Gerodontology

This study cotnpares differences in attitude, of oral health care of nursing personnel working with dependent elderly and se\ crely disabled patients. A questionnaire was administered to 398 person-nel covering (1) personal oral health care habits. (2) experiences and ...

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 Sã o 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 (v 2 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.

Patient ratings of chewing ability from a randomised crossover trial: lingualised vs. first premolar/ canine-guided occlusion for complete dentures Background: Complex procedures involving a facebow transfer and the use of lingualised teeth are deemed to have a positive influence on the chewing ability with complete dentures. Objectives: To determine if patients' ratings of their ability to chew depend on the method of complete denture fabrication. Methods: Edentulous patients (n ¼ 20) participated in a within-subject crossover trial. Each patient received two sets of new complete dentures. One pair was manufactured based on intraoral tracing of centric relation and facebow transfer; semi-anatomical teeth with lingualised occlusion denture (LOD) were chosen. The second pair was made using a simplified procedure without facebow transfer; jaw relations were recorded with wax occlusion rims, and anatomical teeth with a first premolar/canine-guidance (CGD) were selected. The dentures were delivered in randomised order, and each was worn for 3 months. Three months after delivery, patients' ratings of each new prosthesis were recorded on visual analogue scales for their ability to chew seven index foods. Repeated measurements analysis of variance was performed to investigate possible carry-over effects accounting for confounding by treatment period. Results: When comparing the two treatments, participants rated their ability to chew in general, to masticate carrots, hard sausage, steak and raw apple in particular, was significantly better with the CGD (anatomical teeth) than with the LOD (p < 0.05). Conclusion: Comprehensive methods for the fabrication of complete dentures including semi-anatomical lingualised teeth and a full registration do not seem to influence the perceived chewing ability, when compared with more simple procedures. Chewing ability for tough foods appears to benefit from the use of anatomical teeth.

Actualmente son muchas las personas que pueden alcanzar la longevidad, debido principalmente a una serie de factores como una mejor nutrición y los avances en la medicina, en especial el desarrollo y aplicación de vacunas. En el 2018, por primera vez en la historia de la humanidad, a nivel mundial las personas mayores de 65 años superan en número a los niños menores de cinco años 1 ; y según las estimaciones para el 2050, el número de personas mayores de 65 años superará el número de personas con edades comprendidas entre los 15 y los 24 años 2. En Latinoamérica y el Caribe (LAC), la esperanza de vida también ha aumentado con diferencias entre países y dentro de ellos, independientemente del nivel de desarrollo social 3. El rápido crecimiento ha significado la falta de tiempo para que los países se adapten a la nueva estructura demográfica e implementen las transformaciones económicas y sociales requeridas en el área de la salud 4. Las poblaciones de mayor edad en LAC tienen una gran carga de enfermedad agravada por un acceso Cómo citar este artículo:

This study investigated the fracture resistance of maxillary acrylic resin complete dentures subjected to long-term water immersion. Maxillary acrylic resin complete dentures were fabricated from five denture base resins. Half of the dentures were stored in water for 50 h, and the other half were kept in water for 180 days before testing. Ten specimens were fabricated per group. The flexural load at the proportional limit (FL-PL) of the dentures was tested. A two-way anova revealed a significant difference in FL-PL because of the denture base material variable. There were no significant differences in FL-PL because of the effect of water immersion and the interaction between the effect of water immersion and the denture base material. The FL-PLs of the dentures fabricated with the two conventional heat-processed resins, the pour-type autopolymerizing resin and the microwave energy-processed resin were not significantly different from each other; they were significantly higher than the light-activated resin in regard to their FL-PL. The FL-PLs of the maxillary acrylic resin complete dentures did not change after long-tern water immersion, and the FL-PL of the denture fabricated from the light-activated resin was lower than those of the other materials.

