Introduction Peri-implantitis, a common biological complication of dental implant, has attracted ... more Introduction Peri-implantitis, a common biological complication of dental implant, has attracted considerable attention due to its increasing prevalence and limited treatment efficacy. Previous studies have reported several risk factors associated with the onset of peri-implantitis (eg, history of periodontitis, poor plaque control and smoking). However, inadequate data are available on the association between these risk factors and successful outcome after peri-implantitis therapy. This prospective cohort study aims to identify the local and systemic predictive factors for the treatment success of periimplantitis. Methods and analysis A single-centre cohort study will be conducted by recruiting 275 patients diagnosed with peri-implantitis. Sociodemographic variables, healthy lifestyles and systemic disorders will be obtained using questionnaires. In addition, clinical and radiographic examinations will be conducted at baseline and followup visits. Treatment success is defined as no bleeding on probing on more than one point, no suppuration, no further marginal bone loss (≥0.5 mm) and probing pocket depth ≤5 mm at the 12-month follow-up interval. After adjustment for age, sex and socioeconomic status, potential prognostic factors related to treatment success will be identified using multivariable logistic regression models. Ethics and dissemination This cohort study in its current version (2.0, 15 July 2022) is in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Stomatological Hospital, Southern Medical University (EC-CT-(2022)34). The publication will be on behalf of the study site. Trial registration number ChiCTR2200066262.
Nederlands Tijdschrift Voor Tandheelkunde, Oct 1, 2009
Zorgafhankelijke patiënten kunnen problemen met hun gebitsprothese ondervinden waarvoor een proth... more Zorgafhankelijke patiënten kunnen problemen met hun gebitsprothese ondervinden waarvoor een prothetische constructie op implantaten een goede behandeloptie is. Ook kunnen patiënten die in het verleden zijn voorzien van een prothetische constructie op implantaten inmiddels zorgafhankelijk zijn geworden waardoor de dagelijkse zelfzorg voor de mond in het geding komt. Deze situaties behoeven een specifieke aanpak. Bij de keuze van deze aanpak moet de behandelaar zich 6 vragen stellen. Deze vragen zijn gericht op de zinvolheid en de doelmatigheid van de behandeling, het individuele mondzorgplan, de mogelijkheden van coöperatie van de patiënt, het beschikbare netwerk aan mantelzorgers en professionele zorgverleners, en de beschikbaarheid van snel in te roepen professionele mondzorg. Afhankelijk van de antwoorden op deze vragen kan de aanpak bestaan uit het verwijderen van de suprastructuur en het 'begraven' van de implantaten of uit het verbeteren of vervaardigen van een prothetische constructie op bestaande of nieuw te plaatsen implantaten.
Objective To assess oral health, health, and quality of life (QoL) of care-dependent community-li... more Objective To assess oral health, health, and quality of life (QoL) of care-dependent community-living older people with and without remaining teeth who recently received formal home care. Materials and methods For this cross-sectional observational study, community-living older people (≥ 65 years), who recently (< 6 months) received formal home care, were interviewed with validated questionnaires and underwent an oral examination. Oral health, general health, medicines usage, frailty (Groningen Frailty Indicator), cognition (Minimal Mental State Examination), QoL (RAND 36), and oral health-related QoL (Oral Health Impact Profile-14) were assessed. Results One hundred three out of 275 consecutive eligible older people (median age 79 [IQR (Inter Quartile Range) 72-85 years] participated in the study. Thirty-nine patients had remaining teeth and 64 were edentulous. Compared with edentulous older people, older people with remaining teeth scored significantly better on frailty, QoL, physical functioning, and general health. No significant differences were seen in cognition. Dental and periodontal problems were seen in more than half of the patients with remaining teeth. Two third of the edentulous patients did not visit their dentist regularly or at all. Conclusions Care-dependent home-dwelling older people with remaining teeth generally were less frail, scored better on physical functioning and general health and had better QoL than edentulous older people. Dental and periodontal problems were seen in approximately 50% of the elderly. Clinical relevance Notwithstanding their common dental problems, frailty, health, and QoL are better in home-dwelling older people with remaining teeth. To maintain this status, we advise not only dentists, but also health care workers and governments, to encourage people to maintain good oral health. Keywords Community-living older people. Oral health. Dentate. Complete denture. Formal home care. Quality of life * A. Visser
Clinical Implant Dentistry and Related Research, Jun 14, 2022
Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to ret... more Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses. Material and Methods: Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the periimplant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale. Results: A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p < 0.001). No differences in implant loss were found between pre-and post-operative radiotherapy (p = 0.89). Soft tissue problems were not frequently encountered, and the patients were highly satisfied with their implant-retained prosthesis. Conclusion: Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss.
