bluuebunny/crossref_metadata_2025 huggingface dataset:
A dentist's social responsibility to diagnose elder abuse
Authors: Jorgensen Jay E.
Published: March 2008

Because of the high prevalence of dental disease and consequent need for dental care in the elderly, dentists are in frequent contact with the elderly, thus providing an opportunity for realizing their social obligation to become more involved in diagnosing and reducing elder abuse. Current estimates of the incidence of elder abuse in the US indicate that nearly 10% of the elderly population is affected, and this incidence rate is steadily increasing. Problems of vague definitions regarding abuse, elusiveness of the problem, and limited interest on the part of health care professionals may have deterred dentists from more involvement In the past. Apathy, tunnel vision, and vested interests of dental professionals may also contribute to the poor oral health of the elderly and consequently decrease the elders' quality of life. However, by developing a clear understanding of possible etiologies and by knowing physical and behavioral indicators of abuse, dentists can better fulfill their moral and social obligations and greatly reduce the incidence of elder abuse.
Streptococcus mutans, Iactobacilli, and caries experience in older adults
Authors: Hunt RJ. , Drake C.W. , Beck J.D.
Published: March 2008

This study Investigated salivary levels of Streptococcus mutans, lactobacilli, and caries experience in a random sample of 448 black and 362 white older dentate adults living in North Carolina. Significant proportions of the participants had stimulated salivary flow rates less than 1.0 mL/min, salivary buffering capacity less than 4.0, S. mutans levels of 105 cfu/mL or more in stimulated whole saliva, or lactobacilli levels of 105 cfu/mL or more. Each of these factor levels could be considered, on a clinical basis, to increase caries risk. in general, people with higher levels of S. mutans or lactobacilli had more untreated coronal and root caries, but not greater total caries experience.
Lip‐chewing: another treatment option
Authors: Willette Julius C.
Published: March 2008

This article describes a new removable appliance that has been used successfully to treat lip‐chewing in a severely disabled, mentally retarded patient.
The dental status of dentate institutionalized older adults: consideration of retained roots
Authors: Altieri James V. , Vogler James C. , Goldblatt Ruth , Katz Ralph V.
Published: March 2008

Many studies have described the general dental findings in institutionalized older patients, but few studies have used standard dental indices to describe the dental status of these populations. Eighty‐five dentate nursing home residents were examined by a single dentist. Dental findings were reported by means of the DMFS, DMFT, and RCI indices along with the D/DFS ratio for coronal and root caries. The mean DMFS, DMFT, and RCI were 97.0, 22.9, and 28.7%, respectively. The percentages of untreated coronal and root caries lesions, as measured by the D/DFS ratios were 65.4% and 85.4%, respectively. Forty‐eight percent of the subjects had at least one retained root, with a mean of 1.0 for all 85 subjects. None of the dental findings was statistically significant in association with age, gender, or length of stay in the institution. In the population examined, no statistical or clinical differences in relation to age, gender, or length of stay in the institution were found. The dental status of a dentate older adult population can be accurately described by means of the standardized indices of DMFS, DMFT, and RCI along with the D/DFS ratios, with the caveat that these indices must be interpreted differently than when used with pediatric populations. Retained roots present a fifth surface at risk for root caries, the occlusal surface. The role of the occlusal root surface in the dental status of a population needs to be reported and analyzed.
Factors contributing to dentists' extraction decisions in older aduits
Authors: Johnson Teresa E.
Published: March 2008

To evaluate which dental and nondental factors contributed to dentists' extraction decisions in a sample of older adults, an archival study was conducted using community‐dwelling and long‐term‐care older adults receiving dental care at an urban seniors' clinic. Four dentists who provided dental care to older adults reviewed patient records for whom they had extracted at least one tooth over a 21‐month period. They identified one or more factors contributing to their extraction decisions. From 105 adults (mean age, 80.61, there were 221 extractions. Frequent contributors to dentists' extraction decisions included non‐restorability in 53.8% of all extractions, dental caries (45.6%), prosthetic considerations (45.2%), and Periodontal disease (40.3%). The non‐dental contributors in 13% to 17% of extractions included patient/family request, inability to care for one's teeth, and financial limitations. When identiwing the “most important” (or “primary”) factor in their extraction decisions, dentists most frequently indicated non‐restorability, followed distantly by patient/family request, periodontal disease, and financial limitations. This investigation demonstrates tbat non‐dental factors are important in dentists extraction decisions. Of these, patient/family request and financial limitations appear to be most influential.
A preliminary study into the dental health status of multiple sclerosis patients
Authors: Symons Anne L , Bortolanza Mario , Godden Stephen , Seymour Gregory
Published: March 2008

