Prevalence of edentulousness and related factors among elderly Finns

Tobacco products and oral conditions among US adults: NHANES 2017-2020

OBJECTIVES

Smoking is a major global health problem with serious systemic and oral consequences. This study aims at assessing the influence of smoking cigarettes and other types of smoked tobacco on oral conditions (OCs) using a representative sample of US adults.

METHODS

Pre-pandemic data from the National Health and Nutrition Examination Survey 2017-2020 were utilized, and 7840 adults aged ≥30 years were included in our analyses. Descriptive statistics, logistic, and negative binomial regression models were performed to assess the relationship between tobacco products and OCs including, tooth loss (TL), coronal (CC) and root caries (RC).

RESULTS

Overall, 16.29% of our sample were current cigarette smokers (CCS). TL (17.25%) and untreated RC (28.26%) were more evident among CCS. In the adjusted regression models, smoking cigarettes was associated with RC (AOR: 3.20, 95% CI; 2.02, 5.09), untreated CC (IRR: 3.08, 95% CI: 1.50, 6.31), and TL (IRR: 2.18, 95% CI: 1.64, 2.88). Regarding the type of used tobacco product in the past 5 days, cigarettes were the most common type (15.03%). The adjusted model indicated that e-cigarette smokers had the highest odds of untreated RC (AOR: 5.17, 95% CI: 2.19, 12.23) and the highest rate of TL (IRR: 2.21, 95% CI: 1.45, 3.35). Further, cigar smokers had the highest rate of teeth with untreated CC (IRR: 3.25, 95% CI: 1.46, 7.25).

CONCLUSIONS

Using tobacco products is associated with poor OCs. Dentists, being the primary oral health care providers, can play a crucial role in counseling and supporting smokers to quit as part of their routine dental examination.

Oral frailty among dentate and edentate older adults in long-term care

BACKGROUND

The objectives of this study were to compare oral frailty (OFr) among edentate and dentate older adults living in long-term care facilities (LTCF) and to clarify how edentulism and oral disease burden (ODB) of dentate older adults are associated with OFr.

METHODS

The population of this study comprised 94 edentate and 209 dentate residents in LTCF in Helsinki, Finland, who had previously participated in a nutritional study. The participants underwent a clinical oral examination. The dentate residents were further divided into three ODB groups based on asymptotic dental score. The edentate and different ODB groups were compared with each other regarding demographics and oral and medical findings. OFr was defined as ≥ 2 of following: having a diet of soft/pureed food, residue of food in the oral cavity, inability to keep the mouth open during examination, unclearness of speech, dry mouth. The association between OFr and edentulousness and various levels of ODB was analyzed by a multivariate logistic model.

RESULTS

Participants with low ODB had significantly less OFr than their edentate peers (p = 0.009). Furthermore, the edentate and dentate with high ODB had similar odds for OFr.

CONCLUSIONS

Edentulousness and high ODB are equally harmful conditions and may predispose to OFr. This study suggests that maintaining healthy natural teeth and good oral health (low ODB) may protect against OFr.

TRIAL REGISTRATION

The Ethics Committee of the Hospital District of Helsinki and Uusimaa approved the protocols for the nutritional status and oral healthcare studies and the merging of the data, including patient medical records (Register number HUS/968/2017).

Spatiotemporal trends of disease burden of edentulism from 1990 to 2019: A global, regional, and national analysis

Background

Understanding the spatiotemporal trends in disease burden of edentulism is critical to reducing disease burden of edentulism and deploying medical resources. We assessed the changing patterns of disease burden of edentulism at global, regional, and national levels from 1990 to 2019.

Methods

Data on incident cases, prevalent cases, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of edentulism were extracted from the Global Burden of Disease 2019 Study. We calculated the estimated annual percentage change (EAPC) to quantify spatiotemporal trends in the ASRs of edentulism.

Results

In 2019, the number of prevalent cases and DALYs of edentulism were 35.2 and 9.6 million, and the ASPR and ASDR were 43.12/1,000 and 1.18/1,000, with EAPCs of -0.18 [95% confidence interval (CI): -0.28, -0.09] and -0.16[95% CI: -0.26, -0.07] from 1990 to 2019, respectively. Females and the elderly had a higher burden of edentulism. Although the ASPR, ASDR, and ASIR in the high SDI, high-middle SDI, and middle SDI regions showed a decreasing or stable trend, the absolute disease burdens of edentulism in these regions were still high. Although the absolute disease burdens of low SDI and low-middle SDI were low, their ASPR and ASDR showed an upward trend. In countries with high initial disease burden or high SDI, ASPR, ASDR, and ASIR showed stable or declining trends.