Effects of the head lift exercise on the swallow function: a systematic review Objective: Ageing is associated with modifications in upper oesophageal sphincter function that may be deleterious to deglutition. The head lift exercise (Shaker exercise) is a head-raising work out aiming to improve the opening of this segment, and ultimately to reduce aspiration. We aimed to review critically the evidence on the effects of this structured intervention programme and to identify gaps to be filled by future research. Material and Methods: We identified published reports addressing the effect of this exercise in increasing the anteroposterior diameter and cross-sectional area of the deglutitive upper oesophageal sphincter opening or dysphagic symptoms. Results: Nine methodologically heterogeneous studies were included in the review, and the reported effects of the head lift exercise were an increase in the anterior excursion of the larynx and in the anteroposterior diameter of the upper oesophageal sphincter opening, and the elimination of dysphagic symptoms. Conclusion: Further studies including control groups and accounting for potential confounders are needed for a sound assessment of the effectiveness of this technique. The data on the functional results are, however, promising for dysphagia interventions.

Oral health status of the elderly in a residential home in Turkey Objectives: To determine the oral health status and treatment needs of elderly residents of a residential home in Ankara, Turkey. Background: Little is known about oral health problems of elderly living in the institutions. Methods: Among 216 elderly, 193 of them were interviewed and were clinically examined according to WHO criteria. Age, gender, educational and occupational status, oral hygiene practices, dental insurance, access to dental care and systemic diseases were recorded using a structured questionnaire. Coronal and root caries, periodontal disease, dental status and related treatment needs were assessed by two calibrated dentists. Results: The mean age of the subjects were 75.2 ± 8.3 in males, 79.1 ± 7.9 in females; 32.6% of subjects were dentate and the mean number of teeth was 3.7 ± 7.0 (median ¼ 0). A functional dentition was present in 7.3% of subjects ( ‡20). The mean decayed, missing and filled teeth (DMFT) was 29.3 ± 5.8 (median ¼ 32) and mean root caries was 2.2 ± 3.1 (median ¼ 1.0). The major reason for tooth extraction was dental caries. Of the subjects, 20.7% had at least one untreated coronal caries and 18.1% root caries. The assessment of periodontal status according to CPI revealed that only four persons had nine healthy sextants with the score of '0'. Edentulousness was 67.4% while 11.9% of them lacked denture in both jaws. Conclusion: The results illustrated poor dental health and showed extremely high demand for the dental health services programmes for the elderly living in these institutions.

Geriatric dentistry: is rethinking still required? A community-based survey in Indian population Background: India has a large geriatric population (60 years and above) of 77 million; comprising 7.7% of its total population. Poor oral health and loss of teeth not only adversely affect the dietary intake and nutritional status and thereby compromise general health, but can also deny them the pleasure of eating food of their choice. Objective: To assess the level of edentulousness, denture wearing and denture needs of the elderly in the community and to study the correlation between oral health parameters and sociodemographic variables which would help us to define better treatment modalities, counselling and thus improve the oral health of our geriatric patients. Materials and Methods: Subjects who were 60 years and above were considered for this study and were randomly selected. Of the 1360 elderly who were enrolled in the study, 780 (57.35%) were males and 580 (42.64%) were female. This sample size is in proportion to the total population for the pilot study. They were given an oral examination and a questionnaire. Results: Fifty seven percent (57%) of the elderly were not satisfied with their oral health status and function. Conclusion: Complete edentulousness of both the arches was highest in the middle socioeconomic group, and was the lowest in the low socioeconomic group. Less than 50% of edentulous elderly and only 10% of partially edentulous elderly were wearing dentures.

Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial Objective: To compare a supervised versus a non-supervised implementation of an oral health care guideline in Flanders (Belgium). Background: The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline 'Oral health care in care homes for elderly people' was developed to improve oral health of institutionalised elderly. Materials and Methods: A random sample of 12 nursing homes was randomly allocated to the intervention or the control group. Representative samples of 30 residents in each home were monitored during a 6-month study period. The intervention included a supervised implementation of the guideline. Results: At the 6-month follow-up, only a small but statistically significant (p = 0.002) beneficial effect (0.32) of the intervention was observed for denture plaque after adjustment for baseline value and the random effect of the institution. In the linear mixed regression models, including a random institution effect, difference in denture plaque level was no longer statistically significant at the 5% level. Conclusion: Only denture hygiene has been improved by the supervised implementation, although with lower benefits than presumed. Factors on institutional level, difficult to assess quantitatively, may play an important role in the final result.

A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review Background: It has been stated that mandibular overdentures are more satisfactory than conventional dentures, but problems relating to the use of retrospective ratings, lack of control group and sequential provision of treatment may compromise the findings. Objective: To establish a comparison between treatment with conventional complete dentures and implant-retained overdentures in elderly patients by conducting a literature review. Materials and methods: A search of English language peer-review literature was completed using Medline up to 2008 focusing on evidence-based research. Randomised clinical trials (RCTs) and longitudinal prospective studies were favoured in the review, using a general hierarchical classification. Articles that did not focus exclusively on the comparison of patient satisfaction between complete dentures and overdentures were excluded from further evaluation. The last search was conducted in February 2008. Key terms included quality of life, patient satisfaction, edentulism, complete denture and overdenture. Results: Among the 90 articles found in the initial search, 27 met the inclusion criteria. This included 18 RCTs and eight prospective and one cohort study. Most of the articles stated superiority of the mandibular implant-retained overdenture therapy over the conventional complete denture regarding patient satisfaction and quality of life. Conclusion: Even with implant treatment presenting higher patient satisfaction and improvement of quality of life, it was not possible to establish a direct comparison between the studies due to differences in adopted methodologies.

Objectives: To systematically review the current evidence on the relationship between dentition status and chewing ability in older adults, as the latter was subjectively perceived by questionnaires. Background: Tooth loss is associated with functional impairment regarding chewing ability, depending on the number and the location of the remaining teeth. Methods: A search of the English literature was undertaken using the appropriate electronic databases and keywords in order to answer the question of this review. Independent extraction of the related articles was carried out by two authors using predefined eligibility criteria. Results: Full-text analysis was performed for 51 articles of possible relevance. Finally, data were extracted from 18 studies, published in 20 articles that met the inclusion criteria. Conclusions: Although there was a conflict between the studies relevant to the number of functional tooth units needed to maintain adequate oral function, it was revealed that chewing ability was closely related to the number and distribution of teeth remaining. Treatment plan should focus on the preservation of the strategic parts of the dental arch that are critical for adequate oral function. Long-term prospective studies, comprising well-defined criteria, clinical variables, methods and utilising comprehensive questionnaires, should be preferred to obtain a clearer picture on the association between masticatory ability and functional tooth units.

Antimicrobial and mechanical properties of acrylic resins with incorporated silver-zinc zeolite -part I Objective: The purpose of this in vitro study was to evaluate the antimicrobial activity of acrylic resins containing different percentages of silver and zinc zeolite, and to assess whether the addition of zeolite alters the flexural and impact strength of the resins. Background: The characteristics of acrylic resins support microorganism development that can threaten the health of the dentures user. Material and methods: A microwave-polymerised (Onda-Cryl) and two heat-polymerised (QC20 and Lucitone 550) acrylic resins were used. The materials were handled according to the manufacturers' instructions. Fifty rectangular-shaped specimens (8 · 10 · 4mm) were fabricated from each resin and assigned to 5 groups (n = 10) according to their percentage of Irgaguard B5000 silver-zinc zeolite (0%control, 2.5%, 5.0%, 7.5% and 10%). Flexural strength and Izod impact strength were evaluated. The antimicrobial activity against two strains of Candida albicans and two strains of Streptococcus mutans was assessed by agar diffusion method. Data were analysed statistically by one-way ANOVA and Tukey's test at 5% significance level.