Nederlands Tijdschrift Voor Tandheelkunde, Dec 3, 2021
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As the population ages, the risk of becoming malnourished increases. Research has shown that poor... more As the population ages, the risk of becoming malnourished increases. Research has shown that poor oral health can be a risk factor for malnutrition in institutionalized elderly. However, it remains unclear whether oral health problems, edentulousness and health-related quality of life also pose a risk for malnutrition in community-dwelling older adults. In this cross-sectional observational study, 1325 community-living elderly (≥75 years) were asked to complete questionnaires regarding nutritional status, oral status (edentulous, remaining teeth, or implant-supported overdentures), oral health problems, health-related quality of life (HRQoL), frailty, activities of daily living (ADL) and complexity of care needs. Univariate and multivariate logistic regression analyses were performed with nutritional status as dependent variable. Of the respondents, 51% (n = 521) were edentulous, 38.8% (n = 397) had remaining teeth and 10.2% (n = 104) had an implant-supported overdenture. Elderly with complex care needs were malnourished most frequently, followed by frail and robust elderly (10%, 4.5% and 2.9%, respectively). Malnourished elderly reported more frequent problems with chewing and speech when compared with well-nourished elderly (univariate analysis). However, multivariate analysis did not show an association between malnutrition and oral health problems and edentulousness, although HRQoL was associated with malnutrition (odds ratio (OR) 0.972, confidence interval (CI) 0.951-0.955). Based on the results of this cross-sectional study, it can be concluded that poor HRQoL is significantly associated with malnutrition; however, edentulousness and oral health problems are not.
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Nederlands Tijdschrift Voor Tandheelkunde, Nov 5, 2021
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
In an effort to bridge science into practice, the Y is leveraging its vast network to deliver the... more In an effort to bridge science into practice, the Y is leveraging its vast network to deliver the Diabetes Prevention Program to those individuals at risk for type 2 diabetes. The original NIH trial of the DPP lifestyle intervention reduced the number of new cases of type 2 diabetes among adults aged 60 years or older by 71%. These results prompted the Y to undertake a concerted effort to test the intervention with Medicare beneficiaries with a goal of improving care and health outcomes while lowering costs. To date the Y has served 19,141 adults ages 60 or older. Participants aged 60 or greater on average attend 1 more core instructional session than those participants who are younger than 60 years old (82% of core sessions vs 76%, p=<0.001). Similarity, older participants lose on average 1% more of their body weight than younger participants (5.1% vs 4.2%, p=<0.001). Beyond older participants experiencing positive results from participating in the Diabetes Prevention Program, collectively the Y's national network gained incredible knowledge in how to best deliver the program to older adults. Learnings from this concerted effort to serve older adults have included the need to bridge the clinic to community gap, identifying engagement methods that produce the greatest yield of participants, removing cost as a barrier to participation, and tailoring messages to attract participants.
Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to ret... more Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses. Material and Methods: Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the periimplant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale. Results: A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p < 0.001). No differences in implant loss were found between pre-and post-operative radiotherapy (p = 0.89). Soft tissue problems were not frequently encountered, and the patients were highly satisfied with their implant-retained prosthesis. Conclusion: Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss.
