bluuebunny/crossref_metadata_2025 huggingface dataset:
Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs
Authors: Gordon Sharon M. , Dionne Raymond A. , Snyder James
Published: March 2008

Persons with special health care needs due to physical and cognitive impairment can be at increased risk for dental disease which can be attributed to, as well as exacerbate, existing medical conditions. This study assessed the nature of perceived barriers to obtaining oral health care among a special‐needs population and the influence of these factors (in particular, fear and anxiety) on utilization of dental services. A total of 27.9% of the sample reported fear/anxiety about dental visits, with approximately half of those reporting to be very nervous or “terrified”. There was an inverse relationship between the frequency of dental visits and the proportion of respondents reporting themselves as very nervous or terrified, and between the perception of oral health status and the level of dental fear/anxiety (P < 0.001). A large difference was reported between patient preference for pharmacologic modalities for anxiety control and those received at dental visits, with 40% of the youngest age group indicating that they would go to the dentist more frequently if sedation or general anesthesia were offered. The levels of self‐reported fear/anxiety and the high proportion of respondents indicating an unmet need for adjunctive anesthesia services suggest that fear/anxiety acts as a barrier to dental care among this special‐needs group which could be ameliorated with greater use of these services.
Salivary slgA concentrations and stimulated whole saliva flow rates among women undergoing chemotherapy for breast cancer: an exploratory study
Authors: Harrison Tonya , Bigler Lenora , Tucci Michelle , Pratt Lillian , Malamud Fernando , Thigpen James T. , Streckfus Charles , Younger Hope
Published: March 2008

A study was conducted to evaluate the secretion of stimulated whole saliva (SWS) and secretory IgA (slgA) among three groups of women. One group was a healthy control group, the second group consisted of women diagnosed with metastatic breast cancer before being placed on chemotherapy, while the third group consisted of women on chemotherapy taking CMF (cyclophosphamide, methotrexate, and fluorouracil) for at least one month. There were seven patients in each group. SWS was collected. Salivary slgA concentrations were determined by enzyme‐linked immunoabsorbant assay. The results of the study showed that the mean SWS flow rate for the chemotherapy group (x = 0.96 mL/min) was significantly lower (p > 0.03) than that of the control group (x = 2.33 mL/min) and lower than that of the group with cancer (x = 1.81 mL/min). Additionally, the results showed that the mean slgA concentrations for the chemotherapy group (x = 10.9 ng/mg of protein) were slightly lower than those of the control group (x = 13.7 ng/mg of protein) and lower than those of the group with cancer (x = 12.6 ng/mg of protein). The results of this study suggest that women placed on CMF for treatment of carcinoma of the breast may have reduced stimulated salivary production.
Comparison between saliva stimulants and a saliva substitute in patients with xerostomia and hyposalivation
Authors: Stewart Carol M. , Jones Anne C. , Bates Robert E. , Sandow Pamela , Pink Frank , Stillwell Jerilynn
Published: March 2008

The purpose of this study was to assess patient preference and product efficacy of three non‐prescription products for the symptomatic relief of xerostomia. The study group consisted of 80 individuals with a complaint of chronic (> six months) xerostomia and an unstimulated salivary flow rate of c 0.1 mL/min. The three products—a sorbitol/xylitol‐sweetened chewing gum, a sorbitol‐sweetened sour lemon lozenge, and a sorbitol/xylitol‐sweetened artificial saliva substitute spray—were assigned in a permuted block randomization scheme. Each product was used for two weeks with an interval of one week between trials. The study did not identify any product to be statistically significant in terms of patient preference. Kruskal‐Wallis testing revealed no statistical significance (P > 0.589) among the products. No product demonstrated marked efficacy in stimulating salivary output. ANOVA analysis followed by Tukey HSD testing revealed no significant difference between the baseline paraffin‐stimulated mean flow rate and the gum‐ and lozenge‐stimulated flow rates.
Relationship among stimulated whole, glandular salivary flow rates, and root caries prevalence in an elderly population: A preliminary study
Authors: Younger Hope , Harrison Tonya , Streckfus Charles
Published: March 2008

A comparison of salivary flow rates was made between two groups of healthy, unmedicated, elderly, Caucasian men and women ranging in age from 60 to 90 years. One group was a control group, while the other group had both active and restored root caries. The control group consisted of 69 individuals with a mean age of 73 years. The root caries group consisted of 39 individuals with a mean age of 71 years. The groups were evaluated for unstimulated (UPAR) and stimulated parotid gland flow rates (SPAR), unstimulated (USUB) and stimulated submandibular/sublingual gland flow rates (SSUB), and stimulated whole saliva flow rates (SWhole). Parotid flow rates were determined with the use of a Carlson‐Crittenden cup, while submandibular/sublingual flow rates were determined by means of the NlDR collector. A 2% citrate solution was used for stimulation in glandular collections. Subjects chewed a 1‐cm3 cube of paraffin to stimulate whole saliva. The results showed that the control group had higher UPAR, SPAR, USUB, SSUB, and SWhole than the root caries group.
Oral health status and treatment needs of Canadian adults aged 85 years and over
Authors: Hawkins Robert J. , Main Patricia A. , Locker David
Published: March 2008

