Geriatric oral health concerns, a dental public health narrative

Across the world, the segment of the elderly in populations is seen to be increasing at a rapid rate. There also exists a trend in which more teeth are retained as age increases due to effective dental public health measures like fluoridation. This inevitably places an increased need for dental healthcare among the geriatric populations. Since oral health greatly affects the systemic health of aged individuals, it is imperative for dentists and physicians to work together as a team to impart treatment to the best of one’s abilities for geriatric patients. It is therefore, necessary to first assess the oral health concerns surrounding the geriatric population from the perspective of public health dentistry. Relationship of the elderly with periodontal disease, dental caries, salivary hyposalivation and xerostomia, cognitive changes, and simultaneous usage of diverse medications was discussed. This paper reviewed the literature and then examined and discussed the various problems mentioned in depth and suggested recommendations for a plan of action. Knowledge about the specific oral health concerns and issues will help to better position us in developing strategies for providing better oral healthcare to the geriatric population in addition to the existing systemic healthcare. In the future, the elderly will make up a huge portion of the demographic visiting dentist regularly for a myriad of oral health problems. Dental health professionals therefore, must have adequate training and competency to deal with the predicament of this geriatric population. Preventive and treatment services can ensure healthy aging which will improve the quality of life.

Effectiveness of xylitol and polyol chewing gum on salivary streptococcus mutans in children: A randomized controlled trial

Dental caries is a multi-factorial, infectious disease, the prevention of which is based on multifaceted approaches. Chewing sugar-free gum has potential beneficial effects on dental health. Objectives: The aim of this study is to assess and compare the effectiveness of xylitol and polyol chewing gums on salivary Streptococcus mutans in 12–15 years old schoolchildren residing in hostels in Belgaum city. The acceptability of the two chewing gums was also assessed. Materials and Methods: Sixty children of 12–15 year age groups from three hostels, who fulfilled all the inclusion criteria, were included in this triple blind randomized controlled field trial. They were then randomly allocated into one of the three groups using lottery method. Xylitol chewing gum, polyol chewing gum and control group (no chewing gum). Patients were instructed to chew one pellet two times a day after meals for 5 min each for 30 days. Salivary samples were collected at baseline, 30 days after chewing gum use and 30 days after discontinuation, for microbiological analysis. The data were subjected to statistical analysis using SPSS software version 18. Results: Chewing 100% xylitol chewing gum 2 times a day for 5 min for 30 days can successfully reduce salivary S. mutans counts. The xylitol gum has shown a maximum benefit against salivary S. mutans when compared to polyol gum and control group. Conclusion: Xylitol-containing chewing gums can be used as an adjunct to regular home care preventive procedures to prevent dental caries.

Prevalence of dental caries and its relationship with trace elements present in drinking water among 12 year old children in rural areas of andhra pradesh, india

AIM: The purpose of the present study was to assess the relationship of trace elements present in drinking water and dental caries in children aged 12 years in rural areas of Andhra Pradesh India. MATERIAL AND METHODS: A cross-sectional study was conducted among 451children aged 12 years. Clinical examination was carried out and caries experience was recorded. Drinking water samples were collected and subjected to trace element analysis using ICP-MS equipment. Oneway ANOVA, Chi-square test, Pearson's correlation coefficient and Multiple Logistic Regression were used for the statistical analysis. RESULTS: A statistically significant relation was found between caries and trace elements like Vanadium (p<0.001), strontium (p<0.001) and lead (p<0.01) in the drinking water. CONCLUSION: It may be postulated from this study that a mixture of trace elements such as fluorine, strontium, boron, and molybdenum may work together to retard caries.

In vitro antibacterial activity of ethanolic extract of Morus alba leaf against periodontal pathogens.

