The effectiveness of 2-implant overdentures - a pragmatic international multicentre study.

The purpose of this multicentre observational study was to determine patient satisfaction with either conventional dentures or mandibular 2-implant overdentures in a 'real world' setting. Two hundred and three edentulous patients (mean age 68·8 ± 10·4 years) were recruited at eight centres located in North America, South America and Europe. The patients were provided with new mandibular conventional dentures or implant overdentures supported by two implants and ball attachments. At baseline and at 6 months post-treatment, they rated their satisfaction with their mandibular prostheses on 100-mm visual analogue scale questionnaires. One hundred and two (50·2%) participants had valid baseline and 6-month satisfaction data. Although both groups reported improvements, the implant overdenture group reported significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew. These results suggest that edentulous patients who choose mandibular implant overdentures have significantly greater improvements in satisfaction, despite their relatively higher cost, than those who choose new conventional dentures.

Short duration hyperbaric oxygen treatment effects blood flow in rats: pilot observations.

Hyperbaric oxygen (HBO) treatment has been found to improve healing in living tissues, especially those poor in oxygen. The effects of HBO have also been tested in rat experiments. However, oxygen partial pressure in rat's arterial blood is normally about twice that in humans. Disregarding this, a human HBO protocol has been applied in previous rat experiments with HBO. Laser Doppler flowmetry (LDF) is a non-invasive means for measuring blood flow. Using LDF, we measured the blood perfusion rate in rats receiving HBO, according to a modified protocol, in a region of healing soft tissue with bone defect. The results indicate that, in rats, shorter HBO treatment with high O2 pressure can significantly improve the blood flow of healing tissues. In this study, an elevated blood perfusion rate was still evident 2 weeks after the ending of HBO therapy, which indicates improved revascularization in the wound area. A short HBO protocol would save time and effort in future HBO experiments on rats.

Bronchopneumonia and oral health in hospitalized older patients. A pilot study.

AIMS: To correlate microbial findings obtained by bronchoalveolar lavage in pneumonia patients with the clinical situation of the oral cavity. METHOD: Quantitative aerobic and anaerobic cultures were carried out in 150 ml samples of bronchoalveolar lavage (BAL) obtained by means of an endoscope (Video Endoscope Pentax) inserted per os in the infected bronchus. MATERIAL: Twenty consecutive patients with a tentative clinical diagnosis of bronchopneumonia in whom BAL was carried out for diagnostic purposes. A clinical evaluation of the oral health status (oral hygiene, caries, periodontal diseases) was subsequently carried out. RESULTS: In seven edentulous subjects wearing complete dentures the culture of anaerobic microorganisms was negative or yielding less than 100 cfu/ml BAL. Two patients yielded high counts of S. aureus and one high counts of P. aeruginosa. In the 13 subjects with natural teeth left one showed high counts of Veillonella spp. (anaerobic) + P. aeruginosa, one high counts of Veillonella spp. + S. aureus, one high counts of P. aeruginosa + S. aureus and one high counts of E. coli. These four subjects showed poor oral hygiene, periodontal pockets and a BAL microflora consistent with periodontal pathology. CONCLUSION: The results of this pilot study suggest that microorganisms of denture plaque or associated with periodontal diseases may give rise to aspiration pneumonia in susceptible individuals.

Effects of an oral health program on the occurrence of oral candidosis in a long-term care facility.