In an oral health survey, 1375 adults aged 85 and older were examined in North York, Canada. Only 31% of dentate nursing home residents and 47% of dentate independently living subjects had received dental care in the year previous to examination. The overall prevalence of edentulism was 66%, and about 80% of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated decay, and 47% of nursing home residents had untreated root decay. Regarding clinically defined treatment needs, high levels of unmet need were identified in subjects from both types of residences. Among nursing home residents, about 45% of dentate subjects required tooth extraction, and 56% required prosthodontic treatment. Although only 27% of dentate independently living residents required tooth extraction, over 60% needed restorative treatment. Higher prevalence of both untreated decay and unmet treatment needs was associated with lower utilization of dental care for dentate subjects. For edentulous subjects, prosthetic treatment was required by 70% of nursing home residents and by 51% of independently living subjects. These results indicate that, for both nursing home and independently living residents, dental diseases and treatment needs continue throughout the lifespan.
Survey results of reduced‐fee and free‐of‐charge dental services by the membership of the Federation of Special Care Organizations in Dentistry
Authors: Overholser Cynthia A. , Rutkauskas John S.
Published: March 2008

In 1996, a questionnaire was mailed to all members of the Federation of Special Care Organizations in Dentistry (FSCO) in an attempt to learn more about their professional practices. Questions focused primarily on the amount of free and reduced‐fee dentistry that the membership provided to the public. The questionnaire asked respondents to identify their field of practice; estimate the amount of time, the number of patients, and the monetary value of the dentistry provided; as well as to classify the types of patients to whom they provided these dental services for free or at reduced fees. Each of the FSCO respondents reported providing an average of 14,820 in free dentistry in 1995. Not surprisingly, the respondents reported treating a significant number of special‐needs patients. Members also reported spending 31.0% of their clinical time working at reduced fees and 7.4% of the time working for free. This questionnaire revealed that the Federation of Special Care member respondents are donating a significant amount of dentistry and treating a large segment of special‐needs patients.
Evaluation of an oral health education program for nursing personnel in special housing facilities for the elderly
Authors: Paulsson Gun , Fridlund Bengt , Holmén Anders , Nederfors Tommy
Published: March 2008

The aim of this study was to evaluate the influence of an oral health education program (OHEP) on attitudes among the responsible nursing personnel toward performing oral health procedures for care receivers. A total of 2882 nursing personnel were offered participation in the OHEP, and the effect was evaluated by means of a questionnaire distributed pre‐educationally as well as 1–2 months post‐educationally. The nursing personnel were allocated, on the basis of nursing education, to either a “high level of health care education group (HHCE), including registered and enrolled nurses, or a”low level of health care education“group (LHCE), including nursing assistants and home care aides. Statistical analysis was performed by means of descriptive and analytical statistics. After the OHEP, the nursing personnel estimated their ability to perform oral hygiene procedures for care receivers to be significantly increased. Post‐educationally, a significant shift in importance was observed from knowledge regarding the diseased oral cavity to knowledge regarding the healthy oral cavity. It was also observed that, in the LHCE group, the OHEP favored practical procedures, while in the HHCE group, theoretical considerations were favored. This indicates that, when oral health education programs are designed, due attention should be paid to the nursing personnel's education level.
Nifedipine‐induced gingival hyperplasia: Non‐surgical management of a patient
Authors: Naidoo Lionel Christopher D. , Stephen Lawrence Xavier G.
Published: March 2008

A clinical report of nifedipine‐induced gingivitis in a medically compromised patient is presented. This case history also describes the challenges faced by the oral health practitioner to develop an appropriate regimen of treatment for a patient in whom neither withdrawal of the drug nor substituting for it was feasible, and periodontal surgery was contra‐indicated.
The accuracy of tooth loss data collected by nurses
Authors: Warren John J. , Levy Steven M. , Hand Jed S.
Published: March 2008

This paper reports on the accuracy of tooth counts conducted In 22 subjects by 10 trained nurses as part of a large longitudinal study of a pharmacological agent. These nurses participated in a training course consisting of seminars, discussion, demonstrations, and practice examinations. Each of the nurses then counted the teeth of 22 subjects and recorded their findings independently. The counts of the nurses were compared with those of the dentists to assess the accuracy of the nurses' counts. We found that nurses and dentists were in perfect agreement for 86% of the patient counts conducted. Individual nurses' levels of agreement with dentists ranged from 73% to 100%, with pairwise kappa statistic values ranging from 0.70 to 1.00. In addition, both Pearson correlation and interclass correlation measures exceeded 0.98 for every comparison of dentist and nurse counts. The results of this study suggest that training nonden‐tal health care workers may be an accurate and low‐cost way of obtaining tooth loss data and other oral health measures, particularly when oral health data are collected as part of larger, multi‐disciplinary studies.
Preferences for and influences on oral health prevention: perceptions of directors of nursing
Authors: Johnson Teresa E. , Lange Brian M.
Published: March 2008

