Oral findings and health status among hospitalized patients with physical disabilities, aged 60 or above

Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke

Oishi K, Nishioka S, Okazaki Y, Hirakawa K, Nakamura M, Ichinose A, Kurihara M. Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke. Jpn J Compr Rehabil Sci 2022; 13: 17-25.

Objective

This study was designed to examine the relationship between improvement in oral hygiene and function and activities of daily living (ADLs) at discharge in patients admitted to convalescent rehabilitation wards.

Methods

Eligible criteria were patients with stroke with a score of 13 or higher (i.e., severe oral problems) on the Revised Oral Assessment Guide (ROAG) at admission. Age, gender, primary diseases, rehabilitation dose, dentist visits and denture status, Eichner classification, eating status at admission and discharge, and body mass index at admission were collected. The patients were classified into two groups: those with ROAG scores of less than 9 points at discharge (good ROAG group) and those with scores of 9 points or more (poor ROAG group), and Functional Independence Measure (FIM) gain and total FIM discharge scores were compared using univariate and multivariate analyses.

Results

The good and poor ROAG groups comprised 126 and 366 patients, respectively. The good ROAG group had significantly higher total FIM score, FIM efficiency, and FIM gain at discharge than the poor ROAG group (112 vs. 82; P < 0.001). The ROAG scores at discharge were independently associated with FIM gain (partial regression coefficient = -9.889, 95% confidence interval = -13.499 to -6.279) and total FIM score at discharge.

Conclusion

Improvement in oral hygiene and function in convalescent patients with stroke was associated with ADLs at hospital discharge.

Coblation cryptolysis method in treatment of tonsil caseum-induced halitosis

PURPOSE

Halitosis, is a social problem affecting many patients seeking help from clinicians. Tonsil stones can cause halitosis and especially occur in crypts of palatine tonsils. Coblation cryptolysis is an alternative method for tonsil caseum treatment. The coblation technology includes passing a radiofrequency bipolar electrical current through a medium of normal saline which results in the production of a plasma field of sodium ions. In this study, our aim was to investigate the effectiveness of coblator cryptolysis treatment method in chronic caseous tonsillitis-induced halitosis.

METHODS

We included in our study 28 patients who underwent coblator cryptolysis surgery for halitosis due to chronic caseous tonsillitis. The efficacy of treatment and the presence of caseoma were evaluated with the Finkelstein test, organoleptic test and VAS before the procedure and at the 6th month control after the treatment was completed.

RESULTS

At the 6th month follow-up after the procedure (a single coblation cryptolysis) we found that 23 of the patients (82.1%) had no caseum. There was a statistically significant change in Finkelstein measurements before and after the procedure (p < 0.001). Organoleptic measurements demonstrated that 21 patients had no halitosis postoperatively and the mean organoleptic test score was calculated as 0.39 ± 0.79 after the procedure. The recovery was statistically significant (p < 0.001). The mean VAS score before coblation cryptolysis was 8.0 ± 1.33 (range 5-10). On the other hand 6 months after a single coblation cryptolysis session, the mean VAS score was 1.25 ± 1.78 (range: 0-6). This difference was statistically significant (p < 0.001).

CONCLUSIONS

Our results suggest that coblation crptolysis is an effective, safe, minimally invasive and practical alternative method in treatment of halitosis due to tonsil caseums. We did not observe any complication after the procedure.

Oral mucosal lesions and risk factors in elderly dental patients

Background. The aim of this study was to determine the prevalence of oral lesions in terms of sex, age, educational status, medication use, systemic diseases, the duration of denture use and tobacco or alcohol use.

Methods. A total of 709 voluntary patients (375 males and 334 females), aged ≥60 years, were interviewed by one investigator for demographic data, systemic diseases, tobacco or alcohol use, denture use and the duration of denture use.

Results. The majority of the participants (87.6%) had one or more oral mucosal lesions. The prevalence of oral mucosal lesions was 46.3% in males and 41.3% in females (P=0.76). The most common oral mucosal lesion was a sublingual varicosity in both males and females. A statistically significant difference was observed between the three age groups (60–64, 65–69, and ≥70 years) with regard to the prevalence of oral mucosal lesions (P=0.02). There was a significant relationship between the presence of systemic diseases and oral mucosal lesions (P=0.01). There was also a significant relationship between denture use and oral mucosal lesions (P=0.001). Smoking and a history of smoking were also significant predictive factors for oral mucosal lesions (OR: 3.385, P=0.045).

