bluuebunny/crossref_metadata_2025 huggingface dataset:
Dental health among institutionalized psychiatric patients in Spain
Authors: Velasco Eugenio , Machuca Guillermo , Martinez‐Sahuquillo Angel , Rios Vicente , Lacalle Juan , BulloAn Pedro
Published: March 2008

This study assessed the dental health of an institutionalized psychiatric population in Spain. The study population was composed of 347 males and 2A8 females with a mean age of 58.0. The mean length of hospitalization was 26.1 years. The largest proportion of the patients (62%) was diagnosed as having schizophrenia. All subjects were taking psychotropic drugs, with a mean number of 2.1 medications. The sample was examined according to the WHO dental criteria. The DMFT index demonstrated the mean number of carious teeth to be 7.9; missing teeth, 17.0; and filled teeth, 0.0. The DMFT index increased significantly with the patient's age and length of hospitalization. Female and demented patients had significantly higher DMFT scores. These findings suggest that institutionalized patients with mental illness in Spain have extensive untreated dental disease.
Relationships among education, dentate status, and diet in adults
Authors: Papas Athena S. , Joshi Anil , Giunta John L. , Palmer Carole A.
Published: March 2008

The Nutrition and Oral Health Study (NOHS) was established to study the interrelationship of oral health status, dietary intake, and education, and to define their relative impact on the middle aged and elderly. Two hundred forty‐seven partially or fully dentate (at least 6 teeth) subjects returned two food diaries over a 16‐month period. Despite the investigators' efforts to enroll from a socio‐economically diverse Boston population, the volunteers were health‐conscious, with 85% having been to the dentist within the last year; 95% brushed, and 60% flossed daily. More than half the volunteers had attended college. With the exception of cholesterol intake, which was high in both the higher‐ and lower‐educated males, most individuals, despite their dentate status, sought good nutrition. People who wore dentures consumed more refined carbohydrates and sucrose. As the number of teeth declined, Vitamin A, crude fiber, and calcium declined, while cholesterol rose. These factors may have a significant implication for general health.
The role of early dietary habits in dental caries development
Authors: Ismail Amid I.
Published: March 2008

Early Childhood Caries (ECC) is a serious dental condition that occurs during the first three years of life and is associated with the early intake of sugary foods, drinks, or snacks. There is now evidence that early malnutrition episodes could lead to delay in the eruption of primary teeth and possibly to increased caries prevalence. Significant correlations are present between the intakes of carbohydrates, proteins, and fats during infancy and several years later in life. Infants' dietary intake is also significantly correlated with the dietary intake of their mothers. Supplementing milk with vitamins during the first several years of life leads to reduction in the prevalence of linear enamel hypoplasia, a condition that may be associated with future development of dental caries. There are equivocal findings concerning the value of using dietary habits to predict caries incidence during the first three years of life. There is a need for development of educational, nutritional, and prevention programs targeting mothers and infants and for research on effective methods to prevent Early Childhood Caries.
Demineralization inhibition at glass‐ionomer cement and amalgam restoration margins in conjunction with additional fluoride regimens
Authors: Donly Kevin J. , Kerber Lori
Published: March 2008

The purpose of this study was to evaluate demineralization inhibition at restoration gingival margins. The study compared the effectiveness of a fluoride‐releasing restorative material and topical fluoride regimens utilized individually and in conjunction with fluoridated materials. Glass‐ionomer restorations demonstrated significantly less dentin demineralization than amalgam restorations at restoration margins when the restorations were exposed to no external fluoride, when the restorations were brushed with a fluoridated dentifrice twice per day, and when the restorations were exposed to a fluoride rinse (p, 0.05). There was no significant difference in dentin demineralization adjacent to glass‐ionomer and amalgam restorations when both a fluoride rinse and a fluoridated dentifrice were used on a daily basis over 30 days, in vitro.
Dental student perceptions of the elderly: Measuring negative perceptions with projective tests
Authors: Pyle Marsha A. , Jasinevicius T. Roma , Sheehan Robert
Published: March 2008

Stereotypic perceptions of older patients have been documented to influence relationships with older adults. To assess the impact of age and dentate status on dental student treatment decisions and perceptions of patients, we designed a qualitative study utilizing projective tests. Seventy first‐ and third‐year dental students wrote stories about two “cue” statements, one describing a young patient and one an older patient. Each cue varied by dentate status, having either a complete dentition or seven remaining teeth. The stories were evaluated for negativity and for general themes of stereotypic statements. The results indicated that while patient age did not influence the dental care prescribed, a high level of negativity existed toward old patients in general (45%, older patient with teeth; 47%, older patient with seven teeth) and toward a younger patient with few remaining teeth (57.6%). The level of negativity expressed toward the young patient with full dentition (27%) may suggest a patient gender bias among dental students in this sample.
Considerations for the use of oral sedation in the institutionalized geriatric patient during dental interventions: a review of the literature
Authors: Matear David W. , Clarke Diana
Published: March 2008

