Dental health in rural Victoria: the Crossroads Household Survey

BACKGROUND

The aims of this study were to describe dental health and perceived barriers to dental care in a regional centre and surrounding smaller towns in rural Victoria.

METHODS

A stratified, randomized, face-to-face household survey was undertaken to assess levels of edentulism and access to oral health services. A study response rate of 70.3 per cent (6316/9260) was achieved.

RESULTS

When compared with those in the regional centre, people living in the shire capitals were more likely to travel greater distances to see a dentist and were less likely to have seen a dentist within the past 12 months. While there was little difference in the edentulous proportion living in shire capitals compared with the regional centre, the level of edentulousness over the entire region was greater than overall Australian estimates. Differences in perceived barriers to care within the region were less than expected. Existing perceived barriers were lack of need, time until available appointments, attitudes of dentists and lack of public dental facilities. Differences in these barriers existed between socio-economic groups.

CONCLUSIONS

This study shows that the prevalence of edentulism was higher in the areas studied relative to the Australian population. Significant patient perceived barriers to care exist which may contribute to the problem.

Oral hygiene and the need for treatment of the dependent institutionalised elderly

OBJECTIVE

To assessing the oral hygiene and treatment needs of a geriatric institution in southern France.

BACKGROUND

For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments.

MATERIALS AND METHODS

From 2003 to 2004, a cross-sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated.

RESULTS

The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment.

CONCLUSION

The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly.

Adult Oral Health Inequalities Described Using Area-based and Household-based Socioeconomic Status Measures

OBJECTIVES

To describe adult oral health inequalities using an area-based and household-based measure of socioeconomic status (SES).

METHODS

Self-report questionnaires (seeking information on sociodemographic, oral health and oral self-care) were sent to a random sample of adults from the Dunedin South Electorate, New Zealand. Household- and area-based SES measures were collected. The main outcome measures were edentulism prevalence, average-poor self-rated oral health and not having visited a dentist for 2+ years. Data were weighted to produce population-based estimates.

RESULTS

The response rate was 78.2%; the sample mean age was 47 years (sd, 17; range 18-92 years) and females comprised 54.0%. Edentulism was most prevalent among those from low-SES households who were resident in high-deprivation areas (P<0.0001). Poor self-rated oral health (P<0.0001) and 2+ years since the last dental visit (P<0.0001) were also most prevalent among these same individuals. In contrast, respondents from high-SES households located in the least deprived areas had the lowest prevalence of edentulism, poor self-reported oral health or 2+ years since their last dental visit. Those from the other household/area SES combinations occupied intermediate positions.

CONCLUSIONS

There may be added value to dental public health in using a dual socio-economic measurement approach to population research, with greater oral health gains perhaps being possible by concentrating resources and clinical effort on people living in low-SES households in highly-deprived areas, rather than those living in low-SES households in areas that are not deprived.

Pattern of tooth loss in an elderly population from Ibadan, Nigeria

OBJECTIVES

To determine tooth loss, edentulousness, causes of tooth loss and pattern of tooth loss in the elderly in South East Local Government area (SELGA) in Ibadan.

BACKGROUND DATA

SELGA is one of the largest in Oyo State, Nigeria and has a population of 225,800.

DESIGN

A cross-sectional survey.

METHODOLOGY

A total of 690 elderly individuals who were 65 years and above living in various wards in SELGA were interviewed by two interviewers and examined by two trained and calibrated examiners whilst two record clerks recorded all the findings of the examination.

RESULT

Forty-eight per cent of the subjects in the study had not lost any teeth. The mean tooth loss was 4.5+/-7.6. Percentage edentulousness was 1.3% and this was higher in males than in females. This difference was not statistically significant (chi(2)=0.07 p=0.7). The total number of teeth lost was 3,102, 14% of the total number of teeth examined. The study showed that caries was not a major cause of tooth loss. Only 22 (0.7%) teeth were lost as a result of caries, 19 (0.6%) were lost because of trauma and periodontal disease contributed to loss of 3,061 (98.7%) teeth. Mandibular teeth exhibited a higher rate of retention than maxillary teeth. The percentage of elderly individuals with tooth loss increased with age.

CONCLUSION

The study highlights the high life expectancy of a tooth among the elderly in SELGA. Despite the different cause of tooth loss in this area, in comparison with developed countries, the pattern of tooth retention appeared similar.

