Accuracy of Perceived Treatment Needs Among Geriatric Denture Wearers1

Patient satisfaction with and accuracy in assessing condition of dentures and oral tissue were related to their clinical evaluation and several psychological factors in 50 denture wearers 60 years of age or older. Seventy percent of those examined wore clinically inadequate dentures and 34% had unsatisfactory oral tissue. Few respondents were dissatisfied when clinical examination revealed satisfactory conditions but 70% were satisfied with inadequate dentures and 50% with unsatisfactory oral tissue. Contrary t o expectation, accuracy was not found significantly related to clinical evaluation or to psychological factors. However, satisfaction with dentures was related to their clinical evaluation: dissatisfied respondents had technically superior dentures as compared with those satisfied. These findings suggest that psychological factors are not related to denture patient assessment of their oral condition and that dissatisfaction may be of benefit to their oral health. The high proportion of those unaware of denture inadequacies indicates the need for patient education directed toward over-, as well as under-, adapters.     

Oral health-related quality of life--associations with oral health and conditions in Swedish 70-year-old individuals

doi: 10.1111/j.1741‐2358.2011.00495.x Oral health–related quality of life – associations with oral health and conditions in Swedish 70‐year‐old individuals Objective: The aim of this study was to evaluate oral health–related quality of life (OHRQoL) in relation to different chronic oral conditions and perception of oral health among elderly individuals. Background: Health‐related quality of life is important to assess and understand the impact of different diseases and conditions on individuals’ well‐being. Material and methods: Randomly selected 70‐year‐old individuals (N = 561) were included in this analysis. They were clinically examined and answered a questionnaire. Variables used were perceived oral health, satisfaction with appearance of teeth, problems with chewing and dry mouth, burning mouth syndrome, dental anxiety and dental visiting habits. To measure the participants′ perception of the impact of oral conditions on their well‐being, the Oral Health Impact Profile (OHIP‐14) was used. Results: The OHIP‐14 distribution of sum of scores showed a floor effect but revealed acceptable psychometric properties with regard to reliability and validity. Multivariable logistic regression revealed three highly predictive variables for individuals with high OHIP‐14 scores: using dentures, having chewing problems and being dissatisfied with appearance of teeth. Conclusion: Use of dentures, having chewing problems and being dissatisfied with appearance of teeth are associated with high OHIP‐14 sums, indicating strong influence on OHRQoL.     

A Retrospective Investigation on Canine Papillomavirus 1 (CPV1) in Oral Oncogenesis Reveals Dogs Are Not a Suitable Animal Model for High-Risk HPV-Induced Oral Cancer

CPV1 (also called COPV) is a papillomavirus responsible for oral papillomatosis in young dogs. The involvement of this viral type in oral oncogenesis has been hypothesized in oral squamous cell carcinomas (SCCs), but has never been investigated in other neoplastic and hyperplastic oral lesions of dogs. Aim of this study was to investigate the presence of CPV1 in different neoplastic and hyperplastic lesions in order to assess its role in canine oral oncogenesis; according to the results obtained, a second aim of the study was to define if the dog can be considered a valid animal model for oral high risk HPV-induced tumors. Eighty-eight formalin-fixed, paraffin-embedded (FFPE) canine oral lesions including 78 oral tumors (papillomas, SCCs, melanomas, ameloblastomas, oral adenocarcinomas) and 10 hyperplastic lesions (gingival hyperplasia) were investigated with immunohistochemistry for the presence of papillomavirus L1 protein and with Real-Time PCR for CPV1 DNA. RT-PCR for RNA was performed on selected samples. All viral papillomas tested were positive for immunohistochemistry and Real-time PCR. In 3/33 (10%) SCCs, viral DNA was demonstrated but no viral RNA could be found. No positivity was observed both with immunohistochemistry and Real-Time PCR in the other hyperplastic and neoplastic lesions of the oral cavity of dogs. Even though the finding of CPV1 DNA in few SCCs in face of a negative immunohistochemistry could support the hypothesis of an abortive infection in the development of these lesions, the absence of viral RNA points out that CPV1 more likely represents an innocent bystander in SCC oncogenesis. The study demonstrates a strong association between CPV1 and oral viral papillomas whereas viral contribution to the pathogenesis of other oral lesions seems unlikely. Moreover, it suggests that a canine model of CPV1 infection for HPV-induced oncogenesis could be inappropriate.     

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.     

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.     

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.     

