively, while interitem correlation averages were r = 0.44 and r = 0.39 for each application. Interitem correlation and corrected total was rc≥0.30. The test–retest intraclass correlation coefficient value for the XI-Sp score was 0.59 and 0.91. Convergent validity for construct validity correlation with salivary flow showed a medium effect size (r2 = 0.10) for the first application but did not make a statistically significant prediction for the second (r2 = 0.7). Conclusions This study provides evidence concerning the reliability of the XI-Sp, showing that it may be a useful tool for Spanish-speaking xerostomia patients for both clinical and epidemiologic research.

Prevalence of root canal treatment and periapical radiolucency in elders: a systematic review.

Abstract: Introduction Neither the prevalence of periapical radiolucency (PARL), a surrogate for disease, nor the prevalence of non-surgical root canal treatment (NSRCT) in elders have been subjected to systematic review. The purpose of this study was to conduct systematic review and meta-analysis of the prevalence of PARL and NSRCT in elders. Methods Inclusion/exclusion criteria were used for defined searches in MEDLINE and Cochrane CENTRAL. Title lists were scanned and abstracts read to determine utility; articles meeting the criteria were analyzed. Weighted mean percentages were calculated for prevalence of PARL, NSRCT, and PARL in both teeth with and without NSRCT. Results Defined searching produced 3576 titles; 29 prevalence articles were included. Patient samples mostly represented modern populations from countries with very high human development indices. Meta-analyses were performed on up to 74 000 elders’ teeth. For those aged 65+, the prevalence of all teeth with NSRCT was extremely high, 21%; the prevalence of all teeth with PARL was quite high, 7%; the prevalence of PARL in NSRCT teeth was high, 25%; and the prevalence of PARL in untreated teeth was surprisingly high, 4%. In elders, the prevalence of NSRCT and PARL separately increased with age; whereas, PARL in NSRCT teeth decreased with age. Conclusions In comparison to general adult populations, elders had: a much higher prevalence of NSRCT, a higher prevalence of PARL, a lower prevalence of PARL in NSRCT teeth, and a higher prevalence of PARL in untreated teeth. Teeth saved through NSRCT were preferentially retained by elders.

Tooth loss might not alter molecular pathogenesis in an aged transgenic Alzheimer's disease model mouse

Abstract: Background and objective Previous studies have reported that tooth loss is a risk factor of Alzheimer's disease (AD). However, the association between tooth loss and cognition and the impact of tooth loss on the molecular pathogenesis of AD remain elusive. In this study, we tested the effect of tooth loss on learning and memory and on the molecular pathogenesis of AD in an aged AD model mice. Materials and methods We divided 14-month-old amyloid precursor protein (APP) transgenic mice, an AD model mouse line, into upper molar extracted group (experimental) and molar intact group (control). At 18 months old, we analysed not only the changes of amyloid-beta (Aβ), pyramidal cells in the brain but also the learning and memory ability with step-through passive avoidance test. Results The amount of Aβ and the number of pyramidal cells in the hippocampus were not significantly different between the experimental and control group. Similarly, the difference of learning and memory ability could not be distinguished between the groups. Conclusion Neither molecular pathogenesis of AD nor associated learning and memory were aggravated by tooth loss in these mice. The limited results of this study which used the aged mice may help the dental profession to plan and explain treatments to patients with AD, which must be designed while taking into account the severity of the AD symptoms.

Comparative evaluation of antifungal action of tea tree oil, chlorhexidine gluconate and fluconazole on heat polymerized acrylic denture base resin - an in vitro study.

Abstract: Comparative evaluation of antifungal action of tea tree oil, chlorhexidine gluconate and fluconazole on heat polymerized acrylic denture base resin – an in vitro study Objective: Candida albicans-associated denture stomatitis is the most common type of denture stomatitis seen in denture wearers. This study evaluates and compares the antifungal action of fluconazole, chlorhexidine gluconate and tea tree oil on heat-polymerised denture base resin, which has been previously contaminated with C. albicans grown in BHI broth. Material and Methods: Seventy-five specimens were immersed in BHI broth previously inoculated with C. albicans and stored for 3 h at 37°C. They were divided into five groups (n = 15): G1: 2% chlorhexidine solution; G2: 100% pure pharmaceutical grade tea tree oil; G3: 65 lg/ml fluconazole solution; C1: specimens not disinfected; C2: specimens not contaminated with Candida. Each specimen was then transferred to individual tubes containing BHI broth and incubated for 24 h. Culture media turbidity was evaluated for absorbance over a period of 14 days using a microplate reader. It was observed that the lower the absorbance, the stronger the antimicrobial action. Statistical analysis was performed (twoway ANOVA and Bonferroni test, p < 0.001). Results: Chlorhexidine and tea tree oil inhibited Candida up to the 14th day, whereas antifungal effect of fluconazole was not significant after the 7th day. Conclusion: Tea tree oil and chlorhexidine gluconate are more effective than fluconazole in inhibiting C. albicans growth on heat-polymerised acrylic resin.