Risk factors and prevalence of periodontitis in community-dwelling elders in Mexico

AIM

The objective of this study was to determine whether an association existed between chronic systemic diseases/conditions, risk factors common in old age, and the extent and severity of chronic periodontal disease.

MATERIALS AND METHODS

Sociodemographic and lifestyle characteristics were examined by contrasting rural, urban-marginal, and urban social environments in Central Mexico. Data were analysed with Analysis of Variance, chi2 tests, and multivariable logistic regression.

RESULTS

A total of 473 adults 60 years old and over were interviewed; 315 were also examined and underwent laboratory assays (participation rate, 66%); women, 62%; mean age 73+/-8 years; 23% edentulous. The distribution of periodontitis by sociodemographic variables showed differences across locales (73% low-urban, 57% middle-urban, 29% rural). The regression model indicated that periodontitis was more frequently associated with low-urban locale, higher systolic blood pressure, higher body mass index, and worse calculus readings, with an interaction whereby being obese and having a high calculus index was associated with a high probability of having periodontitis.

CONCLUSIONS

Overall periodontal conditions were fair. While we identified oral, systemic, and social variables that modulated the experience of periodontitis, it would appear that urban, low social class elders appeared to have worse periodontal conditions.

Tooth loss and obstructive sleep apnoea

BACKGROUND

Complete tooth loss (edentulism) produces anatomical changes that may impair upper airway size and function. The aim of this study was to evaluate whether edentulism favours the occurrence of obstructive sleep apnoea (OSA).

METHODS

Polysomnography was performed in 48 edentulous subjects on two consecutive nights, one slept with and the other without dentures. Upper airway size was assessed by cephalometry and by recording forced mid-inspiratory airflow rate (FIF50). Exhaled nitric oxide (eNO) and oral NO (oNO), were measured as markers of airway and oropharyngeal inflammation.

RESULTS

The apnoea/hypopnoea index (AHI) without dentures was significantly higher than with dentures (17.4 +/- 3.6 versus 11.0 +/- 2.3. p = 0.002), and was inversely related to FIF50 (p = 0.017) and directly related to eNO (p = 0.042). Sleeping with dentures, 23 subjects (48%) had an AHI over 5, consistent with OSA, but sleeping without dentures the number of subjects with abnormal AHI rose to 34 (71%). At cephalometry, removing dentures produced a significant decrease in retropharyngeal space (from 1.522 +/- 0.33 cm to 1.27 +/- 0.42 cm, p = 0.006). Both morning eNO and oNO were higher after the night slept without dentures (eNO 46.1 +/- 8.2 ppb versus 33.7 +/- 6.3 ppb, p = 0.035, oNO 84.6 +/- 13.7 ppb versus 59.2 +/- 17.4 ppb, p = 0.001).

CONCLUSION

These findings suggest that complete tooth loss favours upper airway obstruction during sleep. This untoward effect seems to be due to decrease in retropharyngeal space and is associated with increased oral and exhaled NO concentration.

Tooth loss, the wearing of dentures and associated factors in Sri Lankan older individuals

OBJECTIVE

To determine tooth loss, wearing of dentures and associated factors in older individuals from Sri Lanka.

DESIGN

A cross-sectional survey where the data were collected by means of an oral examination and an interviewer administered questionnaire.

SETTING

Negambo within the Gampaha district of Sri Lanka.

SUBJECTS

A total of 630 subjects who were aged 60 years and above.

RESULTS

Only 11 subjects had all 32 teeth and 17% were edentulous. Age, gender and level of income were significantly associated with the number of missing teeth. Of those with missing teeth, 22% wore dentures. Only 16% of the non-denture wearers perceived a need for dentures. Among the non-denture wearers who perceived a need for dentures, a majority had cited 'cost' as the main barrier for obtaining dentures. Logistic regression analysis revealed that age, gender, levels of income and education and missing teeth were significant predictors of wearing of dentures.

CONCLUSIONS

Knowledge of factors that influence tooth loss and wearing of dentures may have implications for oral health care planners in the provision and delivery of oral health services to the older individuals.

[Clinical image of oral mucous membrane in rheumatoid arthritis patients]

The aim of the study was to evaluate the character and frequency of pathological changes in the oral cavity mucous membrane and xerostomy in patients with prolonged hospital and ambulatory treatment due to rheumatoid arthritis (RA).

EXAMINATION MATERIAL

The study was conducted in 120 patients with RA, average age 54, and in the control group of 40 generally healthy examinees, average age 53.

