Tooth replacement for partially dentate elders: a randomised controlled trial

Objective: This study aimed to compare two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and functionally orientated treatment based on the shortened dental arch (SDA) concept. Method: 88 partially dentate older patients (mean age 69.4 years) completed a randomised controlled clinical trial. 43 patients received RPDs and 45 received functionally orientated treatment where resin bonded bridgework was used to provide 10 pairs of occluding contacts. Patients were followed for 1 year after treatment intervention. The impact of treatment on oral health-related quality of life (OHrQOL) and cost effectiveness were used as outcome measures. Each patient completed the short form of the Oral Health Impact Profile (OHIP-14) at baseline, 6 months and 1 year after treatment intervention. All costs involved in providing and maintaining each intervention were recorded including dental laboratory bills, materials and professional time. Result: Both the RPD (p=0.004) and the functionally orientated (p<0.001) treatment groups demonstrated statistically significant improvements in OHrQOL 1 year after treatment intervention. On average 9.4 visits were required to complete and maintain the RPDs over the 1 year period as compared to 5.3 visits for the functionally orientated group. The average laboratory cost for the RPDs was $537.45 per patient versus $367.89 for functionally orientated treatment. The cost of achieving the Minimally Important Difference of 5 scale points in OHIP-14 score with RPDs was $732.17. For the functionally orientated group the cost was $356.88. Therefore, functionally orientated treatment was more than twice as cost effective (1:2.05). Conclusion: For partially dentate older patients, functionally orientated treatment based on the SDA concept resulted in sustained, significant improvements in OHrQOL. Provision of functionally orientated treatment was also more than twice as cost effective compared to conventional treatment using RPDs.

Cost Effectiveness of Tooth Replacement Strategies for Partially Dentate Elders

Objectives: This study aimed to compare the cost effectiveness of conventional treatment using partial dentures with functionally-orientated treatment based on the shortened dental arch concept to replace missing teeth for partially dentate elders.
Methods: 44 partially dentate patients aged 65 years and older were recruited following routine dental assessment at a university dental hospital. Patients consented to and were randomly assigned to the two treatment arms. The conventional treatment group received a removable partial denture to replace all missing natural teeth. The functionally-orientated group were restored to a shortened dental arch of 10 occluding contacts using resin bonded bridgework. The costs associated with each treatment were recorded including laboratory charges, treatment time and opportunity costs. The impact on quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile.
Results: Both groups reported improvements in OHRQoL after completion of treatment. For the conventional group, the mean OHIP-14 score decreased from 12.4 pre-operatively to 3.3 post-operatively (p<0.001). In the functionally-orientated group the OHIP-14 score decreased from 11.4 to 1.8 following treatment (p<0.001). On average the conventional treatment group required 8.3 clinic visits as compared to 4.4 visits for the functionally-orientated group. The mean total treatment time was 183 minutes 19 seconds for the conventional group versus 124 minutes 8 seconds for the functionally-orientated group. The conventional treatment group had an average of 6.33 teeth replaced at a laboratory cost of 337.31 Euros. The functionally-orientated group had an average of 2.64 teeth replaced at a laboratory cost of 244.05 Euros.
Conclusions: Restoration to a shortened dental arch using functionally-orientated treatment resulted in a similar improvement in OHRQoL with fewer clinic visits, less operative time and at a lower laboratory cost compared with conventional treatment.

Oral rehabilitation for partially dentate elders: a qualitative analysis

Aims: This study aimed to gain insight into patient’s perceptions of natural tooth loss and explored their experiences of oral rehabilitation according to a functionally orientated approach (SDA) and Removable Partial Dentures (RPD).
Study Design: For this qualitative study, a purposive sample of 15 partially dentate older patients
were recruited from Cork Dental School and Hospital. These patients had previously participated in a randomised controlled clinical trial (RCT) where they were provided with either SDA treatment using adhesive bridgework or provided with Cobalt Chromium framework RPDs. In- depth interviews were undertaken and thematic analysis was utilised to interpret the data.
Results: The findings of this study indicated strong satisfaction with SDA treatment. Patients referred to the ease in which they adapted to the adhesive prostheses as they were “lightweight”, “neat” and “fixed”. Irrespective of treatment option, patients indicated that they felt
their new prostheses were durable and an improvement on previous treatments. Most patients indicated that, previous to the RCT, they had not attended a general dentist for a number of years and only then for acute issues. They had concerns that treatment which was provided to them as part of the RCT would not be available to them in primary care. Interestingly, although they do not want their condition to dis-improve, if their prostheses failed they stated that they would not seek alternative treatment but would revert back
to adopting previous coping mechanisms.
Conclusion: This study illustrates that partially dentate older patients were very satisfied with oral rehabilitation according to a functionally orientated approach. Unfortunately they did not believe that this treatment would currently be made available to them in a primary care setting.