Oral health status of a population of community-dwelling older Canadians

A sample of 170 responsive residents of seniors housing centres in Winnipeg, Canada, were studied, (>65 years, mean 82 years), with the objectives of relating their dental state lo their perception of need and uptake of service. Only 6% rated their oral health as poor, 46% reported a dental visit within the previous year and 68% felt they needed dental treatment. A lack of perceived need (88%) was the primary reasons why dental care was not sought more frequently. Hygiene practices revealed that only 7% brushed <1 time/day, 60% never flossed, 14% cleaned their dentures <1 time/day, and 42% slept with their dentures. Dental histories showed that examination (94%), prosthodontic treatment (76%), and restorative services (65%) were the most commonly sought treatments. Perceived dental needs included prosthodontic treatment (39%), periodontal/ prophylactic treatment (10%), restorative treatment (9%) and pain relief (9%). Study subjects had 2.8 decayed teeth, a DMST of 25.1, and a Root Caries Index of 38%. CPITN scores of 3 or 4 in at least one sextant were found in 80% of subjects. Of the 41 % edentulous, all wore complete dentures but 15% of complete upper dentures and 51% of complete lower dentures fitted poorly. Of the partial dentures, 20% fitted poorly. Soft tissue anomalies were seen in 67% of subjects and 47% had TMJ anomalies. Overall. 77% of edentulous subjects and all dentate subjects required some dental treatment even though 46% had seen a dentist within the preceding year. It is concluded that appropriate management of such people needs further attention.     

Oral care and stroke units

Objective: To investigate oral care provision reported by senior nurses in stroke care settings in Scotland. Background: Stroke can have adverse effects on oral care and health. Little is known about current oral care practices in stroke care settings. Materials and methods: We designed a postal survey to be completed by ward managers or senior nurses. After piloting, the survey was distributed to all 71 units in Scotland, identified as providing specialist care for patients in the acute or rehabilitation stages following stroke. Pre‐notification and reminder letters were circulated. Responses were anonymous. Results: All but one survey was completed and returned. Help from dental professionals was available to most units (64/70) mostly on request. Only a third of units received oral care training in the last year (23/70). The majority of this training was ward based (20/23). The use of oral care assessment tools and protocols was limited (16/70 and 15/70 units respectively). Not all units had access to toothbrushes, toothpaste or chlorhexidine. For patients unable to perform oral care independently, senior nurses expected the patients’ teeth or dentures to be cleaned at least twice a day in 59 of 70 and 49 of 70 units respectively. Conclusion: The response rate was excellent and has provided a national overview of oral care provision for patients in stroke care settings. Access to staff training, assessments, protocols and oral hygiene material varied considerably. This information provides a valuable baseline from which to develop and evaluate the effectiveness of ward‐based oral care interventions for stroke patients.     

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark

doi: 10.1111/j.1741‐2358.2011.00486.x
A cross‐sectional study of oral health and oral health‐related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark Aim: To describe the oral health and the oral‐health‐related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health‐care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. Methods: A cross‐sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health‐care programme. Clinical data and data from interviews comprising social factors, life‐style, dental visit habits, oral hygiene practices and self‐perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. Results: Sixty‐eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1–9 teeth and tooth mobility. Conclusion: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.     

Oral health status of elderly hospitalised psychiatric patients

doi: 10.1111/j.1741‐2358.2012.00633.x Oral health status of elderly hospitalised psychiatric patients Objectives: This study investigated the oral health status of an elderly mentally ill population hospitalised in a psychogeriatric ward in Athens. Materials and methods: A structured interview recorded sociodemographic and dental data, and an oral examination recorded the status of oral tissues and the existing dentures. The patients’ medical records were examined by a hospital’s physician. Results: One hundred and eleven patients with a mean age of 73 years participated in the study. Almost half of them suffered from schizophrenia. Forty percent were completely edentulous but only 38.6% of them used a pair of dentures. The dentate had an average of 12.9 teeth, 50.7% of them had at least one decayed tooth, 44.8% needed at least one extraction, and only 26.7% had filled teeth. The dental hygiene was poor in 83.6% of the patients. More than 60% of the dentures had a defect. Multiple regression analyses showed that increasing age and dementia were significantly related to fewer remaining teeth, and the use of atypical antipsychotics was related to fewer caried teeth. Conclusion: The oral health of the elderly psychiatric patients was very poor. Access to dental care should improve, and the health care staff should be trained to identify oral problems.     