RESULTS

In patients with RA pathological changes in the oral cavity appeared much more frequently: erosions, fissures, perleche, candidiasis oris, lichen Wilsoni, leukoplakia and persistent xerostomy. RA patients more often used partial prosthesis and more frequently were edentulous.

CONCLUSIONS

The treatment of oral cavity diseases and prophylaxis should be provided together with the RA treatment, with special emphasis put on the elimination of xerostomy. Good cooperation of rheumatologists and periodontologists is recommended RA diagnosis.

[Clinical epidemiological study of xerostomia in elderly totally edentulous]

INTRODUCTION

Because of an increasing number of older people in our community presenting with a variable decrease of salivary flow which affects their quality of life, we aimed to analyze the prevalence of salivary decrease and xerostomia in relation to various causing factors.

PURPOSE

The objective of this study was to analyze the prevalence of a decrease of normal salivary secretion and xerostomia in relation to various factors in the older population of our community.

MATERIAL AND METHOD

One hundred and twenty-six edentulous male and female subjects older than 50 years (62.41 8.24) were entered . A chart was specially designed for this study where both local and general predisposing factors were recorded. The results were statistically analyzed.(P < 0.05)

RESULTS

40.5% of the subjects had xerostomia. The number of cases increased with age and was larger among women, being differences statistically significant in women aged 60-69 years. 34.9% appeared to be in good health, 65.1% suffered from one or more systemic diseases, while 53.3% used medication daily (2.4 +/- 1.10 daily drugs).

DISCUSSION

There were significant differences when scarce salivary flow and a feeling of oral dryness were associated with health problems and the use of medication. The study showed that old age is a major factor in the decrease of salivary secretion and xerostomia, and that women are usually more affected.

CONCLUSIONS

Xerostomia may be attributed to various causes. It is not considered a disease but a clinical manifestation of oral dryness with or without hyposalivation. Once the disorder has been identified, health professionals should join to design a suitable treatment planning.

Trends in prosthodontics

Prosthodontics is concerned with the impact of tooth or tissue damage and partial or complete loss of teeth on oral function in its broadest sense. It deals with this largely through prosthetic replacement. The discipline occupies a major portion of a dental school curriculum, and dental practitioners usually devote much of their practice to prosthodontic services. With the rapid improvement in oral health and the reduction of edentulism in many countries, increasing numbers of people are retaining more teeth later in life.Gradually,the main focus in prosthodontics has shifted from removable dentures to fixed prostheses, while implant-supported restorations have attracted intense interest in the dental community. Another factor increasingly influencing prosthodontic practice is patients' awareness of newer technologies in aesthetic dentistry. Because prosthodontic interventions as well as maintenance and repair are by nature costly, the global development in the field manifests fundamental inequalities in the levels of service that patients can access. Diminishing resources for health care in general challenges educators and practitioners of prosthodontics alike. This review is an attempt to describe the recent developments in prosthodontics and its therapeutic areas, and the impact such developments may have on the theory and practice of the discipline.

Saúde bucal de idosos institucionalizados, zona leste de São Paulo, Brasil, 1999

Verificar as condições de saúde bucal de idosos institucionalizados, na cidade de São Paulo, Brasil, por meio de exame epidemiológico. Foram selecionados 293 indivíduos, estratificados segundo a faixa etária (65-74 anos e 75 anos e mais) e gênero. O exame epidemiológico foi realizado segundo critérios preconizados pela Organização Mundial da Saúde para determinar a prevalência das doenças bucais. Foram usados os testes qui-quadrado e Mann-Whitney para verificar as diferenças entre as estratificações com nível de significância de 95%. Do total dos indivíduos, 64,8% eram mulheres e 65,2% tinham 75 anos ou mais. O CPO-D foi de 30,8, com 96,3% de dentes perdidos, sendo que esta porcentagem foi estatisticamente maior para as mulheres (97,0%); 94,7% apresentaram cálculo como maior grau de condição periodontal; apenas 1,8% possuía condição periodontal sadia e 33,3% tiveram perdas de inserção entre 6 e 8mm. Quanto ao uso de prótese total, 48,1% usavam prótese superior e 22,5% inferior. A porcentagem de indivíduos totalmente edêntulos foi de 68,3%. Os dados apresentados caracterizaram condições clínicas insatisfatórias, podendo ser evidenciadas pelo elevado índice CPO-D e alta porcentagem de edentulismo.

