bluuebunny/crossref_metadata_2025 huggingface dataset:
Sickle cell anemia: A review of the dental concerns and a retrospective study of dental and bony changes
Authors: Taylor Lincoln B. , Nowak Arthur J. , Giller Roger H. , Casamassimo Paul S.
Published: March 2008

This paper is a review of the medical concerns pertinent to dental care and a preliminary study of dental findings of the sickle cell anemia (SS) patient. The dental characteristics observed in 21 dental patients with SS are described. Radiographic findings included “stepladder” trabeculae pattern (70%), enamel hypomineralization (24%), calcified canals (5%), Increased overbite (30–80%), and increased overjet (56%). Comparisons are made with other studies of the sickle cell patient, and the need for further study is suggested.
Pemphigus vulgaris—The potential for error: A case report
Authors: Harel‐Raviv Mili , Raviv Eli , Srolovitz Herbert , Gornitsky Mervyn
Published: March 2008

The importance of correlation, referral, and collaboration between dermatology, or any other medical department, and the oral health profession is reported through a case presentation. A case of pemphigus vulgaris diagnosed from a tongue biopsy and confirmed by immunofluorescence is reported.

The patient was treated for actinic keratosis of the scalp for 16 months due to inadequate biopsy material. The diagnostic value of proper biopsy material is stressed. The clinical manifestations leading to a misdiagnosis between actinic keratosis and pemphigus vulgaris are discussed.
Multiple endocrine neoplasia syndrome, Type III: Review and case report
Authors: Haveman Carl W. , Sloan Tod B. , Long Robert t.
Published: March 2008

Successful treatment of the multiple endocrine neoplasia type III (MEN III) syndrome requires early diagnosis. It is highly possible that the patient's dentist may be the first practitioner with the opportunity to diagnose this potentially fatal syndrome. Additionally, patients with this syndrome having a pheochromocytoma and needing invasive dental treatment pose a life‐threatening dental management risk. This article presents a review of the MEN III syndrome and a case report on the surgical management of a MEN III patient with a pheochromocytoma.
Facial developmental vascular anomalies
Authors: McNamara Triona , Trotman Carroll‐Ann , Hewson Antonia , Walshe Matthew
Published: March 2008

Developmental vascular anomalies of the head and neck may give rise to profound esthetic problems that are a challenge to treat. These vascular anomalies may also be of significance in dentistry, particularly where extractions have to be carried out This brief report describes a number of children who presented with different variations of these anomalies.
Perceived barriers to oral health care among the homebound
Authors: Strayer Michael S.
Published: March 2008

Questionnaires and oral examinations were completed on 50 clients of a social service agency which provides home‐based services to functionally dependent elderly. Nearly 61% of all respondents classified their oral health as frail/poor, and 82% reported a perceived need for some oral health care. When asked if they considered themselves home‐bound, 60% reported being home‐bound from 1–10 years (mean = 4.7 years). Two or more home services were received by 80% of the home‐bound group compared with just 45% of the not‐homebound group. Paying for dental care, transportation difficulties, and poor health were the most frequently identified barriers that limited access to oral health care.
Treatment of a patient with hereditary gingival fibromatosis: A case report
Authors: Brown Ronald S. , Trejo Pedro M. , Weltman Robin , Pinero Gerald
Published: March 2008

A case of hereditary gingival fibromatosis is presented. Treatment consisted of apically positioned flap surgery and CO2 laser evaporation. Diagnostic and treatment issues are discussed.
The costs and consequences of neglected medically necessary oral care
Authors: White B. Alex
Published: March 2008

Oral diseases and conditions may adversely affect general health, and certain medical conditions may have a negative effect on oral health.1–9 However, little attention has been given to assessing the economic costs and consequences associated with care that is a direct result of, or has a direct impact on, an underlying medical condition and/or its resulting therapy. The costs can be significant for patients; their families; third‐party payers such as insurance companies, Medicare, and Medicaid; and society. The health consequences of such conditions may dramatically affect function, morbidity, quality of life, and survival.

This paper reviews one possible approach for identifying and measuring the costs and consequences associated with medically necessary oral health care and presents a framework for evaluating medically necessary oral health care. The paper also describes the cost components of care and the dimensions of health consequences. Finally, an example illustrates this approach.

The summary information presented here is meant to offer concepts and ideas important in assessing the costs and health consequences associated with medically necessary oral health care. Individuals interested in a more detailed discussion of economic evaluation of health care programs and outcomes assessment are referred elsewhere.10–23

This is the text of a presentation to the Consensus Conference on Medically Necessary Oral Health Care, Chicago, IL, April 29–30, 1995, sponsored by the National Alliance for Oral Hearth.
National Alliance for Oral Health Consensus Conference on Medically Necessary Oral Health Care: Legal issues
Authors: Cameron Cheryl A. , Litch C. Scott , Liggett Martha , Heimberg Steven
Published: March 2008

