Caries and the older patient

Ageing of the population, together with prolonged retention of teeth, has brought new challenges to dentistry. Whereas in the past oral care for the elderly was restricted to provision of dentures, older patients are now presenting with dental caries and failed restorations. These problems may have an impact on their general health and quality of life. Poor oral hygiene, xerostomia and diet are among the risk factors for caries in older patients and need to be addressed in order to achieve control of the disease. Carious lesions can be treated conservatively in many cases or may need surgical management.

CLINICAL RELEVANCE: Caries is an oral health issue among older patients and can result in tooth loss. Oral health has a great impact on general health and quality of life of elderly people.

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.

La santé orale compromise comme facteur de risque potentiel pour le cancer colorectal sporadique (COLDENT) : une étude de faisabilité

Introduction: Le cancer colorectal (CCR) demeure un véritable fardeau de santé publique au Canada. Malgré les énormes avancés scientifiques, l’étiologie du CCR n’est pas encore clairement définie. La prévention du CCR nécessite l’identification de nouveaux facteurs de risque. Durant ces dernières années, des études épidémiologiques ont rapporté l’association entre la santé buccodentaire et le cancer colorectal. Cependant, aucune étude n’a été conçue spécifiquement pour vérifier cette association. Objectifs : L’objectif principal de l’étude était de tester la faisabilité d’une grande étude épidémiologique ultérieure, conçue pour vérifier l’association entre la santé buccodentaire compromise et le risque de CCR. Les objectifs secondaires étaient de standardiser les procédures de l’étude, d’évaluer le taux de participation et le succès des approches proposées pour le recrutement, d’évaluer la faisabilité et la validité des méthodes de la collecte des données sur la santé buccodentaire et de produire des données préliminaires concernant l’association entre la santé buccodentaire compromise et le risque de CCR. Méthodologie: Il s’agit d’une étude de faisabilité, de devis cas-témoins à base populationnelle. Les participants dans le groupe de cas (n=30) ont été recrutés dans deux hôpitaux de Montréal. Les témoins (n=39) ont été recrutés dans la population générale de Montréal. Les données sur la santé buccodentaire ont été collectées aussi bien par un questionnaire sur la santé buccodentaire que par un examen clinique. Les données sur plusieurs facteurs de risque du CCR ont été collectées par des questionnaires validés. Résultats: L’étude de faisabilité a rencontré un taux de participation de 73% (30) chez les cas et de 32,5% (39) chez les témoins. Seulement 26% (7) des participants dans le groupe des cas et 79% (26) des participants dans le groupe de témoins ont complété l’examen dentaire. La santé buccodentaire compromise était associée au risque de CCR chez les participants plus âgés que 59 ans (OR=8,4 ; IC à 95% : 0,94 – 389,4; p=0,036). Les mesures de santé buccodentaire auto-rapportées par les participants par l’utilisation du questionnaire ont montré une bonne validité par rapport aux mesures de l’examen clinique. Conclusion: L’étude épidémiologique ultérieure est jugée faisable en apportant des modifications. Les résultats préliminaires plaident pour une association possible entre la santé buccodentaire compromise par la maladie parodontale et/ou l’édentement et le risque du CCR.

Association entre les affections buccodentaires et le cancer colorectal : une revue et synthèse de la littérature

Position du problème: La parodontite chronique et l’édentement sont des affections buccodentaires chroniques qui, depuis quelques décennies, sont incriminées dans la survenue de différents types de cancers. Cette revue de littérature avait pour but d’examiner l’association entre le cancer colorectal et ces affections buccodentaires. Résultats: Les études épidémiologiques évaluant une association potentielle entre la parodontite, l’édentement et le cancer colorectal sont peu nombreuses. Cependant, plusieurs mécanismes plaident en faveur de cette association, notamment l’inflammation, la nutrition et possiblement l’infection par certains pathogènes, comme le suggère cette revue de la littérature.