Background: Increased attention has been focused on the associations of periodontal disease with ... more Background: Increased attention has been focused on the associations of periodontal disease with the onset and progression of cognitive impairment. Although the associations are likely to be multifactorial, few studies have explored the role of mitochondrial dysfunction in the periodontitis-dementia link. Methods: Cross-sectional data of 1,883 participants aged ≥60 years in the National Health and Nutrition Examination Survey 2011-2014 were analyzed. The following data were collected: 1) general information on sociodemographic, behavioral, and health-related factors; 2) periodontal status (mean attachment loss [AL] and mean probing depth [PD]); 3) mitochondrion-derived biomarker of mitochondrial dysfunction (blood sample concentration of methylmalonic acid [MMA]); 4) cognitive function (Consortium to Establish a Registry for Alzheimer's disease immediate recall [CERAD-IR] and delay recall [CERAD-DR], animal fluency test, and digit symbol substitution test [DSST]). Mediation analysis weighted for complex survey design was used to assess the effect of MMA on the association of periodontal status with cognitive function after adjusting for potential confounders. Results: Participants with Stage III and IV periodontitis had lower scores on cognitive performance and higher MMA levels than those with Stages I/II periodontitis. Circulating MMA was significantly associated with CERAD-DR (weighted β [SE] = −0.076 [0.011]) and DSST (weighted β [SE] = −0.039 [0.009]), which mediated 9.9% and 6.0% of the total association of mean PD with cognitive function. Moreover, MMA mediated 11.7% and 5.8% of the association of mean AL with CERAD-DR and DSST, respectively. Conclusion: The findings suggest that MMA, a biomarker of mitochondrial dysfunction, plays a mediating role in the link between periodontitis and cognitive impairment in older adults aged ≥60 years.
Background: The aim of this double-blind, placebo-controlled, single-ascending-dose study was to ... more Background: The aim of this double-blind, placebo-controlled, single-ascending-dose study was to determine the safety and tolerability of intranasal dexmedetomidine in the elderly. Methods: We randomly assigned 48 surgical patients !65 yr of age to receive single intranasal doses of dexmedetomidine or placebo (5:1 ratio) in four sequential dose cohorts: 0.5, 1.0, 1.5, and 2.0 mg kg À1. Each dose cohort comprised two groups of six subjects: a group of subjects using b-blockers and a group not taking b-blockers. Vital signs and sedation depth (Modified Observer's Assessment of Alertness and Sedation [MOAA/S] and bispectral index) were measured for 2 h after administration. Blood samples were taken to determine dexmedetomidine plasma concentrations. Results: One subject (1.0 mg kg À1) had acute hypotension requiring ephedrine. Systolic arterial BP decreased >30% in 15 of 40 subjects (37.5%) receiving dexmedetomidine, lasting longer than 5 min in 11 subjects (27.5%). The MAP decreased >30% (>5 min) in 10%, 20%, 50%, and 30% of subjects receiving dexmedetomidine 0.5, 1.0, 1.5, and 2.0 mg kg À1 , respectively, irrespective of b-blocker use. HR decreased 10e26%. MOAA/S score 3 occurred in 18 (45%) subjects; eight (20%) subjects receiving dexmedetomidine showed no signs of sedation. T max was 70 min. C max was between 0.15 ng ml À1 (0.5 mg kg À1) and 0.46 ng ml À1 (2.0 mg kg À1). Conclusions: Intranasal dexmedetomidine in elderly subjects had a sedative effect, but caused a high incidence of profound and sustained hypotension irrespective of b-blocker use. The technique is unsuitable for routine clinical use. Clinical trial registration: NTR5513 (The Netherlands Trial Registry 5513).
Current data show many older adults to have poor oral health, deteriorating even more when they b... more Current data show many older adults to have poor oral health, deteriorating even more when they become frail or care dependent. In order to achieve a structural and sustained improvement of this situation, it is necessary to have a clear view of the factors determining oral health in older adults, such as (endogenous (biological, lifestyle), environmental determinants and determinants associated with the organisation of healthcare. The various determinants show oral health in older adults is the result of thecombined effects of very diverse factors and for that reason, a solution will have to be based on a multidisciplinary approach, also involving people outside of clinical care. To promote good oral health over the full course of life, it is important to invest in a good start in life, that helps accumulate oral health gains, and at the same time it is essential to adapt the healthcare system and prevention strategies to the individual's needs in order to make oral care effective for the full course of life.
