Prosthetic rehabilitation of a completely edentulous maxilla with a sectioned implant-supported screw-retained prosthesis in a multiamputee patient with microstomia: A clinical report.

Providing fixed implant-supported prostheses for edentulous patients with microstomia or limited mouth opening is challenging. The clinical treatment of a patient who was a multiple amputee with microstomia and a complete loss of lips elasticity is described. A custom half-sectioned prosthesis was fabricated to resolve numerous difficulties. A screw-retained complete implant-supported prosthesis was developed from a monolithic zirconia framework supported by 4 implants and with digital scanning and computer-aided design and computer-aided manufacturing of the prosthesis. The protocol achieved a complete screw-retained implant-supported prosthesis and offered a solution for a patient with microstomia and limited mouth opening, leading to improved quality of life.

Quality of life of patients irradiated for head and neck cancer and impact of rehabilitation with a removable dental prosthetic: 1-year follow-up study.

Background: Head and neck cancer and its treatment cause significant functional, aesthetic, and social disabilities. These disabilities have a major impact on the quality of life of patients. When irradiation is required, removable dental prostheses are often the treatment of choice. This study investigated whether removable prosthetic rehabilitation improved patient function and aesthetics over the long term. Material and Methods: In this prospective study, we assessed quality of life in 78 patients with the General Oral Health Assessment Index (GOHAI) questionnaire. Assessments were performed before, and 1 week, 3 months, 6 months, and 12 months after denture insertion. We evaluated whether quality of life was influenced by the type of removable prosthesis and the primary tumour location. Results: We constructed mixed-effects linear regression models to identify correlates of the overall GOHAI score (GOAHI-add score) and the three domain-scores (functional, psychosocial, and discomfort/pain) in a longitudinal analysis over a 12-month follow-up. We compared scores (GOHAI-add score and domain-scores) in multivariate analyses between baseline (T0) and four post-insertion timepoints to determine significant changes. Conclusions: We found that removable prosthetic rehabilitation had an influence on the evolution of quality of life. The psychosocial component scores increased steadily over the year and changed more significantly than the functional and discomfort-pain components. The mandibular location of the primary lesion had a negative influence on quality of life. The type of removable prosthesis did not influence the results. Key words:Quality of life, head and neck cancer, GOHAI, dental prosthesis, radiotherapy.

Quality of life in irradiated patients with head and neck cancer: A preliminary study about the impact of prosthetic rehabilitation.

BACKGROUND: Oral quality of life is of great importance in head and neck cancer, where each patient combines functional, social and esthetic needs. Our study aimed to evaluate the influence of prosthetic and/or maxillofacial rehabilitation on patients' perceived oral quality of life. MATERIAL AND METHODS: The General Oral Health Assessment Index (GOHAI) was used in 28 patients with head and neck cancer who had undergone radiotherapy, recruited at La Timone University Hospital, Marseille, France, and who required prosthetic rehabilitation. The questionnaire was completed at three timepoints in the study: before insertion of the prosthesis (T0), then one week (T1) and three months after insertion (T2). RESULTS: The percentage of patients with poor quality of oral health decreased from 96.4% to 64.3% between T0 and T1. Between T0 and T1, the mean score of the psychosocial component of the GOHAI increased from 14.28 ± 4.51 to 20.14 ± 5.20 and the mean functional component score increased from 9.32 ± 3.86 to 12.07 ± 4.04. CONCLUSIONS: Prosthetic rehabilitation appeared to have a positive impact on oral quality of life in our study subjects, particularly on social relations and self-esteem. Its influence on pain and discomfort remains to be clarified. This preliminary study gives a prospective view of the impact of prosthetic rehabilitation in patients with head and neck cancer who had undergone radiotherapy. Analysis of data yielded by cross-referencing of different questionnaires should make it possible to refine these results. Key words:GOHAI, quality of life, head and neck cancer, prosthetic rehabilitation.

Objective and perceived oral health status of elderly nursing home residents: a local survey in southern France.

