Does case severity make a difference to clinical improvement following complete denture treatment?

PURPOSE: The aim of this study was to investigate the effect of case severity on clinical outcomes when fabricating new complete dentures. MATERIALS AND METHODS: Participants were separated into severe and moderate groups using the index of case difficulty for edentulous patients developed by the Japan Prosthodontic Society. Before and after treatment, self-assessed masticatory ability and oral health-related quality of life (OHRQoL) were examined, and the authors compared them according to case severity using the Mann-Whitney U test. To compare findings before and after treatment, the authors used the Wilcoxon signed rank test. RESULTS: In the severe group, both scores were significantly improved after treatment (P < .01). However, in the moderate group, there was no significant difference in self-assessed masticatory ability as measured by the food acceptance score before and after treatment (P = .11). Before treatment, OHRQoL as measured by the Oral Health Impact Profile score was significantly higher in the severe group than in the moderate group (P < .01). However, after treatment, there was no significant difference between the two groups (P = .92). CONCLUSIONS: The authors concluded that case severity makes a difference in the edentulous patient's OHRQoL and self-assessed masticatory ability during complete denture treatment. Evaluating case severity with the index before treatment is a useful tool for patients and clinicians to predict clinical outcomes.

Cognitive decline and oral health in middle-aged adults in the ARIC study.

Even before dementia becomes apparent, cognitive decline may contribute to deterioration in oral health. This cohort study of middle-aged adults evaluated associations of six-year change in cognitive function with oral health behaviors and conditions in the Atherosclerosis Risk in Communities (ARIC) study. Cognitive function was measured at study visits in 1990-1992 and 1996-1998 with three tests: (a) Delayed Word Recall (DWR), (b) Digit Symbol Substitution (DSS), and (c) Word Fluency (WF). Cognitive decline scores were computed as 'studentized' residuals of 1996-1998 scores regressed against 1990-1992 scores. In 1996-1998, 10,050 participants answered dental screening questions, and 5,878 of 8,782 dentate participants received a comprehensive oral examination. Multiple regression models used cognitive change to predict oral health behaviors and conditions with adjustment for covariates. In the fully adjusted models, greater decline in all three measures of cognitive function was associated with increased odds of complete tooth loss. Greater decline in DSS and WF scores was associated with infrequent toothbrushing. Decline in WF scores was also associated with higher plaque levels. In these middle-aged adults, six-year cognitive decline was modestly associated with less frequent toothbrushing, plaque deposit, and greater odds of edentulism, but not with other oral behaviors or diseases.

A study of assessment of partial edentulous patients based on Kennedy's classification at Dhulikhel Hospital Kathmandu University Hospital.

BACKGROUND: Oral health contributes significantly towards quality of life(QOL). Edentulousness falls in a special category among the various conditions of dental origin. Dietary intake and nutritional status is affected by poor oral health and loss of teeth. This will ultimately compromise general health. OBJECTIVE: To identify the frequency of Kennedy's classification among partial edentulous patients and to compare occurrence among gender and between upper and lower arches and also to compare edentulousness among employed and unemployed population. METHODS: This study was carried out at Dhulikhel Hospital Dental Department. The study was conducted randomly among 194 patients in dental OPD who were partially edentulous. A structured pro forma was used to find out the edentulousness based on Kennedy,s classification. RESULTS: Among the Kennedy's classification ClassIII was found to be most common. Among them females and unemployed group were found to have more edentulousness and upper arch was more common. It was also found that females were more conscious and get the replacement of missing teeth among which those having Class IV missing were replaced most often. CONCLUSION: The Kennedy Class III partial edentulousness type is most commonly found in this study.

Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland.

