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.     

Oral high-dose atorvastatin treatment in relapsing-remitting multiple sclerosis

Background

Recent data from animal models of multiple sclerosis (MS) and from a pilot study indicated a possible beneficial impact of statins on MS.

Methodology/Principal Findings

Safety, tolerability and effects on disease activity of atorvastatin given alone or in combination with interferon-beta (IFN-β) were assessed in a phase II open-label baseline-to-treatment trial in relapsing-remitting MS (RRMS). Patients with at least one gadolinium-enhancing lesion (CEL) at screening by magnetic resonance imaging (MRI) were eligible for the study. After a baseline period of 3 monthly MRI scans (months −2 to 0), patients followed a 9-month treatment period on 80 mg atorvastatin daily. The number of CEL in treatment months 6 to 9 compared to baseline served as the primary endpoint. Other MRI-based parameters as well as changes in clinical scores and immune responses served as secondary endpoints. Of 80 RRMS patients screened, 41 were included, among them 16 with IFN-β comedication. The high dose of 80 mg atorvastatin was well tolerated in the majority of patients, regardless of IFN-β comedication. Atorvastatin treatment led to a substantial reduction in the number and volume of CEL in two-sided multivariate analysis (p = 0.003 and p = 0.008). A trend towards a significant decrease in number and volume of CEL was also detected in patients with IFN-β comedication (p = 0.060 and p = 0.062), in contrast to patients without IFN-β comedication (p = 0.170 and p = 0.140). Immunological investigations showed no suppression in T cell response but a significant increase in IL-10 production.

Conclusions/Significance

Our data suggest that high-dose atorvastatin treatment in RRMS is safe and well tolerated. Moreover, MRI analysis indicates a possible beneficial effect of atorvastatin, alone or in combination with IFN-β, on the development of new CEL. Thus, our findings provide a rationale for phase II/III trials, including combination of atorvastatin with already approved immunomodulatory therapy regimens.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00616187","term_id":"NCT00616187"}}NCT00616187     

Oral health related quality of life in Slovenian patients with craniomandibular disorders

Sixty eight consecutive Slovenian patients with craniomandibular disorders (CMD) participated as the study group and another 400 adults from the regional population sample participated as the control group. The aim was to determine the impact of craniomandibular disorders to the self-perceived oral health related quality of life (OHRQoL) and to compare the OHRQoL with a control group. The mean Oral Health Impact Profile (OHIP) summary scores were computed for all patients with the same diagnosis and for the same subgroups of the axis I according to the RDC/TMD exam protocol. The mean OHIP subscores for the seven domains of the OHIP questionnaire were compared between the study and the control group. Significantly higher OHIP summary scores and all the OHIP subscores were obtained in the CMD patients in comparison with the control group (p<0.05). Furthermore, in the CMD group, patients with two related diagnoses had significantly higher impaired OHRQoL than patients with a single one. The results revealed: 1. The CMD subjects are highly associated with the reduced OHRQoL, 2. Higher number of diagnoses of the axis I according to the RDC/TMD results in the more impaired OHRQoL, 3. The higher age of the patients revealed the more impaired OHRQoL.     

Relationship between symptoms of temporomandibular disorders and dental status, general health and psychosomatic factors in two cohorts of 70-year-old subjects

Objective: To study the prevalence of symptoms of temporomandibular disorders (TMD) in two cohorts of 70‐year‐old subjects examined 8 years apart and analyse the relationship between such symptoms and dental status, general health and various background factors. Materials and methods: Two cohorts of 70‐year‐old subjects, born in 1922 (n = 422) and 1930 (n = 491) respectively, were examined with an interval of 8 years. A TMD symptom index (0–5) was established on answers to five questions related to TMD symptoms. Results: There were no statistically significant differences between the two cohorts for prevalence of TMD symptoms and TMD index, neither for headache, neck ache, bruxism and chewing ability. TMJ sounds was the most prevalent symptom, 14%, whereas other TMD symptoms had low prevalence. The distribution of the TMD symptom index showed that 81% reported no symptoms, 15% one symptom, 3% two symptoms and 1% three to five symptoms. Single TMD symptoms and the TMD index exhibited significant associations (p < 0.001) with bruxism, headache, neck pain and several general health and psychosomatic factors, but with dental status only in women. Logistic regression showed that bruxism, neck pain, mouth dryness and a number of psychosomatic factors were associated with the TMD index. Conclusions: Besides TMJ sounds (14%), other TMD symptoms were rarely reported by the 70‐year‐old subjects. The TMD index was significantly associated with bruxism and several general health and psychosomatic complaints but with dental status only in women.     