Tooth replacement for partially dentate elders: a willingness-to-pay analysis

Objectives: The primary aim of this study was to investigate partially dentate elders’ willingness-to-pay (WTP) for two different tooth replacement strategies: using Removable Partial Dentures (RPDs) and, functionally orientated treatment (SDA). The secondary aim was to measure the same patient group’s WTP for dental implants. Methods: Patients who had completed a previous RCT comparing two tooth replacement strategies (RPDs and SDA) were recruited. 59 patients were asked to indicate their WTP for treatment to replace missing teeth in a number of hypothetical scenarios using the payment card method of contingency evaluation coupled to different costs. Data were collected on patients’ social class, longest held occupation, income levels and social circumstances. Results: The median age for the patient sample was 72.0 years (IQR: 71-75 years). Patients who had previously been provided with RPDs indicated that their WTP for this treatment strategy was significantly higher than those patients who had received SDA treatment (Mann-Whitney U Test: p<0.001). This group were also WTP a higher price for SDA treatment than those patients who had previously been treated according to this modality (Mann-Whitney U Test: p=0.005). The results indicated that patients’ age was not correlated with WTP but both social class and current income levels were significantly correlated (Spearman’s rank correlation: p<0.05). Patients in both treatment groups exhibited llittle WTP for dental implant treatment with a median price recorded which was lower than either RPD or SDA treatment. Conclusions: Amongst this patient cohort previous treatment experience had a strong influence on WTP as did social class and current income levels. The patients’ WTP indicated that they did not value dental implants over simpler forms of tooth replacement such as RPDs or a SDA approach.

Tooth replacement for partially dentate elders: a willingness-to-pay analysis

Objectives: The primary aim of this study was to investigate partially dentate elders’ willingness-to-pay (WTP) for two different tooth replacement strategies: using Removable Partial Dentures (RPDs) and, functionally orientated treatment (SDA). The secondary aim was to measure the same patient group’s WTP for dental implants.Methods: Patients who had completed a previous RCT comparing two tooth replacement strategies (RPDs and SDA) were recruited. 59 patients were asked to indicate their WTP for treatment to replace missing teeth in a number of hypothetical scenarios using the payment card method of contingency evaluation coupled to different costs. Data were collected on patients’ social class, longest held occupation, income levels and social circumstances.Results: The median age for the patient sample was 72.0 years (IQR: 71-75 years). Patients who had previously been provided with RPDs indicated that their WTP for this treatment strategy was significantly higher than those patients who had received SDA treatment (Mann-Whitney U Test: p<0.001). This group were also WTP a higher price for SDA treatment than those patients who had previously been treated according to this modality (Mann-Whitney U Test: p=0.005). The results indicated that patients’ age was not correlated with WTP but both social class and current income levels were significantly correlated (Spearman’s rank correlation: p<0.05).Patients in both treatment groups exhibited llittle WTP for dental implant treatment with a median price recorded which was lower than either RPD or SDA treatment.Conclusions: Amongst this patient cohort previous treatment experience had a strong influence on WTP as did social class and current income levels. The patients’ WTP indicated that they did not value dental implants over simpler forms of tooth replacement such as RPDs or a SDA approach.

Pseudo-neglect in Huntington's disease correlates with decreased angular gyrus density

Visuospatial attentional bias was examined in Huntington's disease (HID) patients with mild disease, asymptomatic gene-positive patients and controls. No group differences were found on the grey scales task (which is a non-motor task of visuospatial attentional bias), although patients' trinucleotide (CAG) repeat length correlated with increasing leftward bias. On the line bisection task, symptomatic patients made significantly larger leftward bisection errors relative to controls, who showed the normal slight degree of leftward error (pseudo-neglect). The asymptomatic group showed a trend for greater leftward error than controls. A subset of participants went on to have structural MRI, which showed a correlation between increased leftward error on the line bisection task and reduced density in the angular gyrus area (BA39) bilaterally. This finding is consistent with recent literature suggesting a critical role for the angular gyrus in the lateralization of visuospatial attention.

Silent Period-Dentate, Edentulous, and Patients With Craniomandibular Dysfunction

Background: The record of electrical activity of elevator muscles in mandible is important for the evaluation of muscular potency and diagnosis of neuromuscular pathologies, which allows prevention and treatment. The aim of this study was to define silent periods (SPs) and the importance in dentistry and compare the SPs in masticatory muscles of dentate and edentulous patients wearing prosthesis considering the presence or absence of craniomandibular dysfunction (CMD).Materials and Methods: Literature review in PubMed database.Discussion: Silent periods are isolated pulses of transcranial magnetic stimulation in the primary motor cortex during voluntary muscular activity that generates an interruption of muscular activity for hundredths of milliseconds. The SP duration depends on the patient (dentate or edentulous), type of stimulus, and presence of CMD.Conclusions: The SP is higher in complete edentulous patients and in individuals with occlusal disharmonies than in dentate patients without CMDs. The treatment of CMDs through occlusal therapy decreases SP duration.

