Masticatory coefficient and physical functioning in older frail patients admitted for a Comprehensive Gerontological Assessment.

BACKGROUND: Physical functioning may be limited in older, frail patients with missing teeth without prosthetic correction. This cross-sectional study examined the relationship between physical performance and the geriatric masticatory coefficient (GMC) in patients who underwent both a comprehensive gerontological assessment (CGA) to improve poly-pathology management and an intra-oral exam. METHODS: All patients were evaluated based on the following: (corrected) GMC, number of posterior occluding pairs (POPs), short physical performance battery (SPPB) or timed up and go (TUG) test, and mini-nutritional assessment (MNA). RESULTS: Of the 256 patients (mean age 83.76[SD 6.16], 148F), 75 (29.30%) were malnourished. The corrected GMC was lower in malnourished patients. When adjusted for age, gender, and MNA, the corrected GMC correlated with the TUG time (r=-0.198, p=0.005) and SPPB score (r=0.282, p=0.009). Correlations between GMC and POPs were determined for the SPPB (r=0.269, p=0.013; r=0.319, p=0.004, respectively) but not for the TUG (r=-0.108, p=0.128; r=-0.136, p=0.072). CONCLUSION: The correlation between physical performance and decreased masticatory capacity was not fully explained by malnutrition in mildly to severely frail and multi-morbid patients; posture may also be impaired by missing teeth. The study of dental care effects on physical performance will provide further insights.

Characterization of mouthguards: Impact performance.

BACKGROUND/AIM: It is difficult to characterize the impact behavior of mouthguards on the basis of their components. Impact behavior tests should be performed on mouthguard formed to simulate their intra-oral performance. The aim of this study was to compare the impact behavior of six models of mouthguards using a standardized experimental protocol. MATERIAL AND METHODS: Four commercially available mouth-formed mouthguards (SDI™, Gel Nano™, Opro Shield Gold™ and Kipsta R300™), one mouth-formed mouthguard prototype and one custom-made mouthguard were tested. The procedures recommended by the manufacturers (injecting procedure for custom-made mouthguard and "boil-and-bite" procedures for mouth-formed mouthguards) were used to adapt five samples per model on steel jaws. Impact performances were assessed according to labial aspect thickness and maximum contact load (FMax) during impact using a drop tower. RESULTS: SDI™ and Opro Shield Gold™ had the thinnest labial aspect thickness (P<.01), followed by the Gel Nano™ and the Kipsta R300™ (P<.01) with a thickness of about 3 mm. The prototype and custom-made mouthguard were thicker (almost 4 mm). The custom-made mouthguard, the Kipsta R300™ and the prototype had the best impact performances, but the labial aspect thickness of the Kipsta R300™ was significantly lower than that of the custom-made mouthguard and the prototype. Analysis of force curves and position of the mouthguard on the impacted zone showed that the Kipsta R300™ was less well adapted. CONCLUSION: Thickness and impact performance are not sufficient criteria to characterize performance of mouthguards.

Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients.

OBJECTIVE: The aim of this study was to describe relationships between oral status, dysphagia and malnutrition in a hospitalised older people. BACKGROUND: Undernutrition in older people is a major concern in geriatric hospital wards. Different factors can modify nutritional status like dysphagia or oral status. MATERIALS AND METHODS: About 159 consecutive inpatients (108 women, 51 men) were examined. Comprehensive gerontological data at baseline and nutritional status according to BMI, MNA and serum albumin concentration, dependency according to ADL scores, dietary intake, swallowing capacities and oral status were collected. Swallowing capacities and dietary intake were reassessed 1 week after. RESULTS: Mean age was 85.28 (SD 5.68). Seventy-seven patients were malnourished (MNA) and 34 had dysphagia. Oral treatment was necessary in 142 patients (89.30% of all population). Candidiasis was present in 17 patients and salivary flow reduction in 50. Patients with dysphagia had the lowest dietary intake. After 1 week, patients with dysphagia were retested and dysphagia had abated in three of them. Dysphagia and undernutrition were associated (p < 0.001), and both were related to candidiasis (p < 0.001 and p < 0.01). Dysphagia was also related to salivary hypofunction (p < 0.001), loss of posterior occluding pairs (POPs; p = 0.014), oral self-care dependency (p < 0.001) and self-feeding dependency (p < 0.001). Salivary hypofunction was related to candidiasis (p < 0.001) and loss of POPs (p < 0.05), and candidiasis to loss of POPs (p < 0.01). CONCLUSION: Although no causality can be demonstrated, poor oral health was strongly associated with malnutrition, emphasising the importance to develop oral care strategies and to incorporate a dental examination into comprehensive gerontological assessment.

