Quantity and quality analysis of dental prosthodontics among retirement age residents from nursing homes in different regions of Latvia and retirement age patients from dental clinic in Riga.

INTRODUCTION: The quality of life is closely related with condition of oral health, influence of subjective factors on the whole human body and patients perception of their oral health. In spite of the fact that the most part of Latvian retirement age residents use low-quality dentures and assess them satisfactory, these patients often have problems associated with quality of dentures. The aim of the present study was to evaluate oral health status, prosthodontics indicators and patients satisfaction with oral health among Latvian retirement age residents. PATIENTS AND METHODS: There were examined 465 retirement age volunteers (170 men and 295 women), 116 of them in dental clinic Sandent (Riga, 24.9% - control group), 137 (29.5%) in nursing homes in Zemgale and 212 (45.6%) in nursing homes in Kurzeme (Zemgale and Kurzeme are districts of Latvia). There were assessed quantity of prosthodontics among patients with partial defects of dental arches, there were estimated quality of dentures and patients satisfaction with existing prosthodontics. RESULTS: Oral health indicators among Latvian retirement age population are better than the same indicators among elderly residents of nursing homes. Among nursing homes residents with partial edentulousness in most of cases in oral cavities remained only few residual teeth which needed treatment. Removable and fixed dental prostheses used by nursing homes residents do not meet denture's quality criteria. Self-evaluation of dentures quality among retirement age residents of nursing homes is better and not correspond with existing dentures quality. CONCLUSIONS: In Latvia the quantity of prosthodontics in respect of partial removable dentures among the retired who regularly visit a dentist does not significantly differ from European retirement age population's dental prosthodontics quantity. Dental prosthodontics indicators of residents of nursing homes in Latvia are unsatisfactory (p<0.001). In retirement age population self-evaluation with quality of dentures is higher than actually existing.

Periodontal health status in the elderly with different levels of education: a 5-year follow-up study.

OBJECTIVE: To assess the association between the periodontal health status and level of education over a 5-year period among the elderly aged 75 years and older. BACKGROUND: Oral health among the higher educated is known to be better than among the less-well educated. On the other hand, the prevalence and severity of periodontal disease has been found to grow with increasing age. METHODS: The participants were derived from a population-based Helsinki Aging Study, a random sample of 76-, 81- and 86-year-old elderly. The 170 dentate elderly who underwent clinical oral examinations at baseline and 71 who participated in the follow-up were included in this study. The data was collected from intraoral and radiological examinations and from a structured questionnaire. RESULTS: Subjects with a higher level of education had more retained teeth than subjects with a lower level of education. According to CPITN index, better-educated participants had more healthy sextants, but they also had more sextants with periodontal pockets. Radiographic examination showed similar results. CONCLUSION: Level of education has a clear effect on the periodontal health status in the elderly. More treatment need seems to polarise into those elderly who are better educated as they retain more teeth into old age.

General health, dental status and perceived dental treatment needs of an elderly population in Istanbul.

BACKGROUND: Comprehensive data on the oral health status and dental treatment needs of the elderly population in Turkey are deficient. OBJECTIVES: This pilot study determined the general and dental health status, perceived medical and dental treatment needs of an elderly population dwelling in residential homes in Istanbul. METHOD: Subjects at three different residential homes, namely one belonging to the state and two supported by foundations in Istanbul (N=121, female: 63 and male: 58) were involved in this study. A detailed questionnaire was prepared and dental examinations were conducted. Information was collected related to age, education levels, financial status, current physical functional status, general health, mental health, previous dental history, current dental status, oral hygiene practices and denture hygiene of these elderly people. The prevalence of edentulism, the presence and type of dental prostheses, dental and denture status and denture cleanliness were further evaluated. RESULTS: The three most prevalent reported general health problems were associated with genito-urinary problems (24%) followed by cardiovascular (18%) and respiratory problems (14%) varying significantly between genders, with males suffering more from cardiovascular problems than females (p < 0.05). Females showed significantly higher gastrointestinal and orthopaedic problems than males (p < 0.05). Females were more frequently edentulous than males but denture hygiene was significantly better in females than in males (p < 0.05). Brushing frequency did not significantly increase denture hygiene (p = 0.6). More than one-third of the subjects had not been to the dentist within the previous 5-10 years, mainly due to lack of demand, followed by the cost of the dental care and fear. More than two-thirds of denture-wearing subjects wore their dentures only during eating. CONCLUSIONS: There was significant perceived dental treatment and care need for the sample population of elderly studied.

Oral health in German children, adolescents, adults and senior citizens in 2005.