Directors of Nursing (DONs) from 196 of 206 Nebraska long‐term‐care (LTC) facilities were sent a pre‐tested questionnaire. The aim was to assess available on‐site dental services, existing oral health education and prevention programs as well as future needs/preferences, and the influence of 10 factors in assessing and maintaining residents' oral health. Of the 196 DONs contacted, 126 (64%) participated. Only 36% of DON responded reported having on‐site dental services. DONs Indicated a preference for nursing staff (NS) oral health in‐service training over other educational and/or programmatic proposals. When asked to select the five most influential factors in assessing and maintaining residents' oral health in their respective facilities, DONs selected resident factors (mean, 2.8) more often than NS factors (mean, 2.2). DONs most often identified residents' (R) ability to perform oral hygiene (n = 99), R’ cooperation with OH assistance (n = 98), R’ interest in their oral health (n = 83), NS interest in R’ dental health (n = 70), and NS time constraints (n = 69).
The management of drooling problems in children with neurological dysfunction: a review and case report
Authors: Shapira Joseph , Becker Adrian , DMD Moti Moskovitz
Published: March 2008

Drooling in children with neurological dysfunction indicates neurogenic failure to coordinate the muscles of the tongue, soft palate, and face which act in the first stage of swallowing. This causes excessive pooling of saliva in the anterior part of the mouth and consequent overspill. Treatment for drooling includes behavioral, pharmacological, and surgical modalities. Correcting a malocclusion has also been reported to help eliminate drooling. This paper describes the treatment of a child with neurofibromatosis, psychomotor, developmental, and neurologic retardation, and difficulty with speech. The patient was referred to our clinic to correct his drooling. Simple orthodontic treatment succeeded in eliminating the drooling and Improving his speech.
Using the GOHAI to assess oral health status of frail homebound elders: reliability, sensitivity, and specificity
Authors: Calabrese Joseph M. , Friedman Paula K. , Rose Lynda M. , Jones Judith A.
Published: March 2008

A pilot study assessed the clinically determined and self‐reported oral health status of 50 randomly selected homebound patients served by Boston's Home Medical Service. The sample was largely female, low‐income, and edentulous. The median age of the patients was 81 years (range, 64–101). While 76% deemed themselves to be in good to excellent oral health, 80% of the patients had not seen a dentist within the last two years, and 80% were found to be in need of routine dental care. To assess whether the Geriatric Oral Health Assessment Index (Atchison and Dolan, 1990) could be used by non‐dental health professionals to determine the need for requesting dental consultation, the study physician repeated the administration of the GOHAI for 23 of the 50 subjects within eight weeks of the initial examination. For the 23 subjects having both dentist‐ and physician‐administered GOHAI scores, the intraclass correlation coefficient was r = 0.61 (p = 0.002), indicating good agreement between the dentist's and physician's administrations of the GOHAI. However, given the high prevalence of need for care, the GOHAI appears to be of less value than an examination for identifying persons who need dental care in this population. Future research is needed to examine the GOHAI's sensitivity and specificity in populations with low to moderate prevalence of treatment need.
Periodontal status and treatment needs among Spanish hospitalized psychiatric patients
Authors: Velasco Eugenio , Bullon Pedro
Published: March 2008

The purpose of this study was to evaluate the periodontal status and treatment needs (by CPITN) of 565 patients hospitalized in a psychiatric facility in Seville, Spain. The results of this study showed that 31.7% of the patients were edentulous and that 68.3%% were dentate. Of the dentate subjects, 8.5% were found to have a healthy periodontium, 14.2% had bleeding on probing, 43.8% had calculus, 24.6% had shallow pockets, and 8.9% had deep pockets. The results of the study also showed that the severity of periodontal disease increased significantly with age and the length of time of hospitalization. The need for oral hygiene instruction among the dentate population was determined to be 91.5%, and the need for treatment (oral prophylaxis and scaling) was 77.3%. These findings suggest that hospitalized psychiatric patients in Spain are in dire need of preventive dentistry.
Using intravenous sedation to manage adults with neurological impairment
Authors: Galli Mark T. , Henry Robert G.
Published: March 2008

Dental care for most medically compromised patients can be accomplished If dentists understand the patients' specific medical conditions and use standard conservative behavioral or physical modifications to prevent complications from occurring. However, In patients who have certain types of neurological conditions, specifically Alzheimer's disease and other types of dementia, dental management typically presents a greater challenge, because, in most kinds of dementia, patients are unable to follow directions or cooperate with simple instructions such as opening their mouths or holding their heads still. This report describes a three‐year retrospective chart review of patients, diagnosed with a neurologic impairment, who underwent intravenous sedation at the Department of Veterans' Affairs Medical Center in Lexington, Kentucky. The goals of this review were to investigate the average doses of commonly used sedative agents, review complications as a result of the sedation, and comment on the safety of intravenous sedation as a means to treat elderly adults with a neurological disability.
Perineural spread of squamous cell carcinoma of the lip: the importance of follow‐up and collaboration
Authors: Pyle Marsha A. , Zak John , Bath Manraj , Sawyer Danny R.
Published: March 2008