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Revista Internacional De Protesis Estomatologica, 2010
Objetivo: el objetivo de este estudio fue evaluar los cuidados globales, tanto quirurgicos como p... more Objetivo: el objetivo de este estudio fue evaluar los cuidados globales, tanto quirurgicos como protesicos, de las sobredentaduras superiores soportadas por 6 implantes endooseos y una mesoestructura de barra microfresada con anclajes Ceka. Materiales y metodos: treinta y nueve pacientes consecutivos con un maxilar superior edentulo que refirieron problemas con sus protesis superiores convencionales fueron tratados mediante una sobredentadura soportada por 6 implantes endooseos y una mesoestructura de barra microfresada (barra solida con colocacion de anclajes Ceka). Los cuidados globales protesicos y quirurgicos se puntuaron desde la primera visita hasta 10 anos despues del aumento del maxilar superior. La satisfaccion del paciente se evaluo al final del seguimiento. Resultados: se diferenciaron 3 grupos de pacientes en funcion de los problemas que sufrieron con sus protesis convencionales: pacientes sin retencion en la protesis convencional debido a problemas anatomicos (n=24), pacientes con problemas de nauseas (n=9), y pacientes que no toleraron una protesis superior convencional debido a problemas subjetivos no relacionados con el sustrato anatomico (n=6). La necesidad de los cuidados globales fue comparable en los 3 grupos. La tasa de supervivencia global de los implantes tras 10 anos fue del 86, 1%. La perdida de implantes se produjo, principalmente, durante el primer ano tras la colocacion. Los cuidados postoperatorios estuvieron relacionados basicamente con la retirada y sustitucion de los implantes (es decir, incremento, sustitucion de implantes y conexion de los pilares). Los cuidados posprotesicos consistieron principalmente en inspecciones rutinarias, cuidados de higiene oral y activacion o sustitucion de los anclajes Ceka. Por ultimo, las sobredentaduras funcionaron bien en todos los pacientes y estuvieron satisfechos durante todo el estudio. Conclusion: independientemente de los motivos subyacentes mencionados para la ausencia de funcionalidad de las protesis superiores convencionales, la sobredentadura superior implantorretenida, en oposicion a una sobredentadura inferior implantorretenida o a la denticion natural, demostro ser una opcion terapeutica eficaz, predecible y fiable que no necesito muchos cuidados postoperatorios o posprotesicos mas que los ajustes de los anclajes Ceka.
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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Introduction Peri-implantitis, a common biological complication of dental implant, has attracted ... more Introduction Peri-implantitis, a common biological complication of dental implant, has attracted considerable attention due to its increasing prevalence and limited treatment efficacy. Previous studies have reported several risk factors associated with the onset of peri-implantitis (eg, history of periodontitis, poor plaque control and smoking). However, inadequate data are available on the association between these risk factors and successful outcome after peri-implantitis therapy. This prospective cohort study aims to identify the local and systemic predictive factors for the treatment success of periimplantitis. Methods and analysis A single-centre cohort study will be conducted by recruiting 275 patients diagnosed with peri-implantitis. Sociodemographic variables, healthy lifestyles and systemic disorders will be obtained using questionnaires. In addition, clinical and radiographic examinations will be conducted at baseline and followup visits. Treatment success is defined as no bleeding on probing on more than one point, no suppuration, no further marginal bone loss (≥0.5 mm) and probing pocket depth ≤5 mm at the 12-month follow-up interval. After adjustment for age, sex and socioeconomic status, potential prognostic factors related to treatment success will be identified using multivariable logistic regression models. Ethics and dissemination This cohort study in its current version (2.0, 15 July 2022) is in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Stomatological Hospital, Southern Medical University (EC-CT-(2022)34). The publication will be on behalf of the study site. Trial registration number ChiCTR2200066262.
Nederlands Tijdschrift Voor Tandheelkunde, Oct 1, 2009
Zorgafhankelijke patiënten kunnen problemen met hun gebitsprothese ondervinden waarvoor een proth... more Zorgafhankelijke patiënten kunnen problemen met hun gebitsprothese ondervinden waarvoor een prothetische constructie op implantaten een goede behandeloptie is. Ook kunnen patiënten die in het verleden zijn voorzien van een prothetische constructie op implantaten inmiddels zorgafhankelijk zijn geworden waardoor de dagelijkse zelfzorg voor de mond in het geding komt. Deze situaties behoeven een specifieke aanpak. Bij de keuze van deze aanpak moet de behandelaar zich 6 vragen stellen. Deze vragen zijn gericht op de zinvolheid en de doelmatigheid van de behandeling, het individuele mondzorgplan, de mogelijkheden van coöperatie van de patiënt, het beschikbare netwerk aan mantelzorgers en professionele zorgverleners, en de beschikbaarheid van snel in te roepen professionele mondzorg. Afhankelijk van de antwoorden op deze vragen kan de aanpak bestaan uit het verwijderen van de suprastructuur en het 'begraven' van de implantaten of uit het verbeteren of vervaardigen van een prothetische constructie op bestaande of nieuw te plaatsen implantaten.