OBJECTIVES: The aim was to evaluate the effectiveness of a preventive oral health program on the prevalence of oral candidosis in 237 frail or dependent residents in a long-term care facility. Half of the residents were included in an experimental group which benefited from a preventive oral hygiene program including instruction of the carers and implementation of a recall program for professional oral hygiene care. METHODS: Intraoral examinations and yeast cultures from the oral mucosa and the fitting denture surface were carried out at baseline and 18 months later. The outgrowth of yeast was estimated on Oricult-N dip slides using the scale: no growth; 1-20 colonies; 21-100 colonies; >100 colonies. RESULTS: At baseline (n = 237) and at 18 months (n = 159) the experimental and the control groups were similar with regard to the residents' distribution by age, sex, dental and prosthetic status and prevalence of denture stomatitis. The 78 residents lost had the same baseline characteristics as the survivors, except for being older. In the experimental group the severity of the inflammation of the palate decreased (P = 0.005) as well as the prevalence of glossitis (P = 0.005). At baseline high yeast scores from the mucosa (>20) were observed in about 50% of the residents in the experimental as well as the control group. At 18 months this figure was 23.4% for the experimental and 48.7% for the control group (P = 0.001). There was also a reduction of the number of residents with positive cultures and the denture yeast scores at 18 months in the experimental group (P = 0.05). CONCLUSIONS: This study has shown that the preventive program was effective in reducing the colonization of the oral mucosa and dentures by Candida and thereby improving the health of the oral mucosa.

Dental care of elderly in nursing homes: perceptions of managers, nurses, and physicians.

Epidemiologic studies have shown that the oral health of residents in nursing homes is poor. This can be due to their impaired ability to maintain appropriate oral hygiene or to a lack of interest in oral care among those responsible for the care. The purpose of this study was to assess the attitudes of managers, caregivers, and physicians with regard to oral health care issues of their residents. A questionnaire sent to the managers of the 65 nursing homes in Geneva was returned by 47 (69%). According to the managers, 85% of the nursing homes organized transportation for the residents to a dental office; dental care with follow-up treatment was organized in 79% of the facilities; 68% of the facilities organized treatment for dental emergencies. Another questionnaire was distributed to 169 caregivers in 13 nursing homes. A majority had received no education in oral hygiene care of the residents. The caregivers did accept responsibility for oral hygiene care, but preferred to share it with a dentist responsible for the oral health care of the residents. Only 33% of the physicians indicated that they carried out a systematic examination of the oral cavity, and 20% agreed that the oral cavity might be an integrated part of the body. The majority of the physicians were in favor of more information on oral diseases and regular visits by a dentist; however, close collaboration with a dentist on oral health issues had a low priority.

Successful aging--the case for prosthetic therapy.

Reduced chewing ability in community-dwelling older people is linked to the presence of removable dentures and having fewer than 20 natural teeth present. Compensation is provided by chewing longer and swallowing larger food particles. Replacement of posterior tooth loss by fixed or removable prostheses increases the activity of the masticatory muscles, and reduces chewing time and the number of chewing strokes until swallowing. In residents of nursing homes and long-term care facilities undernutrition is prevalent because of general medical problems, reduced appetite, and poor quality of life. Poor oral health and xerostomia are often present and may have a negative effect on masticatory function and nutrition, precipitating avoidance of difficult-to-chew foods. There is no evidence that the provision of prosthetic therapies can markedly improve dietary intakes; however, it might improve oral comfort and quality of life and avoid enteral alimentation.

Relationship between oral health and nutrition in very old people.

OBJECTIVE: To evaluate the relationship between oral health status and nutritional deficiency. DESIGN: Cross-sectional clinical study. SUBJECTS: 324 institutionalized frail older adults (mean age 85). MEASUREMENTS: Structured oral examination including an evaluation of mucosa, periodontal state, caries prevalence and denture quality. The nutritional status was assessed using serum albumin concentration and the body mass index. Physical dependence was assessed using the Barthel index. To identify oral health disorders associated with markers of malnutrition we performed the Pearson chi2 test separately for edentulous and dentate patients. Subjects with at least one of the identified oral disorders were classified as having compromised oral functional status. RESULTS: About two-thirds of the subjects were functionally dependent and half had either a body mass index <21 kg/m2 or serum albumin <33 g/l. Among the edentulous, wearing dentures with defective bases or not wearing dentures at all were the factors most associated with malnutrition. In dentate subjects, corresponding identifiers were the number of occluding pairs of teeth (five or fewer, either natural or prosthetic), the number of retained roots (four or more), and the presence of mobile teeth. According to these criteria, 31% of the subjects had a compromised oral functional status. This was more frequently found in dependent subjects (37%) than semi-dependent subjects (18%; odds ratio, 2.6; 95% confidence interval, 1.4-4.8). Those with compromised oral functional status had a significantly lower body mass index and serum albumin concentration. CONCLUSION: Specific detrimental oral conditions are associated with nutritional deficiency in very old people.