Characterization of mouth-formed mouthguards: thermal performance.

This study examined whether the thermo-modeling process suits the thermal properties of the material constituting mouth-formed mouthguards (MGs). Five mouth-formed MGs were compared: four commercially available MGs (SDI™, Gel Nano™, Opro Shield Gold™, and Kipsta R300™) and one prototype. Differential scanning calorimetry was used to determine melting (T(m)) and crystallization (T(c)) temperatures and specific fusion and crystallization enthalpies (∆H(f) and ∆H(c) (J/g)). MGs were modeled with recording of vestibular flange and occlusal cushion temperatures (Toccl). Tm ranged from 45.3°C to 53.0°C and Tc ranged from 40.9°C to 48.2°C. Specific heat of fusion ranged from 40.2 J/g to 62.0 J/g. Toccl was higher than Tm for all MGs except Kipsta R300™. Guidelines provided by manufacturers may not be adapted to thermal properties of the MG material. To ensure proper thermomodeling, heating and biting durations should be adjusted.

Efficiency at the resident's level of the NABUCCOD nutrition and oral health care training program in nursing homes.

OBJECTIVES: To assess the impact of a nutrition and oral care training program on nursing home (NH) policies and residents. DESIGN: Cross-sectional surveys before/after intervention. PARTICIPANTS: One hundred thirty-eight NHs participated in the initial training. INTERVENTION: Training sessions for staff, director, and medical practitioners for nutritional and oral care in NH. MEASUREMENTS: Two waves of self-assessments over a 6- to 8-month interval described NH policies (Institution questionnaire), quality of care in newly admitted residents (Admission questionnaire), and in those present for more than 6 months (Stay questionnaire). RESULTS: Questionnaires were completed at both waves in 24 NHs (17.8%) for Institution, in 42 NHs including 646 residents for Admission, and in 34 NHs including 287 residents for Stay. There was no significant difference in bed capacity and resident dependency between NHs, which performed both assessments, and nonresponders. No change was observed for Institution. Malnutrition screening was carried out in almost all residents. Two risk factors were better screened after training: pressure ulcers (39.4% to 49.1%, P = .014) and dysphagia (33.5% to 41.0%, P = .049). Oral examination improved quantitatively (38.5% of residents to 48.5%) and qualitatively: risk factors for malnutrition and dysphagia were better sought (loss of posterior teeth (P < .0001), asialia (P < .0001), and candidosis (P = .002)). Similar improvements were seen in Stay assessments. Actions to counteract weight loss or low dietary intake records were not found in one third of resident records. CONCLUSIONS: Training program improved staff knowledge with positive results at the level of residents but no significant changes were seen within NH policies.

Behavior under impact of two polyvinyl acetate-polyethylene (PVA-PE) polymers and one elastomer--application to custom-made mouthguards.

A drop tower was used to identify the mechanical behaviors of two polyvinyl acetate-polyethylene (PVA-PE) polymers and one elastomer used to fabricate custom-made mouthguards. The samples were in the form of either small cubes (edge length: 20 mm) or large cubes (edge length: 30 mm). Force and strain were recorded as functions of time, enabling a stress-strain analysis to be performed. In addition, a volume energy analysis was performed. While the three materials were viscoelastic, the stress-strain analysis showed that the PVA-PE polymers were more rigid than the elastomer, i.e., the same stress was reached with a lower strain. With the volume energy analysis, the two PVA-PE polymers were found to absorb a relatively large amount of energy with small sample deformations. Results of this study suggested that the mechanical properties of PVA-PE polymers are particularly useful and relevant for the fabrication of custom-made mouthguards.

Four major disasters in Aquitaine, France: use of odontologic techniques for identification.

The 4 mass disasters that have affected the Aquitaine region (France) in the previous 15 years are related through the specificity and the efficiency of dental methodology in identifying the victims. The results point to the decisive influence and the efficiency of dental methodology for identification of bodies that are burned or disfigured after an accident or a prolonged period in water.