Conclusion

The absolute disease burden due to edentulism was increasing in many countries and regions. Countries should reduce the disease burden caused by edentulism by adopting measures including the prevention and treatment of dental caries and periodontal disease.

Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde

OBJECTIVE

The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde.

MATERIAL AND METHODS

This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated.

RESULTS

The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m²' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors.

CONCLUSIONS

The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Spirometric Assessment of Impact of Complete Dentures on Respiratory Performance: An in vitro Study

INTRODUCTION

Edentulism is one of the debilitating states affecting a significant portion of the geriatric population. It is often considered as the ultimate marker for predicting the pressure and burden on oral health. Respiration is also a routine vital function running continuously through the human body and most commonly assessed by a spirometer. Hence, we planned the present study to assess the impact of complete dentures on the functioning of the respiratory system.

MATERIALS AND METHODS

In the present study, a spirometric assessment of the effect of complete dentures on respiratory performance was done. A total of 100 subjects were included, and diagnostic spirometer was used for carrying out the spiro-metric test at different stages of each subject. The spirometric test was carried out at four different stages: In the absence of both the denture (AODs), with both the dentures (maxillary and mandibular) inserted in the patient's mouth (BDs), with only maxillary denture inserted in the oral cavity (UDs), and finally, by inserting only the mandibular dentures in the oral cavity (LDs). Forced vital capacity (FVC), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and forced expiratory flow between 25 and 75% (FEF_25-75) were evaluated. All the results were compiled and assessed using Statistical Package for the Social Sciences (SPSS) software.

RESULTS

Of the total 100 subjects included in the study, 42 were males and 58 were females. The mean FVC values of AOD, BD, LD, and UD group were 3.10, 3.02, 2.90, and 2.93 respectively. The mean PEF values of AOD, BD, LD, and UD group were 5.79, 5.60, 5.40, and 5.48 respectively; 2.39, 2.35, 2.33, and 2.32 were the mean FEV1 values observed in AOD, BD, LD, and UD group respectively. Statistically significant results were obtained while comparing AOD-FVC and BD-FVC and other oral conditions.

CONCLUSION

Spirometric values of respiratory functional tests in edentulous patients might be unfavorably affected by wearing complete dentures.

CLINICAL SIGNIFICANCE

Since subjects without complete dentures exhibited a maximum value of respiratory functional test, respiratory exercise protocols should also be carried in denture-wearing edentulous patients for increasing the performance of the respiratory system.

Missing Teeth and Prosthetic Treatment in Patients Treated at College of Dentistry, University of Dammam

The percentage of completely and partially edentulous patients and their prosthetic treatment at the Department of Substitutive Dental Sciences (SDS), College of Dentistry, University of Dammam, were investigated. Panoramic radiographs and medical records of adult patients (n = 479, mean age 45.9 years, and range 25-96 years) treated in 2011-2014 were examined. 6% of the patients were completely edentulous, 8% had single jaw edentulousness, and 74% were partially edentulous. Edentulousness was significantly correlated with age and the number of missing teeth was significantly higher among males (p < 0.026). Diabetes was significantly associated with complete edentulousness, single edentulous jaw (p value 0.015), and partial edentulousness (p value 0.023). Kennedy class III was the most frequent class of partial edentulousness in single and/or both jaws (p = 0.000). Patients having class I and/or class II were treated most often with removable partial dentures (RPD) (p = 0.000), while patients having class III were treated with fixed partial dentures (FPD). It was found that complete edentulousness increases in older age and the number of missing teeth was significantly higher among males. Kennedy class III was most common in both upper and lower jaw and was treated more often with FPD than with RPD.

Portuguese self-reported oral-hygiene habits and oral status

BACKGROUND

Good oral health is essential for good general health and quality of life. In Portugal, there are few studies on oral-health habits and the population's perceptions of this behaviour.

OBJECTIVE

The main purpose of this study was to characterise the Portuguese population's self-reported oral-health status, habits and perceptions, as well as their demands regarding national oral health-care services.

METHODS

A randomised group of 1,395 individuals, > 15 years of age, was selected as a representative sample of the Portuguese population. Face-to-face interviews were conducted, based on a structured questionnaire with closed and semi-closed questions. The data were submitted for statistical analysis using SPSS.

RESULTS AND DISCUSSION

A sample of 1,102 individuals answered the questionnaire. The great majority of the sample (97.6%) brushed their teeth daily, 70.3% had lost permanent teeth and 6.4% were edentulous. The loss of permanent teeth was statistically associated with poor oral-hygiene habits (P < 0.01). Moreover, 50.1% of the participants had experienced difficulty eating and/or drinking, 18% had felt ashamed of the appearance of their teeth and 69.3% had experienced toothache or gingival pain. A reduction in visits to a dentist in the previous 12 months was identified mainly for people from a lower social class (31.2%) and older people (29.4%).