Some institutionalized elderly persons need a sedative prior to a dental examination or treatment because they have a disturbance due to physical illnesses, degenerative changes in the brain, and/or psychiatric disorders, associated with advanced aging. Oral administration is one of the safest methods of delivery of a sedative drug. It is almost universally acceptable, easy to administer, costs little, has a low incidence and severity of adverse reactions, and requires no additional formal specialized training for the dentist. However, theoretical and practical knowledge of sedation is essential. This paper reviews the literature on oral sedation for the geriatric patient. Benzodiazepines are most often used for oral sedation of geriatric patients. The properties of these drugs were reviewed, and recommendations were made with respect to the drugs of choice and their dosage. Generally, fast‐acting benzodiazepines of short duration, with rapid rate of elimination and no active metabolites, are recommended. The drug of choice, and the dosage, may vary according to the medical history and physical condition of the patient.
Autoextraction in an autistic dental patient: a case report
Authors: Armstrong Denise , Matt MaryKaren
Published: March 2008

This is a case report of a 21‐year‐old male patient with autism who sought treatment at a General Practice Residency clinic for dental treatment following the autoextraction of several teeth. A review of autism and self‐mutilation is presented.
A comparison of oral health in elderly populations seeking and not seeking dental care
Authors: Mascarenhas Ana Karina
Published: March 2008

The General Oral Health Assessment Index (GOHAI) has been recommended for use as an outcome measure In the evaluation of dental treatment. This study was designed to assess the ability of the GOHAI In the evaluation of differences in those actively seeking dental care compared with those not seeking care. GOHAI was self‐administered to two samples of elderly Individuals, over 65 years of age, In the Columbus, OH, area. The first sample was ambulatory individuals living in a nursing home in Columbus, and the second sample consisted of patients accessing dental care at The Ohio State University (OSU) dental school clinics. Other variables used in this study were age, gender, self‐rated oral and general health, and use of prostheses. Overall mean GOHAI score in the nursing home respondents was significantly higher (32.1 ± 3.0) when compared with that of dental patients (mean, 30.4 ± 3.9, p = 0.01). Mean GOHAI scores for all categories of variables used were consistently higher (better) in the nursing home respondents than for the dental patients. Results of this study show that self‐assessed oral health measured by the GOHAI was higher for those individuals not seeking dental care than for those actively seeking dental care. The GOHAI is sensitive as an outcome measure in differentiating between Individuals actively seeking care and those not seeking care.
Feature Article: Emtala: Impact on hospital dentistry emergency services
Authors: Surabian Stanley R.
Published: March 2008

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospital‐based dental residency programs and hospital dentists to meet Federal standards when patients come to a hospital emergency department and need emergency dental services. EMTALA (42 U.S.C. 1395dd) has three key provisions which must be understood because of Its impact on hospital emergency dental services:

Medical Screening Requirements,

Necessary Stabilizing Treatment for Emergency Medical Conditions, and

Restricting Transfers Until the Individual is Stabilized.

This article reviews the relevant Federal statutes, codes of Federal regulation, and published court cases to help practitioners understand the Issues. An understanding of the informed consent process, including the “informed refusal” doctrine, as well as the dentist's obligation when patients refuse recommended diagnostic tests, treatment, or transfer, is Important. Immunity for failure to obtain informed consent is sometimes appropriate under state law. Under EMTALA, the term “physician” applies to dentists. Recent changes clarify distinctions between the terms “on campus” and “off campus” related to hospital property emanating from the “Ravenswood” tragedy. Hospital dentists must be familiar with these requirements when caring for patients seeking emergency services
Dental care of elderly in nursing homes: perceptions of managers, nurses, and physicians
Authors: Chung Jean‐Pierre , Dent Med , Mojon Philippe , Budtz‐Jørgensen Ejvind , Odont
Published: March 2008

Epidemiologic studies have shown that the oral health of residents in nursing homes is poor. This can be due to their impaired ability to maintain appropriate oral hygiene or to a lack of interest in oral care among those responsible for the care. The purpose of this study was to assess the attitudes of managers, caregivers, and physicians with regard to oral health care issues of their residents. A questionnaire sent to the managers of the 65 nursing homes in Geneva was returned by 47 (69%). According to the managers, 85% of the nursing homes organized transportation for the residents to a dental office; dental care with follow‐up treatment was organized In 79% of the facilities; 68% of the facilities organized treatment for dental emergencies. Another questionnaire was distributed to 169 care‐givers in 13 nursing homes. A majority had received no education in oral hygiene care of the residents. The caregivers did accept responsibility for oral hygiene care, but preferred to share it with a dentist responsible for the oral health care of the residents. Only 33% of the physicians indicated that they carried out a systematic examination of the oral cavity, and 20% agreed that the oral cavity might be an integrated part of the body. The majority of the physicians were in favor of more information on oral diseases and regular visits by a dentist; however, close collaboration with a dentist on oral health issues had a low priority
Nursing directors' perceptions of the dental components of the Minimum Data Set (MDS) in nursing homes
Authors: Ettinger Ronald L , O'Toole Cindy , Warren John , Levy Steven , Hand Jed S.
Published: March 2008

