Trends in predoctoral education in geriatric dentistry.

Historically, education in geriatric dentistry has been limited in both quantity and quality. More recently, a number of educational initiatives have been developed in response to the growing number of older adults and their changing oral health status and dental treatment needs. A survey of U.S. and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of AADS/AoA geriatric dental curricular materials. All schools responded. Compared to previous reports, more schools had geriatric didactic course(s), clinical rotations, and faculty with geriatric dental training. Fifty-eight percent of dental schools support geriatric dentistry in their budgets. The primary barriers to program expansion continue to be the lack of trained faculty members, a crowded curriculum, and fiscal concerns.

The effectiveness of sponge-type intraoral applicators for applying topical fluorides in institutionalized older adults.

Many older adults who reside in nursing homes have disabilities which limit their capacity to benefit from the usual protocols for prevention of dental caries. This is a report of a study of the effectiveness of an alternative method of applying topical fluoride in the institutionalized elderly. Fluoride gel (1.1% NaF) was applied to the facial tooth surfaces of 10 elderly nursing home residents using a sponge-type intraoral applicator (IA). Subsequently, the same subjects rinsed with a commercial fluoride solution (0.05% NaF). Salivary fluoride levels were then assessed by the Taves (1968) method. The IA with fluoride produced significantly higher salivary fluoride levels over a period of three hours compared with rinsing.

Effects of hyposalivatory medications on saliva flow rates and dental caries in adults aged 65 and older.

Institutionalized adults aged 65 or older often receive medications that have been associated with decreased saliva flow. Flow rates depressed by hyposalivatory medications are thought to increase susceptibility to dental caries. In this study, a cross-sectional comparison was made of stimulated whole saliva rates and coronal and root caries prevalence in a group of older adults, in a long-term care facility, taking hyposalivatory medications vs. a control group. No significant differences were found between the two groups in masticatory or gustatory stimulated flow rates or in mean decayed coronal or root surfaces.

Hyposalivatory drug use, whole stimulated salivary flow, and mouth dryness in older, long-term care residents.

Drug-induced hyposalivation has only been anecdotally related to various subjective and objective oral problems. The study described here of 157 residents of a long-term care facility reports data on whole masticatory-stimulated salivary flow rates, use of medications, and perceptions of symptoms associated with hyposalivation, including mouth and eye dryness, tooth sensitivity, chewing satisfaction, and taste and smell acuity. One hundred and twelve residents (71%) were taking one or more drugs that induced hyposalivation. Salivary flow rates were lower in persons who were taking such drugs, and lowest in persons who were taking such drugs for a protracted period. Flow was also lower in females than males, and lower in persons institutionalized for long periods than in persons institutionalized for short periods. Persons who were taking drugs that induce hyposalivation were institutionalized longer, used more medications, had more health problems, were dissatisfied with chewing, and had fewer teeth than persons who were not taking such drugs. Persons who reported having mouth dryness also reported eye dryness and were dissatisfied with their chewing ability. Perceived mouth dryness was not related to salivary flow.

Retrieval of donor livers.

At the inception of a liver transplantation program at our institution, an organ procurement service was established. Specially trained personnel, availability of a transportation system, and development of communication between distant retrieval sites and the operating room were important elements of this service. For the first 100 liver allografts in our transplantation program, 118 retrievals were necessary. The central location of the Mayo Clinic allowed retrieval from anywhere within continental North America. In this initial phase of the liver transplantation program, the concern that organ availability would be the rate-limiting factor was unfounded.

Dentists' verbal communication leads during an interview with geriatric patients.

A reliable method has been developed to describe dentists' verbal communication leads using closed circuit television. The purpose of this investigation was to compare these leads during the greeting and initial discussion portion of an initial dental interview for ten dentists with 20 patients older than 65 years. Leads were categorized as controlling, noncontrolling, or neutral. A controlling lead was defined as a lead that allowed the dentist to exert authority in a controlling manner. The most frequently used leads in this category were closed-ended questions and structuring. Leads were categorized as noncontrolling if the lead allowed patients to express themselves (acceptance, approval, clarification, interpretation, and open-ended question). Examples of frequently observed neutral leads included small talk and information giving. The frequency of noncontrolling, neutral, and controlling leads was 28%, 40%, and 32%, respectively. Correlations between these three categories were weak and indicated that they were measuring different qualities of the communication process. When the three categories of leads were analyzed by doctors and patients' gender, the mean numbers of leads were similar, although male dentists tended to be more controlling with male patients and less controlling with female patients. These differences were not statistically significant using the analysis of variance.

A geriatric special-care unit: experience in a university hospital.

Responding to a perceived need for specialized care for the acutely ill elderly, a 14-bed geriatric special-care unit was established in the University of Massachusetts Hospital in January 1980. Patients were selected for admission after assessment of their potential to benefit from restorative care. Most patients were admitted from the emergency room or outpatient clinics or were scheduled admissions; a few were in-hospital transfers. This report deals with a retrospective analysis of the first 514 admissions (431 patients) to the unit. Admissions by major service were: Medicine, 64 per cent; Surgery, 14 per cent; Neurology, 10 per cent; Orthopedics, 7 per cent; and other, 5 per cent. Approximately 64 per cent of patients were between the ages of 70 and 84. The overall average length of stay per admission was 11.5 days. Mortality rate of patients undergoing surgery (n = 125) was 4 per cent. The percentage of admissions that were discharged home was 78.7 per cent. Only 7.3 per cent of admissions were discharged to a nursing home, when those that were admitted to the unit from a nursing home are excluded. The authors conclude that a special nursing unit for acutely ill elderly patients may serve several purposes in a university hospital: overall patient care may be improved; length of hospital stay may be shortened; and medical students, housestaff, and attending physicians may gain an opportunity to learn the fundamentals of geriatric medicine as demonstrated by the staff of the unit.

Cholesterol and cholesteryl ester concentration in different size classes of cultured human fibroblasts: effect of in vitro aging.

Early and late passage WI-38 fibroblasts were fractionated on the basis of cell size by gravity sedimentation, and free and esterified cholesterol concentrations were determined in each fraction. The cholesteryl ester concentration in all size classes of late passage cells was greater than that of all size classes of early passage cells; the average of all fractions of late passage cells was 2.5 times greater (pg/micrometers 3) and 1.7 times greater (micrograms/mg protein) than that of all fractions of early passage cells (p less than 0.001). The average free cholesterol concentration (micrograms/mg protein) in late passage cell fractions exhibited a consistent, but not statistically significant, increase over that in early passage cells. These results indicate that the increase in cholesteryl ester concentration in late passage WI-38 fibroblasts is not solely attributable to the large, non-dividing cells which accumulate in senescing cultures.