A saúde bucal do idoso brasileiro: revisão sistemática sobre o quadro epidemiológico e acesso aos serviços de saúde bucal

O envelhecimento populacional, evento concomitante à queda da taxa de fecundidade, alterou significativamente a estrutura da pirâmide etária brasileira. Paralelamente à transição demográfica, a transição epidemiológica vem alterando os padrões de morbimortalidade, sem que haja, no entanto, adequada oferta de atenção à saúde para esse grupo populacional. Por meio de busca em bases de dados, objetivou-se realizar uma revisão sistemática da literatura, no período de 1986 a 2004, sobre os problemas bucais mais prevalentes entre os idosos brasileiros e conhecer os principais obstáculos no acesso aos serviços de saúde. Os valores médios do índice CPO-D encontrados nos artigos pesquisados foram de 25 a 31. Verificou-se grande porcentagem de indivíduos edêntulos. As principais barreiras quanto ao acesso aos serviços odontológicos foram a baixa escolaridade, a baixa renda e a escassa oferta de serviços públicos de atenção à saúde bucal. Diante desses fatores, a saúde bucal do idoso brasileiro encontra-se em situação precária, com elevados índices de edentulismo, refletindo a ineficácia historicamente presente nos serviços públicos de atenção odontológica, limitado a extrações em série e serviços de urgência, baseados no modelo curativista.

Mundgesundheitsbezogene Lebensqualität älterer Menschen

PURPOSE

The aim of this study was to describe the oral health related quality of life (OHRQoL) of institutionalized elderly.

MATERIAL

159 elderly were randomly selected for this, study ranging in age from 61 to 98 (mean age 82.8; 19.1% male, 80.9% female). For measuring the OHRQoL the Oral Health Impact Profile (OHIP) was used. Additionally, a dental status was evaluated.

RESULTS

15% of the subjects had only natural teeth or fixed dentures, 80% removable dentures and 15% no dentures at all. OHIP-mean reached 33+/-25 points, between 0 and 112. The subcategory "functional limitation" showed the highest impairment (6.3%). The items with the highest impairment on OHRQoL in the different subcategories were: dentures not fitting properly, uncomfortable dentures, self-conscious due to teeth, avoid eating some foods, felt depressed, avoid going out and general health worsened.

CONCLUSIONS

The OHIP summary score represents an overview of OHRQoL and answers detailed questions with the help of the single items. In institutionalized elderly many items showed impairment, especially in items concerning the prosthetic restorations. This demonstrates the need for dental aftercare and not only dental interventions for acute pain. Establishing aftercare and prophylaxis could increase the OHRQoL and subsequently the overall well-being.

Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002

PROBLEM/CONDITION

Dental caries is a common chronic disease that causes pain and disability across all age groups. If left untreated, dental caries can lead to pain and infection, tooth loss, and edentulism (total tooth loss). Dental sealants are effective in preventing dental caries in the occlusal (chewing) and other pitted and fissured surfaces of the teeth. Enamel fluorosis is a hypomineralization of enamel related to fluoride exposure during tooth formation (first 6 years for most permanent teeth). Exposure to fluoride throughout life is effective in preventing dental caries. This is the first CDC Surveillance Summary that addresses these conditions and practices.

REPORTING PERIOD

1988-1994 and 1999-2002.

SYSTEM DESCRIPTION

The National Health and Nutrition Examination Survey (NHANES) is an ongoing survey of representative samples of the civilian, noninstitutionalized U.S. population aged >/=2 months in NHANES 1988-1994 and all ages during 1999-2002. The dental component gathered information on persons aged >/=2 years.

RESULTS

During 1999-2002, among children aged 2-11 years, 41% had dental caries in their primary teeth. Forty-two percent of children and adolescents aged 6-19 years and approximately 90% of adults had dental caries in their permanent teeth. Among children aged 6-19 years, 32% had received dental sealants. Adults aged >/=20 years retained a mean of 24 of 28 natural teeth and 8% were edentulous. Among persons aged 6-39 years, 23% had very mild or greater enamel fluorosis. Disparities were noticed across all age groups, among racial/ethnic groups, persons with lower education and income, and by smoking status. From 1988-1994 to 1999-2002, four trends were observed: 1) no change in the prevalence of dental caries in primary teeth among children aged 2-11 years, 2) a reduction in prevalence of caries in permanent teeth of up to 10 percentage points among persons aged 6-19 years and up to six percentage points among dentate adults aged >/=20 years, 3) an increase of 13 percentage points in dental sealants among persons aged 6-19 years, and 4) a six percentage point reduction in total tooth loss (edentulism) among persons aged >/=60 years.