Oral status and nutrition in the institutionalized elderly.

OBJECTIVES: To evaluate, in an elderly population, whether poor oral status might be a contributing factor to the development of undernutrition and might be associated with less eating pleasure, more subjective eating difficulty and increased mashed food consumption. METHODS: An oral examination and an evaluation of masticatory capacity were performed on 120 institutionalized elderly subjects. The nutritional assessment included serum albumin concentration, the Mini Nutritional Assessment and a questionnaire on eating habits. RESULTS: Edentulous subjects without dentures or with only one complete denture had significantly lower MNA scores than edentulous subjects with two complete dentures (p < 0.05). Edentulous subjects with two complete dentures more frequently reported taking pleasure from eating (p = 0.05), and had less frequent difficulties with hard foods (p = 0.01) than edentulous subjects without dentures or with only one complete denture. Mashed food consumption (p < 0.01) was also reported more frequently in edentulous subjects without dentures or with only one complete denture. Subjects with two complete dentures had similar or better MNA scores as dentate subjects with relatively few remaining teeth (10.4 +/- 7.8 teeth). About half of the subjects (53%) could not perform the masticatory test. These subjects had lower MNA scores (p = 0.001) and a larger proportion ate mashed food (p < 0.001) compared to those who were able to perform the test. CONCLUSIONS: Poor oral status (edentulous without dentures or with only one complete denture) increased difficulty in eating hard foods, increased mashed food consumption and decreased eating pleasure. It seemed also to put institutionalized subjects at higher risk of undernutrition.

Associations between self-assessed masticatory ability, nutritional status, prosthetic status and salivary flow rate in hospitalized elders.

OBJECTIVES: To compare the association between self-assessed masticatory ability and nutritional status with general health status, salivary flow and dental/prosthetic status. DESIGN: A questionnaire and a cross-sectional clinical investigation combined with a measurement of salivary flow rates. SUBJECTS AND METHODS: A cohort of 99 elderly, non-psychiatric patients in a geriatric hospital; clinical examination to determine dental and prosthetic status, oral health and whole unstimulated (USFR) and stimulated (SSFR) salivary flow rates, examination of anthropometric measures, serum albumin level and body mass index (BMI); questionnaire designed to produce yes or no answers related to masticatory function, nutritional status, appetite and prosthesis function; mini mental score examination (MMES). MAIN OUTCOME MEASURES: USFR, SSFR, BMI, anthropometric measures and serum albumin level; complaints related to appetite and xerostomia. RESULTS: Mean age of the 99 patients was 82.5 +/- 4.04 with a MMES of > 21; 50% with malnutrition of severe or intermediate degree, and 86% with moderately or severely reduced serum albumin concentration; 55% reported recent loss of appetite and 52% had symptoms of oral dryness. Recent loss of appetite was associated with reduced serum albumin and complaints of dry mouth and lack of appetite was associated with BMI < 21, 10% weight loss during the preceding 6 months, SSFR < or = 0.5 ml min-1 and wearing dentures. Complaints on poor retention of the maxillary denture were associated with recent weight loss and SSFR < or = 0.5 ml min-1. CONCLUSIONS: Malnutrition in hospitalized elders is primarily associated with recent loss or lack of appetite whereas complaints related to dentures are associated with poor denture quality.

Effects of an oral health program on selected clinical parameters and salivary bacteria in a long-term care facility.

