Prevalence of and Risk Factors for Dysphagia in the Community Dwelling Elderly: A Systematic Review.

OBJECTIVES: This review clarifies current information regarding the prevalence of and risk factors associated with dysphagia (swallowing disorders) in the community dwelling elderly (CDE). A better understanding of prevalence and characteristics of dysphagia in the CDE will help to determine the scope of this problem. Understanding the scope of dysphagia is a critical first step towards early identification, management, and prevention of dysphagia related morbidities in the CDE. METHODS: Studies identified from multiple electronic databases (MEDLINE (Pubmed), PsychInfo, Google Scholar, EBSCO, PROQUEST, Web of Science and WorldCat dissertations and theses) evaluating prevalence and risk factors for dysphagia in the CDE were reviewed. Data from all eligible studies were abstracted by the first author and independently reviewed by two raters, using the Newcastle-Ottawa scale (NOS). RESULTS: 15 studies (n = 9947 participants) were eligible for inclusion. Studies included were all observational: 14 cross-sectional and 1 prospective cohort. Significant heterogeneity was observed in methodology among studies of dysphagia in the CDE. The average NOS study quality rating was 4.54 points (SD: 0.9), with a mode of 4 points (range 3-6). Only 6 of the 15 studies were identified as high quality research studies, with a mean of 5.33 points (SD: 0.47). Among reviewed studies, the prevalence of swallowing difficulty in the CDE ranged from 5% to 72%. However, the average prevalence of dysphagia estimated from the 6 high quality studies was 15%. Reported risk factors associated with dysphagia include advancing age; history of clinical disease; and physical frailty, including reduced ability to carry out activities of daily living. CONCLUSION: Research on dysphagia in CDE is modest and consists mostly of observational studies with diverse methodology. However, prevalence rate of 15% from the high quality research suggests a significant public health impact of this impairment. Identification of specific risk factors that cause dysphagia in the CDE is premature, given the rigor of published studies. Future research efforts should focus on developing a valid definition and assessment of dysphagia in this population before clarifying causative risk factors.

[Biology of periodontal regeneration: a review and a hypothesis for future researches]. / Biologia della rigenerazione parodontale: una revisione della letteratura e un'ipotesi per ricerche future.

Since the end of the seventies several studies have been carried out about the possibility of regeneration of periodontal osseous defects. The results of such researches supported by histological tests allowed to establish which surgical techniques could yield periodontal regeneration in a predictable way. In spite of a quite large diffusion of these sugical techniques in the treatment of periodontal osseous defects, some biological aspects of periodontal regeneration are still unknown. The most important among them is the origin and the differentiation pathway of the synthetic cells that shall provide for the reconstruction of the deep periodontium. Particularly, the phenotypic pattern and the origin of cementoblasts are not clear. Our researches focused on pericytes, a mesenchyma-derived cell population with remarkable differentiation capacities which have a microvascular location. We considered the hypothesis that pericytes could play an important role in regeneration of the alveolar bone, of the cementum and of the periodontal ligament. Should pericytes be actually the precursors of osteoblatsts, fibroblasts and cementoblasts involved in periodontal regeneration, new therapies, such as cultivated cells reimplantation or the targeted use of growth factors could be feasible. Future researches shall verify these observations.

[Clinical cases of teeth previously treated by endodontic restoration using intra-canal pins of gold-coated brass]. / Casi clinici di ritrattamento di elementi dentari precedentemente ricostruiti mediante perni endocanalari in ottone dorato.

The authors, in previous studies, showed that morphological alterations on gold coated brass pins, extracted after some years of staying in dental roots, are the consequence of a localized corrosion attack, produced by anaerobic bacteria, whose presence is confirmed by the high concentration of sulphur on the most attacked spots. Since, by using a suitable technique of pin inserting, the corrosion should not occur, it was supposed that root resorption could lead to favourable conditions to create corrosion. In order to bear out this assumption, 10 meaningful clinical cases of teeth previously restored by gold coated radicular pins are critically evaluated.

[Morphological changes on gold-coated brass endodontic pins]. / Studio di alterazioni morfologiche su perni endocanalari in ottone dorato.

Scanning electron microscope (SEM) connected with X-ray microanalysis (EDX) was used to study surface alterations of gold-coated brass dental pins (Dentatus), taken out after some years from restored teeth due to necessity for repeating a restorative therapy. The study method led to establish that: --the gold coating of the base material, constituted of copper alloy, absolutely insufficient to prevent corrosion attack; --the observed morphological alterations are the consequence of a localized corrosion attack, produced by anaerobic bacteria, which origin is confirmed by the presence of S on the most attacked points; --finally the corrosive phenomenon does not cause a periapical pathology, but the process is contrary, or rather, it is the pathology that leads to the favourable conditions to create corrosion.