Relationship between nutritional status and tooth loss in an older population from Sri Lanka

doi: 10.1111/j.1741‐2358.2011.00518.x Relationship between nutritional status and tooth loss in an older population from Sri Lanka Objective: To determine the relationship between tooth loss and nutritional status in older individuals in Sri Lanka. Background: In developing countries, both the prevalence of malnutrition and oral disease are high among older individuals. Materials and methods: Four hundred and eighty subjects aged 60 years and above were selected to be included in the sample, of which 437 responded giving an overall response rate of 91%. Data were collected by means of an interviewer administered questionnaire, an oral examination and a physical examination to determine height and weight to calculate the body mass index (BMI). Results: Based on the WHO cut‐offs for BMI, 62, 20 and 18% of the sample were normal, under‐ and over‐weight, respectively. A multinomial logistic regression analysis with normal weight as the reference category revealed that missing teeth and denture status were associated with being underweight but not with being overweight. Conclusion: In older individuals, tooth loss is significantly associated with being underweight.     

Tooth loss, denture wearing and associated factors among an elderly institutionalised Brazilian population

Objective: This cross‐sectional study assessed the prevalence and extent of tooth loss as well as denture wear and associated factors in institutionalised elderly in Brazil. Background: There is scarcity of research in Brazil concerning geriatric oral health issues. Material and methods: A sample of 335 individuals over 60 years of age, representative of the institutionalised elderly from Belo Horizonte, Brazil, were selected through a stratified sampling strategy. Data were collected from structured questionnaires, reviews of medical records and intra‐oral examinations. Results: Edentulousness was observed in 74.9% of the elderly and was related to age, years of study, income, length of institutionalisation, systemic diseases and mini‐mental score. Among the dentate subjects, 17.9% possessed 20 or more teeth. Approximately half the edentulous elderly (42.6%) and most of the partially dentate subjects (66.7%) did not wear dentures. The multivariate analysis showed that subjects that wear dentures were more likely to be female, possess higher incomes, be more functionally independent and married. Furthermore, the odds of wearing dentures among the elderly who had lost 13–32 teeth were 9.11 times higher than those who had lost up to 12 teeth. Conclusion: Tooth loss is highly prevalent in this institutionalised Brazilian population, and the prevalence of denture wear is low. The extent of tooth loss, income, functional status and marital status are important predictors for denture wear. The development of an oral health programme for these individuals should assist in their rehabilitation needs and promote in‐home care or safe transport for the elderly to a health care location.     

The masticatory handicap of wearing removable dentures in elderly men

Objective: This study aimed at describing the masticatory handicap of wearing removable dentures measured by some masticatory tests and the intake of hard and soft foods. Materials and methods: The subjects were participants in a comprehensive health examination of 67–68‐year‐old men living in Malmö, Sweden. Four hundred eighty‐three men took part in a clinical oral examination which recorded the number of teeth and removable dentures. One hundred and one had complete dentures in both jaws and 131 had removable partial dentures in different combinations. Masticatory tests used almonds to record the number of stokes to the first swallow, and two‐coloured chewing gums for recording bolus kneading and shaping. A nutritionist paid a home visit to assess dietary habits including the consumption of hard and soft foods. The data could be split into groups of different tooth and denture situations which were large enough to enable statistical analysis to be carried out. The results of a regression analysis of the group with different numbers of natural teeth (NT) and no removable dentures could be used as a reference for correlation with the masticatory capacity of removable denture wearers. Results: Number of strokes to the first swallow revealed no masticatory limitations of wearing removable dentures, while chewing gum colour‐mixing and shaping revealed more differentiated impairments equivalent to the function of five to 16 teeth in a remaining natural dentition. Hard food intake for the removable denture groups was comparable to 17–19 NT. Soft food intake was not influenced by denture wearing. In a ranking of oral conditions, those with more than 24 NT had the highest test values for all tests, and those with complete sets of dentures the lowest except for the number of strokes to the first swallow of an almond. Conclusion: Removable denture wearing can be regarded as a handicap when measured with objective masticatory tests using chewing gum and the intake of hard foods. The number of chewing strokes to the first swallow of an almond and the intake of soft foods is not affected by the wearing of removable dentures.     