INTERPRETATION

The findings of this report indicate that the dental caries status of permanent teeth has improved since the 1988-1994 survey. Despite the decrease in caries prevalence and severity in the permanent dentition and the increase in the proportion of children and adolescents who benefit from dental sealants, disparities remain.

PUBLIC HEALTH ACTION

These data provide information for public health professionals in designing interventions to improve oral health and to reduce disparities in oral health, for researchers in assessing factors associated with disparities and dental caries in primary teeth, and in designing timely surveillance tools to monitor total fluoride exposure.

Autopercepção e condições de saúde bucal em uma população de idosos

Este estudo avaliou as condições de saúde bucal clinicamente e através da autopercepção. A amostra foi de 112 indivíduos com mais de 60 anos, residentes em Rio Claro, São Paulo, Brasil, dividida em G1 - sem acesso a tratamento odontológico conveniado (n = 55) e G2 - com acesso a tratamento odontológico conveniado (n = 57). Os exames clínicos seguiram critérios da Organização Mundial da Saúde. A autopercepção foi avaliada usando o índice GOHAI (Geriatric Oral Health Assessment Index). O CPO-D foi de 29,13, maior no G1 (p = 0,0091). A média de dentes presentes foi de 7,63, maior no G2 (p = 0,0131). As condições periodontais avaliadas apresentaram uma grande porcentagem de sextantes nulos (70,3%), sendo que o CPI apontou o cálculo como a maior prevalência, e o PIP, as bolsas até 3mm. A porcentagem de indivíduos edêntulos foi de 45,5%, maior no G1 (p = 0,0142). Dentre os edêntulos, 69,6% usavam próteses totais superiores, e 42,9%, inferiores. A média do GOHAI foi de 33,61, qualificando como positiva a percepção da saúde bucal e houve diferença apenas na dimensão física, com o maior valor no G2 (p = 0,0154). A autopercepção da saúde bucal foi satisfatória, o que não pôde ser confirmado com os dados clínicos obtidos nos grupos.

Trends in prevalence of complete tooth loss among Australians, 1979--2002

Edentulism is a key indicator of the oral health status of populations and is associated with reduced quality of life.

OBJECTIVE

To describe temporal trends in the prevalence of edentulism in the Australian adult population.

METHODS

Data were obtained from four national surveys of persons aged 15 years and over conducted in 1979, 1987/88, 1994 and 2002. Prevalence estimates and standard errors were calculated for each survey for males and females and each State/Territory. Birth cohort analysis was undertaken to track changes in prevalence across successive surveys. Data from the 1987/88, 1994 and 2002 surveys were age-standardised to the 1979 resident population estimates for each State and Territory and crude and adjusted prevalence estimates were compared.

RESULTS

The crude prevalence of edentulism declined from 20.5% (95% CI 20.1-20.7) in 1979 to 8.0% (95% CI 7.2-8.8) in 2002. The 2002 age-standardised estimate of 7.1% (95% CI 6.5-7.7) was only marginally lower. There were substantial reductions in prevalence of edentulism in all ages, sexes and State/Territories of Australia during the 23-year period. There were no significant changes in edentulism prevalence in three birth cohorts born since 1915.

CONCLUSION

Edentulism prevalence at least halved between 1979 and 2002 among all ages, sexes and States/Territories of Australia. There was no significant change in prevalence of edentulism in cohorts born since 1915, refuting the notion that the risk of edentulism increases due to ageing, suggesting instead today's elderly had historically high rates of extraction prior to the 1950s that have not been experienced by subsequent cohorts.

A 24-year follow-up of root filled teeth and periapical health amongst middle aged and elderly women in Goteborg, Sweden

AIM

To describe the endodontic status amongst middle-aged and elderly women longitudinally and cross-sectionally over 24 years.