Perineural spread (PNS) of mucosal squamous cell carcinoma of the head and neck region occurs with a reported frequency of 2% to more than 27%. Patients previously diagnosed with and treated for head and neck cancer should be closely followed by both their physician and their dentist in order to facilitate the coordination of care. This case history demonstrates the results that can occur when a team approach to head and neck cancer is not followed, especially in a patient who is an infrequent and somewhat reluctant health care utilizer. Despite mandibular pain, the patient, who had a history of a carcinoma of the lower lip and had developed PNS, was not referred to a dentist. In patients with a previous history of squamous cell carcinoma, sensory and/or motor changes must be closely monitored when there is a suspicion of PNS. The outcome of this case supports improved collaborations between physicians and dentists in following head and neck cancer patients.
Assessment of objectives of post‐doctoral general dentistry programs in Canada
Authors: Epstein Joel B. , Tejani Asif , Glassman Paul
Published: March 2008

Objectives of hospital‐based postdoctoral general dentistry programs in Canada were assessed by questionnaire. Seventy percent (14 of 20) of the program directors responded. Educational goals and objectives were assessed in professional skills and practice management, public health and preventive dentistry, oral medicine and pathology, special needs patient care, trauma and emergency care, restorative/prosthodontic care, endodontics, orthodontics/pedi‐atric dentistry, oral surgery, periodon‐tics, pharmacology, and functioning in a hospital. High rankings of proficiency were related to primary care, restorative/prosthodontic, endodon‐tic, and surgical care. Emergency care, sedation, and pharmacology were also ranked highly. Lower rankings of proficiency were reported in orthodontics, aspects of public health dentistry, practice management, and advanced oral and maxillofacial surgery. When the results of the Canadian survey were compared with those of a survey of US post‐doctoral general dentistry programs, substantial similarity was seen. The findings support continuing reciprocity in accreditation standards between the Canadian and American Commissions on Dental Education and Dental Accreditation.
Dental self‐care among dentate adults: contrasting problem‐oriented dental attenders and regular dental attenders
Authors: Gilbert Gregg H. , Stoller Eleanor Palo , Duncan R. Paul , Earls Janet L. , Campbell Anna M.
Published: March 2008

Self‐care behaviors are common and can act as substitutes for or supplements to formal health care services. We tested the hypothesis that problem‐oriented dental attenders (POAs) report more dental self‐care behaviors than do regular dental attenders (RAs), presumably as a substitute for professional care. The Florida Dental Care Study Is a longitudinal cohort study of changes In oral health, In which we measured dental self‐care behaviors related to three common dental problems: toothache pain, bleed‐Ing gums, and tooth loss. Despite using less dental care, POAs were less likely to report “conventional” methods as means to prevent the three dental problems; however, they were more likely to report that homemade remedies, topical medications, or mouthwashes were ways to prevent or treat these problems. POAs were also more likely to believe that “nothing can be done” to prevent these problems. Additionally, POAs had more negative dental attitudes, used less dental care during follow‐up, had more dental disease, were the only persons who extracted at least one of their own teeth, and were more likely to use tobacco. With the exception of dental self‐extractions, no single self‐care belief or behavior distinguished POAs from RAs, nor were POAs likely to have different explanations tor dental problems. Instead, the pattern was one of modest differences on a number of items. Although POAs use less dental care, they do not compensate by employing more “conventional” dental self‐care behaviors, but report being more likely to employ “unconventional” behaviors. They also are more likely to believe that nothing can be done to prevent dental problems.
Amlodipine‐induced gingival overgrowth: periodontal responses to stopping and restarting the drug
Authors: Morisaki Ichijiro , Dol Shizuka , Ueda Katsura , Amano Atsuo , Hayashi Mikiko , Mihara Joji
Published: March 2008

A case history of a woman with gingival overgrowth (GO) induced by amlodipine is presented. A 49‐year‐old Japanese woman, who was taking amlodipine, had gingival overgrowth and swelling on examination. No specific periodontal treatment was provided to the patient for the GO; however, the amlodipine was replaced with an ACE inhibitor after consultation with her medical practitioner. Within two months, the suspension of amlodipine resulted in a significant improvement in her periodontal condition. Failure to control the hypertension caused the physician to re‐prescribe amlodipine. After three months, the gingival overgrowth returned; however, its severity was less when compared with the original periodontal condition, due to reduction in drug dose and periodontal therapy. This experience suggests that temporary suspension of a drug which can induce GO can improve the periodontal condition without the aid of surgical treatment.
Prevalence of numeric anomalies in the permanent dentition of patients with Down syndrome
Authors: Acerbi Andrea Goes , de Freitas Cládio , de Magalhaes Marina Helena Cury Gallottfni
Published: March 2008