Elderly complete denture wearers: a social approach to tooth loss

doi: 10.1111/j.1741‐2358.2011.00550.x Elderly complete denture wearers: a social approach to tooth loss Objectives: To correlate emotional reactions to tooth loss with denture satisfaction attributes in elderly complete denture wearers. Background: Total tooth loss is a serious life event, and poor oral health has an impact on daily life. Edentulism treated by rehabilitation with dentures can have a positive effect on patients’ self‐image and social behaviour. Methods: A group of 80 edentulous subjects undergoing routine prosthetic care in a Greek Department of Prosthetic Dentistry were interviewed using two structured questionnaires. The first questionnaire explored reactions to tooth loss, whereas the second measured their subjective experience of complete dentures. The responses to both questionnaires were compared using the statistical package spss v.17. Results: The results showed significant correlation between aspects of tooth loss experience and complete denture satisfaction. Despite the fact that a substantial proportion of patients were satisfied with their complete dentures, some patients experienced increased social and psychological problems related to their edentulousness and the wearing of complete dentures. The aesthetic and functional aspects of complete dentures affected both patients’ social behaviour and self‐confidence. Conclusions: Total tooth loss was not only reflected in patient’s social behaviour and self‐image, but it had a complex and multifaceted impact on satisfaction from complete dentures.     

Oral health and treatment needs of the long-term hospitalised elderly

Objectives: To determine the oral health and treatment needs of the long‐term hospitalised elderly. Setting: The Laakso long‐term hospital, Helsinki, Finland. Design: A cross‐sectional study with clinical oral examinations. Subjects: All long‐term patients (n = 260) aged 60 and older. Main outcome measures: Edentulousness, presence and hygiene of dentures, mucosal findings, number of teeth, functioning teeth and tooth remnants, level of dental hygiene, and need for operative treatment. Results: Subjects’ mean age was 83.3 years (SD = 8.1); 42% were edentulous, 45% of women and 33% of men (p = 0.12). With no gender difference, 41% had removable dentures, but one in four were considered to be in need of repair or replacement. Denture hygiene was good in 19%, moderate in 44%, and poor in 37%, and for men worse than for women (p = 0.02). Stomatitis was found in 25%, and angular cheilitis in 28% of the denture wearers. The dentate subjects had on average 12.4 (SD = 8.6) teeth with a clear difference by age (p = 0.03), but no difference by gender. Dental hygiene was considered poor. Of the dentate subjects, 37% were in need of restorations, 51% of periodontal therapy and 42% of extractions. Conclusions: Oral cleanliness should be improved with regards to dentures and teeth. More attention should be focused on dental care of the long‐term hospitalised elderly.     

Patients' experiences with partial dentures: a qualitative study

Objective: The aim of the study was to gain insight into people's experiences of being given and using partial dentures. Methods: In‐depth semi‐structured interviews were carried out with 23 people of varied age, social background and denture wearing experience in Tayside, Scotland. Participants were encouraged to discuss how they came to have partial dentures, their day‐to‐day denture use and their interactions with dentists. The interview data were systematically coded using key theme headings, and summary charts were constructed to facilitate analysis. Results: The initial decision that a partial denture was needed was generally difficult to accept. People perceived the main benefits of partial dentures to be improved appearance and confidence, but experienced a variety of difficulties with their dentures and often coped with these by only wearing them on social occasions. Participants had not always told their dentists about the difficulties they experienced. Barriers to seeking help with denture problems included financial constraints, previous experience of rushed appointments or poor communication from dentists and a perceived lack of entitlement to help when partial dentures were issued free. Conclusions: Partial dentures can be difficult to cope with. People experience a range of difficulties in wearing them, not all of which have been discussed with dentists. Informative and supportive communication when partial dentures are first needed, and subsequently, can improve the quality of patients’ experiences and may help promote effective use and appropriate help‐seeking by partial denture wearers.     