Context: Antibiotic resistance is a major problem with inadvertent usage. Thus, there is a need to search for new antimicrobial agents of herbal origin to combat antibiotic resistance. One such plant is Morus alba which has a long history of medicinal use in traditional Chinese medicine. Aim: To compare the antibacterial activity of ethanolic extract of M. alba leaves with chlorhexidine gluconate against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia. Settings and Design: Experimental in vitro study. Methodology: Crude extract from the leaves of M. alba were prepared by Soxhlet extraction method by using ethanol as a solvent. Minimum inhibitory concentration (MIC) of the extract was assessed against A. actinomycetemcomitans, P. gingivalis and T. forsythia, and compared with that of chlorhexidine gluconate by broth dilution method. Results: P. gingivalis was the most sensitive organism against the M. alba extract with an MIC value of 1.95 mg/ml; while T. forsythia and P. gingivalis both were most sensitive organisms against chlorhexidine gluconate with MIC values of 0.00781 mg/ml. Conclusion: M. alba possess good antibacterial activity against A. actinomycetemcomitans, P. gingivalis and T. forsythia and thus would be beneficial for the prevention and treatment of periodontal disease. However, chlorhexidine gluconate was found to be more effective when compared to M. alba.

Perlecan (basement membrane heparan sulfate proteoglycan) and its role in oral malignancies: An overview.

Perlecan means pearl-like structures. Perlecan is a large proteoglycan (400-500 kDa) present in virtually all vascularized tissues with a distribution that is primarily confined to basement membranes including those of oral mucosa. It is a basement membrane-type heparan sulfate proteoglycan. Perlecan is synthesized by basal cells and fibroblasts adjacent to the basal lamina . Perlecan is also synthesized by vascular endothelial and smooth muscle cells present in the extracellular matrix. It has been demonstrated in recent years that perlecan is distributed in the stromal space of various pathophysiological conditions. The complex pleiotropy of perlecan suggests that this gene product is involved in several developmental processes, at both early and late stages of embryogenesis, as well as in cancer and diabetes. In the oral cavity, perlecan expression is reported to basal cells in normal mucosa and its expression increases in precancer and cancerous conditions. It is also expressed in various odontogenic tumors such as ameloblastoma, keratocyst odontogenic tumor, and also salivary gland tumors such as adenoid cystic carcinoma, mucoepidermoid carcinoma, etc.

Questionnaire vs clinical surveys: The right choice?-A cross-sectional comparative study.

Purpose: To investigate the practical value of using questionnaires (self perceived assessment) as compared with clinical examinations (normative assessment) and to evaluate the role of socioeconomic status and implications of the results in understanding the public perception of oral health. Materials and Methods: This was a cross-sectional single-blind study. A purposive sample of 860 bank employees of Belgaum city, India, were asked to fill in a close-ended questionnaire inquiring about their socioeconomic status, dental, periodontal health levels and treatment needs. Clinical examinations, employing the WHO dentition status and Community Periodontal Index, were performed to determine normative status and needs. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values. Results: The kappa values ranged from 0 (treatment needs) to 0.67 (for prosthesis). The degree of agreement with the following kappa values and sensitivity was seen in filled teeth (0.52, 60%), missing teeth (0.62, 83.8%), and prosthesis (0.67, 58.3%). However, the disagreement was seen with all other questions with average kappa value of 0.20. Conclusions: Self-assessment questionnaires were of low value in evaluating dental, periodontal health status and treatment needs in the study subjects. Findings reflect a low level of awareness that may influence care-seeking behavior and socioeconomic status has a clear role to play in dental health perception.

Toothbrush age, wear, and plaque control.

OBJECTIVE: This study aims to assess the effect of toothbrush age and wear on plaque control. MATERIALS AND METHODS: 36 dental students were recruited for the 3-month double blind trail. Each participant received commercially purchased soft toothbrush and nonfluoridated toothpaste. Group I (n= 18) used the same brush for 3 months and Group II (n=18) replaced the brush every month. Toothbrush wear was recorded using Rawls formula (1989) and Plaque score was recorded using Patient Hygiene Performance index (1968). Recalls for the participants were scheduled after 1 (T1), 2 (T2) and 3 months (T3). OBSERVATIONS: Results indicated that the toothbrush wear varied widely amongst the participants. 25-62% wear was observed in Group I and 6-24% in Group II. The participants using the same toothbrush for 3-months did not exhibit statistically significant different plaque scores compared to those who replaced their toothbrush every month. Toothbrush age and wear was not related to plaque control.