METHODOLOGY

A random sample of 1462 women 38, 46, 50, 54 and 60 years old, living in Göteborg, Sweden, were sampled in 1968 for medical and dental examinations with a participation rate of 90.1%. The same women were re-examined in 1980 and 1992 together with new 38- and 50-year-old women. The dental examination consisted of questionnaires, clinical and panoramic radiological survey (OPG). The number of teeth, number of root filled teeth (RF) and number of teeth with periapical radiolucencies (PA) were registered. The RF and PA ratios were calculated. Cross-sectional data were analysed by means of anova and longitudinal data by a general linear model for repeated measures. Sample prevalences were compared and statistical inferences were made with the chi-squared test. In all analysis, the confidence interval (CI) regarded mean difference between groups (95% CI).

RESULTS

The RF and PA ratio decreased over time as well as the frequency of edentulous subjects. Cross-sectional analysis revealed a minor increase in frequency of RF and PA and loss of teeth with age. Longitudinally, loss of teeth was evident in all cohorts. In addition, there was a trend of lower number of teeth with PA, and the RF ratio increased with age.

CONCLUSIONS

The prevalence of periapical disease did not increase with age, probably as a result of root canal treatment and extractions. Data showed that the prevalence of RF teeth and teeth with PA decreased for comparable age cohorts during the 24-year follow-up.

Cognitive impairment is associated with poor oral health in individuals in long-term care

PURPOSE

The aim of this work was to study oral hygiene and cognition in patients in long-term care.

MATERIALS AND METHODS

A representative sample of individuals in long-term care aged 67 years and above, from all 19 countries of Norway, was selected for the study. Trained local dental teams examined 1910 individuals--1358 from institutions and 552 living at home. Oral hygiene was assessed by means of a combined plaque and mucosal score (MPS), and cognition by means of a short version of Mini-Mental State Examination (MMSE-12).

RESULTS

Mean age was 84.2 years and the age range was 67-106 years. Over 70% were cognitively impaired. Cognitive impairment increased with age and was more prevalent in institutionalised individuals compared to those living at home. Poor oral status was more prevalent among individuals with cognitive impairment.

CONCLUSION

The results of this study indicate that a large proportion of individuals in long-term care in Norway show cognitive impairment. A high proportion of these has a poor oral status. Thus, they carry a high risk of developing dental caries. Obviously, there is a demand for careful and close surveillance of oral hygiene and oral health in individuals in long-term care, and especially of those cognitively impaired.

[Epidemiologic aspects of the edentulous mouth (II). General and local features of the totally edentulous mouth]

PREMISES AND AIM: The study wants to reveal the general and local clinical aspects, which may accompany the completely edentulous mouth and create difficulties in treatment.

MATERIAL AND METHOD

The clinical and statistical study was carried out on 40 edentulous patients; we analyzed general aspects (the present medical status, the patient's medication and its effects) and local aspects (the etiology, the type of previous denture treatment, the type and number of denture's repairs, the extent of the residual ridge resorption, the relationship between residual ridges), the total difficulty of the treatment.

RESULTS AND DISCUSSIONS

80% of the edentulous patients suffered from general diseases, more frequent from cardiovascular, digestive, metabolic, renal, rheumatic diseases. 73% of the edentulous patients received daily medication, which generated in 30% of cases a decrease of the saliva volume. The demand for prosthetic treatment was greater for the recent edentulous patients (less then 1-2 years of edentulousness) or for those who lost their teeth more then 6 years ago. The majority of patients over 70 years are completely bimaxillary edentulous patients, 68% of them had previous bimaxillary dentures. We found the bone resorption moderate (50% of cases) and severe (33% of patients), the relationship of the residual ridges inverse in the anterior and posterior zones (60% of patients) and normal in the anterior zone and inverse in the posterior zone (28%). The difficulty of the treatment was frequently 3Pd degree for the maxilla and 4t' degree for the mandible (the maximum degree of difficulty).

CONCLUSIONS

The completely edentulous patient presents a number of general and local modifications, which increase the difficulty of the treatment, demand supplementary therapeutic procedures, and increase the total cost. The modifications of the oral structures demand specific therapeutic procedures, and in some cases the frequent renewal or adaptation of dentures (every 3-5 years); all those costs must be took over by the insurance company, because of their social status (pensioners).