1Professor, Department of Prosthodontics and Dows Institute for Dental Research, University of Iowa, Iowa City, Iowa 52242

The Directors of Nursing (DON's) of all 428 nursing homes in the state of Iowa were sent a pre‐tested questionnaire. The aim of the study was to examine the perceptions by nursing directors on the utility of a dental component of the Minimum Data Set (MDS) in identifying residents with dental problems in their facility. The return rate was 55.1% from the DON's. It was reported that 66.4% of the homes had a training program for the MDS and that in 38.0% of the homes there was only one person doing the assessments. The majority (76.0%) of the DON's stated that the MDS was useful in tracking residents and that it did help them to identify dental problems. When asked how often it was useful in the identification of dental needs, only 9% stated that it was often useful. Also, regarding frequency of dental appointments for the residents, a mean of 51.0% of residents were estimated to have received some dental care during the previous year (means of 33.2% at the facility, 22.4% at a dental office, and 0.4% in a hospital). If change is to occur, the dental profession must try to get the nursing home assessors to convince the nursing homes to use the oral/nutritional/dental sections of the MDS as they were intended under the OBRA regulations.
Non‐institutionalized elderly dental patients in Israel: socio‐demographics, health concerns, and dental anxiety
Authors: Peretz Benjamin , Mersel Alexander
Published: March 2008

The purpose of this study was to evaluate which factors might Influence health care attitudes such as anxiety about dental care by older adults in Israel. The study population consisted of 103 non‐institutionalized patients (46 men and 57 women) over the age of 65 who attended a dental clinic that provided services for older adults during a one‐year period. Socio‐demo‐graphic Information and Information about the subjects' general health and their level of concern about health problems were obtained from self‐reported questionnaires, while the dental anxiety level was found by means of a dental anxiety scale (DAS). Ninety‐nine percent of the patients suffered from a major systemic disease such as diabetes, hypertension, atherosclerosis, respiratory disease, and rheumatic disease. Both umnarried and first‐time patient expressed high anxiety scores. Patients with 12 or fewer years of formal schooling demonstrated significantly higher dental anxiety. Among patients who regularly attended a synagogue or a social club, concern about oral health was significantly higher than for the rest (p < 0.02). No association was found between having dentures and gender, or between having dentures and level of education. The reason for visiting the clinic (inability to eat, pain, or esthetics) was not associated with any other health concern or with dental anxiety levels. This study determined that patients who were unmarried, less educated, or attending the facility for the first time were more likely to experience dental anxiety. These patients merit special consideration.
Effect of an oral health training program on knowledge and behavior of state agency long‐term‐care surveyors
Authors: Kaiser Catherine M. , Williams Karen B. , Mayberry William , Braun Jean , Pozek Kathleen D.
Published: March 2008

This study examines the effect of a training program on long‐term‐care (LTC) surveyors' knowledge of factors affecting oral health and their behavior in citing oral health deficiencies of LTC residents. Twenty surveyors were recruited for the experimental group, along with a non‐equivalent comparison group of 31 surveyors. The experimental group participated in a three‐hour interactive, case‐based training program. The experimental group had a significant increase in total knowledge (p < 0.002) post‐test scores with a moderate effect size, η2= 0.115. The training program resulted in a statistically significant increase (p < 0.0001) In oral health citation behavior for the experimental group for six months following training. This study provides evidence that an interactive case‐based training program can affect participants' knowledge regarding oral health of LTC residents and participants' oral health citation behavior. As the elderly popution experiences an Increased life expectancy with Increased need for assistance with Activities of Dally Living (ADL), similar training programs will become an important factor In assessing the quality of care provided to LTC residents.
Cleft lip and/or palate in the West of Ireland, 1980–1996
Authors: Hewson Antonia R. , McNamara Catherine M.
Published: March 2008

The aim of this study was to Identify and Investigate care for children born, over a 17‐year period (1980–1996), with cleft lip and/or palate (CL/P) In the Western Health Board region of Ireland. One hundred and six cleft‐affected children were Identified. The Incidence was 1.14 per thousand (1:871) live births. Epldemlological findings In relation to cleft type, gender, family history, and location followed International trends. The establishment of a national Register with mandatory reporting of children with CL/P In Ireland would ensure greater consistency In data collection and may help Improve co‐ordination of care.
Oral health status of older adults in Arizona: results from the Arizona Elder Study
Authors: Berg Rob , Berkey Douglas , Tang Julie M.W. , Baine Connie , Altman Donald S.
Published: March 2008