OBJECTIVE: The aim of this field study (the "Fourth German Oral Health Study") was to obtain representative data on caries (DMFT index), periodontitis (CPI) and prosthetic status in the German population and to evaluate changes in the oral health of the German people as compared with the findings of the Third German Oral Health Study conducted eight years previously. BASIC RESEARCH DESIGN: The study took the form of a population-representative cross-sectional survey with random samples, and was complemented by a questionnaire to reveal sociological as well as behavioural data. PARTICIPANTS: The age cohorts in the present study were 12-year-olds (children), 15-year-olds (adolescents), 35- to 44-year-olds (adults) and 65- to 74-year-olds (senior citizens). RESULTS: All age groups showed considerable improvements in oral health with respect to caries. Of the children, 70.1% were free of dentine caries and the mean DMFT value was 0.7. In adults and senior citizens both the DMFT value and the number of missing teeth and edentulousness declined. With regard to periodontal conditions, increasing prevalence of moderate and severe findings was recorded in adults and senior citizens, owing probably to the larger number of natural teeth remaining in the oral cavity. CONCLUSION: The study documents a distinct improvement in oral health in the German population. Interrelated with the higher numbers of remaining natural teeth a higher prevalence of moderate and severe periodontal conditions in German adults and senior citizens was observed.

An approach to define clinical significance in prosthodontics.

PURPOSE: The concept of the minimal important difference (MID) of an oral health-related quality of life (OHRQoL) questionnaire has been proposed to refer to the smallest OHRQoL score difference considered to be clinically important in oral health. This study determined the MID for the 49-item Oral Health Impact Profile (OHIP) in prosthodontic patients. This could serve as a patient-based approach to define clinical significance for prosthodontic interventions. MATERIALS AND METHODS: A consecutive sample of 224 adult patients completed the OHIP questionnaires twice before treatment was performed and 4 to 6 weeks after prosthodontic treatment was finished. At follow-up patients were asked about their overall impression of the treatment (global transition; answer categories "improved a lot,""improved a little,""stayed the same,""worsened a little," and "worsened a lot"). RESULTS: The median of baseline and follow-up differences in OHIP (change scores) was computed for subjects (N = 47) reporting a "little improvement." This figure was considered the MID for the OHIP, and it was found to be 6 OHIP units (95% confidence interval: 2 to 9). CONCLUSION: The MID of the OHIP is an important benchmark to assess individual and group treatment effects in prosthodontics and could be used to approach what is clinically significant in terms of patient-based outcomes.

Influence of denture improvement on the nutritional status and quality of life of geriatric patients.

UNLABELLED: Recent research suggests that there is a correlation between nutrition, oral health, dietary habits, patients' satisfaction and their socio-economic status. However, the dependent and independent variables have remained unclear. OBJECTIVE: This exploratory interventional study aimed to identify the impact of denture improvement on the nutritional status as well as the oral health-related quality of life in geriatric patients. MATERIALS AND METHODS: Forty-seven patients who were capable of feeding themselves (minimum age: 60 years) and with dentures requiring repair or replacement were selected from a random sample of 100 residents of two nursing homes. Before and 6 months after the dentures were optimised a Mini Nutritional Assessment (MNA) and a masticatory function test were carried out. Nutritional markers (pre-albumin, serum albumin, zinc) were determined and an OHIP-G14 (Oral Health Impact Profile, German version) was recorded in order to determine the effect of the optimised oral situation on the patient's nutritional status and oral health-related quality of life. RESULTS: Despite the highly significant improvement in masticatory ability after the optimisation of the dentures, no general improvement regarding the nutritional status was observed since the albumin, zinc and MNA values remained unchanged and pre-albumin even decreased. CONCLUSION: Since masticatory ability and masticatory efficiency are not the only factors affecting this, prosthetic measures alone apparently cannot effect a lasting improvement in nutritional status as masticatory ability and masticatory efficiency are not the only factors of influence. Nutrition is not only a matter of masticatory function, but also depends on other influencing factors (e.g. habits, taste and cultural customs as well as financial and organisational aspects).

Survey of prosthodontic service provided by general dentists in Virginia.

STATEMENT OF PROBLEM: Activities in prosthodontic treatment may be changing due to prevalence of disease and new treatment options. Studies cite conflicting evidence in regard to prosthodontic services, particularly removable prosthodontics. PURPOSE: This project was designed to describe the amount of prosthodontic services provided by general dentists in Virginia. Results may enhance understanding practice patterns in Virginia and regions with similar demographics. MATERIAL AND METHODS: Licensed Virginia dentists (n=600) were randomly selected from the Virginia Department of Health Professions website. Each individual was mailed a survey of questions about his or her demographics and practice activities with regard to prosthodontics. RESULTS: Of the 333 respondents, 195 provide prosthodontic treatment and function as general dentists. On average, they spend 25% of their practice time providing prosthodontic services (17% fixed and 8% removable). They provide at least 1 complete denture for a mean total of 24.3 patients per year, at least 1 removable partial denture for a mean total of 28.7 patients per year, at least 1 fixed partial denture for a mean total of 23.0 patients per year, at least 1 implant-supported crown for a mean total of 12.3 patients per year, and at least 1 implant-supported fixed partial denture for mean total of 3.3 patients per year. Data were analyzed using descriptive statistics. Data for total population and median income were analyzed with the Wilcoxon signed rank test. CONCLUSION: Virginia dentists continue to provide considerable numbers of fixed prosthodontic restorations, removable partial dentures, and complete dentures, while providing a growing number of implant-supported restorations.

Oral diseases and conditions in community-living older adults with and without dementia.