Dentist skill and setting to address dental treatment needs of care home residents in Wales.

Abstract: Objective To explore the relationship between treatment plans, complexity anticipated in delivering those plans, and the special care dental skills and settings identified as appropriate. Background In older adults, many factors may complicate dental treatment including health and disability problems. Assessment of dental treatment needs amongst care home residents provides information about clinical care required and clinical experience needed for this population. Material and methods Analysis of dental data collected in a 2010 Welsh survey. Data analysed included treatment plan information, complexity assessment and dental expertise and settings required to deliver the treatment plans. Results The majority of participating residents needed simple dentistry, that is examinations, oral hygiene instruction, scaling of teeth, fillings, new dentures and fluoride application. Additional time was the commonest complexity factor. A large proportion of participants required dental treatment within a domiciliary setting. A similar proportion required care within a primary care setting (typically with care from a general dental practitioner) or a special care clinic (typically with care from a dentist with special care experience). Treatment plans involving specialists were more likely to be associated with poor general health, higher levels of interventional treatment and greater complexity. Conclusion Most treatment need in care homes is basic restorative, periodontal and preventive care. Half of this could be managed by general dentists, some on a domiciliary basis and the rest in primary care dental clinics. The commonest complexity was additional time. More complex treatments were associated with care in clinics, skills in special care dentistry and multidisciplinary care.

End-of-life palliative oral care in Norwegian health institutions. An exploratory study

Abstract: Objective To explore circumstances surrounding procedures and knowledge regarding oral care for terminal patients in Norwegian healthcare institutions. Methods A questionnaire was distributed to randomly selected hospitals (n = 19) and nursing homes (n = 57) in central and rural parts of Norway. The questionnaire included three closed-ended and three open-ended questions about oral care for terminal patients. If procedures existed, the respondents were asked to enclose or describe them. Results The response rate was 84% for hospitals and 79% for nursing homes. Of the responding institutions, 25% had no oral care procedures, nor did 48% recognise their importance. Insufficient knowledge about oral care was reported by 39%. Twenty-one different procedures were identified, and a great number of oral care products used. The most common was glycerol, used by 36% of the institutions. Only 2% used a concentration below 30% – the limit above which the glycerol has a desiccating rather than a moistening effect. The most common patient complaint was dry mouth (49%), followed by plaque, food particles and fungus infections, each experienced by 19%. The most common problem for the personnel was lack of knowledge (43%) and patient cooperation (38%). Conclusions Some terminal patients do not receive adequate palliative oral care in Norwegian healthcare institutions. Those that do are exposed to a great number of undocumented procedures and sometimes harmful products. There is a need for evidence-based procedures for oral care for terminally ill patients in health institutions, establishing interprofessional palliative healthcare teams and in particular improved training of the nursing staff.

Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults

Abstract: Objective This study compared the immediate impact of different transcutaneous electrical stimulation (TES) amplitudes on physiological swallowing effort in healthy older adults versus young adults. Background Swallowing physiology changes with age. Reduced physiological swallowing effort in older adults including lower lingua-palatal and pharyngeal pressures may increase risk for swallowing dysfunction (i.e. dysphagia). Transcutaneous electrical stimulation (TES) has been advocated as an adjunctive modality to enhance outcomes in exercise-based therapy for individuals with dysphagia. However, significant variation in how TES is applied during therapy remains and the physiological swallowing response to TES is poorly studied, especially in older adults. Materials and methods Physiological change in swallowing associated with no stimulation, sensory stimulation and motor stimulation was compared in 20 young adults versus 14 older adults. Lingua-palatal and pharyngeal manometric pressures assessed physiological swallowing effort. Results Multivariate analyses identified interactions between age and stimulation amplitude on lingual and pharyngeal functions. Motor stimulation reduced anterior tongue pressure in both age groups but selectively reduced posterior lingua-palatal pressures in young adults only. Sensory stimulation increased base of tongue (BOT) pressures in older adults but decreased BOT pressures in young adults. Motor stimulation increased hypopharyngeal pressures in both groups. Conclusion Age and TES level interact in determining immediate physiological responses on swallow performance. A one-size-fit-all approach to TES in dysphagia rehabilitation may be misdirected.

Wearing complete dentures is associated with changes in the three-dimensional shape of the oropharynx in edentulous older people that affect swallowing

Abstract: Objective To investigate the effects of wearing complete dentures on pharyngeal shape for swallowing in edentulous older people. Background In the absence of complete dentures, edentulous older people often lose the occlusal support necessary to position the mandible, which leads to an anterosuperior shift of the mandible during swallowing. This may result in pharyngeal shape changes effecting swallowing function in older people. However, the details of this phenomenon are currently unclear. Materials and methods Participants were 17 older edentulous volunteers. Cone-beam computed tomography imaging was performed with the participant in the seated position and wearing (i) both maxillary and mandibular dentures, (ii) maxillary dentures only and (iii) no dentures. During imaging, participants were instructed to keep their mouth closed to the mandibular position determined in advance during swallowing for each denture-wearing condition. The volume, height and average cross-sectional area of the velopharynx and oropharynx were measured, and the positions of the epiglottis and mandible were recorded. Results While the vertical height of the oral cavity and pharynx significantly decreased, the volume and average cross-sectional area of the oropharynx significantly increased when dentures were not worn (p < 0.01). The absence of dentures caused an anterosuperior shift of the mandible when swallowing and drew the epiglottis forward, resulting in expansion of the oropharynx where the tongue base forms the anterior wall. Conclusion The absence of dentures results in anatomical changes in oropharyngeal shape that may exacerbate the pharyngeal expansion caused by ageing and reduce the swallowing reserve.