CONCLUSION

Evidence suggests that oral diseases might be more prevalent in Portuguese adults than the European average. Efforts should be made to promote good oral-hygiene habits among older people and people from lower social classes.

Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE)

BACKGROUND

Edentulism (loss of all teeth) is a final marker of disease burden for oral health common among older adults and poorer populations. Yet most evidence is from high-income countries. Oral health has many of the same social and behavioural risk factors as other non-communicable diseases (NCDs) which are increasing rapidly in low- and middle-income countries with ageing populations. The "common risk factor approach" (CRFA) for oral health addresses risk factors shared with NCDs within the broader social and economic environment.

METHODS

The aim is to improve understanding of edentulism prevalence, and association between common risk factors and edentulism in adults aged 50 years and above using nationally representative samples from China (N = 11,692), Ghana (N = 4093), India (N = 6409) and South Africa (N = 2985). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). Multivariable logistic regression describes association between edentulism and common risk factors reported in the literature.

RESULTS

Prevalence of edentulism: in China 8.9 %, Ghana 2.9 %, India 15.3 %, and South Africa 8.7 %. Multivariable analysis: in China, rural residents were more likely to be edentulous (OR 1.36; 95 % CI 1.09-1.69) but less likely to be edentulous in Ghana (OR 0.53; 95 % CI 0.31-0.91) and South Africa (OR 0.52; 95 % CI 0.30-0.90). Respondents with university education (OR 0.31; 95 % CI 0.18-0.53) and in the highest wealth quintile (OR 0.68; 95 % CI 0.52-0.90) in China were less likely to be edentulous. In South Africa respondents with secondary education were more likely to be edentulous (OR 2.82; 95 % CI 1.52-5.21) as were those in the highest wealth quintile (OR 2.78; 95 % CI 1.16-6.70). Edentulism was associated with former smokers in China (OR 1.57; 95 % CI 1.10-2.25) non-drinkers in India (OR 1.65; 95 % CI 1.11-2.46), angina in Ghana (OR 2.86; 95 % CI 1.19-6.84) and hypertension in South Africa (OR 2.75; 95 % CI 1.72-4.38). Edentulism was less likely in respondents with adequate nutrition in China (OR 0.68; 95 % CI 0.53-0.87). Adjusting for all other factors, compared with China, respondents in India were 50 % more likely to be edentulous.

CONCLUSIONS

Strengthening the CRFA should include addressing common determinants of health to reduce health inequalities and improve both oral and overall health.

Prevalence and pattern of partial edentulism among dental patients attending College of Dentistry, Aljouf University, Saudi Arabia

Objective:

The current study aimed to determine the prevalence and pattern of partial edentulism among dental patients attending the College of Dentistry, Aljouf University, Saudi Arabia.

Patients and Methods:

A total of 142 patients were selected, and the prevalence of partial edentulism among the selected patient was recorded. Patients were grouped into three age groups; Group I: 21–30 years, Group II: 31–40 years, and Group III: 41–50 years. Kennedy's classification was used to determine the pattern of partially edentulous arches. Modification areas were not included in the assessment to avoid complexity. Data was analyzed using the Statistical Package for the Social Sciences version 20.0 for windows.

Results:

The results showed that the occurrence of Kennedy Class III partial edentulism was 67.2 % in the maxillary arch and 64.1% in the mandibular arch. Followed by Class II in both maxillary and mandibular arch with an average of 16.3 % in maxillary arch and14.8% in the mandibular arch. Based on these results, class III has the highest prevalence in group II (31- 40 years). Class I and class II have the highest incidence among group III Patients (41–50 years).

Conclusions:

Among selected patients, Class III dental arch was the most prevalent pattern in maxillary and mandibular arches. Class IV being the least dominant pattern between all classes. There are a rise in Kennedy Class I and Kennedy Class II pattern and a decline in Class III and Class IV with an increase in age.

Association between smoking intensity and duration and tooth loss among Finnish middle-aged adults: The Northern Finland Birth Cohort 1966 Project

Background

Smoking is a risk factor for oral diseases and tooth loss. Our aim was to analyze the association between smoking intensity and duration and tooth loss among middle-aged Finnish adults who have enjoyed access to subsidized dental care since childhood.

Methods

This study was based on the Northern Finland Birth Cohort 1966 (NFBC1966) Project, a representative sample of Finnish 46-year-olds. Altogether 1946 46-year-olds participated in a survey and comprehensive clinical oral examinations. We measured smoking exposure in pack-years (intensity) and years of smoking (duration) combined with recent smoking status (current, former, occasional or never). We used negative binomial regression models to estimate the unadjusted and adjusted relative risks (RR) with corresponding 95 % confidence intervals (CI) for tooth loss as an outcome. Gender, education, tooth brushing frequency, dental plaque, diabetes and alcohol use served as explanatory variables for the adjusted models.