This study was undertaken to compare oral health status of independent community‐dwelling elders with those using long‐term‐care services. Clinical examinations and self‐reported socio‐demographlc data were collected for 2927 older adults living Independently, using home‐care services, or living In nursing facilities. Mean age of dentate participants (n = 2021) was 72.2 years (range, 50–103 years); mean number of teeth, 18.16; mean DFS, 28.86; and mean RCI, 15.23. In multi‐variate analyses, receiving home‐care services or living in a nursing facility was significantly predictive of poorer oral health status with respect to both coronal and root carles. This was also true for ethnic groups other than non‐Hispanic‐white. We concluded that, In a large, multi‐ethnic sample, direct comparisons highlight significant unmet treatment need among users of long‐term‐care services, compared with independent older adults living in the same communities.
The issues and challenges of orofacial pain in the elderly
Authors: Cox Matthew O.
Published: March 2008

Dental pain is among the most prevalent of all pain complaints, and pain Is frequently given as a common reason for both avoiding and seeking dental care. Pain is frequently an essential component in the differential diagnosis of many diseases; however, in the elderly, diagnosis Is more difficult due to a greater frequency of multiple chronic diseases and an altered pain response. It Is important to understand the nature and prevalence of pain In this group, and one should be cautious to avoid the oversimplification that “pain decreases with age.” Current studies involving the differences in assessing pain and therapeutic pain control between younger and older age groups are discussed. Pain prevalence Is discussed along with herpes zoster, post‐herpet‐ic neuralgia, flbromyalgia, toothache pain, burning mouth syndrome, and trlgemlnal neuralgia as they relate to the elderly. Pain assessment can be made by means of pain scales and specific open‐ and closed‐ended questions. There Is evidence that some practitioners may be underestimating the severity of pain in the elderly, and thus not prescribing adequate analgesics when indicated. When analgesics are prescribed, a thorough analysis of the patients' current medications and condition should lead to a customized prescription and dosage.
Implant‐supported denture in a patient with Huntington's disease: interdisciplinary aspects
Authors: Jackowski Jochen , Dent Dr Med , Andrich Jurgen , Med  , Kdppeler Harald , Zöllner Axel , Dent Dr Med , Jöhren Peter , Dent Dr Med , Müller Thomas , Med
Published: March 2008

Patients with extrapyramidal diseases often cannot maintain independent, efficient oral hygiene due to restricted motor ability of the upper extremities and lack of coordination. The hermetic closure of the mouth and lips, and the associated ability to keep liquid and toothpaste in the mouth, can become so weak that effective oral hygiene cannot be maintained. Over a period of many years, this illness leads to loss of teeth and the need for complete prosthodontic care. Dyskinesia and hyperkinesia of the tongue and the peri‐oral musculature, combined with xerostomia and pooling of saliva, make it impossible for the patient to wear a conventional complete denture, despite an anatomically‐adequate bearing area. In such cases, an implant‐supported prosthesis is a better therapeutic measure, although some aspects of oral hygiene must initially be disregarded. Two ITITM implants were inserted into the anterior mandibular region of a patient with Huntington's chorea, because a complete denture could not be retained on the alveolar ridge, despite adequate vestibule depth, due to tongue dyskinesia. A bar joint was used to anchor this mucosal‐borne denture. This implant‐supported complete denture led to a clear improvement in the patient's chewing function when observed over a period of a year.
Periodontal conditions among the old elderly: five‐year longitudinal study
Authors: Ajwani Shilpi , Ainamo Anja
Published: March 2008

In the past three decades, there has been a significant rise in the number of old elderly (85+ years old) in Finland, and more of these individuals are retaining their natural teeth. Numerous cross‐sectional studies have reported on the periodontal health of the elderly (aged 75+), but very few long‐term follow‐ups have been reported. This study forms a part of the population‐based Helsinki Aging Study (HAS) and compares the periodontal health status and the treatment needs at baseline with those of the same population five years later. The baseline study, in 1990–91, examined the dentate elderly born in 1904, 1909, and 1914, living in Helsinki, Finland (n = 196). The follow‐up study was completed in 1995–96 (n = 73). Periodontal status was recorded by means of the Community Periodontal Index of Treatment Needs (CPITN) in 175 dentate subjects (55 males and 120 females) who met the criteria at baseline, and in 57 dentate elderly (17 males and 40 females), aged 81, 86, and 91 years, who remained at follow‐up. Among the 57 dentate elderly who participated in both baseline and follow‐up examinations, the mean number of teeth decreased from 15.9 to 15.1, and the mean number of remaining sextants from 4.2 to 3.7. There were minor changes in the periodontal health status during this five‐year period, with an increase in code 2 (from 43% to 58%) and a decrease in code 3 (from 38% to 25%). Nevertheless, the overall treatment needs remained unchanged. It can be concluded that the periodontal health of the elderly had remained stable for 5 years, and almost no change was observed in their treatment needs. Therefore, periodontal disease in the elderly who are relatively healthy is not caused by the aging process.
The Index of ADOH: concept of measuring oral self‐care functioning in the elderly
Authors: Bauer Janet G.
Published: March 2008