Insertion and follow-up of complete dentures: a literature review Objective: The aim of this study was to present the importance of clinical procedures related to insertion and follow-up of complete dentures in elderly patients. Materials and Methods: The success of rehabilitation with complete dentures results from the accuracy of clinical and laboratorial procedures that makes the denture insertion an important step of treatment. Conclusion: The follow-up and professional maintenance of function and hygiene facilitates long-term efficiency.

Oral health care and aspiration pneumonia in frail older people: a systematic literature review Objective: To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia. Background: Oral health care seems to play an important role in the prevention of aspiration pneumonia in frail older people. Methods: Pubmed, Web of Science, Cochrane Library, EMBASE and CINAHL were searched for eligible intervention studies. Only publications with regard to hospitalized or institutionalized older people, who were not dependent on mechanical ventilation were eligible. Two authors independently assessed the publications for their methodological quality. Results: Five publications were included and reviewed. Two studies showed that improvement of oral health care diminished the risk of developing aspiration pneumonia and the risk of dying from aspiration pneumonia directly. The three studies remaining showed that adequate oral health care decreased the amount of potential respiratory pathogens and suggested a reduction in the risk of aspiration pneumonia by improving the swallowing reflex and cough reflex sensitivity. Conclusions: According to the results of the current systematic literature review oral health care, consisting of tooth brushing after each meal, cleaning dentures once a day, and professional oral health care once a week, seems the best intervention to reduce the incidence of aspiration pneumonia.

Knowledge of prosthodontic treatment among denture-wearers and non-denture-wearers attending a dental institute in India: a survey report Objective: Knowledge of subjects regarding prosthodontic treatment may play a role in their acceptance of the prostheses. The purpose of this survey was to assess the knowledge of prosthodontic treatment among the denture-wearers and non-denture-wearers reporting to the Institute of Dental Sciences, Belgaum. Methods: A self-designed closed-ended questionnaire containing 14 questions was designed. Four-hundred and nineteen subjects aged between 25 and 65 years were surveyed over a period of 2 months. Collected data were statistically analysed using chi-squared test at a significance level of p < 0.05. Results: From the 419 subjects surveyed, 140 subjects (33.4%) were dentate and 279 subjects (66.6%) were edentulous either in the maxillary, mandibular or both arches. Among the 279 edentulous subjects, 143 (51.3%) did not use any kind of prosthesis. There was a statistically significant difference in knowledge regarding the replacement of teeth by artificial means, the number of visits required for the provision of a complete denture, problems with dentures among subjects using and not using them (p < 0.001) whereas no significant difference was found among the subjects regarding aesthetics with dentures and socializing with friends. Conclusion: Attempts should be made to raise the level of knowledge of both denture-wearers and nondenture-wearers reporting to the Institute for any dental treatment.

Objective:  This study investigated the efficacy of different techniques for the union of fragments of a denture before repair and on the accuracy of the reposition.Materials and methods:  For this study, 20 maxillary dentures made with Lucitone 550 heat-cured resin were used. Points were determined with a scanner on the cusp of the teeth, as a measurement of the segments. After digitisation, each model was exported to the AUTOCAD R 14 program and two-dimensional measurements of the distances between the marked points were made. After the initial analysis, the dentures were fractured into two segments using an impact test machine. For the repair, maxillary dentures were divided into two groups; in the first, the repair was carried out using Kerr’s sticky wax and in the second group, Super Bonder was used to join the fragments, with subsequent inclusion of DENTSPLY® Repair Material resin. After the repair, the points of the maxillary dentures were measured again. The numerical values obtained were tabulated to compare the measurements before fracture and after the repair. For statistical analysis, analysis of variance was employed, using a single factor and double factor, followed by the Tukey test with a reliability of 95%.Results:  The results demonstrated a statistically significant difference between the materials used to join the dentures for repair, where the dentures were joined with sticky wax presented a larger variation in the distances between the points.Conclusion:  The variation in distances between the points is influenced by the agent of repair.