INTRODUCTION: This audit reports on the oral and general health of patients who were treated in a dental consultation clinic of a geriatric hospital. MATERIAL AND METHODS: Dental and medical records were obtained from 112 female and 80 male patients (mean age, 83.7 ± 8.2 years) who attended a dental consultation. Data analysis included the general health [American Society of Anesthesiologists (ASA) classification, number of diagnoses, cognitive function] and dental state in the age strata 60-69, 70-79, 80-89 and 90-99 years. RESULTS: Seventy-four per cent of patients were aged over 80 years. The prevalence of ASA-P4 and P3 varied between age groups. Most patients (>86%) had more than three chronic diseases. Cognitive impairment was present in almost half of both older age cohorts (43 and 50%). Half of the patients (52%) were edentulous. In dentate patients, the average number of teeth was 12 ± 6 and differed in the maxilla significantly between age groups (p = 0.005). There was no significant association between dental state, ASA classification and systemic conditions. CONCLUSIONS: The profile of this cohort reflects a poor oral and general health status. The results underline the importance of an interdisciplinary consultation in a geriatric ward where oral health care is an integral part.

Screening of edentulous patients in a dental school population using the prosthodontic diagnostic index.

PURPOSE: The aim of this study was to classify a number of completely or partially edentulous patients who attended undergraduate clinics at the Dental School of Athens using the prosthodontic diagnostic index (PDI) to identify the complexity of the cases treated by the students. BACKGROUND: There is a scarcity of studies, concerning prosthodontic patients and screening them according to a classification system such as the PDI. MATERIAL AND METHODS: The survey was conducted on 181 patients who attended the clinics for treatment. The PDI categorised the patients into four classes (Class I-IV) according to the severity of certain diagnostic findings. RESULTS: From the 110 completely edentulous patients, 27 patients were in Class I, 21 in Class II, 15 in Class III and 47 in Class IV. From the 71 partially edentulous patients, two were in Class I, 17 in Class II, 29 in Class III and 23 in Class IV. CONCLUSION: Our results showed that the majority of patients were categorised in Class III (partially edentulous) and IV (completely edentulous). This indicates the need to introduce a proper screening tool, such as the PDIs, during the initial examination, to achieve a successful treatment.

The oral health of older people: general dental practitioners' beliefs and treatment experience.

The purpose of this study was to examine New Zealand general dentists' beliefs about older people's oral health and to identify the important barriers that prevent dentists from treating institutionalized older adults. A postal survey was distributed nationwide to a representative sample of 700 dentists (response rate 64.5%). Dentists' beliefs were mostly consistent with current epidemiological knowledge, although most (81.5%) mistakenly believed that the root surface caries increment was greater than that for coronal caries. One in four had visited a long-term care (LTC) facility during the previous 2 years. Over three-quarters cited the inconvenience of leaving their practices as a barrier, and the lack of a financial incentive was cited by almost half. The results suggested that the areas most in need of attention were the LTC staff's oral health knowledge and attitudes, as well as government policies. Although dentists' beliefs, practices, and attitudes occasion some optimism, the increase in the dentate older population means that policymakers will need to examine efficient, dentist-acceptable ways of delivering care. The profession will need to develop and sustain an appropriate workforce.

Testing the effect of including oral health in general health checks for elderly patients in medical practice--a randomized controlled trial.

AIM: To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. OBJECTIVES: To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. SETTING: Three general medical practices in east Cheshire, UK. DESIGN: A randomized controlled trial. METHOD: Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. RESULTS: Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. CONCLUSIONS: The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met.

Linguistic adaptation and validation of the General Oral Health Assessment Index (GOHAI) in an elderly Japanese population.

OBJECTIVES: This study sought to develop a Japanese version of the General Oral Health Assessment Index (GOHAI) and validate its use in an elderly Japanese population. METHODS: The GOHAI scale was translated in a standardized way consisting of forward translation, pilot study, and backward translation. Psychometric properties of the final version were assessed on 175 participants (mean age: 70.0 years, SD 6.4). RESULTS: The response rate was more than 98% for each item. The reliability in terms of a Cronbach's alpha value was 0.89. The mean GOHAI scores were significantly lower for participants with poor perceived oral health (P<0. 001) or poor perceived general health (P<0.01). Significant correlations were observed between the GOHAI scores and the general health or physical functioning scores of the Medical Outcome Study Short Form 36 (P<0.01). CONCLUSIONS: The present study showed that the Japanese version of the GOHAI was psychometrically valid in an elderly sample population.

Intra-oral findings and general health conditions among institutionalized and non-institutionalized elderly in Greece.