Multiple sclerosis (MS) is an inflammatory disease of unknown etiology involving the central nervous system. Since MS affects the whole body, orofacial aspects of the disease must be expected, particularly since loss of muscular coordination may result in a diminished ability to maintain oral hygiene. This preliminary study examined the dental health status of 22 volunteer MS patients. A questionnaire collected data regarding medical and dental histories and socieo‐demographic information. Extra‐ and intra‐oral examinations were carried out on all subjects to determine the particular dental treatment needs of this special group. The DMFT and CPITN scores for this group did not indicate that MS patients were more susceptible to dental caries or periodontal disease. However, the prevalence of trigeminal neuralgia and symptoms of TMJ dysfunction in the group studied indicated that these conditions may be manifest in MS patients and warrant further investigations.
Closure of a general practice residency and outpatient program
Authors: Brody Harvey A.
Published: March 2008

This paper describes the various fiscal and programatic strategies used by a carefully managed, institutionally integrated, and financially viable dental department that was suddenly told to close its outpatient program and General Practice Residency Program. This case history emphasizes the importance of external factors and the need for the dental leadership in an institution to be certain that the dental department's goals are consistent with the mission of the host institution, especially in times of change. As new programs develop and existing departments expand, the reasons for the success as well as failure experienced by others should be evaluated carefully. This paper adds to this understanding.
The effectiveness of sponge‐type intraoral applicators for applying topical fluorides in institutionalized older adults
Authors: Saunders Ralph H. , Davila C. Edgar , Hayes Abby L. , Fu Jean , Zero Domenick T.
Published: March 2008

Many older adults who reside in nursing homes have disabilities which limit their capacity to benefit from the usual protocols for prevention of dental caries. This is a report of a study of the effectiveness of an alternative method of applying topical fluoride in the institutionalized elderly. Fluoride gel (1.1% NaF) was applied to the facial tooth surfaces of 10 elderly nursing home residents using a sponge‐type intraoral applicator (IA). Subsequently, the same subjects rinsed with a commercial fluoride solution (0.05% NaF). Salivary fluoride levels were then assessed by the Taves (1968) method. The IA with fluoride produced significantly higher salivary fluoride levels over a period of three hours compared with rinsing.
Prevalence and demographic correlates of tooth loss among the elderly in the United States
Authors: Marcus Stephen E. , Kaste Linda M. , Brown L. Jackson
Published: March 2008

The aging of the United States population and the contribution of tooth loss to oral health make it important to describe tooth loss among the elderly in this country. Data from the National Survey of Oral Health in US Employed Adults and Seniors: 1985–1986, conducted by the National Institute of Dental Research, were analyzed to examine the prevalence and demographic correlates of tooth loss among the elderly.

Results show that there were important differences in tooth loss among subgroups of the elderly sample (overall n = 5,649 persons aged 65+ years attending senior centers). The oldest seniors and those with the least education or income were the most likely to be edentulous. The oldest dentulous seniors, blacks, those with the least education or income, and those who lived in New England or the Northeast had the fewest number of teeth present.

These findings suggest that efforts to reduce tooth loss among the elderly should target those with the least education and income.
Oral health care of the mentally retarded and other persons with disabilities in the Nordic countries: Present situation and plans for the future
Authors: Haavio Marja‐Liisa
Published: March 2008

In the Nordic countries, the general goal of policies for persons with disabilities is their Integration into society. At the same time, the social and economic situation has worsened, and, as a consequence, the structures of the welfare state seem gradually to break down. This paper describes the present situation and plans for the future of oral health care for the mentally retarded and others with disabilities in the changing society in the Nordic countries.
A comparison of opinions from parents of disabled and non‐disabled children on behavior management techniques used in dentistry
Authors: Brandes Deborah Ann , Wilson Stephen , Preisch James W. , Casamassimo Paul S.
Published: March 2008

The purposes of this study were to compare the acceptance of pediatric dental behavioral management techniques by 40 parents of children with disabilities with that of 40 parents whose children were not disabled and to determine the effect of prior information on the level of acceptance for both groups of parents. An instrument containing a demographic questionnaire and using a visual analog scale asked parents to indicate acceptance level of hand‐over‐mouth, sedation, restraint using Papoose board, and general anesthesia for either a check‐up/cleaning, dental filling, or treatment of a toothache. One half of each parent group received a written description and rationale for the behavior management technique prior to rating acceptance, and the other half did not. Although differences were found between parents of the disabled and non‐disabled and between those informed and not informed, only one technique and procedure (restraint for checkup/cleaning) was significantly different for acceptability (p ≤ 0.05), and that was between uninformed parents of non‐disabled children and informed parents of disabled children. We conclude that having a disabled child or receiving a prior rationale for pediatric behavior management techniques was not significantly related to differences in acceptance of the techniques for the procedures described.
Outpatient dental services for individuals with mental illness: A program description
Authors: Dicks Joseph L.
Published: March 2008

This paper describes a state‐funded program providing dental services for community‐based mentally ill clients. Contrasts between outpatient services for persons with mental illness and similar programs serving the mentally retarded population are emphasized. Implications of client eligibility, communication, and compliance issues relative to limitations of care are discussed. Suggestions for improving similar programs are provided.
Aging and saliva: A review of the literature
Authors: Vissink Arjan , Spijkervet Frederik Karst Lucien , Amerongen Arie Van Nieuw
Published: March 2008