This paper examines medical malpractice law as it applies to medically necessary oral health care. The basic legal concepts and reported cases involving medically necessary oral health care are reviewed. It is concluded that dental professionals and consumer advocates must advance their educational and legislative advocacy efforts so that health professional colleagues and the public will become aware of the importance of these services and insurers will routinely include coverage of medically necessary oral health care in their medical and dental policies. While failure to provide medically necessary oral health care can be violative of patient rights and legally actionable, medical malpractice litigation should always be the behavior modifier of last resort.
The effect of nurses' background on performance of nursing home resident oral health assessments pre‐ and post‐training
Authors: Blank Lawrence W. , Arvidson‐Bufano Ulla Britt , Yellowitz Janet A.
Published: March 2008

The purpose of this study was to determine the effect of nurses' background on their accuracy in determining oral health status and treatment need of newly admitted nursing home residents before and after tutoring. Eighteen nurses examined SO nursing home residents before and after an in‐service training lecture. Examinations performed by a dentist served as reference. Background items evaluated were: regularity of each nurse's own dental visits; years since graduation from nursing school; length of experience in an LTC facility; and training received in oral health care. At the second evaluation, nurses greatly improved the % agreement on ail items. The results of this study indicate that, regardless of background characteristics, the combination of training, the presence of the dentist, and knowledge that they were in a study appeared to improve nurses' performance on the assessment. Before training, more experienced nurses were better able to determine hard tissue abnormalities than their less experienced counterparts; before training, neither group performed well in assessing soft tissue lesions. Therefore, improvements in basic nursing training in this area appear to be necessary.
Polyol‐combinant saliva stimulants and oral health in Veterans Affairs patients—An exploratory study
Authors: Mäkinen Kauko K. , Pemberton Dwight , Mäkinen Pirkko‐Liisa , Chen Chin‐Yu , Cole James , Hujoel Philippe P. , Lopatin Dennis , Lambert Paul
Published: March 2008

An exploratory study investigated the root caries incidence in Department of Veterans Affairs patients with exposed root surfaces. For a period of six to 30 months, the subjects were systematically assigned to groups which used chewable dragées or chewing gums that contained either xylitol or sorbitol as bulk sweeteners. The mean treatment time was 1.8 years (standard deviation = 0.8). The consumption levels of both polyols was up to 8.5 g daily, used typically in five episodes during a 16‐hour period. The subjects were examined every six months in connection with their standard scheduled visits at the Veterans Affairs Medical Center. The risk for a root‐surface lesion in the xylitol group was only 19% of that for a surface in the sorbitol group (relative risk, 0.19; 95% confidence interval, 0.06–0.62; p <0,0065). Simultaneous study in periodontal patients showed that both polyols significantly reduced the gingival index scores, and slightly (but not significantly) reduced the plaque index scores. Collectively, both studies suggest that frequent daily consumption of chewable, saliva‐stimulating products containing essentially nonfermentable or slowly fermentable dietary carbohydrate sweeteners (xylitol and sorbitol) may have an oral‐health‐improving effect in Department of Veterans Affairs Medical Center patients. It is necessary to evaluate if these procedures would be efficacious in larger and expanded patient cohorts.
Oral health in the elderly with non‐insulin‐dependent diabetes mellitus
Authors: Närhi Timo O. , Meurman Jukka H. , Odont D , Tilvis Reijo , Ainamo Anja
Published: March 2008

The purpose of this study was to examine salivary flow rates and selected oral health parameters in 12 patients (aged 76–86 years) with non‐insulin‐dependent diabetes mellitus (NIDDM) and also in 20 subjects (aged 76–86 years) with NlDDM and cardiovascular diseases (CVD) and to compare them with 32 healthy controls matched for age and gender.

Unstimulated salivary flow rates were lower in both groups of NlDDM patients than in the controls, although the differences were not statistically significant. Subjective oral dryness and other oral and non‐oral symptoms were more frequently reported by the patients with NIDDM+CVD; however, the differences were usually non‐significant. Root‐surface caries was more frequently detected in the subjects with NlDDM only, although the difference among groups was not statistically significant. Periodontal treatment need, according to CPlTN values, was more frequent in the subjects with NlDDM only, compared with controls or those with NIDDM+CVD, although the differences were again not statistically significant.

There were no statistically significant differences in the oral health parameters of the subjects with NlDDM or NIDDM+CVD compared with those of their age‐ and sex‐matched healthy controls.
Salivary secretion and oral health in narcolepsy: A pilot study
Authors: Nordgarden Hilde , Jensen Janicke Liaane , Arneberg Pål , Storhaug Kari
Published: March 2008

Complaints of dry mouth and poor dental health are common in persons with narcolepsy. The aim of this study was to investigate whether salivary secretion is reduced in narcolepsy. Persons using tricyclic anti‐depressants (TCAs) were excluded, since TCAs are known to reduce salivary secretion. Thus, two patient subgroups were studied, one on central stimulant (CS) treatment (medicated group, n = 12), and one unrnedicated group (n = 8), representing all persons with narcolepsy living in the Oslo area meeting these criteria. The survey group and 20 age‐ and sex‐matched healthy control persons without symptoms of dry mouth were examined with respect to the following parameters: unstim‐ulated (UWS) and chewing‐stimulated (SWS) whole salivary flow rates, citric‐acid‐stimulated parotid and submandibular flow rates, buffering effect, and number of some aciduric micro‐organisms in the oral cavity.