Assessing expressed need and satisfaction in complete denture wearers

Objectives: The need to assess both lay and professional views of oral health is believed to be at the centre of success when providing dental health care for older patients. Self‐perceived physical (oral) health and perceptions of psychosocial functioning must be included if expressed need is to be assessed. The aim of this work was to construct an expressed need schedule and to assess the ability of this assessment to predict older community‐based patients' satisfaction with complete dentures. Design: Survey of 260 people aged 65 years and over. Setting: Community setting. Main outcome measures: The participants were interviewed using a 55 item modified version of the Oral Health Impact Profile (OHIP) to assess their psychological, social and perceptions of their oral health. All participants were subjected to an oral examination. Results: The results showed that complete denture wearers compared had greater experience of difficulties associated with oral health and psychological functioning. Factor analysis allowed the identification of three dimensions associated with psychological, social and self‐perceived physical (oral) health. When these factors were regressed with normative denture treatment need against satisfaction with complete dentures, satisfaction was characterised by high self‐perceived physical (oral) health, low social health problems and no identifiable normative need. Conclusion: This work supports the inclusion of self‐perceived physical (oral) health and psychosocial health (expressed need) questions in a schedule when predicting satisfaction with complete dentures.     

The satisfaction with the removable partial denture therapy in the Croatian adult population

Little is known about the outcomes of treatment and patient's satisfaction with removable partial dentures in adult Croatian population. Therefore patient's satisfaction with their partial dentures in relation to some socio-economic variables was studied. Patient's satisfaction with denture retention, speech, aesthetics, comfort of wearing dentures, chewing ability was also studied in relation to different denture classification, construction, material, denture base shape (major connectors), denture support and the number of missing teeth. A total of 165 patients, 59 males and 105 females between 38 and 87 years took part in this study. A questionnaire, devised for a purpose of the study, was divided into three parts. In the first part, patients answered questions about age, gender, marital status, education, general health, socio-economic status, self-supporting life, period of tooth loss and number of previous denture experiences and in the second part, patients graded their partial dentures, depending on the level of satisfaction, by using a scale from 1 to 5. In the third part a dentist determined Kennedy classification and their modifications, denture material and denture support, denture base shape and the number of missing teeth and graded a denture construction. Influence of these factors on patient's satisfaction was analyzed. A majority of the examined patients were satisfied with the partial prosthesis, but a small amount of dissatisfaction existed. More then half of them scored all the examined parameters to the best score category. Considering chewing with lower partial dentures, women were more satisfied than men (p < 0.05). Patients with more missing teeth gave lower grades for the comfort of wearing dentures (p < 0.05). Patients of higher education gave lower grades (p < 0.05) for the aesthetics. Patients were not satisfied with speech if the dentist graded a construction of a lower partial denture low (p < 0.05). Dissatisfaction was related to mastication, aesthetics, number of missing teeth and ability of speech. These findings can aid a clinician in discussing a treatment plan and help a patient understand the risk of dissatisfaction in the presence of certain factors.     

Self-reported denture hygiene of a sample of edentulous attendees at a University dental clinic and the relationship to the condition of the oral tissues

Objectives: This article aims to evaluate the habits of hygiene and usage of a sample group of Brazilian wearers of complete dentures. Design: This study has a cross‐sectional design. Setting: It was performed in the dental clinic of the University of Mogi das Cruzes. Subjects: A sample group of 236 complete denture wearers was selected. Intervention: The individuals were interviewed and clinically examined. Main outcome measures: Most commonly used hygiene habits were assessed and recorded. Possible relationships between habits and oral conditions were also assessed. Results: Dental treatment was sought by 43.6% 10 years after their last dental appointment, 77.5% declared they had been given no instructions regarding the hygiene of their dentures, only 22.9% said they had been instructed about oral hygiene, and 91.9% stated they had not been told to return for periodical review visits. Denture stomatitis was found in 42.4%, although 89% of these patients presented with no symptoms; 98.7% of the group brushed their dentures; 27.1% regularly immersed their dentures in chemical products; 26.3% removed their dentures overnight. A positive relationship was observed between the lack of recommendations regarding oral and denture cleansing and the presence of denture‐related stomatitis and hyperplasia. Family income and periodicity of visits to the dentist were also found to be related. Conclusion: Mechanical cleaning is the most prevalent method of hygiene. Self‐reported lack of guidance to oral care was statistically related to inflammatory oral conditions. Future research is necessary to clarify possible causal role between these factors.     

