bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pouching of medications in the mouth: a case report
Authors: Wakham M. Dean , McNeal Donald R. , Burtner A. Paul 
Published: March 2008

Foods or medicines can be pouched or held in the mouth to prolong taste, enjoyment, or effect. This article describes a patient who pouches medications. The oral injury that occurred from this behavior is reported.SummaryIn this report, an institutionalized 44‐year‐old female who was developmentally disabled with sloughing of oral tissue and ulcer formation in the mandibular buccal vestibules visited the dental clinic. Toothbrush trauma to the oral tissues was suspected initially and was ruled out. On the empirical recommendations of an oral pathologist who examined the patient, ketoconazole was prescribed by the patient's physician. This treatment was not effective. After medication pouching was suspected, simethicone was changed from chewable tablets to a liquid. The patient's caretakers and nurses observed the patient after medications were administered to be sure that the patient was not holding medication in her mouth.Although tissue sloughing was resolved, ulcerations of the tissue persisted in the mandibular mucobuccal fold. A biopsy of these ulcerated areas was not diagnostic for any suspected pathosis. Five months after her initial visit, the patient showed no signs of ulceration or desquamation of her oral tissues. Thus, changing simethicone chew‐able tablets to a liquid, the increased efforts of the direct care staff members and nurses to prevent the patient from holding medications in her mouth, and the gradual improvement of the patient's oral condition confirmed the provisional diagnosis of pouching medications.Medication pouching may not be a unique habit limited to patients in institutions for the mentally handicapped. It is a problem observed in some geriatric patients in long‐term facilities or nursing homes, as well (J. Thomas, director of geriatric dentistry, Veterans Administration Medical Center, personal communication, 1990). Several recommendations should be followed to prevent this habit and the injury that may occur:1. Patients who have difficulty swallowing tablets or capsules may be given liquid medications.2. Medications that can be crushed without adversely affecting the drug's absorption in the gastrointestinal tract can be administered in applesauce or another pleasant tasting food. Mitchell22 has reported on several medications that should not be crushed.3. Fluids should be given to facilitate swallowing.4. After medications are given, inspect the mouth for any remaining portions.One problem dental professionals may encounter when treating patients with mental retardation or impairment is the difficulty in determining the causes that would be helpful in correctly diagnosing certain oral problems. This difficulty results from the reduced capability for communication between the doctor and patient and from the doctor's lack of awareness of unique habits found among these patients. When examining patients of this type, medication pouching should be included as a possible causative factor in the differential diagnosis of oral ulcerative lesions.
Special Concern: Personality and dental care utilization: findings from the VA longitudinal study
Authors: Kennedy Betsy D. , Aldwin Carolyn M. , Bossé Raymond , Douglass Chester W. , Chauncey Howard H. 
Published: March 2008

The personality traits of introversion/extraversion and neuroticism were investigated as determinants of the utilization of restorative dental care, controlling for socioeconomic status and restorative need. The VA Dental Longitudinal Study (DLS) provided information on the restorative treatment received by 593 healthy adult males during a 10–year period. Utilization of restorative services was measured by calculating the percentage of surfaces that needed and received treatment, as identified by the DLS examiners by clinical and radiographic examination. Oral examinations were initiated in 1969 with subsequent examinations occurring at approximately 3–year intervals. Personality measures for these individuals were obtained using the EPI‐Q, a shortened form of the Eysenck Personality Inventory.A plot of neuroticism versus the utilization measure yielded a curvilinear relationship suggesting that participants seeking the most dental care scored moderately on the neuroticism scale while those scoring lowest and highest on this scale sought less treatment. In contrast, the introversion/extraversion scale showed no apparent relationship with dental care utilization. Results from the regression analysis suggest that dentition and socioeconomic status are strong determinants of utilization and that need for restorative treatment influences utilization.
Cri‐du‐chat syndrome: dental considerations and report of case
Authors: Boraz Robert A. 
Published: March 2008