Conclusion. Although the majority of oral mucosal lesions detected in the present study were benign, there were some patients with premalignant and malignant lesions. Therefore, periodic oral examinations for detection of precancerous and cancerous lesions are important, especially in the elderly, smokers and denture users.

Halitosis: Current concepts on etiology, diagnosis and management

Halitosis or oral malodor is an offensive odor originating from the oral cavity, leading to anxiety and psychosocial embarrassment. A patient with halitosis is most likely to contact primary care practitioner for the diagnosis and management. With proper diagnosis, identification of the etiology and timely referrals certain steps are taken to create a successful individualized therapeutic approach for each patient seeking assistance. It is significant to highlight the necessity of an interdisciplinary method for the treatment of halitosis to prevent misdiagnosis or unnecessary treatment. The literature on halitosis, especially with randomized clinical trials, is scarce and additional studies are required. This article succinctly focuses on the development of a systematic flow of events to come to the best management of the halitosis from the primary care practitioner's point of view.

Problems faced by complete denture-wearing elderly people living in jammu district

CONTEXT

Poor oral health is increasing dramatically among old people especially those living in rural and remote areas. Various factors such as low education background, low income, poor living conditions, unhealthy lifestyle, inadequate oral hygiene and tobacco use lead to poor oral health among older people which in turn lead to risks to their general health. The older people especially from rural areas are apprehensive about seeing a dentist and do not visit them regularly. This may lead to various problems which may have a detrimental influence on their quality of life.

AIM

To know the problems faced by complete denture wearers in rural areas in Jammu district.

MATERIALS AND METHODS

Fifty patients from rural area Bishna, initially treated with a complete denture in the maxilla or mandibles were examined. The data were collected with the help of a questionnaire.

RESULTS

The results revealed that majority of respondents were in the age - group of 65-70 y. Majority of respondents complained of "difficulty chewing", "sore spots", "painful and swollen gums". Majority of respondents had difficulty in speech, it was difficult for them to interact and communicate with their dentures on. Most of the respondents had lost confidence and had low self esteem. Clinical observations revealed that the commonest condition associated with denture wearing was Oral Stomatitis/ Burning mouth Syndrome, Superimposed infection and Angular cheilitis.

CONCLUSION

Older people should Communicate and visit dentists, regularly, so that the dentists can adjust the treatment and pace according to their needs. Behavioural therapy techniques can make dental visits relatively anxiety and pain-free.

Utilization of teeth replacement service among the elderly attending teaching hospitals in lagos, Nigeria

Background:

Tooth replacement service is generally available in our environment. However, its utilization by the elderly has not been extensively studied.

Aim:

To determine the utilization of tooth replacement services among the elderly.

Materials and Methods:

This was a retrospective study of 440 patients aged 60 years and above attending the prosthetic out-patient clinics of Lagos University teaching hospital (LUTH) and Lagos state University teaching hospital (LASUTH) from January, 2008 to March, 2010. record books or case records: Age, sex, and number of teeth replaced. Results were collated and analyzed using Epi Info 2004. Values were presented as simple percentages.

Results:

There were 229/440 (52.0%) males and 211/440 (48.0%) females and were aged 60-90 years with a mean age of 68.9 (6.92). A total number of 4,062 teeth were replaced. Average number of tooth replaced among the patients was 9.45 for LUTH and 8.94 for LASUTH. The maxillary anterior teeth were the most frequently replaced 1422/4062 (35.0%) and the least replaced were the mandibular posterior teeth 812/4062 (20.0%). The average number of tooth replaced generally increased with age in both sexes. A total of 90 complete maxillary and mandibular dentures were fabricated, while six single arch complete dentures were made. The remaining were partial dentures.

Conclusion:

The most common age of presentation is 60-65 years. Patients that were 90 years and above appear to utilize teeth replacement facilities in this environment less than those in developed countries. Maxillary anterior teeth were the most frequently replaced.

Clinical diagnosis of hyposalivation in hospitalized patients

OBJECTIVE

The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients.

MATERIAL AND METHODS

A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheeks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination.

RESULTS

Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05).

CONCLUSION

Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

Halitosis: the multidisciplinary approach

Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover,halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear-nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo.Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

Prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, Northeast Iran

OBJECTIVE

The aim of this study was to determine the prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, northeast of Iran.

BACKGROUND

This study was conducted to assess the prevalence of oral lesions in the institutionalized elderly.