Oral mucosal lesions in denture wearers

doi:10.1111/j.1741‐2358.2009.00289.x
Oral mucosal lesions in denture wearers Objective: To determine the prevalence of oral mucosal lesions (OMLs) and denture‐related mucosal lesions (DMLs) in denture wearers and to co‐relate the prevalence with age, gender, type of denture and any systemic conditions. Materials and methods: Dental records of 380 denture wearers were retrospectively reviewed for OMLs and DMLs. Results: We found 45% of the denture wearers had DMLs and 60.8% had OMLs not related to denture wearing. Although the prevalence of DMLs was higher in complete denture wearers than in partial denture wearers (49% vs. 42.2%), this difference was not significant. The most common DMLs were traumatic ulcer (19.5%) and denture‐induced stomatitis (18.1%). When analysed by type, traumatic ulcer, denture hyperplasia, frictional keratosis and candidiasis were more common in complete denture wearers, whereas denture‐induced stomatitis was more common in partial denture wearers. Frictional keratosis was more common in men than in women. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers, and the most common OML was fissured tongue (27.6%). No association between DMLs and systemic conditions or xerostomic drugs was noted. Conclusion: No differences in the prevalence of DMLs in association with denture type were found. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers. This difference was affected by age, and the data were similar to the findings observed in the elderly.     

Validation of a Sinhalese translation of the Oral Health Impact Profile-14 for use with older adults

Objective : To test the psychometric properties of a Sinhalese translation of the OHIP‐14 scale for use among older adults in Sri Lanka. Design : A cross‐sectional survey. The English version of the OHIP‐14 was translated in to Sinhalese, pre‐tested and subsequently administered to the subjects by a trained interviewer. Setting : Moratuwa — a densely populated urban area in the Western province of Sri Lanka. Subjects: 585 individuals aged 60 years and above. Main outcome measures : Reliability of the translated scale was assessed in terms of internal consistency using Cronbach's alpha. Construct validity was evaluated by examining the associations between perceived oral health status, perceived need for dental care and the OHIP scores. Results : Cronbach's alpha of the translated scale was 0.93. Corrected item‐total correlation coefficients ranged from 0.53–0.80. The highly significant associations between perceived oral health status, perceived need for dental care and the OHIP scores support the construct validity of the translated scale. Conclusion : The Sinhalese translation of the OHIP‐14 is a valid and reliable instrument to measure oral health related quality of life in older adults of Sri Lanka.     

Perceptions About Oral Health and Utilization of Oral Health Care Services Among Urban Finnish Elderly1

A representative sample of urban elderly living at home were studied for their perceived problems of oral health, treatment need felt for these problems, and their utilization of oral health care services. The majority of these elderly were denture wearers. Nearly all of the denture-wearing elderly had problems with their dentures, and about half of the dentate elderly had problems with their remaining teeth. The number of problems perceived increased with deteriorating health and decreasing income. Half of the elderly with denture problems and two-thirds of those who had problems with remaining teeth felt they needed dental treatment. Multivariate analyses found the number of perceived problems, having some natural teeth, and perceived general health to be the most important determinants of their perceived treatment need. Although two-thirds of the studied elderly felt no barriers to seeking treatment, only half of them had made their last dental visit less than five years ago. Having some teeth remaining, oral health education experiences, and income were found to be the best predictors of service utilization. Altogether, affective and cognitive factors rather than socio-demographic differences appeared to determine the elderly's perceptions about treatment need and their actual utilization of dental services, emphasizing the necessity of oral health education approaches designed for the elderly.     

