Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions

As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients.

Clinical Relevance: When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.

Minimal intervention dentistry and older patients Part 1: Risk assessment and caries prevention

Ten million people in the UK today are aged over 65. The latest projections estimate that there will be 5 1/2 million more people aged 65 and older in the next 20 years. This projected pattern of population ageing will have profound consequences for dentistry. Minimal intervention dentistry (MID) is a modern evidence-based approach to caries management in dentate patients that uses the 'medical model' whereby disease is controlled by the 'oral physician'. This approach offers considerable benefits over conventional dentistry for older patients. It encourages patients to be responsible for their oral health through the provision of both knowledge and motivation. MID encompasses risk assessment for dental disease, early detection and control of disease processes, and minimally invasive treatment. 

Clinical Relevance: Risk assessment tools can aid the general dental practitioner and the patient to develop a suitable caries prevention programme for that individual and reduce the need for future operative intervention.

Michael Allen: Close Readings: Essays on Irish Poetry

The late Michael Allen was a member of the famous Belfast Group, and one of the most authoritative critical voices on poetry from Northern Ireland, intimately part of the North’s poetic movement since the early 1960s. He taught at Queen’s University, where he was a colleague of Seamus Heaney and tutor to poets such as Paul Muldoon and Medbh McGuckian. Seamus Heaney called him ‘the reader over my shoulder’. Close Readings brings together interlinked critical writings which have crucially influenced approaches to Irish poetry during the last forty years. The book ends with an extended essay, hitherto unpublished: ‘Doubles, Twins and the Feminine: Development in the Poetry of Michael Longley’.

Close Readings contains a Foreword by Fran Brearton, which relates Michael Allen’s essays to continuing critical and cultural debates. Edna Longley’s Afterword offers a personal view of Allen’s involvement with poetry in Belfast.

Biomineralization of Weathered Rock Rinds:Examples from the Lower Afroalpine Zone on Mount Kenya

Rock rinds have been used for half a century to date glacial deposits and recently inroads have been developed to use nuclides to provide absolute ages of weathering rinds in pebble clasts. Although maximum and minimum rind thicknesses have helped to elucidate time since deposition and allowed stratigraphic division of deposits at glacial rank, little has been done to investigate the wealth of mineral degradation, growth of alteration products and biomineralization that occur in these weathered crusts. In some cases the mass of microbe-mineral intergrowth is nearly present on a 50%/50% basis, with the biotic mass intergrown with mineral matter to such an extent that it probably controls pH and redox phenomena that act as accelerators in the weathering process. Assuming weathering time spans of 2 × 10⁶ years or more for a complete cycle, eventual clast decomposition is the end product. Here we present evidence of microbe-clast intergrowth from selected sites of Pleistocene age (~70 ka to 2.0 Ma) in the lower Afroalpine of Mt. Kenya and hypothesize about its role in rock decomposition and fossilization of biotic end-members. © 2013 Copyright Taylor and Francis Group, LLC.

Risk indicators associated with root decay in independently living older adults

Objective: To determine the risk indicators associated with root caries experience in a cohort of independently living older adults in Ireland.
Methods: The data reported in the present study were obtained from a prospective longitudinal study conducted on the risk factors associated with root caries incidence in a cohort of independently living older adults (n=334). Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and other clinical variables. Questionnaires were used to collect data on oral hygiene habits, diet, smoking and alcohol habits and education level. A regression analysis with the outcome variable of root caries experience (no/yes) was conducted.
Results: A total of 334 older adults with a mean age of 69.1 years were examined. 53.3% had at least one filled or decayed root surface. The median root caries index was 3.13 (IQR 0.00, 13.92). The results from the multivariate regression analysis indicated that individuals with poor plaque control (OR 9.59, 95%CI 3.84-24.00), xerostomia (OR 18.49, 95%CI 2.00-172.80), two or more teeth with coronal decay (OR 4.50, 95% CI 2.02-10.02) and 37 or more exposed root surfaces (OR 5.48, 95% CI 2.49-12.01) were more likely to have been affected by root caries.
Conclusions: The prevalence of root caries was high in this cohort. This study suggests a correlation between root caries and the variables poor plaque control, xerostomia, coronal decay (≥2 teeth affected) and exposed root surfaces (≥37). The significance of these risk indicators and the resulting prediction model should be further evaluated in a prospective study of root caries incidence.
Clinical Significance: Identification of risk indicators for root caries in independently living older adults would facilitate dental practitioners to identify those who would benefit most from interventions aimed at prevention.