This study compared the prevalence and experiences of oral diseases and conditions, as well as tooth loss and retained root status, in community-dwelling older adults with and without dementia. Dental examinations were conducted at baseline and at one-year for randomly selected samples of 116 dentate community-living older adults with dementia and a comparable group of 116 adults without dementia. Participants with dementia had significantly higher experiences of oral diseases and conditions at baseline and one-year compared with participants without dementia: decreased use of dentures; increased prevalence of denture-related oral mucosal lesions; increased plaque accumulation; increased prevalence and experiences of coronal and root caries; and increased numbers of decayed retained tooth roots. These higher experiences of oral diseases and conditions were related to dementia severity, not to specific dementia diagnoses. Participants with dementia already had a compromised oral health status when admitted into institutional long-term care between baseline and one-year; of concern were the high plaque levels on the natural teeth of the group of institutionalized participants with dementia.

Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward.

The aim of this study was to test the inter-rater reliability of a revised oral assessment guide (ROAG) for patients residing in a geriatric rehabilitation ward. A consecutive sample of 140 patients was recruited for the study. Oral assessments were performed for 133 newly admitted patients by one registered nurse (RN) during a period of six months. A dental hygienist (DH) carried out 103 oral assessments during the same half-year. For 66 patients, the RN and the DH performed independent assessments. There was an agreement between the RN and the DH in the majority of the independent assessments, except for tongue and teeth/dentures. The percentage agreement exceeded 80 percent. Inter-rater agreement measured by Cohen's Kappa coefficient ranged from moderate to very good and percentage agreement had a range of 58 to 91 percent. The agreement was highest in assessment of voice and swallowing (91%). Assessments of teeth and dentures seemed to be most difficult for the RN to evaluate. ROAG was found to be a clinically useful assessment tool. Additional education and training is needed to improve the reliability of the oral assessments and should include continuous support from a dental hygienist as well as a pictorial manual on how to use the ROAG.

Dental and periodontal status of Sjögren's syndrome.

BACKGROUND: Sjögren's syndrome (SS) is one of the most common systemic autoimmune diseases in middle-aged women. The present study had the aim to examine the dental and periodontal condition in patients with SS in comparison with disease controls and to evaluate the influence of reduced salivary flow in the periodontal tissues. METHOD: We examined 24 patients with primary or secondary SS in comparison with 27 patients who had another autoimmune disease but no signs or symptoms of SS, as well as with 29 subjects who had a subjective feeling of xerostomia or xerophthalmia without exhibiting an underlying disease. The clinical evaluation included examination of the oral mucosa, determination of missing, decayed and filled teeth, fixed or removable prosthetic appliances, plaque index, gingival index, probing pocket depth, probing attachment level, oral hygiene habits and frequency of dental visits. Statistical analysis was performed using the 2-tailed Fisher exact and Kruskal-Wallis tests. RESULTS: No significant difference was found in the dental or periodontal condition of the 3 groups. The number of teeth, feelings and distal or mesial decay lesions correlated negatively with age, while the number of fixed prosthetic appliances correlated positively. The salivary flow was statistically lower in patients with SS and exhibited a negative correlation with the number of cervical decay lesions. It was also found that SS patients had better oral hygiene habits than subjects of the control groups. CONCLUSIONS: No significant,difference could be detected concerning the dental and periodontal status of SS patients, compared with that of patients with other immune diseases as well as with that of controls who had subjective xerostomia.

Social equality and dental conditions--a study of an adult population in Southern Sweden.

This study aimed to: describe dental conditions--focusing on prosthodontic variables--in relation to social conditions in the late 1990s in an adult population of Southern Sweden, evaluate if a change could be traced in the pattern of socioeconomic influences on dental conditions, and study if various attitudes toward dental care were associated with social as well as dental conditions. The study was based on questionnaire responses. Significant differences in dental conditions and denture prevalence were found for age and education. To a majority of the sample it was very important to have own teeth and/or fixed restorations and the opportunity to attend regular dental care. The cost for dental care was very important for 52% of the sample especially for men, those with low education, and those wearing removable denture. Need for dental care that could not be provided for because of the costs was experienced by 9%. Eighteen percent stated that they once or more had refrained from dental care because of the cost. Those with removable dentures and low education dominated. Besides socioeconomic differences in dental conditions, there were sociodental differences in attitudes concerning the importance of costs, self-estimated needs, and cost-barriers for dental care.

[A proposal for a classification of the oral findings in elderly retired persons in nursing homes]. / Vorschlag für eine Klassifizierung von Mundbefunden bei Hochbetagten Heimpensionären.

A systematic collection of dental data is suggested with the aim of providing a simple overview of the degree of dentition in a specified cohort of patients. The classification consists of eight divisions described and defined on the basis of the most frequent typical oral situations found in elderly, disabled residents of nursing homes. The data of elderly people living at home show major differences in comparison to the defined group. This classification should therefore primarily be used in studies on disabled aged residents in nursing homes and similar institutions. Standardized classification allows comparison of results from different nursing homes. Any possible changes of the state of the dentition in nursing home residents can also be visualized in longitudinal studies through the use of standardized data.