As a group, persons with narcolepsy had lower whole salivary flow rates, a lower buffering effect, and higher Candida albicans scores than the control group. When the patients were divided into the medicated and unmedicated groups, these differences were valid only for the medicated group. Whether the observed differences were effects of CS medication or reflected that these persons were more seriously affected by the disease has to be further explored.
Patient satisfaction in a regular and after‐hours dental clinic
Authors: Handelman Stanley L. , Jensen Oivind E. , Jensen Phyllis , Black Peter M.
Published: March 2008

To determine whether financial incentives would have an impact on the quality of care, we compared patient satisfaction in a “regular” daytime postdoctoral general dentistry clinic and an “after‐hours” clinic, using a 14‐item mail questionnaire to a randomly selected sample of adult patients, stratified by age and gender. The providers in both clinics were identical; however, the method of compensation was different. When residents treated patients in the regular clinic, they were paid a fixed stipend, while the “after‐hours” clinic residents' compensation was fee‐for‐service. The percentage of patients giving very favorable or favorable responses was high in both clinics. However, the response of patients in the “after‐hours” clinic was more favorable for total number of visits required for care to be completed, management of pain, and politeness of receptionists. This study demonstrated that the payment of financial incentives to residents did not reduce and may even have enhanced patient satisfaction.
The accessibility of dental treatment to adults with physical disabilities in northeast England
Authors: Oliver C. Heather , Nunn June H.
Published: March 2008

The study was carried out to gain information about the availability and the accessibility of dental services to adults with physical disabilities in Gateshead, an industrial town with a population of 199, 5881 situated in northeast England. Questionnaires were sent to all general dental practices to ascertain the dental staffs perceptions of the accessibility of their premises, their willingness to treat people with disabilities, and the types of treatment offered. The main problem for access was caused by stairs and other physical barriers within buildings. Lack of portable equipment limited the scope of domiciliary treatment offered.
Esthetic overdenture for a patient with possible Seckel syndrome
Authors: Nihill Patricia , Lin Luh‐Yuan , Salzmann Larry B. , Stevens Steve
Published: March 2008

This is a case report of a 21‐year‐old with possible Seckel syndrome (bird‐headed dwarfism), micro‐gnathia, microdontia, severe bony undercuts, and periodontal disease who sought treatment at a university dental clinic. Treatment included extractions, periodontal therapy, retention of premolars with sealants, and overdentures with resilient soft liners. A limited review of Seckel syndrome literature is included. The modification of existing dental materials and procedures required for successful functional and esthetic results are discussed.
Reversion of gingival hyperplasia in a heart transplant patient upon interruption of cyclosporine therapy
Authors: Somacarrera Maria L. , Lucas Miguel , Acero Julio
Published: March 2008

A heart transplant patient undergoing a combined cyclosporine and prednisone treatment was monitored during the 18 months following transplantation. A complete oral and dental examination was performed in each of the first six months after transplantation, and then in the 9th, 12th, 15th, and 18th months. The data collected included gingival hyperplasia secondary to cyclosporine use, and clinical and periodontal variables. Histological studies were also conducted on gingival tissue samples in months 1, 3, 9, 15, and 18. Cyclosporine treatment was replaced by azathioprine treatment in month 10 because the patient was experiencing nephrotoxicity. Between months 9 and 18, gingival hyperplasia regressed by 26.5% due to a reduction in the fibrous connective tissue mass, fibroblasts, and inflammatory infiltration. The control group included 13 heart transplant patients subject to equivalent conditions except discontinuance of cyclosporine treatment; seven of the patients had developed hyperplasia by month 9. Average hyperplasia in the control group increased by 2% between months 9 and 18; only one patient showed a 6.2% decrease in hyperplasia. This provides further evidence for the causal relationship between cyclosporine therapy and gingival hyperplasia, and suggests that this side‐effect is reversible.
The use of intraosseous anesthesia in a patient with myositis ossificans progressiva
Authors: Webb Michael D. , Wilson Carolyn
Published: March 2008

The case of a pediatric patient with myositis ossificans progressiva in whom it became increasingly difficult to obtain local anesthesia is presented. lntraosseous anesthesia was successful in allowing pain‐free dental treatment to be completed. This approach should be considered in other patients who have limited mouth‐opening ability due to injury or disease.

We have presented a case of a patient with myositis ossificans progressiva in whom it was difficult to obtain local anesthesia using conventional infiltration and block anesthesia. Intraosseous anesthesia was successful in providing pain‐free dentistry for this patient and should be considered in other cases where limited opening is present or other local anesthetic methods have failed.
A comprehensive 30‐month preventive dental health program in a pre‐adolescent population with Down's Syndrome: A longitudinal study
Authors: Shapira Joseph , Stabholz Ayala
Published: March 2008