Objective To assess oral health, health, and quality of life (QoL) of care-dependent community-li... more Objective To assess oral health, health, and quality of life (QoL) of care-dependent community-living older people with and without remaining teeth who recently received formal home care. Materials and methods For this cross-sectional observational study, community-living older people (≥ 65 years), who recently (< 6 months) received formal home care, were interviewed with validated questionnaires and underwent an oral examination. Oral health, general health, medicines usage, frailty (Groningen Frailty Indicator), cognition (Minimal Mental State Examination), QoL (RAND 36), and oral health-related QoL (Oral Health Impact Profile-14) were assessed. Results One hundred three out of 275 consecutive eligible older people (median age 79 [IQR (Inter Quartile Range) 72-85 years] participated in the study. Thirty-nine patients had remaining teeth and 64 were edentulous. Compared with edentulous older people, older people with remaining teeth scored significantly better on frailty, QoL, physical functioning, and general health. No significant differences were seen in cognition. Dental and periodontal problems were seen in more than half of the patients with remaining teeth. Two third of the edentulous patients did not visit their dentist regularly or at all. Conclusions Care-dependent home-dwelling older people with remaining teeth generally were less frail, scored better on physical functioning and general health and had better QoL than edentulous older people. Dental and periodontal problems were seen in approximately 50% of the elderly. Clinical relevance Notwithstanding their common dental problems, frailty, health, and QoL are better in home-dwelling older people with remaining teeth. To maintain this status, we advise not only dentists, but also health care workers and governments, to encourage people to maintain good oral health. Keywords Community-living older people. Oral health. Dentate. Complete denture. Formal home care. Quality of life * A. Visser
Clinical Implant Dentistry and Related Research, Jun 14, 2022
Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to ret... more Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses. Material and Methods: Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the periimplant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale. Results: A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p < 0.001). No differences in implant loss were found between pre-and post-operative radiotherapy (p = 0.89). Soft tissue problems were not frequently encountered, and the patients were highly satisfied with their implant-retained prosthesis. Conclusion: Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss.
Nederlands Tijdschrift Voor Tandheelkunde, Dec 3, 2021
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
As the population ages, the risk of becoming malnourished increases. Research has shown that poor... more As the population ages, the risk of becoming malnourished increases. Research has shown that poor oral health can be a risk factor for malnutrition in institutionalized elderly. However, it remains unclear whether oral health problems, edentulousness and health-related quality of life also pose a risk for malnutrition in community-dwelling older adults. In this cross-sectional observational study, 1325 community-living elderly (≥75 years) were asked to complete questionnaires regarding nutritional status, oral status (edentulous, remaining teeth, or implant-supported overdentures), oral health problems, health-related quality of life (HRQoL), frailty, activities of daily living (ADL) and complexity of care needs. Univariate and multivariate logistic regression analyses were performed with nutritional status as dependent variable. Of the respondents, 51% (n = 521) were edentulous, 38.8% (n = 397) had remaining teeth and 10.2% (n = 104) had an implant-supported overdenture. Elderly with complex care needs were malnourished most frequently, followed by frail and robust elderly (10%, 4.5% and 2.9%, respectively). Malnourished elderly reported more frequent problems with chewing and speech when compared with well-nourished elderly (univariate analysis). However, multivariate analysis did not show an association between malnutrition and oral health problems and edentulousness, although HRQoL was associated with malnutrition (odds ratio (OR) 0.972, confidence interval (CI) 0.951-0.955). Based on the results of this cross-sectional study, it can be concluded that poor HRQoL is significantly associated with malnutrition; however, edentulousness and oral health problems are not.