The purpose of this study was to evaluate the prevalence of numeric anomalies in the permanent dentition of patients with Down syndrome by means of panoramic radiographs. The sample consisted of panoramic radiographs from 70 subjects. We examiend the radiographs to detect hypodontia as well as supernumerary teeth. Our results confirm the high prevalence of hypodontia among patients with Down syndrome (60%), mostly with mild expression. The teeth most often missing were the upper lateral incisors, usually bilaterally, followed by the lower second premolars and upper second premolars. Supernumerary teeth were seen in 6% of the subjects, and the concomitant occurrence of hypodontia and supernumerary teeth occurred in one patient.
Tetralogy of Fallot: an overview, case report, and discussion of dental implications
Authors: Spivack Evan
Published: March 2008

Tetralogy of Fallot (TOF) is the most common cause of cyanotic heart disease. The anatomic defects comprising TOF lead to the systemic circulation of oxygen‐poor (desaturated) blood, resulting in symptoms of cyanosis, polycythemia, and hypoxia. Untreated, most patients with this disorder die during childhood. Surgical treatment aimed at correcting the defects is currently recommended for infants. Long‐term studies have reported good results with this approach. The case history of a four‐year‐old male with uncorrected tetralogy of Fallot is presented. The patient required extensive dental treatment prior to scheduled cardiac catheterization. The dental findings and plan of care for this patient are detailed, and attention is given to the role of the medical work‐up, preoperative antibiotics, and sedatives. It is stressed that the dental treatment plan for patients with tetralogy of Fallot must take into account the patients' medical status both prior to and following corrective surgical procedures.
Xerostomic complaints induced by an anti‐sialogogue in healthy young vs. older adults
Authors: Patel Puravi S. , Ghezzi Elisa M. , Ship Jonathan A.
Published: March 2008

Complaints of xerostomia and salivary hypofunction are common in older adults. However, recent studies reported that dehydration‐induced salivary hypofunction caused fewer xerostomic complaints in older compared with young adults. This may predispose older adults to developing oral problems that will subsequently not receive attention from health care providers. Since many medications are known to inhibit salivation, this study attempted to determine if an anticholinergic drug (glycopyrrolate) had a differential effect on xerostomic complaints in young vs. older adults. Eighteen young (age 20–38 yrs) and 18 older (age 60–77 yrs) healthy adults were given a 4.0 g/kg dose of IV glycopyrrolate. For 6 hrs after drug administration, stimulated parotid salivary flow was collected, and an eight‐item Visual Analogue Scale (VAS) subjective xerostomia test was given. At several time points post‐IV glycopyrrolate, salivary flow rates were consistently lower in older compared with young adults. For some measures of xerostomic complaint (time to first complaint; time to maximum complaint; mean maximum complaint), there were no age‐related differences for all VAS items. However, a trend for increased xerostomic complaints in older adults was demonstrated (time to recovery; total duration of complaint; number xerostomic at 6 hrs). These findings suggest that, given equal doses of an anti‐sialogogue, salivary hypofunction is greater in healthy older adults, while increased complaints of xerostomia are not as consistent.
Coping with tooth pain: a qualitative study of lay management strategies and professional consultation
Authors: Stoller Eleanor Palo , Gilbert Gregg H. , Pyle Marsha A. , Duncan R. Paul
Published: March 2008

This research analyzes transcripts of semistructured interviews with patients presenting with tooth pain at a rural dental clinic in North Florida. The primary objectives are to identify the strategies patients use to manage their pain and to elucidate the decision‐making process leading to the clinic visit. Although respondents understood that their condition was not self‐limiting, only about one‐half contacted the clinic within several days of the onset of their pain. Most tried one or more lay management strategies.
Risk factors for dental caries in children with cerebral palsy
Authors: dos Santos Maria Teresa Botti Rodrigues , Masiero Danilo , Simionato Maria Regina Lorenzetti
Published: March 2008

This study was conducted to examine the oral condition and the salivary and microbiological parameters associated with dental caries in 62 children with cerebral palsy, who came from households of low socioeconomic status (Study Group). This group had mixed (6 to 11 years old) and permanent (11 to 16 years old) dentition. Dental examinations were performed to measure dental caries, plaque index, salivary levels of mutans streptococci and lactobacilli, salivary flow rate, pH of stimulated saliva, and buffer capacity of saliva. A group of 67 non‐handicapped children from similar socioeconomic backgrounds also were examined using these parameters (Control Group). Data were analyzed statistically by non‐parametric tests and by correlation. The results showed that children with cerebral palsy who had permanent dentitions had a higher mean decayed, missing and filled surfaces index, as well as a higher plaque index for both sexes. Microbiological examination revealed higher levels of mutans streptococci among Study Group subjects with mixed dentition than in the Control Group. Also, lactobacillus counts were higher in the Study Group, regardless of sex or dentition. With respect to salivary flow rate, pH and buffering capacity, lower mean values were obtained for the Study Group.
Elder mistreatment: dental assessment and intervention
Authors: Cowen Howard J. , Cowen Perle Slavik
Published: March 2008

Elder mistreatment has increasingly been recognized as a serious and complex health issue affecting large numbers of elders each year. Dependent elder populations are often at heightened risk for mistreatment by those individuals and institutions that care for them. Health professionals have been found to lack knowledge regarding assessment, diagnosis, intervention, and reporting criteria of elder mistreatment. This article reviews the types and prevalence of elder mistreatment, risk factors, signs and symptoms, preventive interventions, and ethical considerations.