Apendicitis aguda perforada en adultos; aproximación a las inequidades sociales en salud, Bogotá 2012

La perforación del apéndice es una complicación temprana de la apendicitis aguda, demoras en el diagnóstico o tratamiento incrementan la tasa de perforación. Se desconoce si la perforación dl apéndice es un reflejo de inequidades sociales. Se pretendió determinar la asociación de la apendicitis aguda perforada en adultos y la equidad en acceso a salud. Estudio tipo cohorte retrospectivo documental, de historias clínicas de pacientes con apendicitis aguda; el análisis se realizó con Stata 11.1 y Epi-info. Los resultados se presentaron en tablas y figuras. Se incluyeron 540 casos (292 hombre y 248 mujeres), el grupo de edad que aporto más datos fue el de 18 a 49 años (391 pacientes); el tiempo medio de síntomas a consulta fue de 37,45 horas, y de 5,3 horas para el paso a cirugía desde el ingreso, fueron solicitadas 76 ecografías y 53 tomografías, 50 interconsultas a urología y 10 a ginecología hasta el diagnostico. El grupo de mayores de 49 años, el estrato socioeconómico tres y la tomografía fueron factores de riesgo independientes para perforación del apéndice. El análisis multivariado mostró asociación lineal entre el estrato socioeconómico y tiempo de síntomas al ingreso, tiempo para paso a cirugía, solicitud de ayudas diagnósticas e interconsultas, con buena significación estadística. La apendicitis aguda perforada en adultos, podría ser un indicador de inequidad en salud. Se requiere de estudios multi-céntricos, con mayor tiempo de evaluación y muestra para demostrar si el apéndice perforado es un trazador de inequidades en salud en Colombia.

A prospective 12-month study of the effect of smoking cessation on periodontal clinical parameters

P>Aim The aim of this 12-month prospective study was to assess the adjunctive effect of smoking cessation in non-surgical periodontal therapy of subjects with severe chronic periodontitis. Materials and methods Of the 201 subjects enrolled from a smoking cessation clinic, 93 were eligible and received non-surgical periodontal treatment and concurrent smoking cessation treatment. Periodontal maintenance was performed every 3 months. Full-mouth periodontal examination in six sites per tooth was performed by a calibrated examiner, blinded to smoking status, at baseline, 3, 6 and 12 months after non-surgical periodontal treatment. Furthermore, expired air carbon monoxide concentration measurements and interviews based on a structured questionnaire were performed in order to collect demographic and smoking data. Results Of the 93 eligible subjects, 52 remained in the study after 1 year. Of these, 17 quit smoking and 35 continued smoking or oscillated. After 1 year, only quitters presented significant clinical attachment gain (p=0.04). However, there were no differences between the groups regarding clinical attachment level, probing depth, bleeding on probing and plaque index after 1 year (p > 0.05). Conclusion Smoking cessation promoted clinical attachment gain in chronic periodontitis subjects from a smoking cessation clinic after 1 year of follow-up.

The Usefulness of Caries Frequency, Depth, and Location in Determining Cariogenicity and Past Subsistence: A Test on Early and Later Agriculturalists From the Peruvian Coast

Dental markers have been used to unravel particularities of paleodiet, subsistence, social structure, and health. This article aims to compare oral pathology among four pre-Columbian groups with different degrees of agricultural and socio-cultural development but comparable ecological conditions who lived on the coastal desert of Peru. Three of these groups are assigned to distinct phases of the Formative Period (2500-1 BC), a time critical for our understanding of the development of agriculture and social complexity. The fourth group corresponds to the Late Intermediate Period (1000-1470 AD), when agriculture had its apogee and society was highly stratified. In this study we test whether there is an increase (1) in the frequency of carious lesions and (2) in caries depth, and (3) if there is a shift from occlusal to extra-occlusal caries locations with the development of agriculture. Therefore, we analyze the frequencies of carious lesions and antemortem tooth loss (AMTL), the caries distributions by age, sex, and type of tooth, as well as the tissues affected by, and the location of the carious lesions. Since there are no significant differences in the frequencies of carious lesions and AMTL between the groups, we reject hypothesis 1. In contrast, caries depth does increase, and caries location changes from occlusal to extra-occlusal sites with agricultural development. However, we can only corroborate hypothesis 2 and 3 when taking into consideration dental wear. Thus, we recommend that caries depth and locations should be used with evaluations of dental wear to reconstruct subsistence in ancient populations. Am J Phys Anthropol 143:75-91, 2010. (C) 2010 Wiley-Liss, Inc.