It is often assumed that salivary secretion reduces with age. About 25% of the elderly suffer from oral dry‐ness and related complaints. Nevertheless, data on stimulated salivary flow rate in healthy elderly revealed no significant age‐related decrease other than a slight decrease of the secretion from the (sero)mucous glands under conditions of minimal or extended stimulation. With regard to salivary gland morphology and composition of saliva, age‐related changes have been reported in healthy individuals, too. With increasing age, the number of acini reduces and the amount of fatty and fibrous tissue increases. Moreover, animal studies revealed that the synthesis of proteins is reduced by 60% in advanced years. These data indicate that changes might occur in concentration and/or activity of the organic components of saliva. In human studies, the concentration of slgA in labial saliva and the concentrations of high‐molecular and lowmolecular mucins in mucous saliva appeared to be reduced with age. Since slgA and mucins are important in the immunologic and non‐immunologic defense of the oral cavity, both defense systems are reduced in healthy elderly. Analysis of these data suggests that the oral soft tissues may become somewhat more susceptible to environmental factors due to a reduction of the immunological and non‐immune logical defense systems.
Effect of chlorhexidine gel treatment on the prevalence of mutans streptococci and lactobacilli in patients with impaired salivary secretion rate
Authors: Bondestam Olof , Gahnberg Lars , Sund Marie‐Louise , Linder Lars
Published: March 2008

The potential pathogenic role of mutans streptococci in the etiology of dental caries is well‐documented. Mutans streptococci are sensitive to chlorhexidine (CHX), and several methods for the clinical use of CHX have been described. An important target group for caries‐preventive measures is patients with impaired salivary secretion due to the use of therapeutic drugs such as psy‐chotropics. The aim of the present study was to compare two methods for antimicrobial treatment in such patients. Twenty‐four volunteering patients at a hospital clinic were randomly divided into three groups: Group A, in which each participant was treated with 1.0% CHX gel in gel trays on two consecutive days, followed by application of a fluoride varnish; Group 6, in which the patients were treated with the same CHX gel as above; and Group C, which was used as a control. After treatment, there was a reduction of mutans streptococci in the two groups treated with CHX. In group A, the sames collected one, three, and five weeks after the treatment were significantly lower than baseline values. No clearcut reduction of the number of mutans streptococci was observed in the subjects not treated with CHX. These data indicate that treatment with CHX gel in gel trays is superior to polishing the teeth with CHX gel. From a clinical point of view, our observations suggest that it is important to monitor the effect of antimicrobial treatment individually in order to optimize preventive programs in patients with impaired salivary secretion.
Consensus Conference on Practice Guidelines for Institutionalized Older Dental Patients
Authors: Strayer Michael
Published: March 2008

Sponsored by The Federation of Special Care Organizations in Dentistry; Oral Health America‐America's Fund for Dental Health; Maternal and Child Health Bureau, United States Public Health Service; April 19–21, 1996, Chicago, Illinois
Geriatric dentistry on the Internet: Can we reach our elderly patients using cyberspace?
Authors: Bonnin Stuart F. , Bui Anthony T.
Published: March 2008

A growing number of older Americans use a computer at home, and half of seniors who own computers also own modems that can connect them to online services; 25% of seniors with computers communicate with online services. Over 70% of online seniors use their computers every day. The dental office can interactively communicate one‐on‐one with current and prospective patients using an electronic mail newsletter, a Web page newsletter, an “Ask the Dentist” online service, or by making dental appointments online. Dental practitioners can take advantage of this online revolution and promote oral health for seniors using these technologies.
Anticipatory stress reduction among chronic pain patients
Authors: Logan Henrietta L. , Risner Alicia , Muller Patrick
Published: March 2008

Stress has long been viewed as a contributor to the pain experienced by chronic pain patients. The purpose of this research was to study the relationship between anticipated and experienced stress and anticipated and experienced pain levels among three patient groups: chronic pain patients, patients about to receive molar extraction (acute pain group), and a no‐pain comparison group. Results showed that chronic pain patients anticipated significantly more stress than did an acute pain or a non‐pain comparison patient group but reported non‐significant differences in the actual level of stress experienced. A secondary purpose of this study was to examine cognitive factors, such as perceived daily hassles, which may contribute to this increased anticipatory stress. Results showed that there was consistency among the chronic pain patients as to the types of anticipated stressors, which were similar to those previously reported by chronic headache sufferers.1 The chronic pain group had significantly higher scores than the two remaining groups on the stress they anticipated from hassles related both to practical considerations (F2,45= 3.5, p c 0.05) and to health (F2,45= 9.37, p < 0.001). Strategies the dentist can use in combination with dental therapy to reduce cognitive‐based anticipatory stress as well as strategies for collaboration with the patient and a mental health therapist are discussed.