Measures of ability, or function, are used in the health field to determine the level of performance of a specific task, assess the loss of function, and to measure the return to function as a result of rehabilitation or interventions. While these measures are important to all age groups, it is the elderly and chronically ill who are at most risk for adverse changes in their health and functional status. The Index of the Activities of Daily Oral Hygiene (ADOH) is an instrument to assess and monitor functional dependency in manipulating aids used in oral self‐care. It is part of the overall concept of oral self‐care which subsumes function, education and training, and compliance in achieving and maintaining oral health. The purpose of the Index of ADOH is two‐fold: to assess a subject for the progressive loss of the physical ability to manipulate the aids used in oral self‐care, and to measure the return to function in response to care intervention and rehabilitative services. These manipulative tasks are associated with flossing, brushing, topical fluoride application, and the use of oral rinses. Aside from changes in function, the Index of ADOH can be used by health care providers and administrators to project the need for services or support for home care.
Elder abuse and neglect: detection, reporting, and intervention
Authors: Johnson Teresa E. , Boccia Aldo D. , Strayer Michael S.
Published: March 2008

Dental providers are in an excellent position to identify elder abuse and neglect (EAN), yet they are often reluctant to report or intervene in cases of suspected elder maltreatment. This problem is widespread, and the negative impact of this dilemma cannot be ignored. In 1999, the American Dental Association's House of Delegates, through Resolution 44H–1999, urged constituent dental societies to educate their members about abuse and neglect and individual states' legal reporting requirements. The American Society for Geriatric Dentistry (ASGD), responding to a need to inform its members about this issue, requested this literature review on elder abuse and neglect. This paper emphasizes the role of the dental profession in ameliorating EAN and offers ASGD members recommendations to aid individual practitioners and staff in educating and assisting the profession in recognizing and reporting EAN.
Pyogenic granuloma in a renal transplant patient: case report
Authors: Al‐Zayer Mohammed , da Fonseca Marcio , Ship Jonathan A.
Published: March 2008

This case report describes a 14‐year‐old female referred to Pediatric Dentistry for evaluation and treatment of cyclosporine‐induced gingival hyperplasia. Examination of the anterior maxillary area showed a red, vascular, exophytic, soft‐tissue mass which had been excised a few months earlier without a histopathologic examination being done. The mass did not appear consistent with gingival overgrowth induced by long‐term use of medication, and thus an excisional biopsy was performed, which diagnosed the lesion as a pyogenic granuloma. A review of the literature and management recommendations are discussed.
The implications of visual impairment in an elderly population in recognizing oral disease and maintaining oral health
Authors: Schembri Alexander , Janice Fiske, DipGer
Published: March 2008

The incidence of impairment and disability increases in the elderly population. Disability can affect elderly people's ability to maintain oral health, maintain access to dental care, and accept dental treatment. The oral health of visually impaired people can be disadvantaged, since they are not in a position to detect and recognize early oral disease and may be unable to take immediate action unless informed of the situation. The aim of this pilot study was to identify the problems experienced by a visually impaired elderly population regarding the maintenance of oral health and the need to seek treatment. Sixty‐two legally blind people underwent a structured interview and a clinical dental examination. Data are presented descriptively. All the participants would be potentially able to maintain their own adequate oral health level if given the appropriate stimulus. At the time of the study, 53% brushed their own teeth, 39% of whom brushed daily. Of the denture wearers, 58% cleaned them at least once a week. Most of the participants were independent. Eighty‐two percent believed that they did not need help to brush their teeth or dentures, even though 85% had never been shown how to brush their teeth. Eighty percent of people did not realize that regular oral reviews were necessary. Other barriers to regular care included poor health, mobility problems, cost, and fear. Twenty‐one percent of the sample had toothache or a denture problem. The professionally assessed treatment need was high in the dentate group, and 32% of denture wearers had denture‐related pathology. The professionally assessed treatment need was greater than the visually impaired people's perceived need for care. The majority of visually impaired elderly were capable of maintaining a reasonable level of oral hygiene by themselves and were aware of their own dental needs but either had no reason to seek care or were unable to access oral health care services. It is important for visually impaired persons to realize that they need supervision to maintain good oral hygiene standards and to ensure the early identification of oral pathology. Also, the barriers to access to oral health services need to be reduced.
Oral health profile in an institutionalized population of Italian adults with mental retardation
Authors: Pregliasco Fabrizio , Ottolina Paolo , Mensi Carolina , Carmagnola Daniela , Giussani Francesco , Abati Silvio , Strohmenger Laura
Published: March 2008

The oral health of 219 residents with mental retardation living in a long‐term‐care institution near Milan was assessed. The dental and periodontal status, daily habits, oral hygiene, and oral mucosal status were evaluated. Of the sample, 179 (81.7%) were males. The mean age of the residents was 61.3 years, and the degree of cooperation was evaluated as good for 131 subjects (59.8%), fair for 79 (36.1%), and poor for nine (4.1%). The percentage of residents who were edentulous was 21.5% (47 subjects), of whom 28 subjects (59.6%) were without dentures. Evaluation showed an overall DMFT of 23.1, and the average number of missing teeth was 20.5. All subjects had periodontal disease: Forty‐five subjects had calculus and/or shallow pockets (4–5 mm); 61 had deep pockets (≥ 6 mm). The most common mucosal lesion was oral stomatitis (49.3%). These findings underline the need for special programs aimed at institutionalized subjects with mental retardation.
Experience and assessment of pain in individuals with cognitive impairments
Authors: Gabre Pia , DDS Kerstin Sjöquist
Published: March 2008