Objective: To assess Malaysian government dentists' experience, willingness and barriers in providing domiciliary care for elderly people. Material and methods: A descriptive cross-sectional study was conducted using a self-administered postal questionnaire targeting government dentists working in the Ministry of Health in Peninsular Malaysia. Results: Seven hundred and eleven out of 962 dentists responded with a response rate of 74.0%. Only 36.1% of the dentists had experience in providing domiciliary care for elderly people in the past 2 years with mean number of visit per year of 1. Younger dentists below the age of 30 and those with confidence in providing the service were the most willing to undertake domiciliary care for elderly patients (OR = 13.5, p < 0.05). The 3 most reported barriers were patient's complex medical history (74.1%), patient's poor attitude towards oral health service (67.5%), and dentist's unfavourable working condition (64.4%). Conclusion: The majority of Malaysian government dentists had not been involved in providing domiciliary care for elderly patients. Apart from overcoming the barriers, other recommendations include improving undergraduate dental education, education for elderly people and carers, improving dentist's working condition, and introducing domiciliary financial incentive for dentist.

Objective: The aim of this study was to test the hypothesis that impairment of orofacial function following stroke affects the patients' oral health-related quality of life (OHRQoL). Material and methods: From the University Hospitals of Geneva, 31 stroke patients (18 men, 13 women, mean age 69.0 ± 12.7 years) with unilateral facial and limb palsy were recruited (patient group, PG). In the study, the Oral Health Impact Profile (OHIP)-EDENT was utilised to assess OHRQoL. Further examinations comprised a test of masticatory efficiency and lip force, stroke severity National Institute of Health Stroke Scale and dental state. The control group (CG) consisted of 24 subjects with similar age, gender and dental state. Results: The PG mean OHIP-EDENT sum score was 18.8 ± 15.5 and proved higher than one of the CG, indicating a lower OHRQoL in the PG (p < 0.01). The score of the sub-domains 'functional limitation' and 'physical pain' were significantly higher in PG (p < 0.03 and p < 0.02, respectively). The masticatory efficiency was significantly lower in the PG (p < 0.0001) and was associated with the OHIP-EDENT sum score and its sub-domains, except for 'physical disability'. This effect was not present in the CG. Conclusion: The OHRQoL is significantly reduced in hospitalised stroke patients whereby functional impairment seems predominant when compared with psychological and psycho-social aspects.

The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers Aim: To compare masticatory performance, masticatory efficiency and residual ridge resorption (RRR) in osteoporotic and non-osteoporotic edentulous subjects after rehabilitation with complete dentures. Method: Thirty subjects fulfilling the inclusion criteria were enrolled from the patients visiting the Department of Prosthodontics for complete denture fabrication. Two groups consisting of control subjects (group I; N = 15) and osteoporotic subjects (group II; N = 15) were formed. Complete dentures satisfying certain criteria were fabricated for both groups. Masticatory performance and efficiency were measured 6 months after denture insertion. Areal measurements were taken on lateral cephalograms before and 6 months after denture fabrication. The data were then computed to analyse differences between groups I and II using SPSS statistical software version 15.0. Results: Six months after denture fabrication, the masticatory performance and efficiency were significantly higher (p < 0.001) for group I, with a significant decrease in maxillary and mandibular sagittal area seen in both groups. The rate of bone loss was more in group II compared with group I. Conclusion: Greater masticatory function was demonstrated by the non-osteoporotic group, and the rate of RRR was more in the osteoporotic group compared with the normal group. In this pilot study, osteoporosis leads to greater RRR, decreased masticatory performance and efficiency in edentulous subjects 6 months after denture insertion. Screening for osteoporosis is suggested as a routine procedure for all edentulous subjects undergoing rehabilitation. Recall check-ups for osteoporotic patients should be more frequent, and these patients may require more frequent denture remakes.