METHODS

In this survey, we studied all of the nursing homes in Mashhad; a total of five encompassing 237 residents. The subjects were examined and lesions recorded in a designed checklist. T-test, chi-square and Fisher's exact tests were used for the analysis.

RESULTS

The mean age of the patients was 79.59 ± 8.88. Ninety-eight per cent of cases had at least one oral mucosal lesion. The most common lesions were fissured tongue (66.5%), atrophic glossitis (48.8%), sublingual varicosity (42%) and xerostomia (38%). There was no significant difference in the prevalence of denture-related lesions (DRLs) between men and women (p > 0.05). Xerostomia was more prevalent in 70-79-year-old than in 60-69-year-old subjects. No case of oral malignant lesion was detected.

DISCUSSION

These findings revealed a higher prevalence of oral mucosal lesions in Mashhad city compared with other studies conducted in other major cities in Iran and abroad. The results emphasise the necessity of national programmes towards oral health promotion.

Oral health status among hospitalized patients

AIM

To investigate into oral health status and its association with health status in hospitalized patients.

METHODS

A total of 82 patients were examined and 49 (59.7%) patients were men. The patients answered a survey and oral examinations to detect the number of teeth, oral hygiene index, prostheses hygiene, oral lesions, caries, dental plaque index (DPI), gingival inflammation index (GI), gingival bleeding index, periodontitis and periodontal index.

RESULTS

Oral hygiene was associated with age, but it was not related to physical disability. Difficulty eating was mainly associated with age and tooth loss. All full and partially dentate patients presented dental plaque, 38 (69%) poor oral hygiene, 58 (98.1%) gingival inflammation, 41 (74.5%) periodontal disease and 33 (60%) caries. Oral lesions were detected in 30 (36.5%) and candidiasis (n = 16, 19.6%) was the most frequent mucous lesion. Caries were associated with smoking and poor oral hygiene. Hospital length of stay and age were associated with increased DPI and GI.

CONCLUSIONS

The majority of hospitalized patients did not present satisfactory oral hygiene. Caries and periodontal diseases are associated with health behaviours. Increased time length at hospital could increase gingival inflammation and dental plaque accumulation.

Factors triggering the oral mucosal lesions by complete dentures

Oral mucosal lesions may represent acute or chronic reactions to factors related with dentures. The aim of this study was to determine the frequency of the oral lesions related to gender, age, the length of time of denture usage, the balance of denture and cleaning methods and frequency. The 106 patients who have old complete dentures came to the Dental Faculty of Marmara University, Istanbul (Turkey) to have new complete dentures were asked to participate in the investigation. The subjects (51 men and 55 women) were 37-80 years of age with a mean age of 60.28+/-10.52 years. All main factors were estimated in subgroups: cleaning methods and frequency were divided into 3 subgroups respectively as toothbrush and toothpaste/soap, denture cleansing tablets and sodium carbonate, and 3 times a day, everyday, every 3 day and once a week. The data obtained was evaluated by One-way ANOVA, Mann-Whitney U-test, Kruskal-Wallis-test, Student t-test and chi(2)-test. The level of statistical significance was set at p<0.05. The patients displayed statistically significant differences in the topics of the length of time of denture usage and the balance of denture in terms of retention. The complete denture wearers should be educated in the importance of periodic examination due to the changing of supporting tissues for detection early mucosal lesions to maintain their oral and dentures hygiene in optimum level.

Prevalence of oral lesions in 13- to 16-year-old students in Duzce, Turkey

OBJECTIVE

The aim of this study was to determine the prevalence of oral lesions in 13- to 16-year-old students.

METHODS

A cross-sectional survey was carried out on students in Duzce, a province in the western Black Sea region of Turkey. A total of 993 children aged between 13 and 16 from eight secondary schools were examined. Oral lesions with recurrent behavior, if observed, were recorded at the time of examination. Venous blood samples were obtained for detecting hemoglobin levels.

RESULTS

Two hundred sixty adolescents (26.2%) were diagnosed with at least one oral mucosal lesion at the time of the examination. Thirteen different mucosal alterations were diagnosed, and the most common lesions were angular cheilitis (9%), linea alba (5.3%), and aphthous ulceration (3.6%). The correlation between occurrence of mucosal lesions and sex was not statistically significant (P > 0.05). Statistical evaluation of the data revealed a significant relationship only between the presence of angular cheilitis and anemia (P < 0.05).

CONCLUSION

This study is the first epidemiologic study of oral mucosal lesions in adolescents in Turkey. Angular cheilitis was the only oral mucosal lesion that had a significant correlation with anemia.