Cephalometric study of elderly with nearly intact dental arches

Objective: The purpose of this study was to investigate the craniofacial morphology of elderly people with many remaining teeth using cephalometric analysis. Subjects and methods: The subjects were 30 Japanese elderly who participated in the ‘8020 campaign 2001’ in Bunkyo Ward, Tokyo, organised by The Dental Association of Tokyo, as well as 30 Japanese young adults with normal occlusion. Lateral cephalograms of all subjects were analysed using the Coben method. Results: In the female elderly group, the lower face depth was smaller than in the younger adults. In the male elderly group, the height and depth of both the total face and the lower face were longer than in the younger group. In comparing the 8020 achievers with the younger group, the proportion of the lower facial height was greater than the upper facial height, and this finding was more pronounced in women than in men. Conclusion: For the lateral facial pattern of the elderly, a reduction of lower facial height because of tooth occlusal reduction was not apparent. It was clear that there are age differences for males and females; in addition, differences in the total face and lower face area of the elderly group were due to their having many remaining teeth over a long time period. Also, these changes were more apparent in women than in men, and it is clear that there is a male–female difference in ageing.     

Effects of muscular and aqua aerobic combined exercise on metabolic indices in elderly women with metabolic syndrome

The purpose of this study was to investigate the effects of muscle strengthening exercise using elastic thera-band and aquatic aerobic combined exercise on metabolic syndrome index in elderly with metabolic syndrome. Fifty-four were assigned to muscle strengthening exercise group (n = 19), aquatic aerobic exercise group (n = 19), and combined exercise group (n = 16). The muscle strength exercise, aquatic aerobic exercise and combined exercise were provided three times a week for 12 weeks. Metabolic syndrome indices[Fasting blood glucose, triglyceride, high density lipoprotein cholesterol (HDL-C), systolic blood pressure, diastolic blood pressure and waist circumference] were measured before and after the program. One-way ANOVA, paired t-test and two-way repeated ANOVA were used with the SPSS program for data analysis. There was a significant difference in triglyceride (p < .001), HDL-C (p = .010) and waist circumference (p = .016). Triglyceride and waist circumference was significantly decreased in combined group than muscle strength exercise group and aquatic exercise group. HDL-C was significantly increased in combined group than muscle strength exercise group. The results indicate that combined exercise was more effective in the improvement of dyslipidemia and abdominal obesity.     

Obesity profiles with knee osteoarthritis: correlation with pain, disability, disease progression

Objectives: To identify the prevalence of overweight among community‐dwelling adults diagnosed as having knee osteoarthritis (OA) and the relationship between the weight status of these individuals, selected disease‐related outcomes, and disease progression. Research Methods and Procedures: The BMIs of 82 women and 18 men with unilateral or bilateral knee OA were examined on a single occasion along with data on physical comorbidities, pain, and function and subjected to correlation analyses. BMIs from two additional samples, one that included 16 women with and without knee OA and one that included 24 women and 6 men with knee joint OA that required surgery for the subsequent onset of hip OA, were also assessed. Results: At least 80% of all present cohorts were overweight or obese. Those with higher BMIs reported more pain than those with lower BMIs (p < 0.05) and pain was related to perceived physical exertion (p < 0.05). Body mass indices were not significantly correlated with generic gait measures, but an inverse trend toward the time spent in the gait cycle (r = ?0.63; p = 0.097) that may impact the disease process was identified. Those with comorbidities had the same body mass, on average, as those with no comorbidities, and those with bilateral disease were heavier than those with unilateral disease. Discussion: A high body mass is present in most adults with knee OA. Moreover, being overweight may affect knee joint impact rates and pain incrementally. Having high body weights may heighten the risk for bilateral knee joint, as well as hip joint, OA.     

