Quality of life related to tooth loss and prosthetic replacements among persons with dependency and functional limitations

Fixed partial dentures in adult patients with cleft lip and palate and their relationship with the quality of life: A cross-sectional clinical study

STATEMENT OF PROBLEM

Reports on the impact of fixed partial denture treatments on the quality of life of patients with cleft lip and palate are lacking.

PURPOSE

The purpose of this cross-sectional clinical study was to assess the impact of fixed partial dentures on the quality of life of adults with cleft lip and palate.

MATERIAL AND METHODS

A total of 52 participants (23 women and 29 men) with cleft lip and palate, aged between 20 and 50 years old, and who required treatment with fixed partial dentures were enrolled in the study. They responded to the Oral Health Impact Profile (OHIP)-14 questionnaire before and 30 days after the fixed prosthodontic treatment. The final value from the OHIP-14 was generated by totaling the 14 answers, giving a range from 0 to 56, with higher values indicating a worse relationship between oral health and the quality of life. Nonparametric statistical analysis was performed with the Wilcoxon test (α=.05).

RESULTS

Forty-six participants reported some negative experience before the fixed partial denture, and 48 indicated an improved quality of life 30 days after delivery. All domains assessed showed significant quality of life improvements between the periods compared (P≤.014).

CONCLUSIONS

Oral treatment with fixed partial dentures improved the quality of life in adults with cleft lip and palate.

The Relation between Masticatory Function and Nutrition in Older Individuals, Dependent on Supportive Care for Daily Living

Introduction: Associations between masticatory function and nutritional status have been suggested. Masticatory function can be divided into two subdomains, the objective capacity of an individual to mix solid food and the individual’s subjectively assessed ability to masticate solid food. Aim: The aims of this study were to assess the relationship between these subdomains and nutritional variables in older, care-dependent individuals. Materials and methods: From a group of 355 individuals with care dependency and functional limitations, individuals aged 60 and older were selected. By home visits, the subjects underwent an oral examination and answered chewing related questions. Nutritional status was assessed using the Mini Nutritional Assessment. A total of 196 individuals met the age requirement of 60 years or older. Of these, 86 subjects were able to answer the questions. Results: We could not find any concluding significant associations between the subdomains of masticatory function or the nutritional variables. Conclusions: The absence of associations could be explained by the lack of standardized and validated methods to assess masticatory function and they possibly reflect varying underlying constructs. Self-reported questionnaires seem less useful among older and care-dependent individuals, while an objective clinical measurement will be needed when evaluating masticatory function.

Effectiveness of Organic and Inorganic Fluoridated Dentifrice on Dental Caries Progression Among Institutionalized Geriatrics: A Randomized Intervention

Purpose

To assess the effects of two commercially available organic and inorganic fluoridated dentifrices on dental caries progression amongst the institutionalized geriatric population.

Materials and methods

A total of 80 participants were selected and randomly allocated using the coin toss method into two groups, viz. Group I with subjects receiving organic fluoridated dentifrice and Group II with subjects receiving inorganic fluoridated dentifrice. Allocation concealment was done using the Sequentially-Numbered, Opaque, Sealed Envelopes (SNOSE) method. Participants were blinded using analogous dentifrice tubes. They brushed their teeth with the dentifrices twice daily using the modified Bass technique for a period of six months. Their compliance with the intervention was monitored regularly. The outcome measure was susceptibility to dental caries assessed by a cariogram. A single, trained, and calibrated investigator assessed the cariogram at baseline and after six months. Collected data were compiled and analyzed.

Results

The mean age was found to be 67.75 ± 4.1 years, 70.05 ±7.4 years among Group I and Group II participants, respectively. The results showed that the efficacy of avoiding new carious lesions was higher (75.85%) in Group I participants as compared to Group II (73.4%) participants, but no significant difference in the mean cariogram sectors was observed. However, there was a statistically significant reduction in the Streptococcus (S.) mutans and Lactobacillus colony-forming unit (CFU) (p<0.05) with a considerable increase in salivary pH in Group I participants.

Conclusion

There is a marked increase in the possibility of avoiding new carious lesions with a reduction in S. mutans and Lactobacillus CFU and an increase in saliva buffer capacity over six months of use of organic fluoride dentifrices. Thus, organic fluoride dentifrice can be an effective agent for institutionalized geriatrics in the prevention of dental caries and oral diseases.

Association between physical limitations and depressive symptoms among Indian elderly: marital status as a moderator

BACKGROUND

Depression among the elderly is well-documented and associated with socio-economic factors, physical and mental health conditions. Few studies have focused on older adults' physical limitations and depressive symptoms. However, very little is known about marital status' role in such associations, especially in India. The present study examines the association between physical limitations and self-reported depressive symptoms and moderating role of marital status in such association separately for men and women.