This research shows that elevated levels of anticipatory stress mark this chronic orofacial patient group. Specific stressors such as maintaining high standards and wasting time seem to be one source of this anticipatory stress. Dentists are encouraged to combine their dental therapy with referral to a mental health care professional and to use simple psychological interventions such as guided imagery, deep breathing, and positive self‐talk. These strategies can effectively reduce this patient group's anticipatory stress and its resulting deleterious effects.
Facilitation of informed consent for agency residents with developmental disabilities
Authors: Ferguson Fred S. , Cinotti Debra , Kin Wayne , Berentsen Barbara J.
Published: March 2008

The challenges in the management and delivery of care to persons with developmental disabilities are well‐recognized by the dental profession. However, these challenges are usually not recognized or appreciated by the general public.
Concomitant occurrence of hypodontia and supernumerary teeth in a patient with Down Syndrome
Authors: Chow Kevin M.C. , O'Donnell David
Published: March 2008

Concomitant hypodontia and supernumeraries in a patient suffering from Down syndrome are presented. Concomitant hypodontia and supernumerary teeth are relatively rare, and this is the first case reported in a patient with Down syndrome. A conservative approach to management will be pursued, with the accent on oral hygiene reinforcement and prevention.
The International Normalized Ratio as a measure of anticoagulation: Significance for the management of the dental outpatient
Authors: Meehan Sean , Schmidt Mark C. , Mitchell Paul F.
Published: March 2008

Susceptibility to bleeding in the patient treated with coumarin deriva tives poses difficult management issues for the dentist. Classic monitoring for anticoagulation relied on the prothrombin time, but reagent variability Issues have caused the emergence of the International Normalized Ratio (INR) as an alternative, and possibly more reliable, laboratory test for the assessment of a patient's anticoagulation status. The literature suggests that an INR range of 1.5 to 2.5 represents the most appropriate level of anticoagulation for the surgical patient. That is, at this INR, some protection is afforded against thrombo‐embolic events without significantly sacrificing effective post‐operative hemostasis. Since the patient with an INR value within the recommended range is still anticoagulated, he/she is still at risk for post‐operative bleeding. Adherence to local hemostatic measures—such as pressure, topical thrombin, alveolar‐placed resorbable sponges, and primary wound closure—offers the patient Important adjunctive protection against postoperative bleeding.
An in vitro evaluation of the integrity of stainless steel crown margins cemented with different luting agents
Authors: Ettinger Ronald L. , Kambhu Peter P. , Asmussen Cindy M. , Damiano Peter C.
Published: March 2008

The elderly population is retaining more teeth which require extensive restorations. The purpose of this study was to identify a luting agent which had the least marginal breakdown when used with stainless steel crowns. Thirty‐six caries‐free molars were selected, prepared for stainless steel crowns, and embedded in acrylic to support the crown and tooth. The crowns (Unitek/3M) were cemented with 4 different luting agents: (A) Fleck's Cement®, (B) Ketac‐Cem®, (C) All‐Bond C & B Cement®, and (D) Panavia EX Cement®. All the restored teeth were thermo cycled and divided into 3 experimental groups. Twelve teeth were stained. The remaining teeth were occlusally loaded and stained. The remaining 12 teeth were thermo cycled and stained again. The stainless steel crowns were then sectioned and photographed at 7.5x mag. The dye penetration was evaluated by measurement of the percentage of dye penetration from the crown margin to the cusp tip on each side. Statistical analysis found that the least dye penetration was with All‐Bond C & B Cement® (p = 0.0001). The most extensive penetration was observed in Ketac‐Cem®. Occlusal loading was a significant factor (p = 0.0001) increasing the dye penetration, but the crown‐tooth gap was not
Glycogen storage disease and von Willebrand's disease implications for dental treatment: Dental management of a pediatric patient
Authors: DeIIinger Tracy M. , Livingston H. Mark , Holder Ray , Streckfus Charles F.
Published: March 2008

Glycogen storage diseases (GSD) are metabolic disorders which impair the body's ability to store glucose and utilize it later, requiring patients to take multiple daily dietary supplementation with a high carbohydrate content. Patients undergoing this treatment modality are placed at increased risk for gross dental caries and other oral abnormalities. Additionally, GSD may prolong the patient's bleeding time, which may necessitate consultation with the treating physician. In the following case, our patient required a multi‐disciplinary approach to address not only her dental needs, but also to coordinate the management of both her GSD and an additional complication, von Willebrand's disease. This was best achieved in a hospital setting
Gastroenterological drugs and denture stomatitis
Authors: Syrjälä Anna‐Maija H. , Knuuttila Matti L.E.
Published: March 2008