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Nederlands Tijdschrift Voor Tandheelkunde, Nov 5, 2021
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
In an effort to bridge science into practice, the Y is leveraging its vast network to deliver the... more In an effort to bridge science into practice, the Y is leveraging its vast network to deliver the Diabetes Prevention Program to those individuals at risk for type 2 diabetes. The original NIH trial of the DPP lifestyle intervention reduced the number of new cases of type 2 diabetes among adults aged 60 years or older by 71%. These results prompted the Y to undertake a concerted effort to test the intervention with Medicare beneficiaries with a goal of improving care and health outcomes while lowering costs. To date the Y has served 19,141 adults ages 60 or older. Participants aged 60 or greater on average attend 1 more core instructional session than those participants who are younger than 60 years old (82% of core sessions vs 76%, p=<0.001). Similarity, older participants lose on average 1% more of their body weight than younger participants (5.1% vs 4.2%, p=<0.001). Beyond older participants experiencing positive results from participating in the Diabetes Prevention Program, collectively the Y's national network gained incredible knowledge in how to best deliver the program to older adults. Learnings from this concerted effort to serve older adults have included the need to bridge the clinic to community gap, identifying engagement methods that produce the greatest yield of participants, removing cost as a barrier to participation, and tailoring messages to attract participants.
Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to ret... more Objectives: To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses. Material and Methods: Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the periimplant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale. Results: A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p < 0.001). No differences in implant loss were found between pre-and post-operative radiotherapy (p = 0.89). Soft tissue problems were not frequently encountered, and the patients were highly satisfied with their implant-retained prosthesis. Conclusion: Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss.
Background: Increased attention has been focused on the associations of periodontal disease with ... more Background: Increased attention has been focused on the associations of periodontal disease with the onset and progression of cognitive impairment. Although the associations are likely to be multifactorial, few studies have explored the role of mitochondrial dysfunction in the periodontitis-dementia link. Methods: Cross-sectional data of 1,883 participants aged ≥60 years in the National Health and Nutrition Examination Survey 2011-2014 were analyzed. The following data were collected: 1) general information on sociodemographic, behavioral, and health-related factors; 2) periodontal status (mean attachment loss [AL] and mean probing depth [PD]); 3) mitochondrion-derived biomarker of mitochondrial dysfunction (blood sample concentration of methylmalonic acid [MMA]); 4) cognitive function (Consortium to Establish a Registry for Alzheimer's disease immediate recall [CERAD-IR] and delay recall [CERAD-DR], animal fluency test, and digit symbol substitution test [DSST]). Mediation analysis weighted for complex survey design was used to assess the effect of MMA on the association of periodontal status with cognitive function after adjusting for potential confounders. Results: Participants with Stage III and IV periodontitis had lower scores on cognitive performance and higher MMA levels than those with Stages I/II periodontitis. Circulating MMA was significantly associated with CERAD-DR (weighted β [SE] = −0.076 [0.011]) and DSST (weighted β [SE] = −0.039 [0.009]), which mediated 9.9% and 6.0% of the total association of mean PD with cognitive function. Moreover, MMA mediated 11.7% and 5.8% of the association of mean AL with CERAD-DR and DSST, respectively. Conclusion: The findings suggest that MMA, a biomarker of mitochondrial dysfunction, plays a mediating role in the link between periodontitis and cognitive impairment in older adults aged ≥60 years.
