Ethical Issues in Geriatric Dentistry

Ethical issues involved in providing dental care to geriatric patients have generally been ignored in the practice and academic literatures. Elderly patients require special ethical consideration because of increased burden of illness, sensory deficits which may interfere with symptom interpretation and communication, fiscal constraints and ageism among both providers and patients. A taxonomy of ethical issues is provided including issues pertaining to the patient, the family, service providers, and the health care system. Suggestions are made for improving decision making in geriatric dental care.     

Gerontology and the Practice of Geriatric Dentistry1

The elderly population is rapidly increasing, reflecting the fact that better pre- and post-natal care, better nutrition, immunizations, antibiotics, and better general hygiene have reduced infant, childhood and young adulthood mortality. There are now more of us around to live longer. It is therefore important to develop gerontologic research programs aimed at understanding the normal aging process. We need to know what age-related changes are irreversible concomitants of the passage of time and what age-related changes are associated with various diseases, life-styles and cultures. It is possible that life-style, diet and genetic characteristics, which retard or accelerate aging, can be identified and thus have major public health implications. Aging brings about an unusual immunologic situation that has not yet been thoroughly explained. The primary effect of normal aging on the immune system appears to be a decrease in thymus derived or T-cell functional capacity, especially in the suppressor subpopulation of T-cells. There is also an age associated hyperglobulinemia with an increase in normal autoantibody titer. Thus, one can propose that the T supressor inhibition of B lymphocytes is released in older individuals, allowing B cells an increase in functional response, especially to “slightly altered” self. The implications of these changes to the processes of chronic destructive periodontitis and oral cancer must be explained and eventually understood if we are to prevent and/or successfully treat them.     

Research in Geriatric Dentistry

Little is known about the aging per se of the oral mucosa, the salivary glands, the dental pulp or the periodontium. Even less is known about the relationship of the aging immune system to periodontal disease or to oral cancer. The interrelationship of aging body systems to oral biology is dentistry's challenge for the future. This conference paper is designed to stimulate some thinking, planning, and activity in the dental research community.     

Recent Clinical Research in Geriatric Dentistry1

Current increased interest in gerontology/geriatrics has extended to various areas of dental clinical research. Dental science is still at the stage of defining many problems in this field and much emphasis is placed on epidemiological studies. Contemporary trends in clinical research are reviewed, including radiographic studies of the jaw, masticatory studies, and studies on xerostomia, periodontal disease, and root caries. An emerging priority for this research is to distinguish normal functional and morphological changes with age from pathogenic processes. A cooperative and multidisciplinary approach, spanning various disciplines and methodologies, seems to be one which will yield the most comprehensive picture of clinical changes in the elderly. Of particular interest is the recently funded dual contract to Buffalo, NY and San Antonio, TX for the study of periodontal diseases in older adults. A major emphasis has been placed on a multidisciplinary/interdisciplinary approach with focus on clinical, radiological, immunological, microbiological, nutritional and psychological-social factors. While each may be considered separately, a greater emphasis is placed on the interaction of these parameters. Such a multidisciplinary project with two investigation sites needs detailed planning of the overall design and the cooperation of each discipline to insure the ultimate success of such a venture, particularly with regard to the reproducibility between the sites.     

Recent Advances in Geriatric Dentistry: Implications for Clinical Practice1

The clinical applications of recent research advances in oral health are discussed using a modified case presentation. Conversely, clinical care often highlights the research questions that must be answered to adequately address the oral health problems of the elderly. It is stressed that science transfer is and will continue to be necessary to take the findings from the basic and clinical research arena to the practice arena.     

Recent Advances in Behavioral Research in Geriatric Dentistry1

This paper examines recent studies in behavioral science and health services aspects of geriatric dentistry. With the increased focus on special needs of older patients, researchers have become concerned with psychological and sociocultural factors that influence older people's oral health status, behavior, and attitudes. Studies of dental service utilization patterns among subgroups of the elderly, including those in long-term care settings, will be reviewed. Research on methods to improve oral health care behaviors will be discussed, with their implications for developing oral health promotion and service delivery programs. The special oral health needs of cognitively impaired and frail elderly will be reviewed. Studies of clinical decision-making in geriatric dentistry have been conducted. These studies have revealed significant gaps in dental professionals' knowledge and attention to the special needs of older patients. This and other aspects of behavioral research suggest the need for better methods to disseminate research findings in geriatric dentistry to clinical practice in this field. The presentation will discuss ways of improving dissemination and transfer of research findings to the clinical management of aged patients.     