BACKGROUND: The aim of the study was to record the findings from intra-oral examination and the general health conditions encountered in a group of Greek individuals 65 years of age or older. PATIENTS AND METHODS: The study subjects were derived from the elderly attending 12 randomly selected community centres located in Athens and neighbouring municipalities, consisting the non-institutionalized study group and from the elderly living in three ecclesiastical nursing homes, consisting the institutionalized study group. The research data comprised information from the subjects' interviews, self-defined health status, medical records and intra-oral examination on the following variables: sex, age, general health condition, dentate or not, use of dentures and oral conditions. Fisher's exact two-sided test was used for statistical analysis. RESULTS: Overall, 316 patients were examined; 120 male (38%), 196 female (62%), mean age 78 years (range: 65-99). Of those, 150 were non-institutionalized (59 male, 91 female) and 166 institutionalized (61 male and 105 female). The vast majority (90%) of the patients had at least one general health problem, for which they were taking daily medication. Twenty-three different medical conditions were recorded. The most frequent medical problems were hypertension (56%), cardiovascular problems (41%), depression/anxiety (39%), arthritis (18.5%) and visual problems (16%). The vast majority of the study patients (79%) were edentulous, while 33% were not wearing or using their dentures. Almost half of them (47%) had at least one oral condition. Twenty-seven different oral conditions were recorded. The most frequent oral findings were denture-induced stomatitis (17.2%), dry mouth (14.6%), atrophy of tongue papillae (10.5%), fissured tongue (9.8%) and haemangioma (6.8%). No cases of malignant lesions were observed. CONCLUSIONS: The present study confirms that in this particular age group, general health problems are frequent, variable, coexistent, necessitating the daily administration of multiple medications, while oral examination by a specialist is an essential part of the multidisciplinary medical care in this group of individuals.

Communicating complexity: using a diagnostic classification system for edentulous patients.

A significant number of edentulous patients with complex treatment needs are seen in private practice and faculties of dentistry. The American College of Prosthodontists has developed a classification system for complete edentulism that can be used to guide overall treatment planning and management of patients with complete dentures. The system focuses on specific diagnostic variables and uses a checklist format that can be applied rapidly and easily. Although there is currently little published data to indicate a direct relationship between classification and prognosis, the system can be applied by dental students and dental practitioners to determine the demographic characteristics of edentulous patients. For example, the system has been used by undergraduates in a dental school to determine the suitability of patients for treatment and to assign patients needing complex treatment to appropriate staff-student teams. Discussing the classification system with patients helps practitioners to communicate the complexity of treatment required and may aid in reconciling expectations with outcomes.

[Simulation of pigmented mucosa in complete dentures: development of an oral pigment index]. / Simulatie van de gepigmenteerde mucosa in gebitsprothesen: ontwikkeling van een classificatie.

In the non-Caucasian population the skin and oral tissues show pigmentation to a variable degree, but much more than in Caucasian. When a person becomes edentulous, the tissues containing oral pigmentation disappear. The patient's ethnic background gives no information to predict the characteristics of individual oral pigmentation; other sources have to be found. The mucosal pigmentation of 106 non-Caucasian, dentate people in Amsterdam and Los Angeles was investigated; a classification-chart of oral pigmentation with six types was designed. This tool makes it possible to help patient, dentist and dental technician to choose an accurate simulation of the contour of oral pigmentation in a denture. It is recommended to document the individual pigmentation before extractions are performed.

Classification system for complete edentulism. The American College of Prosthodontics.

The American College of Prosthodontists has developed a classification system for complete edentulism based on diagnostic findings. These guidelines may help practitioners determine appropriate treatments for their patients. Four categories are defined, ranging from Class I to Class IV, with Class I representing an uncomplicated clinical situation and a Class IV patient representing the most complex and higher-risk situation. Each class is differentiated by specific diagnostic criteria. This system is designed for use by dental professionals who are involved in the diagnosis of patients requiring treatment for complete edentulism. Potential benefits of the system include: 1) better patient care, 2) improved professional communication, 3) more appropriate insurance reimbursement, 4) a better screening tool to assist dental school admission clinics, and 5) standardized criteria for outcomes assessment.