Background: The aim of this double-blind, placebo-controlled, single-ascending-dose study was to ... more Background: The aim of this double-blind, placebo-controlled, single-ascending-dose study was to determine the safety and tolerability of intranasal dexmedetomidine in the elderly. Methods: We randomly assigned 48 surgical patients !65 yr of age to receive single intranasal doses of dexmedetomidine or placebo (5:1 ratio) in four sequential dose cohorts: 0.5, 1.0, 1.5, and 2.0 mg kg À1. Each dose cohort comprised two groups of six subjects: a group of subjects using b-blockers and a group not taking b-blockers. Vital signs and sedation depth (Modified Observer's Assessment of Alertness and Sedation [MOAA/S] and bispectral index) were measured for 2 h after administration. Blood samples were taken to determine dexmedetomidine plasma concentrations. Results: One subject (1.0 mg kg À1) had acute hypotension requiring ephedrine. Systolic arterial BP decreased >30% in 15 of 40 subjects (37.5%) receiving dexmedetomidine, lasting longer than 5 min in 11 subjects (27.5%). The MAP decreased >30% (>5 min) in 10%, 20%, 50%, and 30% of subjects receiving dexmedetomidine 0.5, 1.0, 1.5, and 2.0 mg kg À1 , respectively, irrespective of b-blocker use. HR decreased 10e26%. MOAA/S score 3 occurred in 18 (45%) subjects; eight (20%) subjects receiving dexmedetomidine showed no signs of sedation. T max was 70 min. C max was between 0.15 ng ml À1 (0.5 mg kg À1) and 0.46 ng ml À1 (2.0 mg kg À1). Conclusions: Intranasal dexmedetomidine in elderly subjects had a sedative effect, but caused a high incidence of profound and sustained hypotension irrespective of b-blocker use. The technique is unsuitable for routine clinical use. Clinical trial registration: NTR5513 (The Netherlands Trial Registry 5513).
Current data show many older adults to have poor oral health, deteriorating even more when they b... more Current data show many older adults to have poor oral health, deteriorating even more when they become frail or care dependent. In order to achieve a structural and sustained improvement of this situation, it is necessary to have a clear view of the factors determining oral health in older adults, such as (endogenous (biological, lifestyle), environmental determinants and determinants associated with the organisation of healthcare. The various determinants show oral health in older adults is the result of thecombined effects of very diverse factors and for that reason, a solution will have to be based on a multidisciplinary approach, also involving people outside of clinical care. To promote good oral health over the full course of life, it is important to invest in a good start in life, that helps accumulate oral health gains, and at the same time it is essential to adapt the healthcare system and prevention strategies to the individual's needs in order to make oral care effective for the full course of life.
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Revista Internacional De Protesis Estomatologica, 2010
Objetivo: el objetivo de este estudio fue evaluar los cuidados globales, tanto quirurgicos como p... more Objetivo: el objetivo de este estudio fue evaluar los cuidados globales, tanto quirurgicos como protesicos, de las sobredentaduras superiores soportadas por 6 implantes endooseos y una mesoestructura de barra microfresada con anclajes Ceka. Materiales y metodos: treinta y nueve pacientes consecutivos con un maxilar superior edentulo que refirieron problemas con sus protesis superiores convencionales fueron tratados mediante una sobredentadura soportada por 6 implantes endooseos y una mesoestructura de barra microfresada (barra solida con colocacion de anclajes Ceka). Los cuidados globales protesicos y quirurgicos se puntuaron desde la primera visita hasta 10 anos despues del aumento del maxilar superior. La satisfaccion del paciente se evaluo al final del seguimiento. Resultados: se diferenciaron 3 grupos de pacientes en funcion de los problemas que sufrieron con sus protesis convencionales: pacientes sin retencion en la protesis convencional debido a problemas anatomicos (n=24), pacientes con problemas de nauseas (n=9), y pacientes que no toleraron una protesis superior convencional debido a problemas subjetivos no relacionados con el sustrato anatomico (n=6). La necesidad de los cuidados globales fue comparable en los 3 grupos. La tasa de supervivencia global de los implantes tras 10 anos fue del 86, 1%. La perdida de implantes se produjo, principalmente, durante el primer ano tras la colocacion. Los cuidados postoperatorios estuvieron relacionados basicamente con la retirada y sustitucion de los implantes (es decir, incremento, sustitucion de implantes y conexion de los pilares). Los cuidados posprotesicos consistieron principalmente en inspecciones rutinarias, cuidados de higiene oral y activacion o sustitucion de los anclajes Ceka. Por ultimo, las sobredentaduras funcionaron bien en todos los pacientes y estuvieron satisfechos durante todo el estudio. Conclusion: independientemente de los motivos subyacentes mencionados para la ausencia de funcionalidad de las protesis superiores convencionales, la sobredentadura superior implantorretenida, en oposicion a una sobredentadura inferior implantorretenida o a la denticion natural, demostro ser una opcion terapeutica eficaz, predecible y fiable que no necesito muchos cuidados postoperatorios o posprotesicos mas que los ajustes de los anclajes Ceka.
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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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