Cri‐du‐chat syndrome is a severe disease resulting from a deletion of the short arm of chromosome number 5. The basic medical disorder includes dysmorphic facies, mental retardation, and a striking catlike cry in infancy. Because of significant oral anomalies and difficulty in behavior management, the syndrome is of particular interest to the dental practitioner. A case with many of the typical medical findings and significant dental considerations is reported.An aggressive preventive dentistry program is essential. A thorough understanding of the medical and developmental problems of the patient with cri‐du‐chat syndrome ensures safe and effective dental care.
Common misconceptions about oral health in the older adult: nursing practices
Authors: Logan Henrietta L. , Ettinger Ronald , McLeran Hermine , Casko Roberta 
Published: March 2008

A survey of nurses, director‐supervisors, and nursing home health aides who provide home care in Iowa showed that many misconceptions exist about what constitutes appropriate oral and dental care practices for the older adult. Despite differences in formal education among these nursing personnel, several misunderstandings about dental problems among older adults were common to all three employment groups. These misconceptions represented a broad range of topics from the characteristics of orai cancer lesions to the appropriate use of denture adhesives; two dealt specifically with the recognition of potential oral cancer lesions. This paper describes attitudes and misinformation held by the respondents, and suggests ways to correct these fallacies through in‐service training programs.As a part of this funded project, a complete package for presenting a 3 1/2 hour continuing education program about oral health in the elderly was produced. This set entitled “Oral Health in the Elderly: A Workshop Curriculum and Teacher's Guide” includes color slides, 2 video tapes, teaching instructions, and a script and is available at cost. Other materials specifically designed for in‐service training of nursing home personnel are also available. For more information, please write the senior author.
An in vitro analysis of a sustained release system for the treatment of denture stomatitis
Authors: Schneid Thomas R. 
Published: March 2008

This study investigated the feasibility of a sustained‐release delivery system for the treatment of denture stomatitis using four antifungal agents (chlorhexidine, clotrimazole, fluconazole, and nystatin) incorporated into a tissue conditioner (Lynal®) at zero (control), low, medium, and high concentrations.Hardness of all experimental groups increased with both concentration and time, but remained within the range of clinical acceptability (Shore A ≤ 49).Mean tensile strength increased in all experimental groups and was significantly stronger than the control for at least one concentration level of each drug, p ≤ 0.05.All failures for tensile‐strength testing were characterized as cohesive.All drugs demonstrated release from the tissue conditioner matrix and inhibition of growth of C. albicans that was either total, dose‐related, or related to incubation time prior to inoculation. All controls supported growth.
A review of liver transplantation for the dentist and guidelines for dental management
Authors: Glassman Paul , Wong Christine , Gish Robert 
Published: March 2008

The number of recipients of liver transplants has grown rapidly in the last few years and is likely to continue to do so in the future. The dentist should be prepared to see individuals who are contemplating or have had liver transplants.The major goal of dental intervention, before and after liver transplantation, is the prevention of bacteremia from an oral source that could lead to systemic infection. In addition, pre‐transplant medical conditions of concern to the dentist include poor drug metabolism, bleeding disorders, poor wound healing, and an inability to metabolize swallowed blood. Post‐transplant dental treatment must take into consideration immunosuppressive drugs and the potential for infections.Dental treatment should include a thorough dental examination, elimination of dental problems that could cause medical problems, and an intensive preventive dentistry program to minimize the occurrence of dental disease.
Patients with chronic hepatitis—potential risks when undergoing dental surgery: Review and case report
Authors: Reddi Sanjay , Garg Arun K. 
Published: March 2008

This is a case report of a 17‐year‐old male patient with chronic autoimmune active hepatitis (CAAH) who was referred to our clinic for dental treatment prior to his undergoing liver transplant surgery. Coagulation problems and the implications of long‐term corticosteroid usage in patients with chronic hepatitis are presented. Differences in the etiology, histology, clinical features, laboratory findings, treatment, and prognosis are reviewed for the three separate but related forms of chronic hepatitis — persistent, lobular, and active hepatitis.SummaryIt is important to be aware of a patient's total medical picture, and how any preexisting conditions and their treatments might affect the dental care to be provided, especially in cases of invasive dental procedures. Such procedures, like any surgery of similar magnitude, have inherent risks, and the preoperative medical evaluation and postoperative care of these patients should be the same as those provided for other comparable surgeries, thus minimizing the risks of the operative procedure.In our case, the patient's condition had been previously diagnosed, and we were able to develop our treatment plan accordingly. Sometimes, though, a patient presents with problems that may be a manifestation of a more serious systemic disorder (e.g., bleeding gums in the absence of obvious periodontal disease). Thus, the dentist should be alert to the possible presence of other underlying medical disorders and, if any are suspected, should consult with a physician prior to undertaking elective dental procedures.
A preventive dentistry training program for caretakers of persons with disabilities residing in community residential facilities
Authors: Glassman Paul , Miller Christine , Wozniak Thom , Jones Clay 
Published: March 2008