Objective: To explore circumstances surrounding procedures and knowledge regarding oral care for terminal patients in Norwegian healthcare institutions. Methods: A questionnaire was distributed to randomly selected hospitals (n = 19) and nursing homes (n = 57) in central and rural parts of Norway. The questionnaire included three closed-ended and three open-ended questions about oral care for terminal patients. If procedures existed, the respondents were asked to enclose or describe them. Results: The response rate was 84% for hospitals and 79% for nursing homes. Of the responding institutions, 25% had no oral care procedures, nor did 48% recognise their importance. Insufficient knowledge about oral care was reported by 39%. Twenty-one different procedures were identified, and a great number of oral care products used. The most common was glycerol, used by 36% of the institutions. Only 2% used a concentration below 30%the limit above which the glycerol has a desiccating rather than a moistening effect. The most common patient complaint was dry mouth (49%), followed by plaque, food particles and fungus infections, each experienced by 19%. The most common problem for the personnel was lack of knowledge (43%) and patient cooperation (38%). Conclusions: Some terminal patients do not receive adequate palliative oral care in Norwegian healthcare institutions. Those that do are exposed to a great number of undocumented procedures and sometimes harmful products. There is a need for evidence-based procedures for oral care for terminally ill patients in health institutions, establishing interprofessional palliative healthcare teams and in particular improved training of the nursing staff.

Objective: To evaluate the reduction of residual alveolar ridge height on panoramic radiographs and the differences between denture wearers and non-denture wearers. Materials and methods: The study consisted of 147 individuals (74 men and 73 women) [50 were denture wearers and 50 non-denture wearers (examination groups) and 47 of them were dentate (control group)]. Individuals having diseases impacting on bone were excluded. Vertical measurements were made at 15 sites (central incisors, first premolars and molars at the left and right of both jaws and the distance between the zygoma/orbit). MANOVA (multi-variate analysis of variation) was used for the statistical analysis of the results. Results: There were significant differences between the alveolar ridge heights of dentate and edentulous groups (p < 0.001). Between the denture wearer and the non-denture wearer groups, there was significant difference in the lower jaw (p < 0.001), but no significant difference in the upper jaw (p = 0.635). There were also differences between men and women (p < 0.005) and upper and lower jaws at every measurement sites (p < 0.01). Conclusion: Reduction in residual alveolar ridge height was in close relation with gender, denture usage and edentulousness.

Effect of an oral healthcare protocol in nursing homes on care staffs' knowledge and attitude towards oral health care: a cluster-randomised controlled trial Objective: To explore the impact of a supervised implementation of an oral healthcare protocol, in addition to education, on nurses' and nurses' aides' oral health-related knowledge and attitude. Materials and methods: A random sample of 12 nursing homes, accommodating a total of 120-150 residents, was obtained using stratified cluster sampling with replacement. The intervention included the implementation of an oral healthcare protocol and three different educational stages. One of the investigators supervised the implementation process, supported by a dental hygienist. A 34-item questionnaire was developed and validated to evaluate the knowledge and attitude of nurses and nurses' aides at baseline and 6 months after the start of the intervention. Linear mixed-model analyses were performed to explore differences in knowledge and attitude at 6 months after implementation. Results: At baseline, no significant differences were observed between the intervention and the control group for both knowledge (p = 0.42) and attitude (p = 0.37). Six months after the start of the intervention, significant differences were found between the intervention and the control group for the variable knowledge in favour of the intervention group (p < 0.0001) but not for the variable attitude (p = 0.78). Out of the mixed model with attitude as the dependent variable, it can be concluded that age (p = 0.031), educational level (p = 0.009) and ward type (p = 0.014) have a significant effect. The mixed model with knowledge as the dependent variable resulted in a significant effect of the intervention (p = 0.001) and the educational level (p = 0.009). Conclusion: The supervised implementation of an oral healthcare protocol significantly increased the knowledge of nurses and nurses' aides. In contrast, no significant improvements could be demonstrated in attitude.