Occlusal imbalance and temporomandibular disorders in the elderly.

The prevalence of the anamnestic symptoms and clinical signs of temporomandibular disorders (TMD) in 76-, 81-, and 86-year-old subjects was studied, on the basis of Helkimo's anamnestic (Ai) and clinical (Di) dysfunction indexes. Occlusal status was recorded by means of the Eichner index: class A has a maximum of four supporting zones (minimum of one tooth contact between the antagonist jaws in the premolar and molar region on each side), class B has one to three supporting zones or tooth contact in the frontal area only, and class C has no supporting zones. The Eichner index was recorded with two kinds of variations: supporting zones with and without removable prostheses. In the population studied 8% were classified as Eichner class A, 22% as class B, and 70% as class C. Including occlusal supporting zones of the removable dentures, the percentages were 75% in Eichner class A, 21% in class B and 4% in class C. When the groups with and without removable prostheses were compared, no differences were found in the Ai or Di. In conclusion, among the elderly population the severity of TMD does not depend on the supporting zones of the dentition alone, and removable prostheses do not relieve the problem.

Patient evaluation and treatment planning for complete-denture therapy.

A checklist is presented for use in evaluating and planning the treatment of patients for complete-denture therapy. A thorough explanation of each item and classification included in the checklist list also is presented. Classifications from the classic prosthodontic literature are used wherever possible and their sources are referenced appropriately.

Characteristics of 5410 edentulous implant candidates and the treatment they receive.

Since 1989 implant dentistry in the Netherlands is a National Dental Insurance (NDI) benefit, thus reducing out-of-pocket expenditures for implant candidates considerably. A nationwide investigation was set up in order to evaluate quantitative, qualitative and financial effects of this new provision. The patient and treatment characteristics of 5410 edentulous implant candidates are discussed. Intensive monitoring of the usage of these new regulations facilitates health care policy making, including future planning. Over a 3 1/2 yr period, two out of every thousand totally edentulous NDI patients were treated in combination with dental implants. This number is being considered small, bearing in mind the number of edentulous patients in the Netherlands and the proportion of dissatisfied denture wearers. Demographic data, prosthetic and pre-prosthetic surgical history reveal that these patients, mostly female and middle-aged, experience severe denture-related problems. In the majority of cases the implants are placed by an oral surgeon and the suprastructure is made by a general dentist or at a centre for special dental care. The treatment itself mostly consists of an implant retained overdenture on two or four permucosal implants and a bar-construction.

[Anchoring of partial dentures using OT-CAP precision attachments]. / Részleges lemezes pótlások elhorgonyzása OT-CAP finommechanikai rögzítöeszközökkel.

The authors have examined a precision attachment recently invented in Hungary. They are reporting about the experience gained during clinical examination of dentures made in different classes on the basis of the Fábián and Fejérdy classification of partial edentulousness.

[Criteria of anatomo-physiological evaluation of the conditions of the prosthetic substrate and a review of the classification of edentulous mouth]. / Kryteria oceny anatomiczno-fizjologicznych warunków podloza protetycznego oraz przeglad klasyfikacji bezzebnej jamy ustnej.

The criteria for the assessment of the conditions of the mouth for the needs of prosthetic treatment are presented and the classifications of edentulous mouth used as yet are surveyed.

Surgical and prosthodontic reconstruction of the severely handicapped edentulous patient.

There is among some prosthodontists a negative attitude toward preprosthetic reconstructive surgery because of previous poor experience with reconstructive or preprosthetic surgical procedures. Such experiences may have resulted from the limitations of techniques previously used; and, therefore, the prosthodontist may resort to conventional prosthodontic techniques. There are, however, limits to what can be achieved with special impression techniques, tooth form and placement, and so forth. This article was written not only to present the rationale of current techniques but to encourage the prosthodontist to consider and present to the severely handicapped edentulous patient the choice of preprosthetic reconstructive surgery.

Basic principles of obturator design for partially edentulous patients. Part II: design principles.

A classification for partially edentulous maxillectomy patients has been proposed, and a suggested design for each class is discussed. A simplified approach to the planning of resective surgery and a guide for the design of the maxillary obturator prosthesis have been presented.