The authors review the literature on pain experience and pain assessment in people with cognitive impairments, focusing on individuals with dementia and mental retardation. The impact of cognitive impairments on pain sensation is not well understood, although some observations have been published. For example, research suggests that pain experience can be influenced by neuropathological processes in the brain and memory impairments. Reporting of pain decreases as cognitive impairment increases. In addition, poor verbal skills lead to difficulties in communicating pain. Pain assessment depends primarily on one's ability to describe the dimensions of pain. Individuals with limited ability to report pain can use pain assessment methods that rely on simple cognitive tasks. For individuals who have no ability to report pain, an outside observer must describe the discomfort experienced by interpreting the patient's body language. The authors conclude that further research is needed to develop valid and reliable assessment methods for people with cognitive impairments.
Oral disorders in institution‐dwelling elderly adults: a graphic representation
Authors: Maupomé Gerardo , Wyatt Christopher C.L. , Williams P. Michele , Aickin Mikel , Gullion Christina M.
Published: March 2008

This study was conducted to assess the oral health status and dental care needs of elderly adults living in long‐term care facilities. Dentists examined 601 elderly adults, living in one of six extended‐or intermediate‐care facilities, between September 1999 and May 2000. Data from 532 of the subjects were analyzed with descriptive statistics and zero‐order inverse polynomials. Using a computer program, the authors compiled summaries of oral health data on individuals and institutional levels. This study suggests that there are numerous unmet dental needs among elderly adults who live in institutions. The CODE index used to assess the oral health of these residents offers a systematic portrayal of oral disorders in terms of severity. As the authors demonstrated, this index can be readily analyzed using zero‐order inverse polynomials to summarize collected data into a graphic description, which can be helpful in managing and administrating oral health care interventions in long‐term care facilities.
Stimulated whole saliva components in children with Down syndrome
Authors: Siqueira Walter Luiz , Nicolau José
Published: March 2008

The authors report on the components of stimulated whole saliva from children with Down syndrome—including pH, flow rate, sialic acid and protein concentrations, and amylase and peroxidase activity. Saliva samples were collected from 35 children aged 6–10 years. Of the participants, 17 had Down syndrome and 18 did not. To stimulate saliva production, the children chewed a piece of parafilm for 10 minutes before the sample was collected. Soon after collecting the saliva sample, the authors measured pH using a portable pH‐meter. Sialic acid levels were determined with a thiobarbituric acid assay. Protein content was determined with Folin's phenol reagent. Amylase was assayed and the authors measured the maltose produced by the breakdown of starch and peroxidase using ortho‐dianisidine.

No statistically significant difference was observed in levels of sialic acid (free and total) between the two groups. Protein concentration was about 36% higher in the group with Down syndrome. However, the salivary flow rate, pH, and amylase and peroxidase activities were lower among the children with Down syndrome.
Mechanical and chemical home plaque control: a study of Brazilian children and adolescents with disabilities
Authors: de Abreu Mauro Henrique Nogueira GuimaraTes , PaixaTo Helena Heloisa , Resende Vera Lucia Silva , Pordeus Isabela Almeida
Published: March 2008

The purpose of this study was to evaluate the compliance of children and adolescents with disabilities with a home plaque control program. A random sample of 52 students between 7 and 21 years old was solicited from a special school, in Belo Horizonte, Brazil. Measurement of the Debris Index and the presence of bleeding on light probing of the buccal gingival papillae were included as part of the initial clinical examination. Plaque control instructions were given during the first and subsequent clinical sessions. During the fourth clinical session, the patients who had more than 25% sites with bleeding papillae on light probing were placed in a separate group (Group 2) which used a mechanical and chemical plaque control protocol. Group 1 consisted of persons who used mechanical plaque control only. All of the patients were followed up for two more recalls (days 51,81) during which they were given plaque control instruction and had another gingival examination. On day 111, the final Debris Index and gingival examination were carried out. A significant reduction (p < 0.02) was found between the first and final Debris Index recordings in both groups. Subjects in Group 1 had a significant reduction (p < 0.001) when the first gingival examination was compared with days 21, 51, 81, and 111. Group 2 showed significant reduction (p < 0.01) in gingival bleeding when day 21 was compared with days 81 and 111. Our study suggests that it is possible for these children/adolescents and their parents to learn and comply with mechanical and chemical plaque control at home.
Sickle cell anemia and dental caries: a literature review and pilot study
Authors: Laurence Brian , Reid Britt C. , Katz Ralph V.
Published: March 2008