Trends in Oral Disease and Health1

Geriatric dentistry researchers are building a basic knowledge basic pertaining to the oral health status of older adults. Important findings on the prevalence of disease that run counter to “conventional wisdom” surrounding the oral health of older adults are that edentulism is decreasing, that both coronal and root caries are prevalent, that serious periodontal disease is not as prevalent as thought, that chronological age is not strongly associated with disease in older adults, and that oral lesions, especially those related to dentures, are prevalent. An important finding has been that the majority of disease seems to occur in a minority of the population. While the prevalence of oral diseases have been shown to be associated with water fluoridation, systemic diseases, use of medications, social and behavioral factors, and a variety of other oral conditions, there is only preliminary information on the incidence of disease and actual risk factors. The data available on the incidence of disease come from a study of community-dwelling older adults in Iowa, and these data generally confirm the prevalence results. Coronal and root caries are active in this older population with caries being the best predictor of tooth loss. Furthermore, most disease occurs in a high risk group. Multivariate models predicting people at highest risk for root and coronal caries implicate stress and anxiety, use of tobacco, and recent onset of illness as risk factors. In addition, preliminary results indicate that some dental conditions may be predictive of general health status.     

Oral health of institutionalised elderly: a qualitative study of health caregivers’ perceptions in Brazil

doi: 10.1111/j.1741‐2358.2010.00366.x
Oral health of institutionalised elderly: a qualitative study of health caregivers’ perceptions in Brazil Objective: The aim of this study was to qualitatively explore caregivers’ perceptions of oral health care and factors influencing their work in a public long‐term care institution for the elderly in Goiania, Brazil. Method: Data were collected from a sample of 10 caregivers using personal in‐depth interviews and observation. Results: Caregivers were mainly nurses’ aides without training in oral health care. Oral health was associated with access to dental treatment, oral hygiene and use of dentures. Edentulousness, use of inappropriate dentures and appetite loss were perceived as negative images. Procedures used for oral hygiene were toothbrushing, mouth cleaning with a gauze and using a mouthwash. Conflicting priorities in routine care, lack of caregivers’ knowledge and the co‐operation of the elderly were the main obstacles to satisfactory oral care. Conclusion: Oral health care of the elderly was perceived as a burden by caregivers, and did not follow a standard protocol. Caregivers’ knowledge and perceptions reinforce the need for education and training in oral health issues.     

Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients

doi:10.1111/j.1741‐2358.2009.00294.x
Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients Background: Nowadays, there is some speculation among dental educators that the need for complete dentures will significantly decrease in the future and that training in their provision should be removed from the dental curriculum. Objective: To sensitise the reader to the functional shortcomings of complete denture therapy in the edentulous patient and present restorative options including implants to improve edentulous quality of life in these patients. Methods: Information retrieval followed a systematic approach using PubMed. English articles published from 1964 to 2008, in which the masticatory performance of patients with implant‐supported dentures was assessed by objective methods and compared with performance with conventional dentures, were included. Results: National epidemiological survey data suggested that the adult population in need of one or two complete dentures will increase from 35.4 million adults in 2000 to 37.9 million adults in 2020. Clinical studies have showed that the ratings of general satisfaction were significantly better in the patients treated with implant overdentures post‐delivery compared with the complete denture users. In addition, the implant group gave significantly higher ratings on comfort, stability and ability to chew. Furthermore, patients who received mandibular implant overdentures had significantly fewer oral health‐related quality of life problems than did the conventional group. Conclusion: Implant‐supported dentures including either complete overdentures or a hybrid prosthesis significantly improve the quality of life for edentulous patients compared with conventional removable complete dentures. Therefore, the contemporary dental practitioner should consider other options as well as conventional removable complete dentures to restore edentulous patients.     

Assessment of changes in oral health‐related quality of life among patients with complete denture before and 1 month post‐insertion using Geriatric Oral Health Assessment Index

doi:10.1111/j.1741‐2358.2009.00323.x
Assessment of changes in oral health‐related quality of life among patients with complete denture before and 1 month post‐insertion using Geriatric Oral Health Assessment Index Objective: Geriatric Oral Health Assessment Index (GOHAI) is a 12‐item measure of “patient‐reported oral functional problems” intended for use in the assessment of the effectiveness of dental treatment. Design and Setting: As there is scanty literature available on GOHAI in the Indian population, the present study was undertaken to assess the changes in GOHAI before and 1 month after placement of dentures in completely edentulous patients reporting to a dental hospital at Indore, India. Measurements: The GOHAI questionnaire was completed by the examiner who interviewed the patients (n = 35) before placement of complete dentures and 1 month later. Mean, median values were calculated and the data were analysed using Wilcoxon signed‐rank test. Results: When overall mean was considered, the GOHAI scores increased from 27.48 to 30.19 (p = 0.002; highly significant). Conclusion: Patients reported improvement in functional changes after placement of complete dentures.     