Eight-year mortality associated with dental occlusion and denture use in community-dwelling elderly persons

Objective: To evaluate the influence of dental occlusion, with or without the use of dentures, on mortality in community‐dwelling elderly persons. Subjects: A total of 1030 randomly selected healthy independent elderly aged 65 and over were surveyed in 1995. For the study reported here, subjects were classified into three groups according to the presence or absence of maxillo‐mandibular tooth contacts. Subjects with no maxillo‐mandibular tooth contacts were further subdivided into those with and without dentures. Methods: Data on mortality were obtained from Kure City Council in September 2003. Cox regression models were used in analysing the risk for death with gender and age as covariates. Results: Individuals whose teeth had contact in at least the bilateral premolar regions at baseline had 0.78 times (95% CI: 0.60–0.99) smaller risk for death during the succeeding 8 years than those who had no occlusion. Among those who had no occlusion with their own teeth, the risk for mortality among denture non‐users was 1.52 times (95% CI: 1.25–1.83) higher than the risk for denture users. Conclusion: These results may support the view that, in the elderly, poor dental occlusion is associated with an increased risk for mortality and that, in the edentulous, the use of dentures is associated with a decreased risk for mortality.     

Evaluation of the clinical efficacy of a mouthwash and oral gel containing the antimicrobial proteins lactoperoxidase, lysozyme and lactoferrin in elderly patients with dry mouth--a pilot study

Objectives: To evaluate the clinical efficacy of a mouthwash and oral gel containing the antimicrobial proteins lactoperoxidase, lactoferrin and lysozyme, in a sample of elderly individuals with dry mouth. Material and methods: Twenty elderly institutionalised subjects with dry mouth and with a certain degree of independence for daily life activities were included in this pilot study. A randomised, double blind and cross‐over design was used. The study variables comprised subjective dry mouth sensation, the severity of discomfort assessed by means of a visual analogical scale (VAS), the Oral Health Impact Profile (OHIP), the presence of signs and symptoms of dry mouth, sialometry and Candida albicans culture. All the variables were recorded before and after each of the two periods of the study. Results: The 20 selected subjects we made up of 16 women and four men, with a mean age of 81.3 years. Improvement was observed on analysing the data between the first and second intervention period in terms of the OHIP values, the presence of dry mouth, and the need to drink fluids to swallow. However, the improvement in certain variables before and after treatment did not take a positive course in all cases, and some subjects even improved with placebo. Conclusions: The evaluated mouthwash and oral gel improved some subjective and clinical aspects in elderly individuals with dry mouth, though a placebo effect cannot be entirely discarded.     

Bone mass index analysis in elderly people before and after change prosthesis

Objectives: To evaluate the bone mass index (BMI) of senescent patients before and after prosthetic rehabilitation by complete dentures and evaluating any correlations between prosthetic rehabilitation and changes in BMI. Subjects: Thirty‐two edentulous elder patients who were in need of new complete dentures. Setting: Dental clinic of the Prosthodontics Department (Dental Branch) of the University of São Paulo, Brazil. Materials and methods: The study was performed in three different phases: the first one took place before any procedures relating to the new complete dentures had started and consisted of clinical records and a prosthetic anamnesis. The second and third phases took place after the prosthetic rehabilitation was completed, normally after 3 and 5–6 months respectively. The data collected in the different phases were analysed by using bioestat 3.0; the level of significance was p < 0.05, in a bilateral proof. Results: The non‐parametric statistical analysis of BMI did not show any significant differences when compared with the three phases analysed during the study. Conclusion: There was no evidence that accurate prosthetic rehabilitation could influence BMI.     

Orthodontic treatment in an elderly patient with extraction of upper premolar

In the past few years, life expectancy of the world's population has gradually increased and as a result the number of elderly patients seeking orthodontic treatment is becoming higher. The objective of this work is to report a clinical case of orthodontic treatment of an elderly patient in which a dental extraction was performed to correct the relationship between upper and lower arches. The results favoured an improved dental arch relationship and promoted adequate aesthetics and function.     

Morbidity and mortality risk associated with an overweight BMI in older men and women

Background: There is controversy as to whether older adults with a BMI in the overweight range (25 to 29.9 kg/m²) are at increased health risk and whether they should be encouraged to lose weight. The purpose of this study was to determine whether older adults with a BMI in the overweight range are at increased morbidity and mortality risk. Methods: Participants consisted of 4968 older (≥65 years) men and women from the Cardiovascular Health Study limited access dataset. Based on BMI (kg/m²), participants were grouped into normal‐weight (20 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²), and obese (≥30 kg/m²) categories. Participants were followed for up to 9 years to determine if they developed 10 weight‐related health outcomes that are pertinent to older adults. Cox proportional hazards models were used to estimate the hazards ratios of morbidity and mortality after adjusting for age, sex, income, smoking, and physical activity. Results: Compared with the normal‐weight group, the risks of myocardial infarction, stroke, sleep apnea, urinary incontinence, cancer, and osteoporosis were not different in the overweight group (p > 0.05). The risks for arthritis and physical disability were modestly increased in the overweight group (p < 0.05), whereas the risk for type 2 diabetes was increased by 78% in the overweight group (p < 0.01). After adjusting for all relevant covariates, all‐cause mortality risk was 11% lower in the overweight group (p < 0.05). Conclusions: A BMI in the overweight range was associated with some modest disease risks but a slightly lower overall mortality rate. These findings suggest that a BMI cut‐off point of 25 kg/m² may be overly restrictive for the elderly.     