People with disabilities develop more dental disease than the average population and have a harder time accessing and using resources for dental treatment. It is therefore critical to prevent dental problems in this population. This article discusses the development and use of a preventive dentistry training program consisting of a videotape, workbook, instructions for trainers, and pre‐ and post‐tests. The training program was designed to facilitate integration of dental and behavioral information into daily routines.Participants were able to demonstrate that they could learn the information in the training materials using the methodology that was employed. Further work remains to be done to revise and disseminate the materials and to demonstrate that the knowledge that the participants gained can be effectively applied in community care settings.
Factors which influence the oral condition of chronic schizophrenia patients
Authors: Thomas Alex , Lavrentzou Evanthia , Karouzos Charis , Kontis Costas 
Published: March 2008

The oral health status of 249 individuals with chronic schizophrenia was evaluated by means of the Oral Hygiene Index (OHI‐S) and Decayed, Missing and Filled Teeth scores (DMFT). The patients were subdivided as to chronicity of illness and venue of psychiatric treatment (158 inpatients ≥ 10 years' hospitalization, 34 inpatients ≤ 10 years' hospitalization, and 57 outpatients). The severity of schizophrenia was determined by: the Brief Psychiatric Rating Scale (BPRS), the intensity of negative symptoms of schizophrenia [as measured by the Brief Psychiatric Rating Scale, Negative Symptoms (BPRSNEGS)], and the equivalent dose of chloropromazine (EDC).This study demonstrated that inpatients had greater amounts of dental disease than outpatients. The extent of dental disease among inpatients as measured by both the OHI‐S and DMFT scores was directly related to the intensity of schize phrenia (BPRS), magnitue of negative symptoms associated with schizophrenia (BPRSNEGS), and length of hospitalization. DMFT scores were directly related to EDC value.
Practice guidelines and quality: Is there a connection?
Authors: Van Ostenberg Paul R. 
Published: March 2008

Yes! Practice guidelines are clearly connected to quality. To characterize that connection adequately, however, is a more formidable task and is the subject of this paper.This paper will capture, in a few words, the essence of my perspective and experience related to quality issues and then attempt to establish a connection between practice guidelines and quality from two perspectives: first, by suggesting a series of assumptions that would lead to a decision on what should be the focus of an appropriate guideline for an older adult, since there are many possibilities and agreeing on assumptions is a logical first step; and second, by suggesting a framework for the content of such guidelines.
Ethical issues in nursing home care: Practice guidelines for difficult situations
Authors: Shuman Stephen K. , Bebeau Muriel J. 
Published: March 2008

SummaryDental professionals encounter a number of challenging ethical and legal dilemmas when caring for nursing home residents. Questions may arise in determining a patient's capacity to make decisions, securing consent for treatment, choosing the most appropriate from among several treatment options, and when and how to use restraints. When securing consent for treatment, practitioners must consider both the patient's legal competence and his/her decision‐making capacity, and adopt roles appropriate to the patient's circumstances. If legal competence has been retained but decision‐making seems impaired, practitioners must involve others in the process of determining appropriate care. The capacity to consent to treatment can be assessed by questions designed to evaluate the patient's ability to understand relevant information, appreciate the situation and consequences, manipulate information rationally, and communicate choices. When faced with a choice of several treatment options and patient preferences are unclear or unknown, the principle of substituted judgment should be used to attempt to provide care in keeping with the patient's values. To maximize patient safety and dignity, ten guidelines are presented for the use of restraints to provide dental care for individuals with behavior problems.
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, andRestricting 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
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 52242The 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.
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

ABSTRACTPatients 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

ABSTRACTIn 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

ABSTRACTMeasures 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.