Knowledge of prosthodontic treatment among denture-wearers and non-denture-wearers attending a dental institute in India: a survey report

Objective: Knowledge of subjects regarding prosthodontic treatment may play a role in their acceptance of the prostheses. The purpose of this survey was to assess the knowledge of prosthodontic treatment among the denture‐wearers and non‐denture‐wearers reporting to the Institute of Dental Sciences, Belgaum. Methods: A self‐designed closed‐ended questionnaire containing 14 questions was designed. Four‐hundred and nineteen subjects aged between 25 and 65 years were surveyed over a period of 2 months. Collected data were statistically analysed using chi‐squared test at a significance level of p < 0.05. Results: From the 419 subjects surveyed, 140 subjects (33.4%) were dentate and 279 subjects (66.6%) were edentulous either in the maxillary, mandibular or both arches. Among the 279 edentulous subjects, 143 (51.3%) did not use any kind of prosthesis. There was a statistically significant difference in knowledge regarding the replacement of teeth by artificial means, the number of visits required for the provision of a complete denture, problems with dentures among subjects using and not using them (p < 0.001) whereas no significant difference was found among the subjects regarding aesthetics with dentures and socializing with friends. Conclusion: Attempts should be made to raise the level of knowledge of both denture‐wearers and non‐denture‐wearers reporting to the Institute for any dental treatment.     

Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00369.x Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil Objective: The aim of this study was to evaluate the overnight wearing and cleaning habits of complete denture wearers. Background: Successful complete denture treatment can be achieved when the patients are motivated and aware of appropriate denture wear and hygiene. Materials and methods: A sample of 224 complete denture wearers (162 women) aged 37–89 years was studied. Inclusion criteria comprised edentulous subjects who had received their new complete dentures between 2000 and 2005 in the Dental Clinic of the Araçatuba and Araraquara Dental School, São Paulo State University. Ethical approval was sought and granted. Subjects were interviewed using questions related to overnight denture wearing and denture cleaning habits. Possible statistical relationships among some of items were analysed by the chi‐square test at 5% significance level. Results: Of the patients, 55.8% removed their dentures during the overnight period and 88% did this every day. Among them, 66.4% removed both dentures. Most of the patients used brushing with toothpaste (105 patients – 46.87%) as a cleaning method. More than a half of the subjects (63.4%) showed biofilm and calculus on their dentures. Conclusion: The patients need instructions and motivation concerning denture hygienic and denture removal overnight.     

The masseteric jaw-jerk reflex in older dentate subjects and edentulous denture wearers

The aim of the present study was to investigate any variations in the jaw-jerk reflex in edentulous subjects wearing complete dentures, compared to an age and sex-matched dentate group. The reflex was elicited by chin taps in 22 older dentate subjects with mean age 61.3 years and in 22 denture wearers with mean age 63.1 years. Surface electromyographic recordings were obtained from the masseter muscle of the preferred chewing side during mandibular rest and at moderate clenching (40% of the individual maximum clenching masseteric EMG activity). A jaw-jerk reflex was recorded in all subjects at least once, and its occurrence during clenching was reduced compared to rest. The occurrence of the reflex was however increased in the denture wearers in both experimental conditions, while minor differences were observed in the values for latency, duration and amplitude between the two dental status groups. These results suggest that under the present experimental conditions the periodontal ligament receptors might inhibit reflex activity. Multiple sensory interactions are expected in denture wearing. However a particular source of sensory feedback is provided by the stimulation of mucosal receptors from the acrylic denture base. Since the occurrence of the jaw-jerk at clench in the denture wearers was also reduced compared to the rest experiments, a potential inhibitory effect of the mucosal receptors can be speculated. According to the findings in the present study the loss of teeth and the rehabilitation with complete dentures do not severely disrupt the reflex activity investigated.     

Sensory detection of food odour in relation to dental status,gender and age

The aim of this study was to investigate to what extent declining odour perception can be ascribed to dental status and oral hygiene habits, taking into account gender and age. Apparently healthy adults (n=182), ranging from 53 to 93 years (mean age=68.4) were tested. Information about oral hygiene habits (brushing teeth and cleaning dentures) and dental status was obtained by questionnaires. A validated objective procedure was used to measure sensory detection thresholds for isoamylacetate by an ascending method of limits. A significant negative correlation of odour perception with age was shown by the edentulous subjects which might reflect their wider age spread with many subjects over age 75. The evaluation of odour perception as a function of dental status shows no significant difference in odour perception between persons partial denture wearers, with natural teeth only or complete dentures. However, a tendency for lower odour perception was observed among male partial denture wearers, especially those reporting less frequent oral hygiene, which justifies further more detailed study.     