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 30 years (1973-2003). II. Review of clinical and radiographic findings

The aim of this epidemiological study was to analyze various clinical and radiographic data on oral health and compare the results to those of three cross-sectional studies carried out in 1973 and 1983, and 1993. In 1973, 1983, 1993, and 2003 a random sample of 1,000; 1,104; 1,078; and 987 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80 years. In 1973 80-year-olds were not included. All subjects were inhabitants of the City of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations and overhangs, oral hygiene, calculus, periodontal status, endodontic treatment, and periapical status. The number of edentulous individuals in the age groups 40-70 years was reduced from 16 per cent in 1973 to 8 per cent in 1993, and to 1 per cent in 2003. The mean number of teeth increased, and up to the age of 60 years, individuals had more or less complete dentitions. During the 30-year period,the number of carious lesions and restorations decreased in general. In the 15-year-olds the decrease in number of restored tooth surfaces was 900 per cent and the corresponding figure for 30-year-olds was 79 per cent. The age groups 60-800 years showed an increase in number of restored tooth surfaces and had as a mean 50 filled tooth surfaces. The oral health among 3-5-year-olds improved markedly between 1973 and 1993. In 2003, however, there was no further improvement in 3- and 5-year-olds compared to 1993. Generally, restorations in 2003 exhibited a high quality and 90-95 per cent had no proximal overhangs. In 1973 this figure was about 60 per cent. In the age groups 20-50 years there were continuously fewer teeth fitted with crowns or bridges during the 30-year period. In 1973 the 50-year-olds had a mean of 24.5 per cent of the teeth crowned and in 2003 6.8 percent. Compared to data from 1973 there was a reduction by half concerning occurrence of plaque and gingivitis in 2003. The frequency of individuals with one or more periodontal pockets (> or = 4 mm) increased with age. In 2003 the bone level at the age of 60 years corresponded to the bone level at the age of 40 years in 1973. The percentage of endodontically treated teeth was lower in 2003 in all age groups compared to 1973, 1983, and 1993. The percentage of endodontically treated teeth with periapical orjuxtaradicular destructions was generally lower in 2003 than in the earlier surveys, about 20 per cent in 2003 compared to 25-30 per cent in 1973,1983, and 1993. The comparison of the four studies shows that there has been a great overall improvement in oral health over this 30-year period.

Oral hygiene and oral symptoms among the elderly in long-term care

Dental teams examined 1910 elderly adults living in long-term care settings (1358 institutionalized, 552 homebound) from all 19 counties in Norway to document oral hygiene, oral symptoms and ability to receive dental treatment. The Mucosal-Plaque Score (MPS) was used to assess oral status. The MPS was significantly better in women than in men, in individuals with dentures than in those with any remaining teeth, and in people who were homebound rather than those who lived in institutions. The MPS did not differ between age groups or geographic regions. According to the Treatment Ability Index, nearly a quarter of the sample was able to receive comprehensive dental care. Reports of "any oral symptom" and "eating/chewing problems" decreased with age and were most prevalent for individuals who had dentures. The MPS had only slight impact on oral symptoms, chewing ability and dry mouth (p > 0.05). Dry mouth was found in 16.9% and was most prevalent in individuals with dentures.

[State of oral health of adults and the elderly in Hungary]

The purpose of this survey was to assess the oral health situation of the Hungarian adult and elderly population at the turn of the millennium and to compare the data with the results of previous surveys. A total of 1627 male and female individuals were clinically examined at 17 sample sites according to the WHO basic criteria using the pathfinder methodology. National epidemiological examinations (pathfinder surveys) were carried out in 1985, 1991 and 2000 in adults. But nationwide oral data among 65-74-year-olds were never collected before 2000. It is strongly suggested by World Health Organization to undertake a regular epidemiological survey in 5-year intervals to monitor changes in oral health of the key-age groups. During recent years, in children, a dramatic caries decline has been observed. In adults, however, a similar change has not occurred although other important favourable trends have been documented as well. The basic findings were: The mean DMFT score was high, and strongly influenced by MT. At age 35-44, the caries prevalence was 15.7 DMFT and at 65-74 it was 23.3 DMFT. For non-smokers, the MT mean value was 8.7, and for smokers 10.8. For those who had smoked more than 20 years the MT mean value was 12.7. The periodontal condition of both age groups was poor. Of the adult sample only 4.5% had healthy gingiva and 25.2% had at least 3 healthy sextants. Between 1985 and 2000, the percentage of edentulous adult persons increased from 0.3 to 1.4 and in 2000 the ratio of edentulous persons among elderly was 26%. The population's need for treatment at all levels (restorative, periodontal and prosthetic) was enormous. The authors concluded that in Hungary "health for all" efforts have been inadequate. Greater emphasis on risk- and preventive orientated praxis and management is needed; increased individual activities and financial support are also required.