The aim of this study was to investigate the medical and dental variables related to the presence of denture stomatitis. The study population was comprised of 106 elderly people (82 women, 24 men; mean age, 81.3 years) using a maxillary complete denture and living in a geriatric nursing home in Oulu, Finland. The following variables were used in the analysis: medical diagnoses, which could have a possible biological association with stomatitis; daily use of drugs; ability to cope with everyday life; oral hygiene; and the condition of the denture. The prevalence of stomatitis was 52% among residents wearing complete dentures. Patients receiving gastroenterological drugs had less stomatitis (p = 0.01, chi‐square). The results suggest a preliminary finding that older adults using gastroenterological drugs had less stomatitis.
The use of a neoprene “thumb‐sock” to prevent trauma in a thumb‐sucking child with intractable epilepsy
Authors: Dennison Peter J. , Walton‐Jones Adrienne
Published: March 2008

A nine‐year‐old girl with spastic quadripiegia, mental retardation, poor vision, a gastrostomy, and intractable epilepsy was referred by her pediatrician for a dental assessment with a view to extracting her anterior teeth as a means of preventing repeated damage to the skin over the proximal phalanx of her left thumb, which she sucked at night. This was the time of day when the frequency of her epileptic seizures was highest. A simple solution to the problem was developed by a dentist and an occupational therapist In which nylon‐coated 3‐mm neoprene sheeting (wet‐suit material) was formed into a “thumb‐sock” with a simple Velcro fastening around the wrist. No trauma to the thumb from epileptic seizures has occurred since the “thumb‐sock” was fitted 24 months ago.
Oral health knowledge, practices, and status among outpatient veterans at the VA Maryland Health Care System
Authors: Canto Maria Teresa , Horowitz Alice M. , Goodman Harold S. , Watson Maria Rosa , Cohen Leonard A. , Fedele Denise J.
Published: March 2008

Poor oral health can have a significant impact on overall health and quality of life. Yet few studies have established the oral health needs of outpatient veterans. The purpose of this study was to assess the oral health knowledge and practices, the dental status, and the periodontal treatment needs of outpatient veterans seeking primary care services at a statewide healthcare system. Veterans were interviewed and received an oral examination by a trained examiner using NIDCR criteria for dental caries detection and the Community Periodontal Index of Treatment Needs (CPITN). The mean age of the study participants' (n = 135) was 57.7 (SD = 14.1) years. Ninety‐five percent of the sample was male and 44% African‐American. Untreated coronal and root caries was present in 57% and 36% of veterans, respectively. Sixty‐nine participants received the periodontal examination, with 29% of them in Category III. An interpretation of these findings shows a high need for preventive and restorative oral health care among outpatient veterans receiving primary services in an integrated and comprehensive VA health care system.
Opinions and feelings on eating with complete dentures: a qualitative inquiry
Authors: Obrez Ales , Grussing Paul G.
Published: March 2008

Our knowledge of variables affecting the coping strategies that lead to acceptance of foods in populations wearing complete dentures is limited. Focus groups were conducted with the specific aim of determining factors responsible for successful adaptation to chewing with complete dentures. Each of the live focus gfoups consisted of eight to 15 participants (mean = 11; mean age = 64yrs), of mixed gender, with at least five years of denture‐wearing experience (mean = 7 years), and with groups varying in their socioeconomic and ethnic backgrounds. Participants' statements (n=324) were sorted for their content, by consensus between the two investigators, into 12 conceptually independent domains (listed in decreasing order of frequency of mention): foods and food textures causing difficulties when eating foods being avoided, stability and retention of dentures, social constraints, bolus size, general satisfaction with the current dentures, general experience with dentures, sensation of temperature, experience of pain during chewing experiences with taste, experiences with rinsing the dentures after eating and time involved with chewing In addition, further analysis of statements showed that food texture was the most commonly mentioned with foods that were either difficult to chew or avoided. These perceptions significantly affected the choice of food. The results of this qualitative study indicate that food texture is one of the major factors influencing the choice of a coping strategy by denture wearers when trying to overcome difficulties in chewing specific foods. As such, food texture may have a significant effect on patients'success in the process of their functional adaptation.
A study of the effectiveness of oral midazolam as a dental pre‐operative sedative and hypnotic
Authors: Marshall William R. , Weaver Bryan D. , McCutcheon Peter
Published: March 2008

Orally administered Midazolam at dosages of 0.5, 0.6, and 0.75 mg/kg was used with 34 healthy, uncooperative pediatric dental patients. Effective pre‐operative sedation occurred within approximately 15 minutes with a 30‐ to 40‐mlnute duration of action. Blood pressure and respiration remained stable throughout. The numbers and types of procedures performed were dependent on the degree of sedation, the behavior of the patient, the experience of the operator, and the operator's ability to administer the medication. The ideal dosage appears to be 0.6 mg/kg, with an average change of 1.43 Frankel Units in behavior modification. A dosage of 0.5 mg/kg appears to yield erratic results, while a dosage of 0.75 mg/kg offers little advantage with greater potential for adverse reactions. The oral administration of Midazolam for pediatric patients with extreme behavioral problems, such as Attention Deficit Hyperactive Disorder, was of little advantage and may produce an idiosyncratic reaction. Midazolam's quick onset and short duration of action, coupled with its ideal properties of sedation, relaxation, and amnesia, offer a viable alternative for treating the anxious, uncooperative pediatric dental patient.
Necrotizing fasciitis of the head and neck: review of the literature and report of a case
Authors: Dale Robert A. , Hoffman Douglas S. , Crichton Rolf O. , Johnson Scott B.
Published: March 2008

Necrotizing fasciitis is a rapidly spreading, life‐threatening, bacterial disease. Mortality rates have been estimated to vary between 8.7% and 74%. Mortality depends on many factors, one of which Is early recognition. Necrotizing fasciitis of dental origin has a low prevalence and as such presents diagnostic challenges for the dentist. The literature is reviewed, and a case history Is presented.
Dental neglect: definition and prevention in the Louisiana Developmental Centers for patients with MRDD
Authors: Connick Charlotte M. , Barsley Robert E.
Published: March 2008

When dental services and appropriate use of restraints are used for persons who are severely and profoundly mentally retarded and developmentally disabled (MRDD), oral health Is enhanced and dental neglect is controlled or even reduced. This paper defines dental neglect and examines the consequences to persons who are MRDD when appropriate restraints and preventive dental home care are not used. Oral health outcome assessment data of this MRDD population indicate the presence or absence of dental neglect. The outcome assessment measures the level of oral health within the developmental center. The Louisiana Department of Health and Hospitals (DHH) operates nine developmental centers, where approximately 2000 individuals with severe to profound mental handicaps reside. Two‐thirds (66%) of this population are resistive to the delivery of clinical and preventive dental services. The responsibilities and roles of dental health professionals, long‐term‐care facility administrators, and direct service staff are discussed to help reduce dental neglect in these centers. For these individuals to receive quality and comprehensive dental care, appropriate use of restraint/physical hold is necessary. The Dental Health Resource Program (DHRP) developed guidelines for delivering preventive and clinical dental services to reduce confusion and misinterpretation of the definition and use of restraint in the Louisiana Developmental Centers (LADCs).
Respiratory pathogen colonization of the dental plaque of institutionalized elders
Authors: Russell Stefanie L. , Boylan Robert J. , Kaslick Ralph S. , Scannapieco Frank A. , Katz Ralph V.
Published: March 2008

Although it has been established that aspiration of pharyngeal bacteria is the major route of infection in the development of nosocomial pneumonia, colonization of the pharyngeal mucosa by respiratory pathogens has been shown to be a transient phenomenon. It has been suggested that the dental plaque may constitute an additional, possibly more stable, reservoir of respiratory pathogens. The purpose of this study was to assess the prevalence of oral colonization by potential respiratory pathogens in a group of elderly (mean age = 75.9 yrs) chronic‐care‐facility residents (n = 28) and a group of age‐, gender‐, and race‐matched outpatient control subjects (n = 30), with specific attention to plaque present on tooth, denture, and oral mucosal surfaces. Plaque scores on teeth and dentures were significantly higher in the chronic‐care‐facility (CCF) subjects than in the dental outpatient control (DOC) subjects (Pll 2.3 vs. 1.2 and denture plaque 1.4 vs. 0.3). While no subjects in the DOC group were found to be colonized with respiratory pathogens (> 1.0% of the cultivable aerobic flora), 14.3% (4/28) of the CCF subjects were found to be colonized. Oral colonization with respiratory pathogens in CCF subjects was associated with the presence of chronic obstructive pulmonary disease (COPD) and higher plaque scores. These results suggest that deficient dental plaque control and the presence of COPD may be related to respiratory pathogen colonization of dental plaque in chronic‐care‐facility residents.
A solitary maxillary central incisor treated orthodontically: a case report
Authors: McNamara Triona , Field Dennis , McNamara Ted
Published: March 2008

The presentation of a solitary maxillary central incisor is reported and its association with other congenital abnormalities discussed. It is an important finding for dental health professionals, since it may indicate the presence of other significant midline congenital abnormalities. It may also indicate the presence of associated disorders that profoundly affect growth and development and which, once identified, may be treated
Effects of short professional mechanical tooth‐cleaning (PMTC) program in young adults with mental disabilities
Authors: Mori Yuko , Amano Atsuo , Akiyama Shigehisa , Morisaki Ichijiro
Published: March 2008

We evaluated the usefulness of a short professional mechanical tooth‐cleaning (PMTC) program to improve periodontal conditions and caries susceptibility in 10 young adult patients with mental and/or physical disabilities. The PMTC program was carried out once on each of 6 sextants of the full mouth during 6 visits at two‐week intervals. Even one treatment with PMTC was found to be significantly effective in reducing the probing depth in eight of the 10 subjects. A reduction in the total number of bleeding sites on probing was also clearly observed in all subjects. Moreover, the debris index was reduced in nine subjects by the PMTC program. Although caries susceptibility was improved, albeit very slowly, by PMTC, the Cariostat pH values showed no consistent tendency. The effects lasted for more than 6 weeks. Analysis of these results suggests that the PMTC program can be effective in adults with mental disabilities, especially in reducing gingival inflammation.
Characteristics of dental emergency clinic patients with and without disabilities
Authors: Persson Rigmor E. , Stiefel Doris J. , Griffith Mickaella V. , Truelove Edmond L , Martin Michael D.
Published: March 2008