The aim of this study was to evaluate clinically and microbiologically the effects of a preventive oral health program in a long-term care facility. A total of 116 dentate elderly residents agreed to participate, and half of them were included in an experimental group. Almost all of the residents were mentally or physically handicapped, and many were dependent on care-givers for daily living activities. Oral examination and microbiological sampling were performed at baseline and 18 months later. The experimental group benefited from a preventive program, including an oral hygiene course for the health care providers and regular recalls by dental hygienists of the residents. After 18 months, the plaque indices were statistically similar to those at baseline in both groups. Mutans streptococci counts and active root caries at 18 months were lower compared to baseline in the experimental group but did not change significantly in the control group. Thus, it seems that, while the preventive program failed to decrease plaque indices, it was effective in reducing mutans streptococci colonisation and caries prevalence.

Clinical and microbial findings on osseo-integrated implants; comparisons between partially dentate and edentulous subjects.

Clinical and microbiological parameters in partially dentate and edentulous patients treated with oral implants were compared in this study. Twenty-four subjects including 9 males and 15 females, aged 33 to 70 were treated with 98 Brånemark fixtures. Plaque index, gingival index, pocket depth, implant mobility and crevicular fluid flow rate were measured. Latex agglutination tests identified the presence of Actinobacillus Actinomycetem-comitans, Porphyromonas gingivalis and Prevotella intermedia. Partially dentate patients accumulated more plaque than edentulous patients (P = 0.05), whereas crevicular fluid flow rate was significantly higher (P < 0.001) in the partially dentate population. Porphyromonas gingivalis and Prevotella intermedia were more frequently detected (P < 0.01) in partially dentate patients. These results indicate that the presence of natural teeth alter clinical and microbiological parameters which could in turn affect the long term success rate of implants.

Associations between malnutrition, poor general health and oral dryness in hospitalized elderly patients.

OBJECTIVE: To obtain information about the possible relationship between symptoms and signs of oral dryness and malnutrition/poor general health in hospitalized older people. DESIGN: A cross-sectional clinical investigation with measurements of unstimulated salivary flow rates (USFR), stimulated salivary flow rates (SSFR), nutritional status, serum albumin concentration and an evaluation of symptoms of oral dryness and loss of appetite by a questionnaire. SUBJECTS AND METHODS: A cohort of 99 elderly, non-psychiatric patients hospitalized for medical reasons; collection of demographic and health data from medical files, collection of USFR and SSFR, measurements of body mass index (BMI), lean body mass, fat body mass, serum album in concentration; completion of a questionnaire related to symptoms of oral dryness and the patients' appreciation of their nutritional status. MAIN OUTCOME MEASURES: SSFR and USFR. RESULTS: Mean age of the 99 patients was 82.5 +/- 4.0 years. Anthropometric examinations indicated malnutrition of severe or intermediate degree in about 50% while 46% showed moderately and 40% severely reduced albumin. Loss of appetite was present in 54% and 51% complained of oral dryness; 17% had an USFR <0.1 ml/min and 26% a SSFR <0.5 ml/min. Significant associations were found between (i) reduced salivary flow rate, malnutrition and reduced serum albumin concentration, (ii) recent loss of appetite and low serum album in concentration and (iii)complaints of oral dryness and reduced salivary flow rates. There were also significant associations between complaints of oral dryness, loss of appetite and low BMI. CONCLUSION: Reduced salivary secretion and complaints of oral dryness could be signs of poor nutritional or general health status of elderly patients. Reduced salivary secretion and feeling of oral dryness could have a negative effect on alimentation, appetite and oral comfort.

Oral health and history of respiratory tract infection in frail institutionalised elders.