Orienting reaction in patients with multiple sclerosis

A polygraphic study of the somatic (EMG), autonomic (finger plethysmogram, galvanic skin reaction, respiration, pulse, and EEG (acoustic-evoked potential and EEG-blocking reaction) components of the orienting reaction elicited by an auditory stimulus was performed in 71 patients with multiple sclerosis and in 74 matched normal subjects (control group). The study showed a significantly less intense orienting reaction in patients with multiple sclerosis than in control normal subjects. The severity of this responsiveness disturbance depended on the patients' age at symptom onset, major symptom types on admission, and the relapse frequency. The orienting reaction changes found in patients with multiple sclerosis may be ascribed to the diffuse demyelinating lesions in the nervous system of these patients, which generate, apart from the so polymorphous clinical manifestations of this disease, also important responsiveness disturbances.     

Oxidative stress in patients with multiple sclerosis

It is well known that brain and nervous system cells are prone to oxidative damage because of their relatively low content of antioxidants, especially enzymatic ones, and of the high levels of both membrane polyunsaturated fatty acids (PUFA) and iron easily released from injured cells. We have investigated the oxidative stress in the blood (plasma, erythrocytes and lymphocytes) of 28 patients affected with multiple sclerosis (MS) and of 30 healthy age matched controls, by performing a multiparameter analysis of non-enzymatic and enzymatic antioxidants--Vitamin E (Vit. E), ubiquinone (UBI), reduced and oxidized glutathione (GSH, GS-SG), superoxide dismutase (SOD), glutathione peroxidase (GPX), catalase (CAT) and fatty acid patterns of phospholipids (PL-FA). PL-FA and Vit. E were assayed by GC-MS; UBI and GSH/GS-SG by HPLC; SOD, GPX and CAT by spectrophotometry. In comparison to controls, patients with MS showed significantly reduced levels of plasma UBI (0.21 +/- 0.10 vs. 0.78 +/- 0.08 mg/ml, p < 0.001), plasma Vit. E (7.4 +/- 2.1 vs. 11.4 +/- 1.8 mg/ml, p < 0.01), lymphocyte UBI (8.1 +/- 4.0 vs. 30.3 +/- 7.2 ng/ml blood, p < 0.001) and erythrocyte GPX (22.6 +/- 5.7 vs. 36.3 +/- 6.4 U/g Hb, p < 0.001). This blood antioxidant deficiency was associated with plasma levels of PL-PUFA--especially C20:3 n-6 and C20:4 n-6--significantly higher than controls. In conclusion, the blood of patients with MS shows the signs of a significant oxidative stress. The possibility of counteracting it by antioxidant administration plus an appropriate diet, might represent a promising way of inhibiting the progression of the disease. Antioxidant supplements should include not only GSH repleting agents, but also Vit. E, ubiquinol, and selenium.     

Association of occlusal wear facets in patients with temporomandibular disorders

Occlusal changes were important factors in temporomandibular disorder (TMD). It is of interest to evaluate the association of occlusal wear facets in TMD patients. We used a dataset of 49 patients with and without TMD for this study. Occlusal wear facets were evaluated using Smith and Knight tooth wear index. Data shows that teeth wear was present more in patients with TMD (55%). The age group 26-40 years showed high prevalence of teeth wear (grade1) in TMD patients (P value = 0.034). TMD was present more in females than males. Female (54%) patients with TMD showed more teeth wear compared to males. Most patients with TMD showed posterior teeth wear (61%) than generalized teeth wear. Thus, association was present between occlusal teeth wear and TMD patients especially in the age group of 26-40 years. Hence, proper evaluation of occlusal factors will aid in early diagnosis of TMDs.     