Dentistry,

elder mistreatment/ assessment,

elder mistreatment/interventions.
Oral diseases and conditions in community‐living older adults with and without dementia
Authors: Chalmers Jane M. , Carter Knute D. , Spencer A. John
Published: March 2008

This study compared the prevalence and experiences of oral diseases and conditions, as well as tooth loss and retained root status, in community‐dwelling older adults with and without dementia. Dental examinations were conducted at baseline and at one‐year for randomly selected samples of 116 dentate community‐living older adults with dementia and a comparable group of 116 adults without dementia. Participants with dementia had significantly higher experiences of oral diseases and conditions at baseline and one‐year compared with participants without dementia: decreased use of dentures; increased prevalence of denture‐related oral mucosal lesions; increased plaque accumulation; increased prevalence and experiences of coronal and root caries; and increased numbers of decayed retained tooth roots. These higher experiences of oral diseases and conditions were related to dementia severity, not to specific dementia diagnoses. Participants with dementia already had a compromised oral health status when admitted into institutional long‐term care between baseline and one‐year; of concern were the high plaque levels on the natural teeth of the group of institutionalized participants with dementia.
Practical protocols for the prevention of dental disease in community settings for people with special needs: the protocols
Authors: Glassman Paul , Anderson Max , Jacobsen Peter , Schonfeld Steve , Weintraub Jane , White Alex , Gall Teran , Hammersmark Sandra , Isman Robert , Miller Christine Ernst , Noel David , Silverstein Steve , Young Douglas
Published: March 2008

People with special needs have more dental disease and more missing teeth than the general population. They also have reduced access to oral health diagnostic, preventive, interceptive and treatment services. If services are available, they can be complicated and costly. It is critical to prevent dental diseases in these individuals. This article presents a set of practical protocols for preventing dental disease in people with special needs. These protocols are designed to be used in community settings outside of a dental office.
Dental status, xerostomia and the oral health‐related quality of life of an elderly institutionalized population
Authors: Locker David
Published: March 2008

The author examined the relative effects of tooth loss and xerostomia on the oral health‐related quality of life of an elderly, medically compromised population, living in a long‐term care setting. Data were collected from 225 subjects (mean age: 83 years) via a questionnaire and review of dental charts. Oral health‐related quality of life was assessed using self‐ratings, satisfaction ratings, an index of chewing capacity, the GOHAI, and OH1P‐14. Almost all participants had one or more chronic medical conditions and were taking prescribed medications. Two‐thirds of the study group was dentulous with a mean number of 16 remaining teeth. One‐third of the participants had scores on a xerostomia index indicating marked oral dryness. In bivariate and multivariate analyses, xerostomia index scores were significantly associated with all oral health‐related quality of life outcomes. Dental status was associated with chewing capacity only. The results suggest that xerostomia has an important influence on the well‐being and quality of life of this population.
Supervised toothbrushing and oral health education program in Kuwait for children and young adults with Down syndrome
Authors: Shyama Maddi , Al‐Mutawa Sabiha A. , Honkala Sisko , Honkala Eino
Published: March 2008

The authors report on the effectiveness of a school‐based, supervised toothbrushing program among a group of 112 children with Down syndrome in Kuwait. The study involved 45 boys and 67 girls, who ranged in age from 11–22 years (mean, 14.8 years). The participants had moderate mental retardation and attended one of two special needs schools. Plaque was scored according to the Silness and Loe plaque index and gingivitis according to the Loe and Silness gingival index. Supervised toothbrushing and dental health education sessions were conducted twice a week. The program was evaluated at the end of three months. The mean plaque score decreased from 1.93 to 0.95 (p < 0.001), and the mean gingival score from 2.00 to 0.83 (p < 0.001). This three‐month supervised toothbrushing program was effective in reducing plaque and gingivitis scores, but the key to long‐term success of the program is sustaining the children's motivation to make oral hygiene a part of their daily life.
Leukemic gingival infiltrate as an indicator of chemotherapeutic failure following monoclonal antibody therapy: a case report
Authors: Sollecito Thomas P. , Draznin Julia , Parisi Ernesta , Duffy Kathleen , Stadtmauer Edward A. , Luger Selina M. , Schuster Stephen J. , Tsai Donald , Porter David L.
Published: March 2008

Treatment options are limited for patients with relapsed acute myelogenous leukemia (AML), particularly when the disease is refractory to standard cytotoxic chemotherapy. Targeted drug therapy offers the advantage of delivering higher doses of non‐cross‐resistant chemotherapy with potentially less systemic toxicity. Gemtuzumab ozogamicin (Mylotarg, Wyeth‐Ayerst Laboratories) is an immunoconjugate that consists of humanized anti‐CD 33 antibody linked to the potent anti‐tumor antibiotic calicheamicin and has been an effective therapy for some patients with relapsed AML. However, the overall utility of gemtuzumab ozogamicin is not well defined. For instance, it is not known how well this antibody will target extramedullar/ disease. This article reports gemtuzumab treatment of refractory AML in a 32–year‐old man. At the time of recurrence, his bone marrow was hypoplastic and without leukemia, but the condition progressed resulting in marked leukemic infiltration of the oral mucosa. This case history raises the possibility that leukemic sanctuary sites may exist, and that monoclonal antibody therapy may have sub‐optimal activity in non‐medullary sites of disease.
Oral health: perceptions of need in a rural Iowa county
Authors: Ettinger Ronald L. , Warren John J. , Levy Steven M. , Hand Jed S. , Merchant James A. , Stromquist Ann M.
Published: March 2008