A comprehensive systematic preventive dental health program was implemented in a young population with Down's Syndrome during a 30‐month period. Twenty children (nine boys and 11 girls), ages 8–13 (mean age, 11), participated in the study, which took place in three hostel‐like apartments. The main goals of this program were to achieve good plaque control and subsequently prevent periodontal disease as well as to apply fissure sealants and fluorides in an attempt to prevent dental caries. The mean plaque and gingival indices as well as the percentage of bleeding sites decreased significantly (p < 0.01) following the administration of our oral health program. Caries experience, as indicated by DMFS, decreased from 1.35 to 1.05 surfaces per child, and the use of fissure sealants to prevent occlusal caries was proved to be 100% effective. It is concluded that if the children's efforts are integrated with those of a motivated dentist, dental hygienist, and staff, a well‐planned preventive dental health program can lead to a high degree of success in the prevention of dental diseases in young populations with Down's Syndrome.
The effect of dehydration on parotid salivary gland function
Authors: Fischer Dena , Ship Jonathan A.
Published: March 2008

Dehydration is common in the elderly, and has been traditionally linked with salivary hypo function. This study examined the effect of dehydratlon on parotid salivary flow rates. Twelve young and 12 older healthy subjects abstained from food and fluid intake for 24 hrs (dehydration) and then underwent IV rehydration proport Sonal to the amount of weight lost. Unstipulated and stimulated parotid flow rates, weight, hematocrit and hemoglobln values were assessed at baseline and 24 hrs, and 1 hr after completion of rehydration. All subjects experienced decreases in weight and increases in hematocrit and hemoglobin during dehydration. IV fluids caused weight gain and decreased hematocrit and hemoglobin, demonstrating that subjects were metabollcally rehydrated. During dehydration, unstimulated flow rates decreased In young (p ≤ 0.001) and older (p ≤ 0.001) subjects, and stimulated flow rates decreased in young (p ≥ 0.05) and older (p = 0.03) subjects. While flow rates increased with rehydration, they remained lower than baseline levels. No age or gender differences were detected for salivary data. These findings suggest that dehydration may cause decreased parotid flow rates, independent of age in healthy adults.
Comparison of the Interplak® and manual toothbrushes in a population with mental retardation/developmental disabilities (MR/DD)
Authors: Carr Michele P. , Sterling Edward S. , Bauchmoyer Susan M.
Published: March 2008

A major dental problem confronting persons with mental retardation/developmental disabilities (MR/DD) is poor dental hygiene, which can result in an increased incidence of gingivitis and periodontal disease. Studies indicate that the most obvious reason for the poor oral hygiene of such persons is their inability to clean the oral cavity adequately. The objective of this study was to determine whether there was a difference in the oral health between a group of residents with MR/DD using the Interplak® and a group using manual toothbrushes. Fifty‐six residents from four Franklin County group homes completed the study. Each group home was divided into two study groups, one using the Interplak® and the second using manual toothbrushes. Each subject was seen for initial recording based on the Gingival Index (Löe) and Simplified Oral Hygiene Index (Greene and Vermillion), followed by a thorough prophylaxis. These measurements were recorded again at three, six, and nine months, with a final recording at 12 months. At the conclusion of the study, analysis of the data indicated significant improvement in the Gingival Index over a 12‐month period for the residents using the Interplak® compared with a manual toothbrush.
Dental caries in chronically disabled elders
Authors: Wyatt Chris C.L. , MacEntee Michael I.
Published: March 2008

Dental caries is the major cause of tooth loss in elderly individuals with physical and mental disabilities. The diagnosis of caries in elderly individuals is difficult due to a complicated oral environment compounded by the prevalence of physical and mental barriers to care. The restoration of tooth structure and the replacement of teeth lost due to caries result in considerable economic and biological cost to both individuals and society. Decisions to remineralize, restore, or extract teeth depend largely upon the extent of the structural damage caused by the infection. Teeth with small lesions can be remineralized with fluorides, whereas teeth with large lesions may be restored or extracted. Caries risk assessment based on the history of previous infection, salivary parameters, and ingestion of sugar can be used as a basis for placing a patient on a caries‐preventive regimen. This paper discusses the patho‐physiology of caries to explain the appropriate diagnosis, prevention, and treatment of dental caries in elderly individuals with chronic disabilities.
Video as a medium of oral health education for children with mental handicaps
Authors: Palin‐Palokas Tuija , Nordblad Anne , Remes‐Lyly Taina
Published: March 2008

This study assessed the usefulness, appropriateness, and relevance of a video as an oral health education medium for children with mental handicaps and for preschool groups where children with mental handicaps and healthy children are taught together. The evaluated video was designed for children with mental handicaps but was also recommended for integrated groups. Forty children with mental handicaps from four special education classes and two nursery school groups, 151 normal children from 11 nursery school groups, and the teachers of these classes and groups evaluated the material. The assessment of the material's value was based on the teachers' records of their experiences with the material, their records of the children's opinions and discussions about the material, and their records of drawing interviews with the children. Based on the evaluation, it is apparent that, when used by trained teachers, professionally made videos designed for children with mental handicaps can be useful and valuable aids in educating children of different levels of mental and social development about oral health. Integrated groups need videos featuring both children with mental handicaps and normal role models and with a diversity of contents that will interest and challenge both types of audiences. E.
Masticatory muscle pain: An important indicator of giant cell arteritis
Authors: Hayreh Sohan Singh
Published: March 2008