Challenges and barriers to quality oral care as perceived by caregivers in long-stay institutions in Brazil

doi: 10.1111/j.1741‐2358.2011.00475.x
Challenges and barriers to quality oral care as perceived by caregivers in long‐stay institutions in Brazil Objective: To describe how caregivers perceive the oral health status in the elderly they care for; the routines for oral hygiene in nursing homes; caregivers perceived barriers for quality oral care; and the caregivers competence and need for training in this area. Background: The phenomena surrounding ageing has been the subject of worldwide interest, particularly concerning issues related to institutionalised elderly, where several studies have shown the precarious oral health status of such individuals. Materials and methods: A qualitative interview study was held in a city in southern Brazil. Study participants were 26 caregivers of elderly people, belonging to seven institutions. Statements were collected through interviews, whose results were interpreted by phenomenological analysis. Results: Caregivers of institutionalised elderly reveal contradictions in knowledge and practices of oral health. Although it could be expected that the perception and attitudes of caregivers of their own oral health could influence the care they offer to the elderly, barriers to the implementation of such activities appear to refer to situations outside of their responsibility, especially in the absence of time and staff. Conclusions: The oral care of older people in geriatric institutions requires multidisciplinary and interinstitutional actions capable of reversing the continuing framework of neglect, requiring interventions for health promotion and disease prevention that can and should be implemented in institutions.     

The effect of muscle power training with elastic band on blood glucose,cytokine, and physical function in elderly women with hyperglycemia

[Purpose]

The purpose of this study was to identify the effects of muscle power training with elastic band on body composition, glucose relation factor, and physical function in elderly women with hyperglycemia.

[Methods]

A total of 16 elderly women volunteered to participate in this study as subjects, and they were randomly assigned into one of the following two groups: muscle power training group (MPT: n = 8) and control group (CON: n = 8). The muscle power training group took exercise program using elastic band for 12 weeks, and the other group did not receive any exercise program during the same period. Before and after the experiment, both of the two groups received measurement in body composition (BMI, %Fat, skeletal muscle mass), glucose, cytokine (interleukin 6, adiponectin), and physical function (IPPB, grip strength). With these methods, the following conclusions were achieved.

[Results]

The results showed significant increases in adiponectin (p = 0.006), interleukin 6 (p = 0.018), SPPB (p = 0.024), and grip strength (P=.014). Blood glucose was significantly decreased in exercise group than contruo group.

[Conclusion]

It shows that the muscle power training with elastic band can give positive effects in elderly women with hyperglycemia.     

Cytomegalovirus infection is associated with increased mortality in the older population

Cytomegalovirus (CMV) is a common herpesvirus infection and stimulates the expansion of very large numbers of CMV‐specific T cells that reduce the CD4/CD8 ratio and suppress the number of naïve T cells. CMV infection has been associated with frailty and impaired survival. We investigated the correlates of CMV and the impact of the CMV infection on mortality within a cohort of 511 individuals aged at least 65 years who were followed up for 18 years. The mean age of the participants was 74 years of which 70% were CMV‐seropositive. CMV was strongly linked to socio‐economic status, and CMV infection increased the annual mortality rate by 42% (Hazard ratio = 1.42, 95% CI: 1.11–1.76 after adjusting for age, sex and baseline socio‐economic and health variables) corresponding to 3.7 years lower life expectancy from age 65. Infection was associated with a near doubling of cardiovascular deaths, whereas there was no increase in mortality from other causes. These results show that CMV infection markedly increases the mortality rate in healthy older individuals due to an excess of vascular deaths. These findings may have significant implications for the study of immune senescence and if confirmed more generally could have important implications for measures to optimize the health of the elderly.     