This study compared oral health and demographic characteristics of patients with and without disabilities at a dental school emergency clinic. Of 407 consecutive patients surveyed, 20.4% reported disabilities. Two groups matched by age and gender, those with disabilities (DIS, n = 79) and those without disabilities (ND, n = 177), were compared on questionnaire responses; two subgroups, DIS (n = 38) and ND (n = 44), were assessed clinically. The mean ages of the DIS and ND groups were 44.0 years (SD ± 11.6) and 43.0 years (SD ± 12.3), respectively. By chi‐squared analysis, DIS vs. ND subjects had significantly lower levels of education, employment, income, and dental Insurance, and greater dependence on Government funding. In the DIS group, 79.5% were not working, while 6.4% did work regularly. In the ND group, the corresponding values were 30.9% and 46.9%, respectively. In the DIS group, 51.9% identified Medicaid acceptance as the reason they sought care at the clinic, while 62, 7% of the subjects In the ND group identified the lower fee structure as the reason for clinic selection. More DIS than ND subjects reported dentists' unavailability and inability to manage the disability, lack of transportation, effect of dental problems on health, and referral by a health professional. DIS vs. ND subjects had significantly fewer sound teeth and more missing teeth. The results suggest that one in five dental school emergency clinic patients has disabilities.
Evaluation of a long‐term oral health program by carers of children and adults with intellectual disabilities
Authors: Faulks Denise , Hennequin Martine
Published: March 2008

The oral health program presented here was undertaken in three French centers for persons with special needs. The program aimed to educate the carers about dental disease, to motivate them with regard to prevention, and to improve the oral hygiene and oral health of the residents. This study evaluated the impact of the program in terms of change in attitudes and behavior expressed by the carers by means of a questionnaire. Following demonstration of oral hygiene techniques on an individual basis, the number of residents who had their teeth cleaned more than once a day rose from 24% to 52% (p < 0.05). The percentage of carers able to clean both posterior and anterior teeth of their key residents increased from 24% to 60% (p < 0.05), and the percentage finding tooth cleaning easy Increased from 36% to 60% (non‐significant). The intervention was thus deemed moderately successful, although the carers continued to take better care of their own oral health than that of the residents. The need for ongoing training is emphasized, both for the carers of those with special needs and for the dental profession. The lack of a validated means of measuring the impact of such interventions on care providers for this population is discussed.
Hepatitis: still a concern?
Authors: Anders Patrick L. , Fabiano Jude A. , Thines Terrence J.
Published: March 2008

Although some forms of viral hepatitis were identified more than 50 years ago, hepatitis continues to have an impact on the practice of dentistry. Possible transmission in the dental setting, management of the chronically ill, and legal issues related to treatment of infectious patients combine to emphasize that hepatitis is still an important issue for dental health care workers. Currently, 7 viral forms are recognized. Those with predominantly enteral modes of transmission‐including HAV, HEV, and HFV‐are of minor concern in the dental environment. HBV, the most infectious blood‐borne pathogen, has been largely controlled in this country by vaccination and the use of universal precautions. HDV is an incomplete virus that has HBV infection as a prerequisite. HCV is of great concern today for several reasons. A high percentage of HCV infections results in chronic disease. Most cases remain asymptomatic for an extended period of time, and many have no identifiable risk factors. Currently, no vaccination is available for HCV. Patients infected with HCV present a management challenge, because they may ultimately develop serious liver dysfunction. In fact, HCV infection is presently the most common reason for liver transplantation. By understanding the various forms of viral hepatitis and following recommended infection control and vaccination protocols, the dental healthcare worker can treat infected patients in a manner that is safe for both patients and dental health care workers.
Dental caries history in nine children with chromosome 18p deletion syndrome
Authors: Hermesch Charles B. , Cody John T. , Cody Jannine D.
Published: March 2008

Chromosome 18p deletion syndrome is caused by the deletion of a portion of genetic material on the short (p) arm of chromosome 18. Many of 100 prior case reports In the medical literature describing the dental health of subjects with this syndrome reported multiple carles associated with the syndrome. At the third annual International conference of The Chromosome 18 Registry & Research Society, dental examinations were carried out on nine children with chromosome 18p deletion syndrome and five of their unaffected siblings. The dental examination Included an intra‐oral evaluation of coronal decay and filled permanent teeth surfaces (DFS) and decayed and filled primary tooth surfaces (dfs) using a mouth mirror, explorer, and a high‐Intensity fiber optic light An evaluation of the data revealed that five of nine children with 18p deletion syndrome (56%) were free of tooth decay or a history of tooth decay. Four of the nine (44%) had tooth decay or a history of tooth decay. The prevalence of decay was quite similar in the genetically unaffected siblings. Three of the five (60%) unaffected siblings of the children with 18p‐ were free of tooth decay, whereas two of the five (40%) had tooth decay. One of the affected children had a missing mandibular left central incisor. None of the children had abnormally shaped teeth. The caries pattern seems to be similar to that reported in the NHANES III data collected In the United States from 1388–1991. Analysis of these preliminary data suggests that the risk for carles In chromosome 18p deletion syndrome may be lower than previously reported.
Desensitization of the gag reflex in an adult with cerebral palsy: a case report
Authors: Reid Julie A. , King Peter L. , Kilpatrick Nicky M.
Published: March 2008