Several studies have shown that oral health problems impact the quality of life of older adults. However, few data are available to describe the oral health status, barriers to care, and patterns of care for adults and older populations living in rural areas. The purpose of this study was to evaluate the perceived need for treatment of oral health problems by adult residents in a rural county in Iowa.

The oral health component was part of a larger longitudinal health study of the residents. The sample was stratified into three groups by residence, that is, farm households, rural non‐farm households and town households. The sample was subsequently post‐stratified by gender and age group into young elderly, 65–74 years old, and old elderly, 75 years and older.

Dentition status varied according to age and was related to the perception of treatment needs. Edentulous persons had fewer perceived treatment needs and utilized a dentist less frequently. Place of residence, education, and marital status were not associated with the subjects' perceived problems with eating and chewing. However, persons with difficulty chewing were more likely to have some missing upper teeth, have a perceived need to have denture work, and have smoked for a number of years. The results suggest that this rural population is retaining more teeth and consequently may need and may seek dental services more often than previous more edentulous cohorts.
Evaluation of Class I ART restorations in Brazilian schoolchildren: three‐year results
Authors: Wang Linda , Lopes Lawrence Gonzaga , Bresciani Eduardo , Lauris José Roberto Pereira , Mondelli Rafael Francisco Lia , Navarro Maria Fidela de Lima
Published: March 2008

Atraumetic Restorative Treatment (ART) has been adopted around the world to avoid unnecessary extractions, especially in non‐industrialized countries The development of specific glass ionomer cements marketed for the ART technique has contributed to the technical success rate. In this study. Ketac‐Molara (3M ESPE. Dental Medzn Germany) was used to restore 150 Class I cavities in 118 Brazilian public school children, aged from 7–12 years. At baseline and at subsequent recalls. CPI probes with a ball‐end of 0.5 millimeters (mm) were used to assess loss of restorative material, and photographic color transparencies of restorations were made. After six months. 83 patients returned for follow‐up examinations, with 71.8% of their restorations designated as acceptable. After three years. 49 patients with 57 ART‐restorations were evaluated, with 21.0% of these restorations graded as acceptable Another 29.8% of their restorations had been replaced by more permanent materials. The main objective of the ART technique is tooth retention; this was achieved for 94.7% of the restored teeth in a high caries risk population who returned for recalls.
The oral health of children with Down syndrome in Ireland
Authors: Bradley Conac , McAlister Triona
Published: March 2008

The authors investigated the oral health of a convenience sample of 71 children with Down syndrome. The study group had a lower caries prevalence but similar levels of unmet treatment needs as children at special and mainstream schools. Treatment experience varied with age: 5‐year‐olds had more extractions and fewer restorations, and 15‐year olds had fewer extractions and more restorations. The number of teeth with fissure sealants was comparable to that of other children in Special Needs Schools. Although the study group had poor oral hygiene, a need for advanced periodontal treatment was not evident. Few had evidence of dental trauma. Malocclusion was prevalent. Through a government‐funded program, most of the sample had seen a dentist within the previous year, and few parents reported problems accessing dental care.

This study suggests that services targeted toward groups with special needs could generate outcomes comparable to those seen in other service users. A finding that also may hold true for other underserved populations.
Dental management prior to hematopoietic stem cell transplantation
Authors: Morimoto Yoshinari , Niwa Hitoshi , Imai Yuichiro , Kirita Tadaaki
Published: March 2008

The authors investigated oral health treatment in patients scheduled for hematopoietic stem cell transplantation. Fifteen patients were scheduled for bone marrow transplantation: 12 had leukemia, two had aplastic anemia, and one had myelodysplastic syndrome. Twenty‐three patients were scheduled to undergo peripheral blood stem cell transplantation: 20 had malignant lymphoma and three had leukemia.

Patients with platelet counts of ≤ 50,000/mm3 who required tooth extraction and those with platelet counts of ≤ 30,000/mm3 who required scaling received platelet transfusions before the dental treatment. We saw no bleeding problems in these patients.

