[Oral health in dementia patients].

Dementia shares multiple clinical symptoms characterized by cognitive deficits that interfere with daily activities but differentiated by etiology. Advanced age is a major risk factor for dementia especially in more developed countries where older adults are most evident and growing rapidly. Since the prevalence of edentulism is decreasing, greater efforts will be necessary in the future to maintain oral health in dementia patients. Meeting the oral care needs of these individuals can be very challenging and should include prevention, maintenance of oral function and improved access for emergencies as well as regular dental care. Dental professionals should provide complex treatment utilizing appropriate behavioral and communication techniques. At the national level there is also a need for oral disease prevention programs directed towards staff, family members, and other caregivers of dementia patients.

Geriatric oral health issues in the United States.

Of the more than 270 million people in the United States, about 13 per cent are aged 65 years or older. As in most other countries throughout the world, this proportion of the population is projected to increase in the coming years. To care for this ageing and racially/ethnically diverse population, health care professionals, especially dentists, must initiate changes in public policies, available resources and access to services. The dental profession especially must improve awareness among the general public and health care professionals of the link between oral health and general health. Immediate improvements should be made to increase the proportion of dentists who are willing and qualified to treat these patient groups. Increasing the reimbursement rates available through the Medicaid programme and expanding the types of services Medicaid recipients can seek are critical. Dental education programmes must continue to provide more training opportunities to prepare professionals to meet the needs of these patients.

Inhibitory actions of ceramide upon PKC-epsilon/ERK interactions.

We have previously shown that interleukin-1 receptor-generated ceramide induces growth arrest in smooth muscle pericytes by inhibiting an upstream kinase in the extracellular signal-regulated kinase (ERK) cascade. Here, we now report the mechanism by which ceramide inhibits ERK activity. Ceramide renders the human embryonic kidney 293 cells (HEK 293) resistant to the mitogenic actions of growth factors and activators of protein kinase C (PKC). A role for PKC to mediate ceramide inhibition of growth factor-induced ERK activity and mitogenesis is suggested, as exogenous ceramide directly inhibits both immunoprecipitated and recombinant PKC-epsilon activities. To confirm that PKC-epsilon is necessary for ceramide-inhibited ERK activity, HEK 293 cells were transfected with a dominant-negative mutant of PKC-epsilon (DeltaPKC-epsilon). These transfected cells respond to insulin-like growth factor I (IGF-I) with a significantly decreased ERK activity that is not further reduced by ceramide treatment. Coimmunoprecipitation studies reveal that the treatment with IGF-I induces the association of ERK with PKC-epsilon but not with PKC-zeta. Ceramide treatment significantly inhibits the IGF-I-induced PKC-epsilon interaction with bioactive phosphorylated ERK. Ceramide also inhibits IGF-I-induced PKC-epsilon association with Raf-1, an upstream kinase of ERK. Together, these studies demonstrate that ceramide exerts anti-mitogenic actions by limiting the ability of PKC-epsilon to form a signaling complex with Raf-1 and ERK.

Spectrum of care treatment planning: application of the model in older adults.

A model for treatment planning is presented to help emphasize the most important elements of the clinical decision-making process for older adult patients. The patient's concerns and needs in the domains of function, symptoms, pathology, and esthetics are the central elements of the process. With sophisticated assessment methods and creative interventions, the dentist can work with each patient to identify and successfully address his or her needs and concerns. This model is applied to two clinical cases which illustrate the importance of considering innovative treatment plans, even when the patient is advanced in years.

Oral health status of older adults in Arizona: results from the Arizona Elder Study.

This study was undertaken to compare oral health status of independent community-dwelling elders with those using long-term-care services. Clinical examinations and self-reported sociodemographic data were collected for 2927 older adults living independently, using home-care services, or living in nursing facilities. Mean age of dentate participants (n = 2021) was 72.2 years (range, 50-103 years); mean number of teeth, 18.16; mean DFS, 28.86; and mean RCI, 15.23. In multivariate analyses, receiving home-care services or living in a nursing facility was significantly predictive of poorer oral health status with respect to both coronal and root caries. This was also true for ethnic groups other than non-Hispanic-white. We concluded that, in a large, multi-ethnic sample, direct comparisons highlight significant unmet treatment need among users of long-term-care services, compared with independent older adults living in the same communities.

Periodontal health and the role of the dental hygienist.

This study was conducted to evaluate the influence of hygienist services in an Israeli kibbutz (communal settlement) upon periodontal disease levels and periodontal treatment needs. The Periodontal Index (PI) and the Community Periodontal Index of Treatment Needs (CPITN) were utilised to examine 412 subjects of which 202 adult participants resided in a kibbutz employing a hygienist and 210 participants resided in one of three kibbutzim lacking a history of hygienist employment. Examinations were conducted by two calibrated examiners. Results revealed a gradual increase in the CPITN and PI scores with age and generally statistically significantly higher periodontal pathology and treatment need scores among the population not employing a dental hygienist (especially within the 35-44 age grouping). The results of this study suggest that employment of a dental hygienist may be an effective approach to lower the burden of periodontal disease within a community.

Dental caries prevalence and treatment need in Chiriqui Province, Panama.

A pathfinder pilot survey was conducted in rural Chiriqui Province, Panama, using standard WHO methodology, in order to estimate dental caries prevalence and treatment need. Examinations for caries and treatment need were performed by six trained, experienced examiners. From a convenience sample of 2,597 subjects, a stratified cluster sample was constructed using index ages 12 and 15 years and age groups 35-44 and 65-74 years. The results showed a mean Decayed, Missing and Filled Teeth index (DMFT) of 4.08 for 12 year olds, 6.40 for 15 year olds, 13.20 for the 35-44 age group, and 18.88 for the 65-74 age group (P < 0.001). No statistically significant differences by gender were found. These findings rank rural Panama with Mexico and Haiti when compared to the results of other Central American community studies. The percentage of caries free 12 year olds was 6.8 per cent. Of the total sample, 74.7 per cent of individuals would require one or multiple surface restorations and 47.9 per cent would require at least one extraction. Restorative need was greatest in the 15 year olds. The severity of dental caries in this sample was moderately severe and the treatment need extraordinarily high.