Prevalence of soft tissue oral lesion in elderly and its relations with deleterious habits

doi: 10.1111/j.1741‐2358.2011.00618.x Prevalence of soft tissue oral lesion in elderly and its relations with deleterious habits Introduction: With ageing, the oral mucosa becomes more susceptible to external stimuli. Objective: To investigate the prevalence of soft tissue oral lesion in elderly and its relations with deleterious habits. Materials and methods: It was a quantitative research conducted at the dental clinic of UNIFOR, Fortaleza‐CE, in the period from 1998 to 2006. The sample consisted of all 756 records of the elderly, and the data were processed by SPSS 15.0 (SPSS, Inc., Chicago, IL, USA). Results: The majority (63.0) were women, age 60–92, mean age 67 ± 6. The most significant proportions were married (48.4%), retired (42.3%) and incomplete primary school (31.5%). It was found a prevalence of 18.3% of oral lesions, with the risk being 1.6 times higher (p = 0.030) among youngest (up to 65 years) and 1.7 times higher among smokers (p = 0.048). Although this risk is 1.6 times higher among those who drank alcohol, it was not statistically significant (p = 0.122). Conclusion: The elderly showed a high prevalence of oral lesion, being the youngest, the smokers and the alcohol consumers those most vulnerable to the emergence of these diseases. Dental services need to implement programs of elderly care and health education, essential to clarify the risks and their associations with oral diseases, aiming to promote health.     

TMD and GOHAI indices of Brazilian institutionalised and community-dwelling elderly

Rationale and objectives: Considering the controversy in the literature regarding several aspects of temporomandibular dysfunction (TMD) in elderly populations and the absence of reliable data on elderly Brazilians in this field, this study consisted of an evaluation of TMD prevalence and the self‐perception of oral health among institutionalised and community‐dwelling elderly in São José dos Campos, Brazil. Methods: Two hundred and fifteen community‐dwelling and 185 institutionalised elderly people were evaluated by the Helkimo anamnestic (Ai) and clinical dysfunction (Di) indices and answered a questionnaire using the Geriatric Oral Health Assessment Index (GOHAI). Results: The major prevalence of TMD symptoms was for the Ai0 (symptom‐free) group (69.5%), while the major prevalence of clinical signs was for the DiI (mild) group (56%). Women presented a higher AiII classification than men (χ² test, p = 0.049). Community‐dwelling elderly presented a significantly lower Ai0 classification than the institutionalised ones (Two ratios equality test, p < 0.001). There was no relationship between the institutionalised status and the clinical dysfunction index for Di0 and DiIII classification (Two ratios equality test, p = 0.194 and 0.535 respectively). The institutionalised elderly presented greater (One‐way anova = 0.005) self‐perception of oral health (33.45) than did the community‐dwelling group (32.66). There were only weak Pearson’s correlations among the anamnestic (?33.0%) or clinical (?14.7%) findings by the TMD and GOHAI indices. Symptom‐free (Ai0) institutionalised elderly presented better scores in all GOHAI dimensions and elderly representing an absence of clinical TMD signs (Di0) presented higher GOHAI physical dimension scores in both groups. Conclusions: The prevalence of TMD symptoms among this sample of elderly individuals was relatively low, self‐perception of oral health was reasonable and a weak, inverse correlation was found between TMD signs and symptoms and elderly self‐perception of oral health measured by the GOHAI index.     

Oral health practices and beliefs among caregivers of the dependent elderly

doi: 10.1111/j.1741‐2358.2011.00553.x Oral health practices and beliefs among caregivers of the dependent elderly Background: Caregivers deal with oral health care of the dependent elderly; however, this has a low priority among them, and their education in daily oral care is deficient. Therefore, studying the oral care practices as well as their oral health beliefs is important as these affect the quality of the oral care they perform. Objective: To compare formal and informal caregivers’ oral care practices and oral health beliefs when taking care of severely dependent elderly. Material and methods: A cross‐sectional study was conducted on a convenience sample of 21 formal caregivers from a long‐term residence and 18 informal caregivers from a local primary health care domiciliary programme. Caregivers were surveyed using a questionnaire designed to elicit oral care practices and oral health beliefs. The nursing Dental Coping Beliefs Scale questionnaire was translated and validated in Chile. Results: Significant differences were observed between formal and informal caregivers’ performance of some oral health care practices. There were no significant differences between formal and informal caregivers’ oral health beliefs. Conclusions: Although there are some differences in formal and informal caregivers’ oral health care practices, we cannot state that one caregiver’s performance is better than the other, in fact, negative oral health beliefs were found in both groups.     