OBJECTIVE: The aim of this study was to compare the perceived oral health of elderly persons and the clinical reality of their oral status. BACKGROUND: Persons aged over 60 have considerable need for oral health care; a need that increases over time. However, this population appears to be unaware of their state of oral health, and this may be a further obstacle to professional management. We thought it useful to examine the objective and the perceived oral health of these patients. Understanding what may influence their perception can help us to improve their management. METHODS: The data analyzed in this work are the findings of a field survey carried out in elderly nursing home residents. Their objective oral health was evaluated by using two variables: oral profile, determined by clinical examination, and the oral health index determined using the Oral Health Assessment Tool (OHAT). Perceived oral health was evaluated using the various categories and fields of the General Oral Health Assessment Index (GOHAI). RESULTS: Our clinical study showed a discrepancy between perceived oral health and the clinical reality: although a significant association can be demonstrated between the OHAT and the GOHAI, there are considerable variations. It also appeared that the number of teeth and total edentation considerably influence perceived oral health and that findings vary according to different situations. CONCLUSION: Numerous factors influence elderly persons' perception of their true oral health. In order to improve our elders' quality of life, the necessary measures must be taken for the follow-up and regular monitoring of their oral health. At the same time, all possible means should be used and awareness should be raised to improve the health behavior and perception of patients and their entourage.

Use of care and the oral health status of people aged 60 years and older in France: results from the National Health and Disability Survey.

OBJECTIVE: We aimed to analyze, from the data in a national survey, the use of oral care and the oral health status of patients living at home or in an institution. BACKGROUND: Patients aged 60 years and older have important oral health needs, but their oral management may differ according to their immediate environment. The fact of living at home or in an institution can influence the use of care and alter the patients' perception of their oral health status. METHODS: The data analyzed were taken from a survey on disability and health carried out in 2008-2009, which is representative of the population living in France. It consists of two sections, one centered on disability and health among home-dwellers and the other on patients living in an institution. In each of these two populations, we carried out descriptive analysis of three themes: use of care, forgoing of care, and oral health. RESULTS: Although visits to physicians and specialists were frequent, visits to dentists were lower in both populations. While a minority of patients forwent care, it was dental care that was mainly forgone by both home-dwellers and institutionalized patients. The cost factor remained the principal reason, but other factors such as fear or accessibility problems were cited. Use of a dental appliance was considerably more frequent among institutionalized patients than among home-dwellers, with just over half the institutionalized population wearing a dental appliance. Perceived state of oral health remained difficult to interpret. CONCLUSION: To improve access to oral care for the elderly, the patients, their entourage and health providers need increased awareness and information on the importance of good oral health. Better information must be associated with regular clinical examination.

Alveolar bone loss and ageing: possible association with coronary heart diseases and/or severe vascular diseases.

OBJECTIVE: The objective of this study was to utilise a new methodological approach based on radiographic examinations to demonstrate a potential association between coronary heart diseases (CHD) as well as severe hypertension and alveolar bone loss (ABL) in older adults. BACKGROUND: Many studies, primarily assessing clinical parameters, underline the association between periodontal diseases and cardiovascular diseases. The relationship between ABL and CHD/vascular diseases (VD) is potentially of high importance because of their prevalence in populations, and they represent an important issue in the fields of epidemiology and public health. Therefore, this topic was approached with new tools. MATERIALS AND METHODS: The study was comprised of 236 participants over 50 years. A clinical examination and a radiographic assessment of ABL were performed. Direct measures of alveolar bone level were recorded using CT scans, and different variables were studied (age, sex, Plaque index, cigarettes per day, coronary heart disease and vascular disease status). A medical examination report was attached to the investigation file. RESULTS: The results confirmed a positive association between CHD/VD and periodontal destruction; alveolar bone destruction represented a risk factor for CHD/VD [odds ratio (OR): 1.27; 95% CI: 1.01-1.60; p < 0.037]. CONCLUSION: This study supports an association between periodontal diseases and CHD/VD independent of known confounders, although an aetiological link of causality has not been established.