Knowledge and attitudes of Arizona high-school coaches regarding oral-facial injuries and mouthguard use among athletes.

The authors assessed high-school athletic coaches' perceptions about oral-facial injuries and mouthguard use in sports that do not mandate mouthguard use. About 72 percent of the coaches said that their athletes sustained oral-facial injuries, 28 percent that some athletes used mouthguards regularly, 48 percent that athletes had sustained injuries and did not use mouthguards regularly, and 31 percent said they would not encourage mouthguard use. Advocacy for mouthguard use should focus on coaches, coaches' associations and rule-making organizations.

Dental health profile of a population with mental retardation in Israel.

The dental status and treatment needs of Israeli children and adults with mental retardation were studied in a random sample of 387 subjects. Four levels of mental retardation were represented: (1) educable (n = 70), (2) trainable (n = 92), (3) with mental retardation and behavioral problems (n = 106), and (4) with mental retardation and severe physical handicap (n = 119). The total age-adjusted DMF-T was 12.78 and differed significantly by behavioral group (p < 0.001); the M-T was 10.70 for the educable group compared with 5.52 for the group with mental retardation and severe physical handicap. Total treatment needs included a participant mean of 3.32 for restorations and 0.61 for extractions. Institutions having dental clinics had higher participant mean DMF-T, D-T, M-T, and F-T values (p < 0.05) compared with those institutions which had no clinics (16.04 vs. 9.74; 5.17 vs. 5.06; 9.45 vs. 4.16; 1.41 vs. 0.52). Age-adjusted CPITN scores significantly differed by behavioral group; the group with mental retardation and severe physical handicap had the highest CPITN 3 category mean score of 2.93 compared with x = 1.89 for the educable group; however, the educable group had the most sextants with no teeth (x = 2.48). Findings confirm high dental morbidity and significant oral health differences by behavior group, age, and dental clinic status. Advanced training is recommended for dental providers and the staffs of institutions to enhance oral health outcomes.

The relationship of age and gender to fear and anxiety in response to dental care.

The apparent association in the published literature of gender and age with dental fear and anxiety is far from consistent or universal. A random, age-stratified telephone survey of 398 adults was performed in a US metropolitan area: Denver, Colorado. Information collected included Kleinknecht's Dental Fear Survey (DFS). In addition to total DFS scores, values were also calculated for the sums of the five DFS physiologic response items (PATRESP) and 12 DFS fear-producing stimulus items (DENTSTIM). Tests for reliability of these three scales were performed (alpha = 0.804 to 0.936). In this sample population, significant age and gender differences were noted. In general, fear and anxiety decreased in importance with increased respondent age, with the largest difference noted between the 40-50 and 60-69 age groups. Increased fear and anxiety were most apparent among younger females (20-30 and 40-50) as compared with older females (60 and older). However, among males, the summary variable for physiologic response to fear and anxiety did not appear to be age-related. Among the oldest respondents (ages 70+), 12.2% did report a "major" response to muscle tension when in the dental chair. Females reported more fear of some stimuli associated with dental care (e.g., "feeling the drill in the mouth") than did males.

The old-old dental patient: the challenge of clinical decision-making.

As the U.S. geriatric population grows older, dentists should recognize the need to carefully consider age-related concerns that influence clinical decision-making. The authors discuss several prevalent problems typically found in "old-old" patients and propose a model for determining the appropriate extent of dental care for them.

Variables affecting denture satisfaction in Israeli elderly: a one year follow-up.

The purpose of this study was to investigate patient satisfaction with complete dentures after one year of use and several potential mitigating factors in Israeli elderly. Eight-four patients who were 54 years of age or older and who were rehabilitated with complete dentures were recalled for examination 12-15 months later; 84.5% (n = 70) were interviewed and reexamined by calibrated examiners who judged all prostheses to be clinically acceptable. The mean age of participants was 71.90 years and two-thirds were females. Over 73% reported that they wore their dentures "always." Nearly 79% indicated that they were pleased with their denture appearance. Difficulties were reported by 28.2%, while 46.5% reported difficulties with chewing. Chewing problems were significantly related to swallowing problems (P < .001); food enjoyment "as much now as you did five years ago" (P < 0.001); difficulties speaking (P < 0.05); and "having sores under your dentures" (P < 0.01) which affected 28.2% of the survey group. Married elderly expressed higher satisfaction with denture comfort as compared to "single" patients, and patients suffering from any systemic chronic diseases were more dissatisfied with appearance. A summary satisfaction scale of 7 items was constructed (Cronbach alpha reliability 0.6834) and logistic regression performed to identify key model variables for overall satisfaction. Stat sign findings included: 1) immigration year; 2) neurological or psychological disorder; and 3) age. The model correctly classified 92.75%. Findings suggest that a variety of factors may influence denture satisfaction. Gathering detailed information by means of a questionnaire before new denture fabrication may be an important tool for the dentist in predicting and consequently enhancing patient satisfaction with complete dentures.

Advances in portable and mobile equipment systems.

Specific efforts need to be directed towards eliminating and/or minimising the significant barriers that threaten the oral health of nursing home and homebound individuals. Exciting new portable dental system options are now available which will help to overcome difficulties associated with meeting the dental needs of this cohort.