Does mandibular edentulous bone height affect prosthetic treatment success?

OBJECTIVES: The aim of this study is to determine whether mandibular bone height affects patients' ratings of satisfaction and function with mandibular 2-implant overdentures (IODs) and conventional dentures (CDs). METHODS: 214 edentulous elders were randomly allocated into 2 groups and treated with maxillary CDs and either mandibular CDs or IODs. Classifications of mandibular bone height were carried out on panoramic radiographs using 4 published methods. At baseline and 6 months after delivery, all participants rated their satisfaction with their prostheses using the McGill Denture Satisfaction Instrument. Independent t-tests and a linear multivariable regression model were used for statistical analyses. RESULTS: Mandibular bone height has no effect on patients' ratings of general satisfaction, nor on ratings of ability to chew, stability, comfort, aesthetics and ability to speak at 6 months (p>0.05, linear regression). There were significant between treatment differences in ratings of general satisfaction, comfort, stability and ability to chew from all mandibular bone height categories, with higher ratings assigned to IODs (p<0.01, t-tests). Linear regression analyses confirmed that, for general satisfaction, as well as ability to chew, stability, comfort, aesthetics and ability to speak, treatment with IODs contributes to higher satisfaction ratings (p<0.001), while mandibular bone height does not. CONCLUSIONS: The evidence demonstrates that mandibular bone height has no effect on patients' satisfaction with the function, chewing ability and comfort of their prostheses. Furthermore, no matter how much mandibular bone, these results suggest that edentulous elders will benefit more from mandibular IODs than from CDs.

Researching the impact of oral health on diet and nutritional status: methodological issues.

OBJECTIVES: Assessment of the impact of dental function on diet and nutritional status requires robust methodologies and a standardised approach to increase accuracy of results and to facilitate cross study comparisons. The objectives of this paper are: to report the outcomes of a consensus workshop that critically reviewed publications reporting on dietary methodologies in relation to the impact of oral health on nutrition; to highlight future directions for research and; to make recommendations for appropriate use of methodologies for future research. DATA: Data relevant to nutrition and dental status published from 1980 to 2005 in English were presented at the consensus workshop for discussion and appraisal. SOURCES: Relevant papers were retrieved through PubMed. Relevant texts were obtained from the library at Newcastle University, UK. STUDY SELECTION: A purposive sample of original articles that illustrated the application of a range of nutritional methodologies to the study of oral health impacts was identified. Original flagship texts on nutritional methodologies were reviewed. CONCLUSIONS: Numerous studies have shown an association between loss of teeth and inferior diet. Further research is required to elucidate the impact of novel approaches to prosthetic rehabilitation and the impact of contemporaneous dietary and dental intervention on diet, nutritional status, disease progression and quality of life. The recommendation of the consensus workshop was that future studies should adopt a comprehensive approach to the assessment of nutrition that encompasses measurement of diet, body composition, biochemical indices of intake and levels of nutrients, and functional biomarkers of disease.

Sex differences in denture satisfaction.

OBJECTIVES: Males and females differ in their responses to many health conditions and treatments. The aim of this randomized clinical trial was to determine whether there are differences in the way that male and female edentulous elders rate their satisfaction with new mandibular implant overdentures (IODs) and conventional dentures (CDs), at 6 and 12 months following delivery. METHODS: Edentulous elders (n=256) were randomly assigned to receive maxillary conventional dentures and either mandibular overdentures supported by two implants with ball attachments or conventional dentures. Participants rated their general satisfaction, as well as other features of their dentures (comfort, stability, ability to chew, aesthetics, etc.) prior to treatment and 6 and 12 months after delivery. RESULTS: Ratings of satisfaction with IODs were significantly higher than with CDs. Six months after delivery, females in the CD group rated their general satisfaction and satisfaction with ability to chew and aesthetics significantly lower than did the males. The sex differences in the CD group remained at 12 months after delivery. However, males and females in the IOD group rated their general satisfaction and all six subcategories equally. CONCLUSIONS: Elderly females are less satisfied with conventional dentures than elderly males with regards to aesthetics and ability to chew, but equally satisfied with implant overdentures. At 6 and 12 months after delivery, elderly edentulous males and females wearing mandibular implant overdentures were significantly more satisfied than those wearing conventional dentures.