Giant cell arteritis (GCA) is a poly symptomatic disease which constitutes an ophthalmic emergency because early recognition and management can prevent blindness. There is conflicting information in the literature on the validity, sensitivity, and specificity of various systemic symptoms and signs of GCA. This paper presents a review of our prospective studies on the subject, and our findings are particularly relevant to dentists. We investigated 363 patients in a prospective study. Positive temporal artery biopsy was seen in 106 patients and negative in 257 referred for diagnosis of GCA. Systemic symptoms and signs of GCA and erythrocyte sedimentation rate (Westergren‐ESR) and C‐reactive protein (CRP) levels were compared in these two groups of patients. The odds of having a positive temporal artery biopsy (i.e., GCA) were 9.1 times greater with jaw claudication (pain in masticatory muscles on eating), 3.4 times with neck pain, 3.2 times with CRP > 2.45 mg/dL, 2.0 times with ESR 47–107 mm/hr, 2.7 times with ESR > 107 mm/hr, and 2.0 times when the patients were aged≥75 years. Other signs and symptoms did not show a significant association with a positive biopsy. Our study showed that “normal” ESR values do not rule out GCA but that CRP is a more useful test than ESR. Since jaw claudication is one of the most important symptoms of GCA, dentists should keep this possibility in mind when older patients come complaining of jaw pain while eating.
Oral health and medical status in dentate low‐income older persons
Authors: Persson Rigmor E. , Persson G. Rutger , Kiyak Dr. H. Asuman , Powell L. Virginia
Published: March 2008

Oral and medical conditions of 295 low‐income dentate older persons (17% African‐Americans, 14.5% Asians, 11.5% Hispanics, and 57% Caucasians) were studied. The mean age was 72 (SD ± 6.8; range, 60–91). Oral examinations were performed, stimulated saliva was collected, and interviews were conducted regarding oral health attitudes, knowledge, and behaviors. Past history of restorative care, defined by filled coronal surfaces, differed by ethnicity, with Caucasian elders having most filled surfaces (p < 0.001). Ethnic minority elders had significantly poorer periodontal health (p < 0.001), with the worst conditions in Asians. Low salivary flow (< 0.01 mL/min) was found in 31% using medications known to cause hypo salivation. Frequent diseases were arthritis (46%), hypertension (39%), heart disease (25.2%), and diabetes (8.5%). Hypothyroidism was associated with low flow rate (F = 13.2, p < 0.0003). Seventy percent reported that they had never smoked. Smokers had deeper probing depths (X2= 11.98, p < 0.05) and more gingival recession (F = 8.08, p < 0.001). Women on hormone replacement therapy (HRT) had less calculus (F = 11.33, p < 0.01) and fewer sites with probing depths > 5 mm (F = 8.99, p < 0.003). The present study found Pew associations between physical and oral health and ethnicity. The benefits of HRT for women's periodontal health and the effects of hypothyroidism on stimulated salivary flow are noteworthy.
Gorlin‐Goltz: What's in a name?
Authors: McNamara Triona , Trotman Carroll‐Ann , Russell Kathleen A.
Published: March 2008

This paper describes the clinical features of two very distinct syndromes with similar names: Gorlin‐Goltz and Goltz‐Gorlin Syndromes. A case report is presented that highlights the differences between these syndromes. To avoid errors in diagnosis because of the similarity in names, the authors caution that, based on additional information now available, the preferred names should be Focal Dermal Hypoplasia syndrome for Goltz‐Gorlin syndrome and Nevoid Basal Cell Carcinoma syndrome for Gorlin‐Goltz syndrome.
Dental treatment outcomes among dentate nursing facility residents: an initial study
Authors: Kambhu Peter P. , Warren John J. , Hand Jed S. , Levy Steven M. , Cowen Howard J.
Published: March 2008

This investigation used retrospective methodology to examine the outcomes of previous dental treatment and the incidence of developing restorative and extraction needs, including dental caries, among nursing facility residents. Data were taken from treatment records of 48 dentate residents in 10 nursing facilities who received comprehensive dental treatment delivered through the Geriatric Mobile Unit (GMU) program operated by the University of Iowa College of Dentistry and were examined an average of 2.9 years had a mean age of 84 years at the second exam, and 90% were female. About 18% of all previously placed restorations needed to be replaced, and an additional 11% of teeth that received a restoration needed to be extracted at follow‐up. At follow‐up, nearly 70% (33/48) of residents needed restorative care, while 44% (21/48) needed extractions. The mean incidence of teeth developing new treatment needs between the two visits was 2.7 teeth/person (14.9% of teeth) for restorative need and 1.1 teeth/person (6.6% of teeth) for extraction need. Results suggest that successful treatment outcomes can be achieved for nursing facility residents, but that dental disease and treatment needs develop at a high rate among these residents.
Dental health profile of a population with mental retardation in Israel
Authors: Shapira Joseph , Efrat Jacob , Berkey Douglas , Mann Jonathan
Published: March 2008