Effects of oral moisturising gel containing egg yolk antibodies against Candida albicans in older people.

Abstract: Objective The aim of this study was to evaluate the inhibitory effects of oral moisturising gel containing egg yolk antibody against Candida albicans (anti-CA IgY) in older people. Therefore, we measured the number of Candia CFU present on oral swabs at baseline and after using the gel. Methods A randomised, double-blind, placebo-controlled trial was conducted among volunteers living in a nursing home in Japan. The participants were divided into two groups. The group 1 participants received oral care using an experimental oral moisturising gel with anti-CA IgY, and those in group 2 received oral care using a placebo oral moisturising gel without anti-CA IgY. The oral care was performed by care workers three times a day for 4 weeks. The participants’ tongues were sampled using a swab method at baseline and after 2 and 4 weeks of using the oral gel, and the number of C. albicans, Candida tropicalis and Candida krusei colonies was counted. Results The baseline oral condition of the participants in the two groups did not differ significantly. The experimental gel significantly reduced the number of C. albicans colonies from baseline to after 4 weeks of using the oral gel; however, no significant reductions were observed in the number of C. tropicalis or C. krusei colonies. Conclusion The use of oral moisturising gel containing anti-CA IgY for 1 month significantly reduces the number of C. albicans CFU present on swabs in older people.

A Persian version of Geriatric Oral Health Assessment Index

Abstract: Objective This study aimed to translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into a Persian version and to assess the preliminary psychometric properties of the translated index among a sample of Persian elders. Material and methods Twelve items included in GOHAI were first translated into Persian using a back-translation technique and then were compared with the original version. Four hundred and seventeen elderly subjects who were admitted to a day care centre answered GOHAI and an attached socio-demographic questionnaire. Internal consistency of the Persian version was measured by Cronbach's alpha. Test–retest reliability was assessed by intraclass correlation coefficient (ICC) and weighted kappa. Factor structure of GOHAI was evaluated by principal component factor analysis. Results Mean of GOHAI score was 45.71 (SD: 5.14; range: 27–51). The mean of GOHAI score was higher for the elders who rated their oral and general health as ‘good’. The Cronbach's alpha for GOHAI score was 0.748, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test–retest correlation for the total GOHAI score using ICC was 0.763 (95% CI = 0.713–0.809). Factor analysis revealed a three-factor solution that bolstered the theoretical construction of the index. Significant differences in the GOHAI scores were found for income and current number of teeth. Conclusion The Persian version of the GOHAI can be used reliably to identify oral health-related concerns of older Persian speakers, but further research is needed to confirm its cultural consonance in this population.

Influence of melaleuca and copaiba oils on Candida albicans adhesion.

Abstract: Objective To evaluate the efficacy of Melaleuca alternifolia and Copaifera officinalis in inhibiting the adhesion of Candida albicans biofilm. Background Over 65% of denture wearers suffer from denture stomatitis, which is one of the most prevalent forms of oral candidiasis. This disease is characterised by the inflammation of the oral mucosa in contact with the contaminated denture. The contaminated denture contributes to the switch of C. albicans from yeast to its pathogenic hyphal form. Candida albicans adheres and colonises the polymethylmethacrylate resin surfaces and thus contributes to the development of denture stomatitis. Materials and methods The minimal inhibitory concentration (MIC) of M. alternifolia and Co. officinalis was assessed by the agar dilution method. Sixty-six thermopolymerised acrylic resin squares were used and treated with phosphate-buffered saline, sodium hypochlorite 1%, melaleuca 0.75%, melaleuca 0.375%, melaleuca 0.188% and copaiba 10%. For adherence and biofilm formation, the treated squares were placed in six-well tissue culture plates containing 1 × 107 cells/ml of ATCC1023 or SC5314 in Roswell Park Memorial Institute (RPMI) medium, and after 12 h, the planktonic cells were counted. Results Copaiba oil did not inhibit C. albicans growth. However, melaleuca oil showed an MIC value of 0.375% (3.4 mg/ml) for ATCC10231 and 0.093% (0.84 mg/ml) for SC5314. Conclusions Our results demonstrated that M. alternifolia oil inhibited the growth of C. albicans. Moreover, both oils promoted significant adhesion reduction in the tested strains. These findings suggest the possibility of using these oils in prophylaxes against candidiasis.