Background: Patients with dementia have poorer oral health and fewer teeth than their peers without cognitive impairment. Objective: The hypothesis of this study is that the number of natural teeth and the chewing efficiency are associated with cognitive functioning. Methods: This cross-sectional study included 29 patients diagnosed with dementia aged 75 years or older and 22 controls who were either cognitively normal (n = 19) or with mild cognitive impairment (n = 3). Neuropsychological, nutritional and dental assessments were performed. The chewing efficiency was evaluated with a two-colour mixing test. Results: Demented patients and controls presented with a mean of 4.9 and 6.5 teeth, respectively (n.s.). The number of natural teeth was not associated with dementia (p = 0.553). Same results were found for age (p = 0.746) and sex (p = 0.901). The chewing efficiency by visual inspection proved worse in participants with dementia than in the controls (p < 0.011) and explained 9.3% of the variance in the diagnosis of dementia. Neither dental state nor chewing efficiency was related to the nutritional state. Conclusion: Chewing efficiency seems stronger associated with cognitive impairment than the number of teeth. Hence, in a more holistic approach for the geriatric assessment, the dental examination may be complemented by a chewing efficiency test.

Attempts to eonsttuct an index of otal health or disorder suitable for older adults have been limited in clinical scope or based on the judgement of vety few individuals. Consequently, we present here a multidimensional index of Clinical Oral Disorder in Elders (CODE) based on a breadth of clinical measures teley ant to elders. The data fortheindex are detived from a clinical examination of jaw function, dentures, mucosa. teeth, and periodontium. Weighting or ranking for each dist)rder within the context of an elderly petson was established as tiiild, moderate or sevete by experienced dental clinicians and dental hygienists.

ormal speech and swallow depend on the integrity of the oral motor system and the underlying processes of respiration, phonation, sensation, resonance and articulation. A variety of age-related changes occur in the oral peripheral mechanism, some of which affect speech and swallow. Nonpathologic changes in the thoracic and laryngeal structures that serve to reduce the vital capacity of the lungs and produce perturbations in the acoustic signal alter the quality of the aging voice. As one ages, the oral mucosa reportedly thins, salivary flow may be decreased, and the sensory and motor integrity of the tongue musculature is altered. The effect of such changes on speech articulation and voice production in the elderly is discussed. Although not dependent on one another, speech and swallowing use many of the same oral structures and underlying physiologic mechanisms. The anatomic and physiologic changes in the aging pharvngeal area and oral tract that can affect swallowing are reviewd and studies of these changes are discussed. Viewing the oral area and vocal tract has required invasive, cumbersome or dangerous radiographic procedures, thereby limiting the quantity of research in this field. Recent work on the use of real-time ultrasound imaging to view the oral soft tissues and dynamic lingual gestures in vivo during speech and swallow are reviewed and ongoing studies of speech and swallowing performance in normal aging persons using this technique are presented.

A conventional microwave oven for denture cleaning: a critical review Introduction: Denture cleaning should be quick and easy to perform, especially in long-term care facilities. The lack of proper oral hygiene can put older adults at higher risk from opportunistic oral infections, particularly fungal. As an alternative to regular brushing, the use of a microwave oven has been suggested for cleaning and disinfecting dentures. Objectives: To synthesise and discuss the advantages and disadvantages of the use of a conventional microwave oven for cleaning and disinfecting complete dentures. Methods: A brief literature search focused on papers dealing with microwave therapy for denture cleaning through PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar, Ovid MEDLINE(R) In-Process, and Scifinder Scholar. Results: One hundred and sixty-seven manuscripts published in English with full text were found, and 28 were accepted and discussed in the light of the advantages and disadvantages of the use of conventional microwave oven for cleaning and disinfecting complete dentures. Conclusions: There was no standardisation for microwave use for denture cleaning. Manual cleaning still seemed to be the optimal method for controlling fungal infection and denture stomatitis. However, such a daily routine appeared to be underused, particularly in long-term care facilities.