The dental status and treatment needs of Israeli children and adults with mental retardation were studied in a random sample of 387 subjects. Four levels of mental retardation were represented: (1) educable (n = 70), (2) trainable (n = 92), (3) with mental retardation and behavioral problems (n = 106), and (4) with mental retardation and severe physical handicap (n = 119). The total age‐adjusted DMF‐T was 12.78 and differed significantly by behavioral group (p < 0.001); the M‐T was 10.70 for the educable group compared with 5.52 for the group with mental retardation and severe physical handicap. Total treatment needs included a participant mean of 3.32 for restorations and 0.61 for extractions. Institutions having dental clinics had higher participant mean DMF‐T, D‐T, M‐T, and F‐T values (p < 0.05) compared with those institutions which had no clinics (16.04 vs. 9.74; 5.17 vs. 5.06; 9.45 vs. 4.16; 1.41 vs. 0.52). Age‐adjusted CPlTN scores significantly differed by behavioral group; the group with mental retardation and severe physical handicap had the highest CPITN 3 category mean score of 2.93 compared with X̄= 1.89 for the educable group; however, the educable group had the most sextants with no teeth (X̄= 2.48). Findings confirm high dental morbidity and significant oral health differences by behavior group, age, and dental clinic status. Advanced training is recommended for dental providers and the staffs of institutions to enhance oral health outcomes.
Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: A review
Authors: Reynolds Eric C.
Published: March 2008

Using laboratory, animal, and human in situ caries models, investigators have shown that casein phosphopeptide amorphous calcium phosphate complexes (CPP‐ACP) exhibit an anticariogenic activity. The casein phosphopeptides (CPP) are produced from a tryptic digest of the milk protein casein by aggregation with calcium phosphate and purification by ultrafiltration. The CPP have a remarkable ability to stabilize calcium phosphate in solution and substantially increase the level of calcium phosphate in dental plaque. Through their multiple phosphoseryl residues, the CPP bind to forming clusters of amorphous calcium phosphate (ACP) in metastable solution, preventing their growth to the critical size required for nucleation and precipitation. The proposed mechanism of anticariogenicity for the CPP‐ACP is that they localize ACP in dental plaque, which buffers the free calcium and phosphate ion activities, thereby helping to maintain a state of supersaturation with respect to tooth enamel depressing demineralization and enhancing remineralization. The CPP‐ACP, unlike fluoride, can be added to sugar‐containing foods and therefore have commercial potential as an additive to foods as well as to toothpastes and mouth‐washes for the control of dental caries.
Changing dietary patterns with changing dentition: How do people cope?
Authors: Ettinger Ronald L.
Published: March 2008

Food plays a significant and essential role in the survival of all people. There has been a suggestion that there is a strong association between changes in dental status such as loss of teeth and denture wearing and low intake of essential nutrients. This paper explores the relationship between diet and nutrition and a change from (A) an old complete denture to an implant‐sup ported denture, from (6) the dentate status to an immediate complete denture, and from (C) an old complete denture to a functionally corrected new complete denture. A summary of the findings is that loss of teeth influences masticatory efficiency and function and that a replacement prosthesis may improve function but does not significantly change dietary intake.
Oral health care in US nursing homes, 1995
Authors: Gift Helen C. , Cherry‐Peppers Gail , Oldakowski Richard J.
Published: March 2008

In 1993, nursing home care was a $70 billion industry. Since oral diseases are intertwined with declining health, it is important to achieve a better understanding of oral health care in nursing homes. The purpose of this paper is to present basic information regarding the nature of dental care from the 1995 US National Nursing Home Survey. Data include general availability of dental services, a description of types of dentists' and dental hygienists' services, and numbers of full‐time equivalent dentists and dental hygienists. SUDAAN software was used to adjust for the complex, multistage sample design. Of the estimated 16,700 nursing homes in the contiguous US in 1995, between 14,000 and 15,000 offered some level of dental services. About 15,600 nursing homes provided assistance for oral hygiene, while some 7720 nursing homes had dental hygienists' services available. Approximately 60% of nursing homes either did not have services of dentists at all, or had them only on call or only off‐site. Availability of dental services varied by characteristics of nursing homes. Examination of the nature of dental care raises questions about whether the intent of the Federal standards for dental care in Medicare and Medicaid are really being met. As more elderly remain dentate, and as the oral comorbidities of chronic diseases become more recognized, appropriate oral health services for individuals in long‐term care settings likely will increase as public health issues
The occurrence of xerostomia and salivary gland hypofunction in a population‐based sample of older South Australians
Authors: Thomson W. Murray , Chalmers Jane M. , Spencer A. John , Ketabi Mohammad
Published: March 2008