Estudo psicossocial das perdas dentárias na terceira idade

The present study seeks to understand tooth loss by investigating the social representations in the daily life of elderly individuals, thus characterizing itself as a comparative and analytic research. It is known that tooth loss is a common occurrence in elderly individuals, interfering at the psychosocial and biological levels, through its functional, esthetical and social implications. The area of oral health in Brazil is lacking studies on this topic, especially with respect to the psychosocial aspects of the elderly. The Theory of Social Representations and the Central Nucleus Theory were selected for theoretical-methodological support. The Free Association of Words Test was used, whose inducing stimulus were the words tooth loss , in which each subject was asked to associate 3 words, to respond to a questionnaire related to socio-economic conditions and containing an investigation of tooth loss, access to odontological services and the need for dental treatment, and to undergo a focus group interview. The study sample consisted of 120 individuals 60 years of age or over, resident in Natal, RN, Brazil and participants of the Live Together to Live Better group of the Basic Health Unit of Felipe Camarão Residential District and Unati (Open University of the Elderly); an interview was performed with 36 subjects. Data analysis was performed by Evoc 2000, SPSS/99, Graph Pad and Alceste softwares. The results demonstrate that the central nucleus of the social representations of tooth loss for the Live Together group emerged from the difficulty in eating categories, showing a relation between physiologic necessity, desire and pleasure from eating, not to mention the pain that resulted from justifying the tooth loss. Besides the central discourses, the following peripheral elements were gathered: difficulty in adapting to the prosthesis, treatment and difficulty in speaking. All of these categories, except the last, also comprised the class themes of the group interview. For the Unati group the central nucleus emerged from the socio-economic difficulties categories, demonstrating a narrow relation between poverty, access to health and education and esthetics, confirming in the discourse of common sense, the association between tooth loss and aging. At the margin of the central discourses was collected the peripheral element difficulty in adapting to the prosthesis, found both in the Live Together and Unati groups, which expresses the resistance of the subject to this new situation and the failure of the rehabilitation treatment in the sense of reviving the memory of their natural teeth. All of these categories also constitute the class themes of the of the group interview. Thus, through the study of the social representations, we can reveal a reality in the perspective of the social subjects, contemplating the multiple facets of the social-cultural reality experienced by these individuals

A produção das perdas dentárias: narrativas de usuários do SUS

For a complete comprehension of the effect of tooth loss is necessary to listen to the patients that have it. This study, of qualitative approach, investigate, in the dental history of users of SUS, listening to his/her experiences with the services of dental care, the reason that lead his/her to dental lost and the repercussion of this in his/her life. The collect of data was made by narrative interview, obeying to a pre-defined schema. The subjects interviewed were six (three of urban zone and three of rural zone), all of them were users of Family Health Units. The criterions of inclusion were the followings: the presence of tooth lost (total lost in both dental arch or in one of them, or partial lost in at least six elements in one of the arches); age between 25 and 59; male or female; to live in municipal district of São Tomé/RN or Natal/RN. Based on previous interviews was elaborated the odontological history of each patient. Such narratives, systemized in odontological history, were analyzed taking as base the studies of Souza71 and the proposal of Schutze, suggested for Jovchelovitch, Bauer34. The results show that toothache was the main reason for the search of odontological care. The patients confront the ache with home-made medicaments, allopathic ones, and searching for dental care. The searching for exodontics was stimulated for geographic access difficulties or for repressed demand, which as a result produced the aggravation of the lesions and the discredit in restoration s treatment. The self-care practice of tooth-brush with juá or toothpaste and the controlled ingestion of sugar was not sufficient to avoid dental lost. Guilty sentiments were identified in relation with lack of care with teeth. The acceptance of dental lost as a natural factor is an important motivation in lack of pain and in the belief that it was a simple part of life in old age. Life with dental prosthesis makes clear the difference between which was natural and which was unnatural, and difficulties with the prosthesis appeared. The limitation of the prosthesis in its functional aspect can be compensated by esthetic restitution, making possible smiling expression. Starting with this study and considering the high number of dental lost, mainly in low-rent population, which live with toothless limitations or bad-quality prosthesis which do not rehabilitate adequately, we suggested the realization of qualitative researches which include, also, another actors in heath care services such as professionals and administrators

Evaluation of sixth grade primary schoolchildren's knowledge about avulsion and dental reimplantation