AIDS and HIV-1 Infection: Clinical Entities in Geriatric Dentistry1

The number of AIDS cases in individuals 50 years of age or older in the United States is reported to exceed 9000. Contaminated blood and blood transfusions are major contributors to HIV-1 infection in this age group. Sexual transmission and infection through intravenous drug abuse are also potential avenues of HIV-1 transmission in the older population. AIDS presents with a variety of clinical manifestations, including dementia, frequently seen in non-HIV-1-infected older people. Neurological deficiencies associated with AIDS are very common and may lead to misdiagnosis in the elderly. The observed incubation period of HIV-1 infection is longer than previously estimated, increasing the risk of older individuals exposed to HIV-1 in the past to develop AIDS. Oral manifestations may present as one of the early clinical signs of AIDS. Little is known concerning AIDS in the geriatric population. It demands consideration by dental professionals treating older individuals belonging to one of the exposure categories of the disease.     

Development and Macroevolution: Introduction to the Symposium

Despite the historical relationship between embryology and evolutionarybiology, during most of the 20th century developmental biologyand evolutionary biology have existed as two separate subdisciplinesof biology. Recently a reunion of these subdisciplines beganto take place. This reunion involves the formulation of evolutionaryexplanations of developmental phenomena and the applicationof developmental processes as mechanisms of evolutionary change.The symposium speakers have considered both aspects of the reunionas well as some of the theoretical and methodological issuesthat are emerging from it.     

Introduction to the Nigel Barlow Symposium

Dr Nigel Barlow died on 4 June 2003 aged 53 in Christchurch, New Zealand. Nigel completed his PhD at the University of East Anglia in 1977 and emigrated to New Zealand in 1979 where he worked initially at Palmerston North and for the last 12 years for AgResearch at Lincoln. Nigel made an enormous contribution to New Zealand ecological science through the use of mathematically based models. In particular, he worked on insect pests such as grass grubs and vertebrate pests such as possums and rabbits, producing over 130 papers. Nigel’s models of bovine tuberculosis underpinned the current strategies and expenditure of over $50 million each year on the control of wildlife vectors on this disease. Nigel’s capabilities as a scientist were not only in the applied field but also reflected in his ability to win funds with his student John Kean from the prestigious Marsden Fund for basic research on the causes of rarity. He was Editor of the New Zealand Journal of Ecology from 1985 to 1990 and of the Journal of Applied Ecology. Nigel was awarded the New Zealand Ecological Society Award for his outstanding contribution to applied ecology in 1996 and posthumously in 2003 the Caughley Medal for lifetime contributions to wildlife management and ecology by the Australasian Wildlife Management Society. Nigel was a true polymath and enthusiast about all natural history. He had an interest in bird-winged butterflies and regularly vanished into the jungles of Indonesia and Papua New Guinea to study them. He was fascinated by crocodilians and anacondas, mountain climbing, landscape painting, and malt whisky. At work he was resistant to bureaucratic interference but happy to pass on his abilities and insights to his students and numerous colleagues.     

The Biology of Tardigrades: An Introduction to the 9th International Symposium on Tardigrada*

The 9th International Symposium on Tardigrada took place in Tampa, Florida, USA from 28 July to 1 August 2003. Fifty-four participants representing thirteen countries attended and there were fifty-two presentations of which fourteen were chosen for the publication in these proceedings. Topics include cryptobiosis, ecology, taxonomy and systematics of tardigrades. * This symposiumvolume is dedicated to Nigel Marley (Fig. 4) for his courage and persistence in pursuing research on tardigrades, despite ongoing medical challenges. His optimism and positive attitude are an inspiration to all of us, and his willingness to help other tardigradologists is gratefully acknowledged and appreciated.     

Introduction to the Symposium: What is Computational Neurobiology?

SYNOPSIS. Current advances in computational biology are derivedfrom two sets of ideas established in the work of Santiago Ramóny Cajal. One is the neuron doctrine, which holds that neuronsare the functional units of the nervous system, and has ledto detailed models of neuronal properties based on increasinginformation on the physical and chemical properties of neurons.The second is the idea of networks of neurons with specificpatterns of interconnections that has led to a variety of mathematicalmethods of analyzing such networks. Future work in computationalneurobiology promises to be a blend of these two modeling approaches.