A Cluster Analysis of Oral and Cognitive Health Indicators: An Exploratory Study on Cholinergic Activity as the Link.

INTRODUCTION: Poor oral health has been suggested as a risk factor for cognitive decline. Yet, biologically plausible mechanisms explaining this relationship remain unknown. OBJECTIVES: We aimed (1) to identify oral and cognitive health clustering patterns among middle-aged to elderly Canadians and (2) to investigate the extent to which these patterns could be explained by bone mineral density (BMD), a proxy measure of the cholinergic neurons' activity. METHODS: This cross-sectional study used baseline data from the Comprehensive cohort of the Canadian Longitudinal Study of Aging (CLSA). Oral health was assessed by a self-report questionnaire, and 7 task-based instruments measured cognitive health. We identified oral and cognitive health clusters, our outcome variables, using latent class analysis. Two sets of multivariate logistic regression and 95% confidence intervals were used to investigate whether BMD explains the odds of membership in a certain oral and cognitive health group. The final models were adjusted for socioeconomic, health, and lifestyle factors. RESULTS: Our study sample (N = 25,444: 13,035 males, 12,409 females) was grouped into 5 and 4 clusters based on the oral health status and performance on the cognitive tasks, respectively. After adjusting for all potential covariates, increase in BMD was not associated with higher odds of membership in classes with better oral health (odds ratio [OR] = 1.58 [95% confidence interval {CI}: 0.85-2.92]) and cognitive health (OR = 1.61 [95% CI: 1-2.6]) compared with the groups with the least favorable oral and cognitive health status, respectively. CONCLUSION: Middle-aged and elderly Canadians show different oral and cognitive health profiles, based on their denture-wearing status and performance on cognitive tests. No evidence could be found to support BMD in place of cholinergic neurons' activity as the common explanatory factor behind the association between oral health and cognitive health. KNOWLEDGE TRANSFER STATEMENT: This study is probably the first of its kind to shed light on the cholinergic system as a potential pathway influencing oral and cognitive health. Our findings may support the notion that any potential association between poor oral health and cognitive health might be explained by common contributors, helping clinicians to find the common risk factors for both conditions.

Single-Implant Overdentures Retained by a Novel Attachment: A Mixed Methods Crossover Randomized Clinical Trial.

INTRODUCTION: Single-implant mandibular overdentures (SIMOs) are one of the least invasive implant treatments for edentulism. The new Novaloc attachment system can improve the clinical performance of implant-retained overdentures but has not been tested for SIMOs. OBJECTIVES: To compare Novaloc and a gold standard system (Locator) for SIMOs in an edentate elderly population in terms of patient-reported outcomes and device- and treatment-related complications. METHODS: In this single-center crossover randomized clinical trial (RCT), 10 edentulous participants received an implant in the lower midline and had their lower complete dentures converted to SIMOs. The participants received each attachment system for 3 mo in a randomized order, followed by measurement of patient satisfaction and oral health-related quality of life via the McGill Denture Satisfaction Questionnaire and the Oral Health Impact Profile for Edentulous People questionnaire, respectively. Complications were registered throughout the RCT. Patients were interviewed for their experiences with SIMOs and preference for one of the attachment systems. Quantitative analysis employed mixed linear models and chi-square tests (α = 0.05), whereas interview data underwent thematic analysis and, in turn, integration into quantitative data (mixed methods explanatory design). RESULTS: All 10 randomized participants completed the trial. Mean ± SD general satisfaction was 92% ± 8% with Novaloc versus 85% ± 13% with Locator (mean difference, 9%; 95% CI, 1% to 17%). For specific McGill Denture Satisfaction Questionnaire items, only denture stability was significantly increased for Novaloc. Seven participants preferred Novaloc over Locator at the end of the RCT (chi-square, P = 0.045). No difference was found between the attachments in terms of oral health-related quality of life based on the Oral Health Impact Profile for Edentulous People and complications. Thematic analysis revealed high patient satisfaction with SIMOs, with denture stability the main criterion for their satisfaction and attachment preference. CONCLUSION: Among elderly edentulous patients wearing SIMOs, Novaloc led to increased patient satisfaction and preference. Better patient-perceived denture stability may explain this result. The attachment systems exhibited similar short-term maintenance needs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03126942 (first registered on April 13, 2017). Secondary identifiers: A03-M07-17A (McGill University, Institutional Review Board) and 2018-3873 (McGill University Health Centre, Research Ethics Board). KNOWLEDGE TRANSFER STATEMENT: The results of this mixed methods study can be used by clinicians when choosing which attachment system to use for SIMOs. Results suggest that edentulous patients prefer attachments with a better-defined seating position, such as that of the Novaloc system, as opposed to the nylon matrix on metallic abutment of the Locator system.

Physical Properties of Nanohybrid and Microhybrid Resin Composites Subjected to an Acidic Environment: A Laboratory Study.

BACKGROUND: This study investigated the hardness and color stability of five resin composites subjected to different polishing methods following immersion in distilled water or lactic acid for up to three months. METHODS AND MATERIALS: Three nanohybrid, Paradigm (3M ESPE), Estelite Sigma Quick (Tokuyama), Ice (SDI), and two microhybrid, Filtek P60 and Filtek Z250, composites were examined. Disc-shaped specimens (10×1.5 mm) were prepared and immersed in distilled water for 24 hours then polished using either silicon carbide paper, the Shofu polishing system or were left unpolished (control). The CIE values and microhardness were determined using a spectrophotometer and digital Vickers hardness tester, respectively (n=10) after one, 45, and 90 days of storage in distilled water or lactic acid. Data were analyzed using analysis of variance, Tukey test, and Pearson correlation coefficient. RESULTS: Ice exhibited the greatest color change, yet Paradigm and Filtek P60 demonstrated the least. Overall, discoloration of tested materials was multifactorial and the effect of storage media depended on the material, polishing method and time interval. The greatest hardness was obtained for Paradigm and the lowest for Estelite. Hardness was found to be significantly higher in lactic acid after 45 days (p=0.014) and even higher after 90 days (p<0.001) compared with distilled water. CONCLUSIONS: An acidic environment did not adversely affect color stability or microhardness of the resin composites. There was a significantly mild reverse correlation between hardness and color change in both storage media.