Objective:  To evaluate students’ attitude towards the clinical component of the Leipzig Programme of undergraduate Education in Gerodontology (LPEG).Background:  Undergraduate student education has long been recognised as a mainstay of fostering the aims of gerodontology. Extramural clinical education with direct exposure to various groups of vulnerable elderly is known to contribute to the formation of positive attitudes. LPEG has been designed to include didactic components and six visits to a long-term care facility (LTC) spread over 4 of the 5 years of the dental course.Methods:  A structured questionnaire with 10 items was administered to 230 students (60.9% female) on three occasions in 2004–05. Total return was 411 questionnaires. The mean age of respondents was 24.3 (SD 2.67) years. Students were asked to indicate the degree of their agreement with seven statements presented using a 5-point scale. A choice of responses which characterised the course was offered to mark all those deemed agreeable.Results:  The vast majority of students responded positively. In the students perception there was no significant difference (Kruskal–Wallis p = 0.24) in the amount of knowledge acquired between subjects participating once, twice or three times. ‘Interesting’ and ‘feel pity for patients’ were the two items that received the most support. Respondents expressed the wish to accompany up to 10 patients during their course with a mean of 3.5 (SD 2.9) but 31 (7.5%) subjects did not wish to see any frail elderly patients at all.Conclusion:  The LPEG is well received by dental students. A complex subject including overarching social skills has been integrated seamlessly into the dental curriculum.

Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among elderly edentulous patients: satisfaction and quality of life Objectives: The aim of this study was to compare the satisfaction and the quality of life in an elderly population using either mandibular conventional dentures or implant-retained overdentures. Materials and methods: A total of 34 patients were divided into two groups: group I -complete dentures users; group II -users of upper complete dentures opposed by implant-retained overdentures. The subjects were submitted to a questionnaire based on Oral Health Impact Profile and oral health related quality of life to evaluate their satisfaction levels and quality of life with their prostheses. Data were evaluated using a non-parametric statistical analysis (Fischer test) with significant difference at a = 0.05. Results: There were no significant differences between the groups in relation to comfort, aesthetics, chewing ability, overall satisfaction, pain, functional, phonetic, social, and psychological limitations (p > 0.05). Comparing the stability of mandibular dentures, group II presented the better results (p < 0.05). Conclusion: Although the stability of the mandibular implant-retained overdenture was enhanced compared to a conventional denture, the quality of life and satisfaction levels were similar for both the groups.

Objectives: This study evaluated colour stability, surface roughness and flexural strength of microwavepolymerised acrylic resin after overnight immersion in sodium hypochlorite, simulating 180 days use. Materials and methods: Forty disc-shaped (15 mm · 4 mm) and 40 rectangular specimens (65 mm · 10 mm · 3 mm) were prepared from microwave-polymerised acrylic resin. The specimens were immersed in 0.5, 1% sodium hypochlorite, Clorox/Calgon and distilled water. Colour measurements (DE) were determined by a portable colorimeter. A surface analyser was used to measure roughness (lm). The flexural strength (MPa) was measured using a three-point bending test in a universal testing machine. Data were evaluated by one-way ANOVA, followed by Student-Newman-Keuls test (a = 0.05). Results: Statistical analysis found significantly higher colour changes (SNK, p < 0.001) for the 1% sodium hypochlorite, but mean DE value quantified by National Bureau of Standards was classified as slight. When comparing the surface roughness, no statistical significance was found among the solutions (ANOVA, p = 0.637). The 1% sodium hypochlorite presented significantly lower flexural strength compared with the control group (SNK, p = 0.034). Conclusion: It was concluded that immersion in 1% sodium hypochlorite solutions for 8 h does influence the colour stability and flexural strength of microwave-polymerised acrylic resin, during the simulated period of 180 days.

Results: 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classification found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anterior-posterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps. Conclusion: The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedy's classification was Class I in mandible and Class III in maxilla; the most common major connector was anterior-posterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws.