bluuebunny/crossref_metadata_2025 huggingface dataset:
Cellular and molecular aspects of muscle growth, adaptation and ageing
Authors: Goldspink Geoffrey
Published: January 2004

Although major advances have been made over the past few decades in prosthetic dentistry, deterioration in oral function and altered facial appearance are still common accompaniments of ageing. Molecular biology methods now allow us to understand these age‐related changes at the level of gene expression. Muscle loss as well as bone loss still present major problems, the magnitude of which increases as the age profile of our society changes. Both muscle and bone tissue respond to mechanical signals for which bone depends on muscle and for muscle, stretch has been shown to be important as it induces protein synthesis and an increase in girth as well as length of the muscle fibres. The latter involves the production of more sarcomeres in series so that the jaw muscles adapt to a new functional length following changes in vertical dimension of occlusion. It also determines the postural position of the lower jaw. In our investigations into the control of muscle mass we have recently cloned a growth factor which is expressed in exercised and/or overloaded muscles. This comes in two forms: an autocrine or local form and a paracrine or systemic form. Both growth factors influence muscle growth markedly and it is probable that the systemic type is also involved in maintenance of bone. The discovery of these growth factors provides the mechanisms by which mechanical signals are transduced into chemical signals that in turn regulate gene expression and protein synthesis.
A comparison of four home‐care fluoride programs on the caries incidence in the elderly
Authors: Fure S. , Gahnberg L. , Birkhed D.
Published: January 2004

Objective: To estimate the caries preventive effect of 4 fluoride programs over 2 years in the elderly. Setting: The Public Dental Clinics of Balsta and Knivsta and the Faculty of Odontology in Göteborg, Sweden Subjects: One hundred and sixty‐four individuals, aged 60 years and older (mean age 71.5 years) who were considered to be at risk from caries. Design: The participants were randomly assigned either to: 1) rinse twice a day with a 0.05% NaF solution (n=49; rinsing group), 2) suck twice a day on a 1.66 mg NaF tablet (n=51; tablet group). 3) brush their teeth three times a day using a toothpaste slurry rinsing technique (n=32; slurry group), or 4) brush their teeth in their usual manner (n=32; control group). The participants in all 4 groups used a fluoride toothpaste (containing 0.32% NaF) at least twice daily. Results: No new carious lesions were found in 67% of the participants in the rinsing, 43% in the tablet, 25% in the slurry and 16% in the control group over the 2 years. The mean (± SD) 2‐year caries increment was 0.8±1.4, 1.4±1.7, 1.9±1.9 and 2.3±2.1 DFS in the rinsing, tablet, slurry and control groups, respectively; it was significantly lower in the rinsing than in the control group (p<0.01). A lower incidence of DFS was also found in the tablet group than in the slurry group, but only for the lingual surfaces (p<0.05). Conclusion: The type of fluoride program may be of importance in the reduction of new caries lesions in an older population.
Reasons for referral of very elderly patients to the Community Dental Service in rural England and the implications for developing oral health care services
Authors: Fenwick J.E. , Batchelor P.A. , Samarawickrama D.Y.D.
Published: January 2004

Objective: To analyse the medical conditions and dental treatment requirements. Design: Retrospective analysis. Setting: Rural South West Surrey, England. Subjects: 100 patients aged 75 or over who were referred for dental treatment to the Community Dental Services (CDS) because of various medical disabilities. Measurements: Age, sex, medical history including drug intake, dental treatment provided, time taken for treatment. Results: Two‐thirds of the patients required domiciliary care; two‐thirds had problems of mental confusion. In addition, 89% were dependent on carers. Treatment requirements indicate that the majority of dental care, although time consuming, were simple in nature and within the technical scope of a competent general dental practitioner (GDP). Conclusion: This study implies that the reasons for referral are other than lack of dental skills and may be due to perceived difficulties in managing patients. Further research is recommended to establish whether aspects of patient management are problematic so that resources, including appropriate training programmes, can be developed to enable a quality service to be provided. In the evolving health care system in the United Kingdom (UK) these issues will need to be considered when developing contracts at a local level.
Burning mouth in Parkinson's Disease sufferers
Authors: Clifford T.J. , Warsi M. J. , Burnett C. A. , Lamey P.J.
Published: January 2004

Objective. The purpose of the study was to determine the prevalence of burning mouth (BM) in a population of Parkinson's Disease (PD) sufferers and also to assess the use of pain profiles in identifying the type of burning sensation experienced. Design. Subjects were surveyed by means of a one shot postal questionnaire for which ethical approval had previously been granted. Anonymity was guaranteed and therefore no attempt was made to follow up non‐respondents. Main outcome. BM was reported by 24% of respondents. The pain profiles were completed by 17 BM sufferers. Conclusion. Burning mouth is reported to occur in 24% of PD sufferers which is 5 times greater than that of the general population. The reason for this is uncertain but the result has implications for the future care of PD patients and indicates the need for increased dental input at PD outpatient clinics.
Affective state and acceptance of dentures in elderly patients
Authors: Golębiewska Maria , Sierpiñska Teresa , Namiot Dorota , Likeman Peter R
Published: January 2004

Objective: To examine the relationship between the affective state and acceptance of dentures by elderly patients. Setting: Dental Outpatient clinics and a residential home for the elderly. Bialystok, Poland. Design: Cross sectional survey of denture wearers. Subjects: One hundred and forty one patients between the ages of 60–94. Intervention: A semi‐structured interview, which focused on the patient's self‐evaluation of their affective state, and a clinical examination. Results: There was a trend for the negative affects (irritability, boredom, anger, loneliness, helplessness) to relate to denture intolerance and for the positive affects (joy, peace, usefulness) to relate to denture acceptance. Conclusions: Anger related significantly t o intolerance of upper and lower dentures. The relationship of age and gender to the acceptance of dentures in the present sample was not significant.
The effect of variation of the lingual shape of mandibular complete dentures on lingual resistance to lifting forces
Authors: Miller William P. , Monteith Brian , Heath M. Robin
Published: January 2004

Increasing life expectancy, age related reduction in adaptability and progressive severe mandibular resorption all add to the importance of any factor improving the prosthetic success. Objective: To investigate the effect of two different lingual shapes of lower dentures on patients' ability to resist lifting forces. Design: Tongue pressures on the lingual surface of complete mandibular experimental dentures were recorded from mid‐line, premolar and molar transducers. Two experimental prostheses were fabricated for each subject: one conventionally contoured, the other formed by piezography. Setting: A clinical research laboratory. Subjects Five experienced complete denture wearers between age 64 and 82 years. Intervention Lifting forces were applied at the midline, left and right premolar sites in random order. Main outcome measures: Peak resistance to lifting forces and lingual pressures used during these tests. Results: Lingual pressures exerted anteriorly were dramatically higher than those on premolar and molar surfaces. Significantly higher pressures were used to resist lifting forces applied to piezographically than conventionally formed contours; correspondingly, significantly higher lifting peak forces were, on average, resisted. Conclusions: Providing a lower denture with a piezographically produced lingual surface was shown, in this preliminary study, to enhance tongue retentive ability over a conventional design. It seems reasonable to maximise retentive potential with oblique sublingual polished surfaces and minimise the adaptive demand, particularly for older patients, by using a piezographic technique which “customises” the contour and precludes over‐extension.
Double blind clinical trial of a remineralizing dentifrice in the prevention of caries in a radiation therapy population
Authors: Papas A. , Russell D. , Singh M. , Stack K. , Kent R. , Triol C. , Winston A.
Published: January 2004

Objectives:The purpose of this study is to determine the efficacy and safety of a specially formulated remineralizing toothpaste in controlling caries in a group of high risk, head and neck radiation patients. Design:The study compares the performance of the remineralizing toothpaste with a leading conventional fluoride dentifrice using double‐blind randomization. Test ProductsThe products compared both contain equivalent quantities of fluoride (1150ppm). The remineralizing toothpaste also delivers soluble calcium and phosphate ions, the essential components of teeth. Subjects:On completion, 50 subjects who received >50 Gy of radiation to the head and neck. Measurements:Examinations include coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over one year. Results:At this point subjects are enrolled in the study at various phases. However, the current average for the net increment per month per subject is −0.12 (±1.30) for coronal caries and 0.06 (±0.73) for root caries in subjects using the remineralizing toothpaste and 0.53 (±1.62) for coronal caries and 0.45 (±0.98) for root caries in subjects using the conventional fluoride dentifrice. Non‐parametric analysis of rank scores for net root surface increments/month was statistically significant (p=0.02), suggesting lower net root surface increment/month for the remineralizing toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces. Conclusions:The results to date indicate that the remineralizing toothpaste is significantly superior to the conventional fluoride dentifrice in preventing root caries in high risk patients.
The impact of oral health on stated ability to eat certain foods; Findings from the National Diet and Nutrition Survey of Older People in Great Britain
Authors: Sheiham A. , Steele J.G. , Marcenes W. , Finch S. , Walls A.W.G.
Published: January 2004

Objectives. To assess how the dental status of older people's mouths affected their stated ability to eat common foods. Design. Cross sectional study. Subjects. Survey was part of the oral health component of the nationwide British National Diet and Nutrition Survey: people aged 65 years and older. Two separate representative samples aged 65 and over: a free‐living and an institutional sample. 881 free‐living and 275 institution subjects had a dental exam and were interviewed about ability to eat key foods. Results. Significant percentages of free‐living people had difficulty or could not eat at least 4 of 16 foods, and about 1 in 5 dentate stated they had difficulty eating or could not eat raw carrots, apples, well‐done steak or nuts. More of the edentate subjects stated that they had difficulty eating than the dentate. Perceived chewing ability increased with increasing numbers of natural teeth and pairs of opposing posterior teeth. Subjects reporting a sociodental impact were more likely to consider that they were unable to eat foods that required more chewing. Associations remained valid after correction for the effects of age, sex, social class and denture wearing status and region. Perceived dryness did not affect significantly the stated ease of eating most foods. There were more dietary restrictions reported by the institution sample. Some foods, such as nuts, apples and raw carrots could not be eaten easily by over half of edentate people in the institution sample. Conclusions. The stated selection of foods are substantially affected by numbers of teeth and occluding pairs of posterior teeth and presence of full dentures in significant percentages of older people.
Age‐related changes in cellular activity in human submandibular glands as evaluated by argyrophilic nucleolar organizer regions
Authors: Saito Masaji , Shimizu Yoshinaka
Published: January 2004

Objective: To examine the age‐related changes in cellular activity of epithelial components of human submandibular glands, evaluated on the basis of argyrophilic nucleolar organizer regions (AgNORs). Design: Epithelial components of human submandibular glands were divided into serous acinar cells, mucous acinar cells, intercalated duct cells, striated duct cells, and interlobular duct cells. The mean AgNOR number of each cell type was compared among six age groups. Setting: The study was conducted at the Department of Oral Pathology, Tohoku University School of Dentistry, Japan. Subjects: Necropsy specimens from 66 males and 57 females 1 to 97 years old. Results: In all cell types except for intercalated duct cells, the mean AgNOR number was lowest in the 0‐14 year‐old group and highest in the 15‐29 year‐old group. The value then gradually decreased with advancing age and ultimately reached a similar level to that in the 0‐14 year‐old group. In intercalated duct cells, the mean AgNOR number did not differ significantly between any age group. There were no significant sex‐related differences. Conclusions: The cellular activity of almost all components of human submandibular glands rises in adolescence and young adulthood and then decreases with aging. These results suggest that intercalated duct cells are capable of not only proliferation but also division into other components; these cells may thus compensate for the reduced activity of other components in elderly subjects.
Caries activity and associated risk factors in elderly hospitalised population – 15‐months follow‐up in French institutions
Authors: Guivante‐Nabet C , Berenholc C , Berdal A
Published: January 2004

Only a few studies have been published concerning hospitalised elderly disabled people. Objectives: 1) to investigate the oral health status of elderly French patients hospitalised in the two main geriatric hospitals of Paris. 2) to describe the respective influences of general parameters (type of hospitalisation, pathologies and medication) on oral environment parameters. 3) to analyse the influences of these oral parameters on caries activity in Long‐Term Care (LTCF) and in rehabilitation facilities (RF) patients and to study the incidence and the time‐course of caries in these specific population. Subjects: 117 subjects (mean age=83.0 years, SD=7.8, range=64 to 102 years) were examined at baseline and 32 of the 50 LTCF subjects were reexamined 15‐months later. Methods: The general parameters recorded were age, gender, type of hospitalisation, period of stay, removable prosthesis, general diseases, number of diagnoses, medications with hyposalivary side‐effects. The oral environment parameters recorded were flow rate, buffer capacity, mutans streptococci and lactobacilli counts, measured at baseline by tests on stimulated saliva, and plaque index. Crown and root surfaces were recorded according to a modified caries activity index. Results: Among the polypathological subjects (85.5% of the population), the number of diseases ranged from 2 to 8. The LTCF patients had a significantly higher mean number of diagnoses (3.5; SD=1.5) than the RF patients (2.8; SD=1.4). 76.9% of patients were taking medications with hyposalivary side‐effects. The stimulated flow rate ranged from 0.02 ml/min to 5 ml/min. Its mean was significantly lower for LTCF patients (0.67 ml/min; SD=0.51) than for RF patients (1.12 ml/min; SD=0.89). The plaque index was significantly higher in LTCF subjects and in patients with mental diseases. At baseline, 17,442 crown and root surfaces were examined. Flow rate was related to crown caries and buffer capacity to root caries. During the 15‐months follow‐up, the mean number of active root surfaces was significantly increased: from 0.148 (SD=0.116) at baseline vs. 0.250 (SD=0.174) at the second examination. Conclusions: The strongest relationship in the present study between oral parameters and caries activity was the negative relationship between buffer capacity and active root caries. This study confirms an association between the type of hospitalisation and both salivary parameters flow rate and plaque index. This investigation illustrates the critical need for hygiene and oral care, in this elderly disabled population.
The importance of oral health to older people's quality of life
Authors: McGrath Colman , Bedi Raman
Published: January 2004

ObjectivesThis study was designed to determine whether older people perceive oral health as being important to Quality of Life (QoL) and if so, to identify the most important ways in which their lives are affected. In addition, to identify if subgroups of older people perceive its importance differently. Design: Nationwide qualitative face to face interviews with older people were carried out utilising the Office for National Statistics Omnibus survey in Great Britain. Subjects and methods 454 adults aged 65 or older took part in this study, part of a random probability sample of adults in the UK. Setting Respondents were interviewed in their homes. Results 72% (313) perceived their oral health status as important to their QoL through a variety of physical, social and psychological ways. Most frequently its impact on function: eating (29%, 126) and symptoms: comfort (14%, 59) were considered most important. Gender and social class variations were apparent (P<0.05). Conclusion Older people perceive oral health as being important to life quality in a variety of different ways. There are significant social class and gender variations which must be taken into consideration when assessing oral health needs of older people.
Mobility in old age
Authors: Walsh K , Roberts J , Bennett G
Published: January 2004

Immobility is common In older people and may impact on their dental care. Immobility in old age may have physical, psychological and environmental causes. Immobile elderly people often suffer from a number of diseases which worsen their mobility. Arthritis, osteoporosis, hip fracture, stroke and Parkinson's disease are among the most common causes of immobility in old age. Complications of immobility such as orthostatic hypotension may occur in the dental patient. Careful history‐taking and a thorough physical examination by the physician are the most important parts of the assessment process. This assessment should lead to a list of active problems and treatment should then be aimed at these problems. Active management, carried out by the multidisciplinary team, will lead to improvements in mobility and lessen the frequency and severity of the complications of immobility. This broad description thus provides the basis for a wide understanding for the special problems that the immobile patient present to the practitioner and ways of overcoming the problems.
Behind the screens: care staff observations on delivery of oral health care in nursing homes
Authors: Frenkel H F
Published: January 2004

Objective: To identify qualitatively carer staff attitudes, practices and clinical comments related to oral health care of functionally dependent nursing home clients.

Design: Open‐ended questions included in a longer quantitative questionnaire.

Setting: 22 randomly selected nursing homes in the Bristol area.

Subjects: 416 carers employed in these homes.

Results: The majority of carers thought that clients had a right to good oral health, accepted the carers' role in helping clients with oral and denture hygiene, but recognised that oral health care provision was deficient. However, some carers believed oral health care to be solely the clients' responsibility despite high disability levels. Main barriers to providing oral health care were low prioritisation of oral health by nursing management, lack of co‐operation from cognitively impaired clients, and lack of training. Carers were critical of homes' lack of arrangements for routine professional dental cheeks, lack of commitment to staff training, low standards of oral health care by colleagues, and lack of provision of oral hygiene aids and cleansing materials for clients. Many responses indicated ways in which nursing home oral health care could be improved. Carers reported contrasting experiences of dental treatment, and deplored recent decreased availability of subsidised dental care.

Conclusions: Carers' generally positive attitudes towards clients' oral health care should encourage health educators. Insights gained from qualitative data can help to identify the less obvious causes for poor oral care delivery, which can then be addressed in education and training initiatives in nursing home settings.
The orodental status of a group of elderly in‐patients: A preliminary assessment
Authors: McNally Lisa , Gosney Margot A , Doherty Una , Field E Anne
Published: January 2004

Objective: To provide a preliminary assessment of the orodental status and dental treatment requirements of a group of elderly in‐patients. Design: Cross‐sectional.

Setting: Acute Care of the Elderly and Stroke Rehabilitation units at teaching hospitals in Merseyside.

Subject: 150 patients aged 58 to 94 years, in which a history could be validated at interview.

Intervention: Questionnaire administered by dentist and clinical examination. Main outcome measures: Registration with a dentist, prosthetic status and difficulties with dentures, denture hygiene and identification marking, dental treatment needs and evidence of mucosal pathology.

Results: Only 27% of patients claimed registration with a dentist. Three quarters of the patients were edentulous and 66 patients wore full dentures; 18 had no prostheses. Difficulties were experienced by one quarter of patients with upper dentures, compared with a half of lower denture wearers. Of the dentures available for inspection, 61 % had removable soft debris, 66% were left out at night and 75% were cleaned by the patient, whilst on the ward. No dentures had evidence of identification marking. Of the 39 partially dentate patients, 75% required interventive dental treatment. Denture stomatitis was diagnosed in 29% of patients and 19 had evidence of benign mucosal pathology.

Conclusions: The orodental status of this group of elderly in‐patients was poor, with a high proportion being edentulous. Few were registered with a dentist and denture hygiene was inadequate. Lack of identification marking is a matter of concern. Closer liaison between hospital staff responsible for elderly in‐patients is required, to improve the orodental health and quality of life of this medically compromised group of patients.
An Index of Clinical Oral Disorder in Elders (CODE)
Authors: MacEntee M I , Wyatt C C L
Published: January 2004

Attempts to construct an index of oral health or disorder suitable for older adults have been limited in clinical scope or based on the judgement of very few individuals. Consequently, we present here a multidimensional index of Clinical Oral Disorder in Elders (CODE) based on a breadth of clinical measures relevant to elders. The data for the index are detived from a clinical examination of jaw function, dentures, mucosa, teeth, and periodontium. Weighting or ranking for each disorder within the context of an elderly person was established as mild, moderate or severe by experienced dental clinicians and dental hygienists. Subsequently, the index was constructed by transforming the weights into a numerical value for each clinical measure. Individual scores can relate to the heaviest weight identified during the examination or to the sum of the weights assigned throughout the examination, and the average score during a series of examinations will reflect the clinical status of a particular population. Clinical applications in elderly residential‐care populations indicate that the index can be constructed efficiently and with reasonable reliability. We suggest, therefore, that the CODE index is suitable for descriptive and comparative research by providing a clinical format for measuring oral disorder in disabled elders, and, when combined with a psychosocial index, it should be very comprehensive indicator of oral dysfunction in older adults
Factors influencing older people's self reported use of dental services in the UK
Authors: McGrath Colman , Bedi Raman , Dhawan Niharika
Published: January 2004

Objectives: This study was designed to determine the use of dental services and factors associated with their use among the United Kingdoms' older population.

Design: A national study involving 1,116 older people (aged 60 or older).

Setting: Home Interview s were undertaken exploring the time and reason for last dental visit. In addition, socio‐demographic characteristics and proxy oral health measures (self‐reported number of teeth and edentulous status) of the respondents were collected.

Results: Forty seven percent (528) claimed they visited the dentist within the past year, 10% (116) claimed that the reason for their last visit was because of a dental emergency, 43% (484) were classified as “regular attenders” ‐ having attended the dentist within the past year for a non dental emergency. Bivariate analysis identified that regular dental attendance was associated with age (P<0.01), social class (P<0.01), income level (P<0.01), educational attainment (P<0.01), self‐reported number of teeth possessed (P<0.01) and edentulous status (P<0.01). In regression analysis, self reported edentulous status and number of teeth possessed emerged as the most important factors in determining service utilisation. Possessing a full denture was associated with a 6‐fold decrease, having accounted for other factors, in the likelihood of attending the dentist within the past year for a non dental‐emergency (OR=0.15, CI 0.10,0.21).

Conclusion: Less than half of the sample population were “regular dental attenders”, their attendance was associated with a number of socio‐demographic and oral health factors. In particular, edentulous state was a major factor associated with their use of services.
The oral health of older people from minority ethnic communities in South East England
Authors: Newton JT , Gibbons DE , Gelbier S.
Published: January 2004

Objectives: To describe the clinical health status and subjective oral health status of older adults from minority ethnic communities resident in South East England.

Design: Cross sectional survey incorporating a clinical examination and a questionnaire assessment of subjective oral health status.

Setting: Community groups working with individuals from minority ethnic communities.

Subjects: A total of 540 individuals from 7 minority ethnic communities.

Measures: Clinical assessment of oral health status using BASCD criteria. Assessment of oral symptoms and impact experienced together with satisfaction with oral status, by structured questionnaire.

Results: On all measures of clinical health status the participants were healthier than a comparison group based on data from the Adult Dental Health Survey. The participants expressed high levels of subjective oral symptoms. Levels of satisfaction were lower than those found in the Adult Dental Health Survey. There was evidence of some variation across minority ethnic communities in clinical and subjective oral health status.

Conclusions: Approximately 20% of the 540 adults from minority ethnic communities resident in the South East of England surveyed were relatively fit orally. They experienced a great many oral symptoms, and in approximately 30% of individuals these were sufficient to interfere with their quality of life.

Ethical approval: The research described in this paper was approved by the Ethics committee of King's College London.
Efficacy of antifungal agents in tissue conditioners in treating candidiasis
Authors: Chow C K W , Matear D W , Lawrence H P
Published: January 2004

Chronic atrophic candidiasis is prevalent in up to 72% of institutionalized geriatric populations and is causally associated with Candida albicans. Topical antifungal treatments are difficult to implement in some geriatric patients due to cognitive impairment, reduced motor dexterity and memory loss.

Objective: This in vitro study incorporated antifungal agents into tissue conditioners to investigate the effectiveness of this method of drug delivery.

Design: Combinations of nystatin, fluconazole, itraconazole and Coe Soft, Viscogel, Fitt were tested at 1, 3, 5, 7, 9 and 11wt/wt%, with and without sterilized saliva. 6 mm diameter cores were punched in Sabouraud plates pre‐grown with standardized C. albicans. Antifungal agents plus tissue conditioner mixtures were injected into each core. Inhibition diameters were measured for 14 days.

Results: Cores with only tissue conditioners acted as negative control and showed no significant inhibition activity (ANOVA, p>0.05). Peak activity was between 65 to 89 hours; followed by a plateau. Itraconazole had greater fungicidal activity than fluconazole; while nystatin was found to have the least fungicidal activity (ANOVA. p<0.05). The most effective concentration for nearly all combinations was 5%wt/wt (ANOVA, p<0.05). Specimens with saliva showed greater antifungal activity than those without (t‐test. p<0.001). Itraconazole altered the physical properties of Viscogel hence this combination is not recommended for clinical use.

Conclusion: The treatment of chronic atrophic candidiasis by incorporation of antifungal drugs into tissue conditioners is efficacious. 5% wt/wt itraconazole mixed with Coe Soft or Fitt is recommended for clinical study where compliance of patient or care giver cannot be relied upon. Peak antifungal activity at 3 days suggests that mixtures prepared for clinical study may be replaced soon after this time for maximum effectiveness.
Bitter taste thresholds, numbers and diameters of circumvallate papillae and their relation with age in a Turkish population
Authors: Mavi A , Ceyhan O
Published: January 2004

Objectives: This study analyses the relationship between the sense of bitter taste and age. The relationships between these and the numbers and diameters of Circumvallate Papillae (CP) are also analysed.

Subjects: Twenty‐four elderly subjects (from 65 to 85 years) and 30 young subjects (from 17 to 25 years) were studied.

Method: Bitter taste thresholds were determined by the three drop method with an ascending series of concentrations. The numbers and diameters of CP were observed by direct naked eye observation using a wooden tongue depressor, a gauge and a light source.

Results: The bitter taste acuity was significantly poorer in the older sample. There was no relationship between the bitter taste acuity and number of papillae but an inverse relationship was observed between the bitter taste acuity and diameters of papillae, thus lower acuity was associated with larger papillae. It was also observed that the diameters of papillae were inversely related to the numbers of CP. The distribution of numbers and diameters of CP were not significantly different between these samples with age.
Geriatric Dentistry in the Next Millennium: Opportunities for Leadership in Oral Health*
Authors: Niessen Linda C.
Published: January 2004

“The twentieth century will be remembered chiefly, not as an age of political conflicts and technical inventions, but as an age in which human society dared to think of the health of the whole human race as a practical objective.” Arnold Toynbee, British historian

Individuals throughout the world often view the passage of a new year as a time for re‐evaluation of personal and/or professionals goals. The new millennium offers the dental profession a chance to view the future and observe the challenges and opportunities facing it.

Professor Toynbee's observation is particularly poignant when one considers the improvements in oral health made in the last 100 years. Caries, once considered a ubiquitous oral disease, has been prevented in some children in developed countries. Research on periodontal disease continues to identify risk factors and the pathobiological mechanisms underlying the disease. Concurrently the population of the world is aging presenting new opportunities for improving oral health.

In this paper the data on aging, chronic diseases and oral health is largely from the US but reflects to varying degrees other industrial countries. By integrating these demographic, epidemiologic and biologic data, one can paint a portrait of the future dental patient and their oral health needs. From this portrait, dental professionals can identify leadership opportunities to improve the oral health of an aging world population.
Conducting geriatric dental research with cognitively impaired adults
Authors: Chalmers Jane M
Published: January 2004

A growth in research focusing on the oral health of older adults has been evident in recent years. However, there are new and complex challenges for geriatric dental researchers studying the increasingly functionally dependent and cognitively impaired older adult population. Many geriatric dental studies have underreported oral disease prevalence and incidence by excluding adults who are cognitively impaired and/or behaviourally difficult. To ensure representative samples of older adult populations are studied, traditional oral epidemiological protocols in studies with cognitively impaired adults, require additional components detailing: (1) communication and behaviour management strategies for cognitively impaired adults; and (2) methodologies to facilitate the completion of dental examinations. A description of such additional protocol components is presented, along with a discussion of the use of cognitive testing tools by dental researchers.
Food choice by older people: the use of semi‐structured interviews with open and closed questions
Authors: Millwood Joanna , Heath M Robin
Published: January 2004

Objective: To evaluate difficulty chewing, consequent food choice and impacts using both open and closed questions within a semi‐structured interview format.

Design: A cross‐sectional study using a semi‐structured interview (SSI) with open and closed questions Setting: Independently living people in South‐West London interviewed in their own homes Subjects: A group of 54, edentate people (mean age 82, R= 60‐93 years) were studied.

Results: Most subjects (69%) expressed difficulty eating at least one type of food, half were unwilling to eat the foods they found difficult, others were conscious of cooking longer or cutting smaller in order to manage these foods, although no one accepted that they overcooked food. There were dramatic differences in the number of subjects expressing difficulty to chew various foods when responding to open and closed questions. Roast beef proved a good discriminator in this group of predominantly English subjects. The importance of the questioning process was also shown by the discrepancy of responses between variously prepared apples and the inability of any subjects to bite an unpeeled apple.

Conclusions: For sensitive appraisal of food choice it is obviously essential to assess relevant foods, for the culture of the group being studied. Open questions provide a way of exploring which are the appropriate foods and food preparation as criteria to assess perceived chewing ability and treatment benefit. The semi‐structured interview method is particularly valuable for the study of older people. Closed questions provide different information which is also necessary to secure recall by older people.
Oral health care among nursing home residents in Avon
Authors: Frenkel Heather , Harvey Ian , Newcombe Robert G.
Published: January 2004

Objective: To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention.

Design: Descriptive survey, interview and clinical data.

Setting: 22 randomly selected nursing homes in the Bristol area.

Method: 412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture‐related stomatitis, gingivitis, calculus and root caries.

Results: Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture‐related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two‐thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects.

Conclusions: Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.
Amalgam fillings and cognitive abilities in a representative sample of the elderly population
Authors: Nitschke I. , Müller F. , Smith J. , Hopfenmüller W.
Published: January 2004

Objectives: The ongoing controversial discussion about a possible negative effect of amalgam fillings on the cognitive abilities and the pathogenesis dementia was the objective of the present study.

Sample: A total of 300 patients aged from 70 to 103 years were selected from the multidisciplinary ‘Berlin Aging Study’ (Base). The sample was heterogeneous concerning lifestyle, education and social prestige. According to their dental state subjects were allocated into three groups: edentate ≥20 years (I) and residual teeth without (II) or with (III) amalgam restorations. All groups were matched for age and gender.

Design: Dental examinations and various psychiatric as well as psychological assessments were carried out by professionals within the protocol of the BASE. Tests were chosen to reveal the presence and degree of dementia and assess cognitive abilities such as ‘perceptual speed’, ‘reasoning’, ‘memory’, ‘fluency’ and ‘knowledge’.

Results: The present findings negate a correlation between the dental state and the pathogenesis of dementia and the physiological age‐related decline in cognitive abilities. Thus the presence of amalgam fillings did neither correlate to a demented mental condition nor an impaired cognitive performance.
Success of dental implants in elderly people ‐ A literature review
Authors: de Baat C
Published: January 2004

Implant‐supported dentures seem particularly appropriate for the predicament of being elderly and becoming edentulous. The aim of this article was to review the literature on success of dental implants in elderly people. The results of two studies suggested that the treatment with implants can be considered safe and predictable for older as well as for younger patients. Three studies found no increased implant failure‐rate in patients with a compromised medical status. Four studies revealed high success‐rates of dental implants among groups of elderly people. Within the limitations of this review of the literature it can be concluded that old age does not seem to represent a factor of major prognostic significance in treatment with dental implants.
Palliative care dentistry
Authors: Wiseman M A
Published: January 2004

The importance of dental care is often overlooked due to the omission of the dentist as a member of the palliative care team. However, many terminal patients exhibit oral difficulties that affect their quality of life. Palliative care dentists must exhibit empathy and compassion, and must be excellent communicators Dentists can play an important role in alleviating both the physical and psychological pain of dying. This paper describes the role of dentistry in palliative care.
Patterns of dental caries and treatment experience in elderly Lithuanians
Authors: Aleksejuniene J. , Holst D. , Eriksen H. M.
Published: January 2004

Objective: The aim of the study was to evaluate patterns of caries experience in a representative sample of Lithuanians, aged 65‐74.

Methods: This cross‐sectional study included 301 participants (response rate 54%). Information was obtained from a clinical examination (caries experience, stimulated salivary flow rates and oral hygiene levels) and a questionnaire. The questionnaire comprised questions about oral, general, physical, mental and social health and about background, knowledge, attitudes and lifestyle. The study had a multidimensional approach to negative consequences of disease and positive aspects of health. For bivariate testing, t‐test, ANOVA and Spearman's correlation were used. Factor analysis was combined with linear multiple regression for a multivariate study of caries experience patterns.

Results: Elderly Lithuanians were found to have lower levels of edentulousness (range 11‐15%) than elderly people in other European countries. The mean number of missing teeth was also lower than in any of the neighbouring countries. A comparison of dentate and edentulous groups did not show any major differences. Those who reported that they had general disease had higher levels of oral health maintenance. In dentate elderly, caries experience differed according to place of residence, fluoride content in the drinking water, socio‐economic status, gender, lifestyle, and many other factors. The multivariate approach explained 52%. 61% and 55% of the variation in the number of filled or sound teeth (FS‐T), delayed (DT) and missing teeth (MT) respectively.

Conclusion: Levels of oral health maintenance and caries experience show substantial variation among elderly Lithuanians, according to many health‐related characteristics. These elderly people require appropriate oral care, just as much as people in other population sub‐groups.
Number of teeth and risk of root caries
Authors: Nicolau Belinda , Srisilapana Patcharawan , Marcenes Wagner
Published: January 2004

Objective: This study aimed to investigate the association between number of natural teeth and prevalence of root caries.

Design: A cross‐sectional design was adopted. A stratified multi‐stage purposive sampling method was used to select a wide range of elderly people from all social classes, educational levels and sexes. Data was collected through interviews and clinical examinations.

Setting: Urban area in Chiang Mai‐Thailand.

Participants: 549 elderly dentate aged 60‐74 years.

Main Outcome Measures: Teeth with decay and filled roots (DF‐T).

Results: The prevalence of root caries was 18.2% with a mean DF‐T of 0.58 (S.D. 2.02). Results of multiple logistic regression showed that number of teeth, DMF‐S scores, sex, and socio economic factors were statistically significantly associated with root caries (P<0.05). Adjusted odds ratios demonstrated a 14% increase in the chance of having root caries when the number of teeth increased one unit. Similarly, a 3% increase was observed for each unit increase in the DMF‐S scores (p<0.001). Being male, having more than four years of education and earning more than 1500 baht/month increased the chances of root caries by 76%, 139% and 85% respectively (p<0.001). Recession and age were not statistically significantly associated with root caries.

Conclusions: Having more teeth, higher DMF‐S scores, earning more than 1500 baht/month, having more than 4 years of education and being male increased the likelihood of having root caries.
Factors associated with dental anxiety among older people in Britain
Authors: Bedi Raman , McGrath Colman
Published: January 2004

Objective: This paper reports on a study of denial anxiety among adults aged 60 years living independently in Britain.

Design: A national cross‐sectional study carried out with the assistance of the Office for National Statistics' Omnibus Surveys in 1999.

Setting: Data was collected by face to face interviews with older people in their homes Measurements: Data on dental anxiety were collected from 973 subjects by means of face to face interviews and was measured by the Dental Anxiety Scale (DAS) (Corah, 1969). In addition, data on dental service use and oral health status (self‐reported) was collected.

Results: The mean DAS score was 8.4 (sd 3.5), and 13% (129) of subjects were classified as dentally anxious (DAS ≥ 13). DAS scores were associated with numerous socio‐demographic factors (P<0.01), self‐reported oral health status (P<0.01) and dental service (P<0.01) factors. A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioural and oral health outcomes.

Conclusion: One in eight older people in Britain are dentally anxious and this is associated with their use of services and oral health status (self‐reported).
Significance of saliva for the denture‐wearing population
Authors: Niedermeier W. , Huber M. , Fischer D. , Beier K. , Müller N. , Schuler R. , Brinninger A. , Fartasch M. , Diepgen Th. , Matthaeus C. , Meyer C. , Hector M.P.
Published: January 2004

This paper summarises a series of studies already published in German and presents new data related to the aetiology of the dry mouth' and its associated problems.

Aims: to study factors affecting mucous and serous salivary gland secretion, the aetiology of the ‘dry mouth’ and its associated problems, causative factors for hyposalivation and it's treatment Setting: two university dental hospitals.

Subjects: 587 denture wearers and 521 control subjects, and autopsy material Interventions: exercise, chewing, water, oestrogen, pilocarpine, and anetholtrithion theiapy, biopsy of the minor glands Main outcome measures: Palatal secretion (PAL, μL/cm2/min) and parotid salivary flow (PAR), subjective complaints and clinical findings.

Results: resting flow rates for PAL between 0 and 65 μl/cm2/min were seen in every age group. The flow rates of PAR (0 to 3.7 ml/10 min) were not correlated with PAL. Most patients with a resting flow rate of PAL≤6.0 μl/cm2 suffer from a ‘dry mouth’ and Burning Mouth Syndrome (BMS) or oral dysaesthesia (OD) with or without chronic lesions of the oral mucosa. Etiological factors for the incidence of reduced PAL and associated problems include xerostomic drugs, oestrogen deficiency, ladiotherapy, thyroid dysfunction, smoking or continuous wearing of complete upper dentures. PAL also correlated with the retention of upper complete dentures. PAL was correlated with the water content of epithelial tissues. PAL and PAR were both increased by drinking ample fluid, improving their circulation by physical exercises, chewing intensively, or taking oestrogens, pilocarpine, anetholtrithion.

Conclusions: Variation in palatal salivary secretion occurs and is clinically important.
Attitudes to oral care among caregivers in Japanese nursing homes
Authors: Sumi Y , Nakamura Y , Nagaosa S , Michiwaki Y , Nagaya M
Published: January 2004

Objectives:The purpose of this study is to investigate oral care practice and awareness of it among caregivers in Japanese nursing homes.

Methods:Caregivers were surveyed by means of a self‐administered questionnaire designed to elicit the following information: awareness of oral care, its importance, the burden involved in oral care, and systemization of oral care.

Results:The results showed that most caregivers are adequately informed of the importance of oral care, but are inadequately educated in oral care and have little training in systematic oral care.

Conclusion:The importance of providing appropriate and systematic oral care training must be stressed among caregivers along with the need to develop equipment to simplify and support oral care.