Diagnostic usefulness of cerebrospinal fluid IgG in multiple sclerosis and other neurological disorders

MS is one of the most common neurologic disorders encountered in the United States. An increase in the CSF IgG index or IgG synthesis rate within CNS, and the presence of CSF oligoclonal bands, now serve as important tools for the diagnosis of MS. Although IEF shows better identification of a number of distinct oligoclonal bands compared to AGE, the latter appears to be a more convenient system for the average hospital's clinical laboratory. These findings are not specific to MS, and similar CSF abnormalities occur in other, more rarely neurologic diseases. It is generally easy to distinguish MS from these other diseases when a thorough clinical and laboratory evaluation is carried out. However, the detection of these CSF IgG abnormalities in non-MS patients may offer an important clue to the presence of a previously unsuspected chronic infection or inflammatory process involving the CNS.     

Measurement of mandibular movements in patients with temporomandibular disorders and in asymptomatic subjects

The aim of the study was to investigate the range of mandibular movements and to analyze the difference in range of mouth opening, right and left lateral movements, and protrusive movement between patients with clinical diagnoses of temporomandibular disorders and asymptomatic subjects (control group) in a young male population. A total of 240 subjects, aged 19-28, were included in the study. The TMD sample comprised 180 patients (60 patients with muscle disorders; 60 patients with disc displacement with reduction; and 60 patients with muscle disorders and disc displacement with reduction) and was compared with 60 healthy control subjects. All participants were evaluated by the attending dentists at baseline by means of a physical examination of the masticatory system and a history questionnaire which included the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I measures. Analysis of variance (ANOVA) with the post hoc Bonferroni criteria showed significant difference in ranges of mandibular movements between and within the groups of asymptomatic subjects and TMD patients for active mouth opening (p = 0.001), right lateral movement (p = 0.002), left lateral movement (p = 0.006), and protrusive movement (p = 0.05). It has been found that there are statistically significant differences in the range of mandibular movements that separate asymptomatic subjects and patients with muscle disorders and disc displacements with reduction in this young male population. However, we cannot conclude that measurements of active mandibular movements can discriminate one group (TMD patients) from the other (asymptomatic subjects), because the mean ranges of these active movements between the groups were measured in clinically "normal" values.     

Genomic effects of IFN-beta in multiple sclerosis patients

The purpose of this report was to characterize the dynamics of the gene expression cascades induced by an IFN-beta-1a treatment regimen in multiple sclerosis patients and to examine the molecular mechanisms potentially capable of causing heterogeneity in response to therapy. In this open-label pharmacodynamic study design, peripheral blood was obtained from eight relapsing-remitting multiple sclerosis patients just before and at 1, 2, 4, 8, 24, 48, 120, and 168 h after i.m. injection of 30 micro g of IFN-beta-1a. The total RNA was isolated from monocyte-depleted PBL and analyzed using cDNA microarrays containing probes for >4000 known genes. IFN-beta-1a treatment resulted in selective, time-dependent effects on multiple genes. The mRNAs for genes implicated in the anti-viral response, e.g., double-stranded RNA-dependent protein kinase, myxovirus resistance proteins 1 and 2, and guanylate binding proteins 1 and 2 were rapidly induced within 1-4 h of IFN-beta treatment. The mRNAs for several genes involved in IFN-beta signaling, such as IFN-alpha/beta receptor-2 and Stat1, were also increased. The mRNAs for lymphocyte activation markers, such as IFN-induced transmembrane protein 1 (9-27), IFN-induced transmembrane protein 2 (1-8D), beta(2)-microglobulin, and CD69, were also increased in a time-dependent manner. The findings demonstrate that IFN-beta treatment induces specific and time-dependent changes in multiple mRNAs in lymphocytes of multiple sclerosis patients that could provide a framework for rapid monitoring of the response to therapy.     