Dental care for patients who had neutrophil counts of ≥ 500/mm3 included tooth extractions or scaling, with no postoperative infection. Even those with severe immunosuppression (neutrophil count: 100–150/mm3) tolerated treatment when prophylactic measures, such as intravenous administration of antibiotics, were used. One patient with a neutrophil count of ≤ 50/mm3 developed an infection after even conservative therapy. Thus, caution should be exercised when treating patients scheduled for HSCT as even conservative therapy can initiate and infection.
Gainsharing in a general practice residency: Report of an experience
Authors: Durham Timothy M. , Lange Brian , Carroll Kathy , Brown David
Published: March 2008

Postgraduate general dentistry programs are facing critical problems with funding, resident recruitment and viability, Recent federal actions reduced and eliminated graduate medical education (GME) support for some programs, and rising student debt and increasingly lucrative private practice opportunities reduce the value of postgraduate general dentistry experiences. Faced with these complex and interlinked challenges, the University of Nebraska Medical Center College of Dentistry General Practice Residency implemented a gainshare plan. The first 12 months of the plan produced a 44% increase in production and a concomitant 42% increase in actual collections resulting in enough funds to provide remuneration over base salary for residents, staff and faculty. The plan also compensated the Dean, the host department and the College of Dentistry while also funding the development of a reserve account for program enhancement and future stipend support. Gainshare concepts, rationale and details of the pilot plan are presented along with a discussion of key outcomes and experiences.
Progressing toward a more culturally competent approach to dental care for African American elders
Authors: Slaughter Ann , Smith Virginia J. , Taylor Lynne
Published: March 2008

This study was conducted to understand perceptions that may influence oral self‐care behaviors among elderly African American adults living in an urban community. Four focus groups at two senior centers were recruited, involving a total of 25 participants. Content analysis and ethnographic summaries were used to identify themes, common concepts and language. The results indicated that although the participants recognized the advantages of routine brushing, the importance of keeping teeth clean to prevent gum disease was not widely acknowledged. On the basis of these focus groups, the authors suggest that health promotion approaches for adults who are elderly should be linked to the audience's cultural norms and perceptions regarding the benefits of oral hygiene practices.
Designing and implementing a school‐based dental program for students with developmental disabilities
Authors: York Jill A. , Holtzman Joseph M.
Published: March 2008

Students with developmental disabilities in Atlantic County Special Services School District (ACSSSD) receive on‐site dental care through a program created by UMDNJ‐New Jersey Dental School (NJDS). The program's goal was to coordinate dental school resources with those of a school district, county agencies and the Delta Dental Foundation to provide quality dental services to the students, aged 3–21 years. The University developed a Needs Assessment Survey and distributed 450 surveys to the students' parent/guardian(s). Completed surveys were returned by 131 respondents. Of the 131 children represented, 75 had not been seen by a dentist within the past year. In response to guardian reported access problems, UMDNJ‐NJDS and ACSSSD developed a school‐based dental care delivery system and a program for health promotion and disease.
A Comparison of the Gingival Health of Children with Down Syndrome to Healthy Children Residing in an Institution
Authors: Morinushi Takanobu , Lopatin Dennis E. , Nakao Rie , Kinjyo Sachiko
Published: March 2008

The purpose of this study was to compare the onset and severity of gingivitis in children with Down syndrome, when compared to a healthy control group of children. The subjects included 41 children with Down syndrome ages two to 14 years (mean age: 7.6 years) and 112 age‐matched healthy controls. We assessed the gingival health of all subjects using the gingival inflammation (M‐PMA) index and periodontal probing depth (PD). Children were divided into three age categories: <5 years (AD, 5 to <10 years (AID, and 10 to <17 years (AIII). Supragingival plaque was measured using the Oral Hygiene Index (OHI) and the subjects were screened with the BANA test (Perioscan‐Oral‐B). Measurement of the M‐PMA index in the healthy children showed an age‐related increase (F = 10.369. p<0.001), and the M‐PMA index at the younger age group <5 year (AD was significantly lower than that for the other two age groups AII or AIII (p<0.005, p<0.001). In contrast, the M‐PMA index values at AI and AIII in the subjects with Down syndrome were significantly higher than those for healthy children (p<0.001, p<0.001). Both groups had an age‐related increase in PD (F=3.388, p<0.05 & F= 10.806, p<0.001). and PD at AIII was significantly higher than that at AI in both groups (p<0.01, p<0.001). The children with Down syndrome showed an age‐related increase in the BANA test score (F=3.452, p<0.05), and the BANA test score at AIII was significantly higher than that at AI (p<0.02). The BANA test score in the healthy children was not age‐related but was significantly higher than that in the children with Down syndrome (p<0.02, p<0.05).
Oral health status of homeless people in Hong Kong
Authors: Luo Yan , McGrath Colman
Published: March 2008

The authors report on an oral health survey among Hong Kong Chinese homeless people. A total of 140 homeless men underwent clinical examination and were interviewed with a structured questionnaire. More than 90% had evidence of caries experience; most (75%) were related to untreated caries. The mean DMFT score was 9.0 (DT=3.2, MT=5.2. FT=0.6). Periodontal disease was highly prevalent, with 96% having periodontal pockets. The dental problems most frequently reported by the homeless were: bleeding gums or drifting teeth (62%), dental pain (52%) and tooth trauma (38%). More than 70% of the study's participants perceived a need for dental care. The population surveyed had poorer oral health compared to the general population. High levels of dental needs, both normative and perceived, were found. There is a need to provide more accessible and affordable oral health services to this group of people.