Oral hygiene of elderly people in long-term care institutions--a cross-sectional study

Objective: The aim of this cross‐sectional study was to assess the level of oral hygiene in elderly people living in long‐term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness. Materials and methods: Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes. Results: Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score = 3) and the mean denture plaque score was 2.13 (maximum possible score = 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43). Conclusion: Oral hygiene was poor, both for dentures and remaining teeth in residents in long‐term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively.     

Influence of the partial denture on the articulation of dental and postalveolar sounds

Dental prosthesis is a foreign body in oral cavity and thus necessarily interferes with speech articulation. The purpose of this study was to examine influence of partial denture on speech quality and to show eventual differences in pronunciation of dental sounds c[ts], z [z], s [s] and postalveolar sounds c [t], z [3] and s [integral of]. We have examined differences in pronunciation between subjects with removable partial dentures, the same group without partial dentures and a control group. The study was performed on 30 subjects with removable partial dentures and 30 subjects with complete dental arch. All subjects were recorded while reading six Croatian words containing the examined sounds. Recordings were analyzed with Multispeech Program (Kay Elemetrics Inc.). Acoustic analysis--LPC (linear prediction coding) provided formant peaks (Hz) for each examined sound, its intensity (dB) and formant bandwidths (Hz). Results showed that subjects with partial dentures had 50% less distorted variables and that prostheses did not completely restore articulation of postalveolar sounds. Groups with and without prostheses had lower formant peaks intensities and wider formant bandwidths in comparison to the control group. Partial dentures have not significantly interfered with resonance frequency. At the same time, pronunciation of the examined sounds was significantly improved. However, precision of the articulation movements has deteriorated.     

The dental awareness of nursing home staff in Singapore - a pilot study

Objective: The aim of this pilot study was to assess the oral health knowledge among staff working in a local nursing home managed by a voluntary welfare organisation. Method: A self‐administered questionnaire was completed by 53 nursing staff working in a home with 270 residents. The questionnaire was structured to assess the staff's knowledge of dental caries, periodontal disease and the care and use of dentures. Results: 99.6% of the respondents felt that oral health care of the elderly was very important. However, only 45.3% of them attributed the cause of dental caries to the frequent intake of sugar. Bacteria in dental plaque was identified by 88.7% of them as the main cause of periodontal disease while 96.2% of them indicated that dentures should be cleaned at least once a day and rinsed after every meal. Conclusion: The staff of this nursing home demonstrated positive knowledge of periodontal disease and denture care. However, their knowledge of dental caries revealed substantial room for improvement. This could signal an area for future staff training and development. Such efforts would help establish a team of caregivers who can improve the oral health and quality of life for residents in the nursing home.     

Significance of saliva for the denture‐wearing population

This paper summarises a series of studies already published in German and presents new data related to the aetiology of the dry mouth' and its associated problems. Aims: to study factors affecting mucous and serous salivary gland secretion, the aetiology of the ‘dry mouth’ and its associated problems, causative factors for hyposalivation and it's treatment Setting : two university dental hospitals. Subjects: 587 denture wearers and 521 control subjects, and autopsy material Interventions : exercise, chewing, water, oestrogen, pilocarpine, and anetholtrithion theiapy, biopsy of the minor glands Main outcome measures : Palatal secretion (PAL, μL/cm²/min) and parotid salivary flow (PAR), subjective complaints and clinical findings. Results: resting flow rates for PAL between 0 and 65 μl/cm²/min were seen in every age group. The flow rates of PAR (0 to 3.7 ml/10 min) were not correlated with PAL. Most patients with a resting flow rate of PAL≤6.0 μl/cm² suffer from a ‘dry mouth’ and Burning Mouth Syndrome (BMS) or oral dysaesthesia (OD) with or without chronic lesions of the oral mucosa. Etiological factors for the incidence of reduced PAL and associated problems include xerostomic drugs, oestrogen deficiency, ladiotherapy, thyroid dysfunction, smoking or continuous wearing of complete upper dentures. PAL also correlated with the retention of upper complete dentures. PAL was correlated with the water content of epithelial tissues. PAL and PAR were both increased by drinking ample fluid, improving their circulation by physical exercises, chewing intensively, or taking oestrogens, pilocarpine, anetholtrithion. Conclusions: Variation in palatal salivary secretion occurs and is clinically important.