Calcium concentration in brains from multiple sclerosis patients

Calcium (Ca) concentrations were studied in the central nervous system (CNS) of four patients with definite multiple sclerosis (MS, average age 49 yr) and five controls (average age 68 yr). The Ca concentration was determined by neutron activation analysis in autopsy samples taken from the 26 subanatomical regions of CNS tissues. Although the mean Ca concentration in the 26 CNS regions combined was higher in the four MS patients than in the controls, the content of white matter was lower. Whether or not this significantly lower Ca concentration found in the white matter of MS patients plays an important role in the demyelinating process remains unclear, although that lower concentration seems not be age dependent, but MS specific.     

Inapparent visual field defects in multiple sclerosis patients

To assess inapparent visual field defects in patients with multiple sclerosis free from optic neuritis. During 5 years period 120 patients with multiple sclerosis were examined at the University Department of Ophthalmology, Zagreb University Hospital Center. They were divided into three groups with 40 patients each: patients with acute unilateral optic neuritis, referred to ophthalmologist and treated with pulsed steroid therapy; patients with subjective feeling of blurred vision, normal visual acuity and no signs of acute optic neuritis; and patients free from subjective signs of visual impairment. Study patients underwent standard ophthalmologic examination and visual field testing in photopia by use of quantitative kinetic Goldmann perimetry. The initial and control examination by visual field testing were performed at least 6 months apart. Study results showed 65% of multiple sclerosis patients to have visual field defects without subjective signs of impaired vision. The most common defects were mild to moderate visual field narrowing with blind spot enlargement and depression from above. The following results were recorded: acute optic neuritis group: normal in 13/40 (32.5%) for the affected eyes and 27/40 (67.5%) for fellow eyes; mild visual field narrowing in 4/40 (10%) for the affected eyes and 10/40 (25%) for fellow eyes; moderate visual field narrowing with blind spot enlargement in 14/40 (35%) for the affected eyes and 1/40 (2.5%) for fellow eyes; and paracentral and arcuate scotomata in 9/40 (22.5%) for the affected eyes and 2/40 (5%) for fellow eyes; subjective symptom group: normal in 8/40 (20%) for the affected eyes and 11/40 (27.5%) for fellow eyes; mild visual field narrowing in 11/40 (27.5%) for the affected eyes and 16/40 (40%) for fellow eyes; moderate visual field narrowing with blind spot enlargement in 18/40 (45%) for the affected eyes and 10/40 (25%); andparacentral and arcuate scotomata in 3/40 (7.5%) for both affected and fellow eyes; and subjective symptom-free group: normal in 24/80 (30%), mild visual field narrowing in 22/80 (27.5%) moderate visual field narrowing with blind spot enlargement in 24/80 (30%); and paracentral and arcuate scotomata in 10/80 (12.5%). The presence of subclinical form of optic nerve involvement could be demonstrated in a very early stage of multiple sclerosis by the introduction of visual field testing in the standard examination protocol.     

Electromyographic indices, orofacial myofunctional status and temporomandibular disorders severity: A correlation study

This study examined whether there is an association between surface electromyography (EMG) of masticatory muscles, orofacial myofunction status and temporomandibular disorder (TMD) severity scores. Forty-two women with TMD (mean 30 years, SD 8) and 18 healthy women (mean 26 years, SD 6) were examined. According to the Research Diagnostic Criteria for TMD (RDC/TMD), all patients had myogenous disorders plus disk displacements with reduction. Surface EMG of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices were obtained. Validated protocols were used to determine the perception severity of TMD and to assess orofacial myofunctional status. TMD patients showed more asymmetry between right and left muscle pairs, and more unbalanced contractile activities of contralateral masseter and temporal muscles (p<0.05, t-test), worse orofacial myofunction status and higher TMD severity scores (p<0.05, Mann-Whitney test) than healthy subjects. Spearman coefficient revealed significant correlations between EMG indices, orofacial myofunctional status and TMD severity (p<0.05). In conclusion, these methods will provide useful information for TMD diagnosis and future therapeutic planning.