METHODS

The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-2018, a nationally and state representative longitudinal large-scale survey of ageing and health. For the present research, a total sample of 20,806 older adults aged 60+ years was selected after excluding missing values. Along with descriptive statistics, binary logistic regression analysis and interaction effect of marital status were applied to examine the association between physical limitations (functional limitations and mobility difficulty) with the depressive symptoms separately for men and women.

RESULTS

About 58, 50, and 45% elderly reported having depressive symptoms and had difficulty in 2+ ADLs, 2+ IADLs, and 2+ mobility difficulties, respectively. By the marital status, the prevalence of depressive symptoms was higher among currently unmarried than currently married, irrespective of type and number of physical limitations. The unadjusted, marital and multivariate-adjusted association suggested that elderly with more than two ADLs, IADLs, and mobility difficulty had higher odds of depressive symptoms. The gender stratified interaction effect of marital status and physical limitations on depressive symptoms indicated that currently unmarried elderly, particularly unmarried older women with 2+ ADLs (OR = 2.85; CI 95% = 1.88-3.09), 2+ IADLs (OR = 2.01; CI 95% = 1.74-2.31) and 2+ mobility difficulty (OR = 2.20; CI 95% = 1.86-2.60) had higher odds of depressive symptoms. However, such association was only valid for unmarried men having mobility difficulty.

CONCLUSION

The study highlights that the elderly with physical limitations such as ADLs, IADLs, and mobility difficulty require attention and care. Although married elderly are less likely to have depressive symptoms even with all the mentioned physical limitations, unmarried women are more vulnerable to have depressive symptoms with physical limitations.

DENTAL PATIENT-REPORTED OUTCOMES -- THE PROMISE OF DENTAL IMPLANTS

In general dental practice, the use of implants is focused mostly on prosthodontic issues. That is, the replacement of missing teeth or the support of dental prostheses. However, there are other dental fields using implants such as orthodontics or maxillofacial prosthodontics. A classic way to measure success in implant dentistry is to look how long implants and the corresponding superstructure survive and are in function. Nevertheless, this alone is a very crude parameter. Therefore, biological and technical complications are taken in account additionally. Nonetheless, these objective measures do not well replicate the perception of the patient. That why, subjective measures, reflecting the perception of the patient are recommended to complement objective parameters. If these dental patient-reported outcome measures (dPROMs) are wisely chosen, they offer a wide variety of options. Besides comparing therapeutic effects by using the instruments' summary score only, dPROMs such as the Oral Health Impact Profile (OHIP) provide the opportunity to additionally assess patients` perceptions in the 4 dimensions of oral health-related quality of life. These are functional limitations, pain, esthetic issues as well as psychosocial impairment. Even the 5-item short form of the OHIP captures these dimensions and provides an efficient way to assess patients' perception with low administrative burden. This in turn offers new insights into the patient perspective and therefore helps improving shared decision making.

Factors associated with oral health-related quality of life of institutionalized elders

This study aimed to evaluate the correlation between two Oral Health-Related Quality of Life (OHRQoL) questionnaires (the Oral Health Impact Profile (OHIP-14) and the Geriatric Oral Health Assessment Index (GOHAI)) and to investigate the factors associated with the OHRQoL of institutionalized elderly individuals. A cross-sectional multicenter study was performed with 344 institutionalized elderly individuals residing in two Brazilian cities. Six trained researchers interviewed the elderly individuals. Sociodemographic data were collected from medical records. Dental caries experience and the use of and need for dentures were recorded through oral examination performed by two trained examiners. A Likert scale (1-5 points) was used to assess general health and self-perceived oral health. The number of chewing cycles needed to chew a portion of peanuts was used to assess the swallowing threshold. The OHIP-14 and GOHAI were used to evaluate OHRQoL, and statistically significant correlations were assessed using Spearman's correlation test (p < 0.05). Poisson regression (p < 0.05) was used to investigate the association of OHRQoL with independent variables. Scores on the OHIP-14 (7.57 ± 8.63) and GOHAI (32.46 ± 3.85) were strongly and inversely correlated (r2 = -0.671, p < 0.001), although these measures were associated with different factors. A higher OHIP-14 total score (worse OHRQoL) was associated with female gender, a greater number of healthy teeth, worse self-perceived general health and oral health, and a lower swallowing threshold (p < 0.05). A higher GOHAI total score (better OHRQoL) was associated with a greater number of filled teeth, better self-perceived oral health and a greater swallowing threshold (p < 0.05). In conclusion, worse OHRQoL among institutionalized elderly individuals is associated with worse self-perceived oral health and a greater swallowing threshold.