This paper examines the prevalence of and concurrence between the symptoms of dry mouth (xerostomia) and reduced salivary flow (SGH) among a population‐based sample of older South Australians. Participants in a longitudinal dental study of older people were asked a global question about their experience of dry mouth (“How often does your mouth feel dry?”), and those who responded “Always” or “Frequently” were categorized as xerostomic. Unstimulated whole salivary flow rate was measured, and individuals whose flow rate was less than 0.1 mL/min were categorized as SGH cases. Saliva samples were collected from 700 individuals, of whom 683 (97.7%) answered the dry‐mouth question. The mean unstimulated salivary flow rate was 0.27 mL/min (SD 0.22). The prevalence of SGH was 22.1%, and the prevalence of xerostomia was 20.5%, but only 5.7% of participants had both conditions. Almost two‐thirds of the sample had neither condition. Males and females differed in the degree of concurrence between the two conditions. It appears that, in the group studied, xerostomia and SGH were largely discrete conditions, supporting the assertion by other workers that low salivary flow may not be the key factor in the etiology of xerostomia among older people.
Oral health assessment by nursing staff of Alzheimer's patients in a long‐term‐care facility
Authors: Lin Christopher Y. , Jones David B. , Godwin Karen , Godwin R. Kenneth , Knebl Janice A. , Niessen Linda
Published: March 2008

Dental care and oral hygiene are often neglected in nursing homes. This study examines the effect of an education program on the ability of nursing staff to conduct an oral health assessment for a population of persons with Alzheimer's disease and related disorders. The findings of this study showed that the CNA ‘s are as capable as the Licensed Nurses in assessing oral health status. In future training of nursing staff, increased emphasis on identification of problems in specific areas may improve the overall assessments by nurses and nursing assistants.
Functional status and untreated dental caries among nursing home residents aged 65 and over
Authors: Hawkins Robert J.
Published: March 2008

This descriptive study examined the relationship between untreated dental caries and functional status among 958 dentate nursing home residents aged 65 and over. Functional status was measured by the Physical Self‐Maintenance Scale (PSMS). The PSMS assessment revealed that 32% of subjects were unable to perform all activities, and only 10% could perform all activities. Overall, 59% of subjects had untreated coronal decay and 46% had untreated root decay. In bivariate analysis, untreated coronal and root caries experiences were significantly associated with PSMS limitations, lack of dental care utilization, sex, and number of remaining teeth. Stratified analysis suggested an interaction between functional status and dental care utilization. Among subjects who had received dental care in the preceding year, PSMS status was not significantly related to untreated caries experience; but among subjects who had not received care, PSMS status was significantly related to untreated caries experience. In logistic regression analysis of untreated root decay, a significant interaction was found between PSMS status and dental care utilization. However, in logistic regression analysis of untreated coronal caries, no significant interaction was found; significant independent effects were found for dental care utilization and number of remaining teeth, but not for PSMS status.
Conflicting priorities: oral health in long‐term care
Authors: MacEntee Michael I. , Thorne Sally , Kazanjian Arminee
Published: March 2008

Open‐ended interviews were conducted with 109 individuals. These included: administrators, staff, dental personnel, residents, and family members, associated with 12 long‐term‐care (LTC) facilities to contrast different human resource and organizational strategies for managing the delivery of oral health care to the elderly residents. A multiple case‐study analysis revealed that no particular organizational strategy was ideal, although three important components—oral hygiene, diagnostic assessments, and dental treatment—were common to all. The dental personnel everywhere believed that oral health in the midst of other conflicting priorities received inadequate attention, while the administrators and staff acknowledged that they were weak at recognizing oral disorders and assisting with oral hygiene. In all, the interviews offered a portrait of the conflicting priorities associated with LTC, and they provide practical insights to successful strategies of care in this population.
An association between dentate status and hearing acuity
Authors: Schell Cathrina L. , Diehl Roberta L. , Holmes Alice E. , Kubilis Paul S. , Loers Wayne W. , Atchison Kathryn A. , Dolan Teresa A.
Published: March 2008

Hearing improvement following dental treatment has been reported in case studies, yet few objective studies of this phenomenon have been conducted. To determine if a relationship exists between dentate status and hearing acuity, we conducted a retrospective study of elderly subjects enrolled in a health promotion clinical trial. Air‐conduction pure tone average thresholds (PTA) administered to left and right ears at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz were used to create six hearing outcome variables, and were compared between groups of subjects who either had 25 or more teeth (n = 182) or were edentulous (n = 43). Mean PTA thresholds were significantly greater (p < 0.05) in edentulous subjects for each hearing outcome variable, and differences between unadjusted group means ranged from 4.9 dB to 8.6 dB. Mean PTA thresholds adjusted for clinical factors known to affect hearing also Indicated worse hearing acuity In the edentulous group. These pilot findings suggest an association between dentate status and hearing acuity.
Dental care for children fed by tube: a critical review
Authors: Dyment Heather A. , Casas Michael J.
Published: March 2008

No guidelines for the oral care of children fed by tube have been published. Poor oral health (unrestored caries lesions, poor oral hygiene, dependence for oral care) and tube‐feeding are associated with the development of aspiration pneumonia. Children fed by tube have abundant calculus, and low caries activity. The potential for dental erosion related to gastroesophageal reflux and oral hypersensitivity is high. To optimize oral health and reduce the risk of aspiration pneumonia, this population should receive dental care at more frequent intervals than children fed orally. Modifications to dental procedures are suggested to minimize the risks associated with dental treatment. Evidence‐based treatment guidelines are indicated to optimize dental care for children fed by tube.
Nursing assistants' opinions of oral health care provision
Authors: Pyle Marsha A. , Nelson Suchitra , Sawyer Danny R.
Published: March 2008