A preliminary report of the cost‐effectiveness of tooth replacement strategies for partially dentate elders

doi: 10.1111/j.1741‐2358.2012.00665.x A preliminary report of the cost‐effectiveness of tooth replacement strategies for partially dentate elders Objective: To compare the cost‐effectiveness of conventional treatment using partial dentures with functionally orientated treatment to replace missing teeth for partially dentate elders using a randomised controlled clinical trial. Background: In many countries, including the Republic of Ireland, the only publically funded treatment option offered to partially dentate older patients is a removable partial denture. However, evidence suggests that these removable prostheses are unpopular with patients and can potentially increase the risk of further dental disease and subsequent tooth loss. Materials and Methods: Fourty‐four partially dentate patients aged 65 years and older were recruited. Patients were randomly assigned to the two treatment arms of the study. The conventional treatment group received removable partial dentures to replace all missing natural teeth. The functionally orientated group was restored to a Shortened Dental Arch (SDA) of 10 occluding contacts using resin‐bonded bridgework (RBB). The costs associated with each treatment were recorded. Effectiveness was measured in terms of the impact on oral health‐related quality of life (OHRQoL) using OHIP‐14. Results: Both groups reported improvements in OHRQoL 1 month after completion of treatment. The conventional treatment group required 8.3 clinic visits as compared to 4.4 visits for the functionally orientated group. The mean total treatment time was 183 min 19 s for the conventional group vs. 124 min 8 s for the functionally orientated group. The average cost of treatment for the conventional group was 487.74 Euros compared to 356.20 Euros for the functional group. Conclusions: Functionally orientated treatment was more cost‐effective than conventional treatment in terms of treatment effect and opportunity costs to the patients’ time.     

Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2009.00351.x
Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers Objective: To determine the frequency of the oral lesions related to gender, age, the length of time of denture usage, education level and economic status. Methods: The 153 patients with old complete dentures (CD) were asked to participate in the investigation. The subjects (76 male and 77 female) were 37–85 years of age with a mean age of 61.8 ± 9.8 years. Education, economic status and age factors were estimated in subgroups. The data obtained were evaluated by one‐way anova , Mann–Whitney U‐test, Kruskal–Wallis test, Student’s t‐test and chi‐squared test. The level of statistical significance was set at p < 0.05. Results: The patients who had denture stomatitis and traumatic ulcers were statistically significantly older than the ones who did not have these lesions (p < 0.05). Based on the length of denture usage, patients who had a flabby ridge, fibrous inflammatory hyperplasia, traumatic ulcers (p < 0.01) and denture stomatitis (p < 0.05) were using their dentures statistically significantly longer than the ones who had healthy tissues. Conclusions: The CD wearers should be advised to visit their dentist regularly to prevent oral mucosal lesions due to the changing supporting tissues during the length of denture usage and to improve their quality of life.     

Prevalence of temporomandibular disorders in a population of complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00574.x
Prevalence of temporomandibular disorders in a population of complete denture wearers Background: Complete tooth loss among the elderly is still frequent in developing countries and the incidence of temporomandibular disorders (TMD) is a common finding in complete denture wearers. Objectives: The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in a population of complete denture wearers. Materials and Methods: The data were collected by four examiners for the diagnosis of use and need for complete dentures followed by the World Health Organization standards and interviews for TMD signs and symptoms evaluation. Exploratory variables included demographic, socio‐economic status and TMD prevalence. Results: The prevalence of TMD among denture wearers was 55.12%. Chi‐squared test showed no statistical difference between subjects with or without TMD for gender, geographical location and skin colour (p < 0.05). The number of subjects with TMD increased as the period of complete denture wear increased, although no statistical difference between groups were found (p < 0.05). Conclusions: There is a need of educational programmes aiming at the importance of health care and periodical change of a complete denture, and strategies with a preventive approach to quality general dental care.