The purpose of this cohort study was to determine whether individuals with sickle cell anemia (SCA) were more susceptible to dental caries than non‐sickle‐cell control subjects. A review of the literature suggests several reasons why individuals with SCA may be at increased risk. Thirty‐five cases of SCA aged 6 years and older were identified from a screening of 15,900 current patient files at the Howard University College of Dentistry Dental Clinic. A total of 140 non‐SCA control subjects (four per case), frequency‐matched on enrollment period (pL 5 yrs) and age (pL 2 yrs if under age 21, or pL 5 yrs if 21 or over), was selected by a nonbiased method from the same dental clinic files. SCA cases and controls were identical on mean age (30.4 pL 19 yrs, ranging from 5 to 92 yrs) and were similar in sex distribution (males: 34% of SCA cases, 40% of controls). The mean number of permanent teeth present was very similar for SCA cases and controls (23.4 pL 6.4 vs. 24.2 pL 6.4). The mean DMFT was 21% higher in the SCA cases (12.0 pL 8.4 vs. 9.9 pL 6.9), and the mean DMFS was 26% higher in the SCA cases (33.0 pL 32.3 vs. 26.2 pL 27.7). While there was virtually no difference in DMFS between SCA cases and controls for 6‐ to 19‐year‐olds, for subjects aged 20 and older, the DMFS was 30.4% higher in the SCD cases. For all ages, the M component for SCA cases was 40.7% higher, and the D component was 20.0% higher, while the F component was only 3.5% higher than for controls. Untreated decay (the D/D+F surfaces ratio) was 24.4% higher in the SCA cases. The findings from this pilot study suggest that SCA cases have a higher susceptibility to dental caries and/or that SCA patients may have different treatment pathways once caries is detected. While none of the observed differences was statistically significant, these findings were of clinical interest and should be pursued in future large‐scale studies.
Osteonecrosis of the maxilla as a complication to chemotherapy: a case report
Authors: Sung Eric C. , Chan Stephen M. , Sakurai Kari , Chung Evelyn
Published: March 2008

Numerous oral complications have been documented as a consequence of chemotherapy for the treatment of cancer. One not so well documented consequence of this treatment is avascular necrosis or osteonecrosis of the underlying bone. In this case report, osteonecrosis of the maxilla in a 48‐year‐old female patient who was treated for acute myelogenous leukemia is presented. The patient had successfully completed both induction and consolidation chemotherapy without steroid administration. Possible causes and difficulties in diagnosis were reviewed.
Program evaluation of mobile dental services for children with special health care needs
Authors: Brooks Constance , Miller Louise C. , Dane John , Perkins Dean , Bullock Linda , Libbus M. Kay , Johnson Paula , Stone Jill Van
Published: March 2008

This paper summarizes an evaluation of the Elk Mobile Dental Program for children with special health care needs. Evalutation results indicated overall client satisfaction with mobile dental unt services in the absence of competent community based dental care. Evaluator recommendations included expanding the mobile dental services along with a continued effort to establish permanent community based dental care for children with special healthcare needs. Recommendations for program improvement in the areas of patient care, service coordination, and ongoing continuous quality improvement evaluation were provided to program personnel and funding organizations. Many of the improvement recommendations were initiated during the process of the program evaluation.
Stimulated parotid salivary flow rate in patients with Down syndrome
Authors: Chaushu Stella , Becker Adrian , Chaushu Gabriel , Shapiro Joseph
Published: March 2008

Saliva is essential for oral defense against infections. Decreased salivary secretion may result in increased dental caries, oral mucosal changes, an altered sense of taste, difficulty in swallowing, and oral pain. A review of the literature reveals sporadic and contradictory reports on the use of sialometry and sialochemistry to explain the role of saliva in the oral health and well‐being of subjects with Down syndrome. The present study documents parotid gland saliva secretion at different ages in a group of subjects with Down syndrome. Saliva was collected from 39 patients 11 to 62 years old, by means of a parotid salivary gland cup and under standardized conditions of stimulated secretion. The rate of salivary secretion in the entire group of patients with Down syndrome was lower than that of healthy controls and lower in the older study group compared with the younger group. Institutionalized subjects or those living in hostellike apartments had a lower secretion rate than those living at home. No difference in salivary flow was found between those patients with Down syndrome with normal thyroid output and those with hypothyroidism who were receiving replacement therapy. In a four‐way ANOVA with flow as the dependent variable and Down syndrome, hypothyroidism, institutionalization, and age as factors, Down syndrome was found to be the only variable significantly related to flow (p = 0.017). Our findings indicate that stimulated parotid salivary hypofunction in Down syndrome subjects is mainly related to their genetic disorder.
The effect of an oral health education program after three years
Authors: Paulsson Gun , Söderfeldt Björn , Nederfors Tommy , Fridlund Bengt
Published: March 2008