Dental trauma, particularly tooth avulsion, is a frequent cause of tooth loss in children, adolescents, and young adults. The avulsed tooth should be immediately reimplanted in its alveolus. This procedure can be performed by anyone at the accident site and not only by dental surgeons. Therefore, the purpose of this study is to evaluate the knowledge of sixth graders of the city of Aracatuba, SP, about dental avulsion and tooth reimplantation through a structured and standardized survey. Our sample consisted of 778 students. The data collected was processed using the program epiinfo 2000. Most students were around 12 years of age and 94.5% related to practice some kind of sports. Results demonstrated that the possibility of tooth reimplantation after dental avulsion is not acknowledged among these students and dental traumatism was associated to caries, toothache, and use of orthodontic appliances. Only 18.9% of the students associated dental traumatism to an impact trauma; 3.6% would store the tooth in milk, and 3.1% believed the tooth could be reimplanted by anyone present at the accident site. In summary, the results show an overall the lack of knowledge about dental traumatism and highlight the need of special programs designed to educate school-aged students about emergency procedures to handle cases of dental traumatisms.

Resolution of a titanium implant fracture after a recurrent trauma

Post-traumatic complications occasionally lead to tooth loss as well as the need for future implants. However, rehabilitation with endosseous osseointegrated implants does not protect the patient from the risk of suffering a new trauma. Implant fracture and the damage of the hexagon are post-traumatic complications that guide the clinician to preparing a more intricate treatment plan. The authors present a clinical case of a recurrent trauma of maxillary implant fracture. The treatment plan was to remove the implants followed by autogenous bone grafting to correct the defect. Two titanium implants were replaced, followed by connective tissue graft after allowing complete the healing process of the bone graft to occur. In the postoperative period of 6 months, satisfactory results have been shown as regards soft and hard tissues wound healing.

Perda dentária em uma população rural e as metas estabelecidas pela Organização Mundial de Saúde

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

Relação entre perdas dentárias e queixas de mastigação, deglutição e fala em indivíduos adultos

OBJETIVO: investigar se as perdas dentárias em indivíduos adultos apresentam relação com as queixas de fala, mastigação e deglutição. MÉTODOS: participaram deste estudo 50 indivíduos adultos, trabalhadores de uma Avícola, do município de Bariri (SP), com faixa etária entre 18 e 52 anos. Os participantes selecionados foram submetidos à avaliação odontológica por um cirurgião-dentista e à entrevista fonoaudiológica, por duas fonoaudiólogas, em um consultório do município que mantém contrato de prestação de serviço com a Avícola. Para análise dos resultados, foram comparados os indivíduos com e sem perda dos elementos dentários, denominados de grupo experimental (GE) e grupo controle (GC), respectivamente, a partir da aplicação do teste Qui-Quadrado. RESULTADOS: os resultados revelaram maior ocorrência de mastigação unilateral no GE. Queixas quanto à dificuldade e dor na mastigação estiveram presentes apenas no GE, com diferença estatisticamente significante entre os grupos (p<0,05). O tempo de deglutição mostrou-se inadequado para a maioria dos indivíduos em ambos os grupos. A maioria dos indivíduos do GC mencionou utilizar algum tipo de líquido para facilitar a deglutição. Nenhum indivíduo mencionou queixas de fala. CONCLUSÃO: os achados revelaram que a ausência de elementos dentários em indivíduos adultos apresentou relação apenas entre dificuldade e dor durante a mastigação.

Analysis of the association of polymorphism in the osteoprotegerin gene with susceptibility to chronic kidney disease and periodontitis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Evaluation of clinical periodontal conditions in smokers and non-smokers

Given that tobacco smoking habit is a risk factor for periodontal diseases, the aim of this study was to compare clinical periodontal aspects between smokers and non-smokers. The clinical status were assessed in 55 patients, 29 smokers and 26 non-smokers, aged 30 to 50 years, with mean age of 40. The clinical parameters used were: probing depth (PD), plaque index (PI), gingival index (GI), clinical attachment level (CAL), gingival recession (GR) and gingival bleeding index (GBI) for arches (upper and lower ) and teeth (anterior and posterior). Tooth loss was also evaluated in both groups. Multiple regression analysis showed: tendency of greater probing depth and clinical attachment level means for smokers; greater amount of plaque in smokers in all regions; greater gingival index means for non-smokers with clinical significance (p<0.05) in all regions. Although, without statistical significance, the analysis showed greater gingival bleeding index means almost always for nonsmokers; similar gingival recession means in both groups and tendency of upper tooth loss in smokers and lower tooth loss in non-smokers. The findings of this study showed that clinical periodontal parameters may be different in smokers when compared to non-smokers and that masking of some periodontal signs can be a result of nicotine's vasoconstrictor effect.