Severe oral hypersensltlvlty and averslve oral behaviors present a significant barrier to dental treatment and compromise oral health status. Although several authors have addressed the reduction of oral hypersensltlvlty and averslve behaviors (such as gagging, retching, and vomit‐Ing) In the otherwise well dental patient, treatment for patients with severe disability has not been explored. The successful management of oral hypersensltlvlty and averslve behavior can have significant health benefits. These can be described van outcomes paradigm as physical and social benefits for the patient, psychological benefits for the patient, carer, and practitioner, and organizational benefits for the Institutions providing dental care and medical management. This paper summarizes the management of a severely disabled patient whose averslve behaviors were eliminated with non‐Invasive therapy techniques. Oral hygiene was facilitated and health benefits were Identified across a number of domains following successful multi‐disciplinary management.
Hospital‐based dental care for persons with disabilities: a study of patient selection criteria
Authors: Hulland Sarah , Sigal Michael J.
Published: March 2008

The objective of this Investigation was to generate a medical and dental profile of patients attending the Mount Slnal Hospital Dental Program for Persons with Disabilities, to determine If certain selected criteria could Identify patients likely to require dental care In that setting. The need for dental care under general anesthesia was used as the prime Indicator that care should be provided In a hospital setting. A retrospective review of all the charts of the patients enrolled In this hospital program was undertaken. Results Indicated that patients who were treated In this hospital‐based dental program had the following characteristics: moderate to profound mental retardation (39.5%), moderate to severe behavioral problems (31.1%), and/or a history of seizure activity (29.1%). Behavioral criteria appear to be the predominant reason for the provision of hospital‐based dental care for persons with disabilities.
The dental management of a patient with a cocaine‐induced maxillofacial defect: a case report
Authors: Tsoukalas Nikolas , Johnson Cleverick D. , Engelmeier Robert L. , Delattre Veronique F.
Published: March 2008

There are several dental complications associated with cocaine abuse, Including adverse reactions to dental anesthetics, post‐operative bleeding, and cellulltls, which can lead to necrosis of orbital, nasal, and palatal bones. Following Is a report of the Initial treatment rendered to a patient who had destroyed most of her hard palate over a ten‐year period of cocaine abuse. There are no classic socio‐economic or educational profiles for abusers of cocaine. Drug abuse victims may present as patients In any dental office. Though there are certain classic physiological and psychological symptoms of their condition, they may not display symptoms at all.
Perception of dry mouth in a sample of community‐dwelling older adults in Japan
Authors: Ikebe Kazunori , Nokubi Takashi , Sajima Hidenori , Kobayashi Sonoe , Hata Kenji , Ono Takahiro , Ettinger Ronald L.
Published: March 2008

The purpose of this study was to examine the prevalence of perceived dry mouth among a group of independently‐living elderly persons in Japan, and to determine its association with general disease, medication, and dental status, as well as its effect on oral function. The study population consisted of participants of the Senior Citizens' College. The subjective sensations of oral dryness on waking and while eating a meal were measured by a questionnaire. The number of usable questionnaires was 1003 or 77.9%. The mean age of the subjects was 66.3 ± 4.2 years, and 53.0% were male. More than one‐third (37.8%) of the subjects reported oral dryness on waking. Only 9.1% of them noticed a subjective feeling of dry mouth during eating. Persons who had at least one of these symptoms made up 41.0%. A multiple stepwise logistic regression analysis indicated the following results: Perception of dry mouth on waking was more frequent among males (p < 0.001), persons who had a low BMI (p < 0.05), and those taking two or more prescribed drugs (p < 0.01). Sensation of dry mouth when eating was more frequent among subjects with a low BMI (p < 0.001) and those who wore a denture in the maxillary arch (p < 0.05). Perception of dry mouth when eating was associated with self‐assessed chewing ability (p < 0.01) and dissatisfaction with speaking clearly (p < 0.05), as well as dental status. However, dissatisfaction with tasting a meal had a significant relationship with the reports of mouth dryness on waking (p < 0.01). Our findings suggest that a substantially higher percentage of persons have the perception of dry mouth on waking than when eating, which was associated with medications, being male, and having a low BMI. This perception may influence oral function, especially the reported dissatisfaction with tasting foods.