Three years after providing an oral health education program (OHEP) to nursing personnel, the authors analyzed the effect of the program on knowledge of the importance of oral health and on perception among the nurses of the possibility to implement oral care in patient care. The study was based on a cross‐sectional survey of all nursing personnel (N = 2,901) in five municipalities in the Southwestern Sweden, of whom 950 had attended four one‐hour lessons during an OHEP in 1996. The response rate to the survey questionnaire was 67% (1,930 subjects). Statistical analysis was performed by means of descriptive and analytical statistics. The program was shown to have an independent effect on the dependent variables “knowledge of oral health” and “assessment of implementation possibilities,” This study has given further evidence of the feasibility of an educational program to improve both knowledge and implementation of oral health care.
Irrigational therapy of a dentigerous cyst in a geriatric patient: a case report
Authors: Nishide Naoto , Hitomi Gonjiro , Miyoshi Norio
Published: March 2008

Dentigerous cysts are recognized as one of the most common lesions of the jaws. Although surgical enucleation is usually the preferred treatment method, it is not always the best choice for elderly patients who have other medical complications. With cyst irrigational therapy, repeated irrigation allows bone regeneration around the cyst to progress more rapidly than that around a cyst treated operatively with marsupialization. We used irrigational therapy to treat a dentigerous cyst in a 72‐year‐old man who did not agree to surgery because he had no symptoms associated with the cyst, and he had other medical complications. After one year, remarkable bone regeneration was observed. We conclude that irrigational therapy appears to be an effective, less‐invasive alternative to surgery for geriatric patients.
Making clinical decisions for dental care: concepts to consider
Authors: White B. Alex , Maupomé Gerardo
Published: March 2008

Clinical decisions are often made with incomplete information, yet patient care decisions are made every day. Patients vary clinically, uncertainty exists in diagnostic and prognostic information, and many preventive and treatment alternatives have not been formally assessed for their effectiveness. Because scientific information will never answer all clinical questions, clinical decisions are partially based on probabilistic information.

This paper describes how to apply clinical decision making to diagnosing and managing dental caries and periodontal diseases. By using explicit information to quantify probabilities and outcomes, clinical decision making analyzes decisions made under uncertain conditions and the uncertain impact of clinical information.

Clinical decision making incorporates concepts for preventing, diagnosing and treating dental caries and periodontal diseases: risk assessment, evidence‐based dentistry, and multiple oral health outcomes. This information can serve as a tool for clinicians to augment clinical judgment and expertise.
Fluoride varnish for caries prevention: comparisons with other preventive agents and recommendations for a community‐based protocol
Authors: Weintraub Jane A. , Professor Lee Hysan
Published: March 2008

This paper reviews fluoride varnish (FV) literature to develop a community‐based protocol for people with special needs or those who are caries susceptible. Safety, personnel and cost issues are discussed and existing NIH, CDC and WHO recommendations are presented. FV studies are assessed with respect to type of FV to use and frequency of application. FV is compared with studies using other caries preventive agents: 0.2% NaF mouthrinse, acidulated phosphate fluoride (APF) gel, dental sealants, water fluoridation and chlorhexidine. Because there are few FV studies among special need populations, conclusions are based on available literature and public health principles. If personnel are available, FV use is preferred to APF gel and may be preferable to 0.2% NaF mouthrinse. FV is more effective in optimally fluoridated communities. If many occlusal surfaces are at risk, sealants should be applied. Additional combinations and frequencies of preventive agents should be tested, especially for people with special needs and high caries risk adults.
Dental implants for patients who have had radiation treatment for head and neck cancer
Authors: Harrison Jody S. , Stratemann Scott , Redding Spencer W.
Published: March 2008

Implant therapy is no longer considered impossible for patients who have received radiation treatment. However, the risk of osteoradionecrosis and failed osseointegration are barriers to implant therapy for this population. This paper reviews the published literature on the effects of radiation on tissue, such as osteoradionecrosis, hyperbaric oxygen therapy, and evaluates implant therapy in patients who have received radiation treatment, focusing on treatment of the mandible. Recommendations for dentists planning implant therapy for patients who have had radiation treatments are presented.
Special Olympics: The oral health status of U.S. athletes compared with international athletes
Authors: Reid Britt C. , Chenette Ronald , Macek Mark D.
Published: March 2008

The Healthy Athletes Special Smiles Program provides oral health screening and data collection for athletes with mental retardation who are participating in Special Olympic events. Recently, data regarding international athletes have become available for the first time, allowing a comparison against data collected in the United States. The international athletes from the countries of China, Lebanon, Poland, South Africa, and Turkey were generally younger than those of the United States (mean age 17.4 versus 24.0 years) and were more likely to be males (64.3 versus 54.6%). The international athletes were more likely to have untreated caries (50.1 versus 28.2%), and less likely to have restorations (19.6 versus 62.9%), sealants (1.8 versus 13.5%), fluorosis (3.5 versus 8.8%), signs of gingival disease (27.8 versus 40.1%), or to be edentulous (0.1 versus 3.7%). These relationships persisted after adjustment for sex and age differences between the populations.