Monitoring recruitment success and cost in a randomized clinical trial.

Recruitment of older adults into research studies is challenging and, as a consequence, the recruitment period is often extended and more expensive than planned. This study monitored the effectiveness (number of subjects attracted) and cost of different recruitment strategies when recruiting edentulous elderly adults. Socio-demographic data were gathered and compared to 2001 Canadian census data. Advertisements in major Montreal newspapers attracted the most people (24.3%). However, the most economical recruitment method proved to be placement of ads in senior newspapers (dollar 73.74 per subject). The information gathered in this study will assist others in planning recruitment strategies for edentulous elderly populations.

Effects of a medium chain triglyceride oil mixture and alpha-lipoic acid diet on body composition, antioxidant status, and plasma lipid levels in the Golden Syrian hamster.

The objective of this study was to examine the effects of the antioxidant alpha-lipoic acid (ALP) versus a medium chain triglyceride oil mixture (MCTo), which was designed to increase energy expenditure and to improve lipid profiles containing medium chain triglycerides, phytosterols, and omega-3 fatty acids in the form of flaxseed oil. A total of 48 hamsters were fed a) hypercholesterolemic (HC) control, b) HC MCTo, c) HC ALP, or d) HC MCTo/ALP diet for 4 weeks. No differences were observed on food intake, body weight, total body water, lean and fat mass, and tissue thiobarbituric acid reactive substances (TBARS). ALP alone had no effect on total cholesterol (TC); however, MCTo feeding increased TC with (P < 0.03) and without (P < 0.003) ALP when compared with control. ALP increased HDL levels compared with control (P < 0.04) and MCTo/ALP (P < 0.007) groups. MCTo, with (P < 0.0001) or without (P < 0.006) ALP, increased non-HDL cholesterol levels versus control. The non-HDL:HDL cholesterol ratio was decreased by ALP compared with MCTo (45%) and MCTo/ALP (68%) (P < 0.0001), a similar trend was seen when compared with the HC control (22%) group (P < 0.14). Triglyceride levels were not altered by any dietary treatment. Liver and heart tissue reduced glutathione (GSH) was increased (P < 0.05) by all three treatments when compared with control. Both tissues showed an increase (P < 0.05) in oxidized glutathione (GSSG) when fed ALP as compared with other treatments. Hamsters fed ALP had a lower (P < 0.05) GSH/GSSG ratio compared with other treatment groups. In conclusion, MCTo feeding does not elicit beneficial effects on circulating plasma lipids and measures of body composition. In addition, our results do not clearly support an improvement in oxidative status through supplementation of ALP. However, our results do support the existence of beneficial effects of ALP on circulating lipoprotein content in the hamster.

Alpha-lipoic acid and cardiovascular disease.

Alpha-lipoic acid (ALA) has been identified as a powerful antioxidant found naturally in our diets, but appears to have increased functional capacity when given as a supplement in the form of a natural or synthetic isolate. ALA and its active reduced counterpart, dihydrolipoic acid (DHLA), have been shown to combat oxidative stress by quenching a variety of reactive oxygen species (ROS). Because this molecule is soluble in both aqueous and lipid portions of the cell, its biological functions are not limited solely to one environment. In addition to ROS scavenging, ALA has been shown to be involved in the recycling of other antioxidants in the body including vitamins C and E and glutathione. Not only have the antioxidant qualities of this molecule been studied, but there are also several reports pertaining to its blood lipid modulating characteristics, protection against LDL oxidation and modulation of hypertension. Therefore, ALA represents a possible protective agent against risk factors of cardiovascular disease (CVD). The objective of this review is to examine the literature pertaining to ALA in relation to CVD and describe the most powerful actions and potential uses of this naturally occurring antioxidant. Despite the numerous studies on ALA, many questions remain relating to the use of ALA as a supplement. There is no consensus on dosage, dose frequency, form of administration, and/or preferred form of ALA. However, collectively the literature increases our understanding of the potential uses for supplementation with ALA and identifies key areas for future research.