Silent Period of Masticatory Cycles in Dentate Subjects and Complete Denture Wearers

Purpose: The purpose of this study was to assess, through electromyographic activity (EMG), the silent period (SP) of masseter and anterior temporal muscles in dentate subjects (DS) and complete denture wearers (CDW).Materials and Methods: The evaluations were performed at the initial and final period of the mastication for the DS group. For the CDW group, the evaluations were performed at the initial period of mastication, with old complete dentures worn for more than 10 years (OCDW) and at the final period of the mastication with new complete dentures (NCDW), 5 months after rehabilitation. Twenty-four asymptomatic subjects (12 DS, 12 CDW) answered a questionnaire based on the Research Diagnostic Criteria for temporomandibular disorders. The CDW group answered the questionnaire before and after new denture insertion and after 5 months of rehabilitation. The SP of the muscles was recorded through EMG at the initial and final periods of mastication using artificial food (Optocal). The operator monitored 35 chewing cycles performed to grind the artificial food and selected eight open-close-clench-chewing cycles for the record.Results: The SP of the muscles analyzed with new complete dentures showed no statistical difference in comparison to the old dentures. There was a statistically significant difference in the SP between the CDW and DS groups for initial and final chewing.Conclusion: Lowered muscular capacity and ability reduced the SP of muscles after rehabilitation with NCDWs.

Evaluation of partially dentate patients' knowledge about caries and periodontal disease

Objective: This investigation evaluated the knowledge of dental caries and periodontal disease among removable partial denture (RPD) wearers.Method: A total of 127 partially dentate patients participated in this observational study. A structured questionnaire, which included eight questions referring to knowledge about aetiology and prevention of dental caries and periodontal disease, was developed in the local language (Portuguese) and used to collect the data of all the partial denture wearers. A descriptive analysis of data was performed by means of drafting tables.Results: The results demonstrated that 68.5% of patients interviewed had previously received information about oral health care. With regard to bacterial plaque, it was observed that only 34.6% reported having knowledge of this. Whereas, in relation to caries, 76.4% of the interviewees replied that they knew the meaning of this. Nevertheless, 28.3% referred to caries as a whole in the teeth, 16.5% as bad teeth and 9.4% bacteria/creatures on the teeth. Only 17.3% of the partially edentulous patients evaluated were shown to know what disease of the gingiva was.Conclusion: By means of the methodology applied, it could be concluded that the patients who wore RPDs presented deficient knowledge with regard to the prevention, aetiology and development of dental caries and periodontal disease.

Kinesiographic study of deglutition in dentate individuals and complete denture wearers

Swallowing is used as a clinical method in prosthodontics to determine and record jaw relationships. The aim of this study was to perform a quantitative evaluation, in naturally dentate subjects and complete denture wearers, of three measurements associated with the mandibular position during the act of swallowing water: 1. intermaxillary distance on vertical axis; 2. anteroposterior deviation; and 3. lateral deviation. Two groups were selected: Group I (GI) included 40 subjects with complete dentition (mean age 45.27 yrs) and Group II (GII) included 40 bimaxillary edentate subjects, complete denture wearers (mean age 63.92 yrs). A kinesiographic instrument was used for analysis. Three records were taken for each measurement and a mean value obtained. It was concluded that: 1. intermaxillary distance on vertical axis and horizontal deviation were similar for both groups; 2. there was a significant intermaxillary distance on the vertical axis; and 3. for anteroposterior and lateral axis, results showed moderate deviation in relation to maximal intercuspation (MI).

Relation between speaking space of the /s/ sound and freeway space in dentate and edentate subjects.

The purpose of this study is to assess the relation between the speaking space of the /s/ sound and the freeway space in two subject groups. One group had natural dentition (Group I, n = 61) and the other comprised complete denture wearers (Group II, n = 33). The analysis was done by means of a jaw-tracking device (K6-I Diagnostic System, Myotronics Research Inc., Seattle, WA, USA). Freeway space was determined by asking the subjects to occlude from the postural rest position. Speaking space of /s/ was measured during the pronunciation of the word seis and comprised the mean distance from the /s/ speaking position to maximal intercuspation. A weak correlation was found between the speaking space of /s/ and the freeway space in Group I (r = 0.41, p < 0.01), but in Group II, the correlation was stronger (r = 0.75, p < 0.01). The speaking space of /s/ and freeway space were different in Group I, but statistically similar in Group II (paired t-test, alpha = 0.05). It can be suggested that anatomic changes following prosthetic procedures caused a functional adaptation which resulted in more similar values for the speaking space of /s/ and the freeway space.

The effects of acute and chronic administration of phosphatidylserine on cell proliferation and survival in the dentate gyms of adult and middle-aged rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)