Interleukin‐6 (G‐174C) and tumour necrosis factor‐alpha (G‐308A) gene polymorphisms in geriatric patients with chronic periodontitis

doi:10.1111/j.1741‐2358.2009.00291.x
Interleukin‐6 (G‐174C) and tumour necrosis factor‐alpha (G‐308A) gene polymorphisms in geriatric patients with chronic periodontitis Background and objective: Periodontitis is a chronic inflammatory disease, and genetic factors may have an important role in its severity. Polymorphisms in the promoter regions of the interleukin‐6 (IL‐6) and tumour necrosis factor‐α (TNF‐α) genes have been reported to cause changes in the production of these cytokines. The aim of this study was to evaluate the possible role of IL‐6 (G?174C) and tumour necrosis factor (G?308A) polymorphisms, in the severity of chronic periodontitis in an elderly population. Materials and methods: In this study, a group of 65 elderly women, comprising 17 patients with moderate chronic periodontitis, 21 with severe chronic periodontitis and 27 healthy patients were selected. DNA was isolated from all subjects, and polymerase chain reaction was used to study the IL‐6 and TNF‐α gene polymorphisms. Results: The results of this study showed a significant difference in the allele and genotype frequencies of IL‐6 gene polymorphism between patients with periodontal disease and controls. Subjects carrying the G/G genotype of IL‐6 were most severely affected by periodontitis. The TNF‐α gene polymorphism showed no association with chronic periodontitis between patients and controls. Conclusion: The results suggest that the IL‐6 gene polymorphism may be associated with chronic periodontitis, and that TNF‐α gene polymorphism may not be involved in the progression of chronic periodontitis in the population of elderly Brazilian women.     

Tooth loss and its relationship with protein intake by elderly Brazilians—A structural equation modelling approach

Objective

This study aimed at assessing the relationship between self‐perceived tooth loss and wearing dentures, on the one hand, and the consumption of protein, on the other hand, among the elderly population of Botucatu, SP. Food consumption tends to decrease with ageing, especially protein intake, and one of the causes could be the precariousness of oral health. Several risk factors associated with deficient dietary protein intake have been identified, namely greater physical dependence, reduced caloric intake and food insecurity, but no studies have analysed whether tooth loss and prostheses interfere with protein intake.

Methods

An interview was conducted among 365 elderly individuals, in which we examined oral health‐related quality of life (OHRQoL) as the only latent variable, in a 24‐hour nutritional assessment dietary recall repeated 3 times, conducted in person by a trained nutritionist and also performed an analysis of nutritional needs using the Nutrition Data System Research (NDSR) Program.

Results

The structural equation model, performed using Stata v.14, showed that lack of teeth (standardised coefficient [SC] = 0.21, P < .001), and prosthesis use (SC = ?0.21, P < .001) was associated with OHRQoL. Lack of teeth had a direct effect on the consumption of animal protein (SC = 0.08, P = .02), a strong total effect on animal protein intake (SC = 0.51, P = .04) and a medium effect on total protein intake (SC = 0.20, P = .03), adjusted for confounders (depression and medical problems).

Conclusion

Tooth loss had a strong and significant total effect on animal protein intake and a medium effect on total protein intake among elderly Brazilians.     

A prospective study on elderly patients with facial fractures in a developing country

Background: This paper describes the incidence, aetiology, treatment and complications of facial fractures seen among the elderly in a developing country. Methods: A prospective study evaluated 85 patients over 60 years of age who were diagnosed with facial fractures over a period of 12 months in 23 public hospitals nationwide. Results: The elderly accounted for 4.5% of the total number of patients seen with facial fractures during the study period. Elderly men outnumbered women by a ratio of 4.31:1. Of the elderly patients, 35.3% had at least one medical condition, the commonest of which was hypertension. Road traffic accidents were the main cause of injury. The fractures were treated in only 26.2% of cases. Complications were uncommon. Conclusions: With a low incidence, and conservative treatment often being practised, the healthcare burden of treating facial fractures among the elderly in Malaysia is at present still low.