Understanding the attitudes and perceptions about oral health in nursing assistants (NAs) may facilitate efforts to improve daily oral care in long‐term‐care settings. By exploring the attitudes of Individuals charged with daily oral care, we may gain insight into the level of care provided for the residents. To explore motivation for oral care by NAs, we developed a 28‐item survey. The survey included descriptive information and a 20‐item Likert‐type Instrument dealing with oral care for self‐care and dependent individuals. Factor analysis was used to test the validity of the constructs intended to be measured by the survey items. The results indicated favorable responses to knowledge items and Items related to the importance of oral health in general. However, the responses to questions related to amount of time to perform mouth care, the risk of being bitten by a resident, resident cooperation, and myths about oral health in aging revealed significant variation by NAs descriptive variables. An understanding of the implications of NAs' perceptions, values, and knowledge may provide impetus for new strategies for improving oral health and daily care in long‐term‐care facilities.
Dental care access among individuals with Down syndrome in France
Authors: Allison Paul J , Hennèquin Martine , Faulks Denise
Published: March 2008

The aim of this study was to compare levels of dental care utilization, receipt of dental services, and oral hygiene habits between a sample of individuals with Down syndrome (DS) and their siblings. Data were collected by means of a recently validated, French‐language, questionnaire measured of oral health and its related problems for individuals with DS. A cross‐sectional survey was undertaken of parents of children with DS attending a national meeting for families and carers of individuals with DS in France. Older individuals with DS were significantly more likely to visit a dentist regularly than their older non‐DS siblings, but the group with DS was significantly less likely to have received any dental treatment. The group with DS was significantly more likely to have difficulty finding both medical and dental services. Parents were nearly twice as likely to report problems finding dental services for their child with DS as they were medical services. In a multiple logistic regression analysis within the DS group, it was found that older age, regular speech therapy and ophthalmology consultations, and reports of no difficulty finding a dentist were independently associated with increased odds for regular dental consultations. Analysis of the findings suggests that the parents of children with DS in France frequently encounter problems of access to oral health care and that individuals with DS are less likely to receive dental services than are their non‐DS siblings.
Evaluation of an oral health education program for nursing personnel in special housing facilities for the elderly. Part II: Clinical aspects
Authors: Isaksson Rita , Paulsson Gun , Fridlund Bengt , Nederfors Tommy
Published: March 2008

In Sweden, efforts are being made to create strategies for evaluating realistic dental treatment needs among the elderly, who are retaining more natural teeth. These strategies focus on the importance of maintaining adequate oral hygiene. Elderly in long‐term‐care facilities often depend on nursing personnel for carrying out daily oral hygiene procedures. Therefore, the nursing personnel's knowledge about and attitudes toward oral health make oral health education for health care professionals an important concern. The purpose of this study was to evaluate the clinical oral health outcome in residents after their caregivers had undergone a one‐session, four‐hour oral health education program. The study consisted of an intervention with a pre‐ and a post‐test and was carried out in three municipalities in the southwestern part of Sweden. A newly developed oral health screening protocol was carried out for 170 subjects living in long‐term‐care facilities both before and 3–4 months after nursing personnel had attended an oral health education program. Following the Intervention, a statistically significant improvement was recorded for changes in oral mucosal color, a modi‐fled plaque index which measured oral hygiene status, and a mucosal index which recorded mucosal inflammation. This study indicated that a limited, one‐session, four‐hour oral health education, offered to caregivers within long‐term‐care facilities, had a positive impact on the oral health status of residents.
The epidemiology of non‐albicans Candida in oropharyngeal candidiasis in HIV patients
Authors: Redding Spencer W. , Kirkpatrick Wiliiam R. , Dib Olga , Fothergill Annette W. , Rinaldi Michael G. , Patterson Thomas F.
Published: March 2008

Oropharyngeal candidiasis (OPC) is the most common fungal infection In patients with HIV infection. Fluconazole has been proven to be very effective In treating this Infection, but decreased susceptibility of Candida to this drug has emerged. Certain non‐albicans species such as C. glabrata and C. krusei are commonly less susceptible to fluconazole than C. albicans and are being Isolated with Increased frequency in HIV patients. The purpose of this study was to determine if the presence of non‐albicans Candida with OPC in HIV patients had an Impact on clinical presentation. This study shows that latestage HIV patients have a high prevalence of Candida with decreased susceptibility to fluconazole, especially non‐albicans species. OPC episodes with non‐albicans Isolates were more likely to require higher doses of fluconazole to achieve clinical cure. Also, the presence of non‐albicans Candida was more frequently associated with severe symptoms.
Early tooth loss due to cyclic neutropenia: long‐term follow‐up of one patient
Authors: da Fonseca Marcio A. , Fontes Fernanda
Published: March 2008

In young patients with abnormal loosening of teeth and periodontal breakdown, dental professionals should consider a wide range of etiological factors/diseases, analyze differential diagnoses, and make appropriate referrals. The long‐term oral and dental follow‐up of a female patient diagnosed in early infancy with cyclic neutropenia is reviewed, and recommendations for care are discussed.