OBJECTIVES: The purpose of this study was to look for a relationship between history of respiratory tract infection (RTI) and oral health in very old subjects. SETTING AND SUBJECTS: 302 frail elders (mean age: 85 years) living in a medical care facility were examined by one dentist. OUTCOME MEASURES: The incidence of RTI over 1 year had been recorded along with markers of nutritional status and degree of dependency. The oral examination comprised an evaluation of hygiene, quality of prostheses and the prevalence of caries, periodontal disease and mucosal disorders. RESULTS: One third (33%) of the subjects had experienced at least one episode of RTI, and a fifth (19%) had visited the dentist in emergency. The incidence of RTI had been greater among dentate subjects and those who came to the dentist in emergency. The dentate subjects with a history of RTI had higher plaque score (P = 0.02). Half (49%) of the subjects had oral disorders that could develop in a dental emergency and these subjects had had a higher risk of RTI (relative risk: 1.9, 95% confidence interval: 1.1-3.9). The presence of selected oral disorders associated with low serum albumin increased the relative risk of having had RTI to 3.2 (1.5-6.7). The association between presence of actual oral health problems and previous experience of RTI was more noticeable in those who had poor general health or were more debilitated. CONCLUSIONS: The present study suggests that poor oral hygiene and the presence of potential emergency could be major risk factors for RTI among the frail elderly.

Oral candidosis in long-term hospital care: comparison of edentulous and dentate subjects.

OBJECTIVE: To obtain information on the oral health status of the elderly living in a medicalized, geriatric institution. DESIGN: A cross-sectional clinical investigation with complementary microbiological studies. SUBJECTS AND METHODS: A cohort of 233 elderly in one long-term care ward; collection of demographic data; clinical examination to determine dental and prosthetic status and health of the oral mucosae; swabs for detection of mucosal and denture colonization by Candida; paraffin stimulated saliva for detection of colonization by mutans streptococci and lactobacilli. MAIN OUTCOME MEASURES: Oral and denture hygiene; oral mucosal health; degree of colonization by Candida, mutans streptococci and lactobacilli. RESULTS: Mean age of the 233 patients was 85.6 +/- 6.9 years; 61% were totally dependent, 62.7% were wearing one or two complete dentures; 19.7% had natural teeth and no denture and 17.6% neither teeth nor denture. Of those wearing dentures 72% had denture stomatitis. Of those with natural teeth 72% were affected by active caries. Yeast counts were significantly correlated with the intensity of the erythema of the palatal mucosa, plaque score of the natural teeth, denture plaque score, and salivary counts of mutans streptococci and lactobacilli. CONCLUSIONS: High oral yeast counts and frequent prevalence of oral candidosis in elderly subjects living in institutions are associated with poor oral hygiene and neglect of denture care.

Salivary albumin of edentulous patients.

In order to evaluate the contribution of the periodontal sulcus or pocket to the presence of albumin in the mouth, this protein was analysed in whole saliva of 20 completely dentate adults, aged between 63 and 83 years, and in 23 edentulous patients of similar age (51-88 years). In spite of the considerable intra- and interindividual variations revealed by a preliminary trial, the concentration of salivary albumin was significantly higher (range 60-1080 mg/l) in the dentate than in edentulous individuals (range 2-690 mg/l). The low albumin content in saliva of old edentulous people was similar to that in a group of younger individuals with a healthy periodontium.

Caries prevalence and associated predisposing conditions in recently hospitalized elderly persons.

The prevalence of caries and caries risk factors was studied among 120 consecutively hospitalized elderly persons. Coronal caries was recorded using the WHO criteria, and active and inactive root caries in accordance with Fejerskov et al. The CPITN was used to evaluate the periodontal state and plaque accumulation in accordance with Löe & Silness. Of the 1212 teeth examined 5% had active coronal caries (2% inactive), 14% active root caries (2% inactive), and 10% fillings with recurrent caries. No relationship was found between caries prevalence, degree of dependence, number of medicaments, age, and gender. Patients with psychiatric diseases had increased caries prevalence (P < 0.01), and lower caries prevalence was associated with frequent tooth brushing (P < 0.05). At the tooth level root caries was associated with high plaque scores (P < 0.001), degree of gingival recession (P < 0.001), presence of coronal caries (P < 0.001), and increased pocket depth (P < 0.01). The results strongly indicate that oral hygiene measures should be introduced immediately after hospitalization of these patients.