Results

Smoking intensity associated with tooth loss in an exposure-dependent manner: those with a high number of pack-years had a significantly greater probability of tooth loss than never smokers: 11–20 pack-years (RR = 1.55, 95 % CI = 1.15–2.08) and 21 or more pack-years (RR = 1.78, 95 % CI = 1.36–2.33). Smoking duration also associated with tooth loss: those who had smoked for several years had a significantly higher probability of tooth loss than never smokers: 21–30 years of smoking (RR = 1.66, 95 % CI = 1.29–2.12) and 31 or more years of smoking (RR = 1.72, 95 % CI = 1.20–2.45).

Conclusions

We found a clear intensity- and duration-dependent relation between smoking and tooth loss among adults with access to subsidized dental care and in good oral health.

Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa

Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.

Effect of Patient's Personality on Satisfaction with Their Present Complete Denture and after Increasing the Occlusal Vertical Dimension: A Study of Edentulous Egyptian Patients

Complete denture wearers often find it difficult to accept a new denture. Personality traits are among the factors that possibly affect patient satisfaction with a complete denture. Our aim was to investigate the influence of patients' personality on satisfaction with their present denture and after an increase in the occlusal vertical dimension (OVD). Sixty edentulous patients with complete dentures (22 men and 38 women, mean age 66 years, and range 50–75 years) participated in the study. The age of their complete dentures ranged from 5 to 16 years. Patients' personalities were evaluated using the Arabic version of the Eysenck Personality Questionnaire. Their satisfaction with their dentures before and after restoration of the OVD and relining of the mandibular denture was evaluated using two questionnaires (I and II), Patients with a high score of neuroticism were less satisfied with their original dentures and after relining and an increase of OVD compared with patients with an average score in that trait. The personality trait of psychoticism was significant to patients' acceptance of an increase in OVD; that is, patients with a high score were less satisfied with their dentures after increase of OVD than patients with an average score. It is concluded that personality traits affect patients' acceptance of their complete dentures.

'Your whole life is lived through your teeth': biographical disruption and experiences of tooth loss and replacement

The experience and meaning of tooth loss and replacement has varied historically and culturally but has received relatively little attention from social scientists. Our study set out to understand these experiences in the context of the arrival of newer, dental implant treatments. Semi-structured qualitative interviews were carried out with 39 men and women who had experienced tooth loss and replacement. A thematic analysis was sensitised by previous sociological work on chronic illness, particularly Bury's notion of biographical disruption. We found that while for some individuals the loss of a tooth was relatively insignificant, for others it was devastating and disruptive. In seeking to understand this difference, the concept of biographical disruption was a helpful analytical tool. Our analysis identified two forms of disruption. The first related to the meanings of tooth loss (the neglected mouth) and denture wearing (a marker of old age). The second, embodied, disruption concerned the relationship between the self and mouth in those wearing dentures (the invaded, unreliable mouth) and could occur even where tooth loss and denture wearing had been biographically anticipated.

Outcome of treatment of implant-retained overdenture in patients with extreme mandibular bone resorption treated with bone grafts using a modified tent pole technique

PURPOSE

To evaluate the outcome (prosthetic maintenance, survival of implants, patient satisfaction, and quality of life) of prosthetic treatment using an implant-retained overdenture and a modified tent pole procedure for severe mandibular resorption.

MATERIAL AND METHODS

Seventeen edentulous patients (mean age, 68 yr; range, 54 to 77 yr) with severely resorbed mandibles were treated with autogenous bone grafts using a modified tent pole technique and implant overdentures. A bar was used to splint the implants and the final prostheses with implant connection were completed approximately 7 months after surgery. The mean follow-up time was 5 years (1.5 to 7.4 yr). Patients filled out the Oral Health Impact Profile-14 questionnaire concerning their oral health-related quality of life, and then panoramic radiographs were taken during clinical examination.

RESULTS

The stability of the overdenture was good in 58.8% of cases and retention was good in 64.7%. The most usual prosthetic complication was loosening of the attachment component, which occurred in 7 cases (41.2%). The amount of plaque and bleeding was more remarkable on the lingual surface of the implants and less remarkable on the buccal surface. Pocket depth around the implants seemed to correspond to intraoral implantation. The radiographs depicted excellent grafted bone survival. The patients' oral health-related quality of life was found to be good after treatment.

CONCLUSIONS

Implant placement with bone grafting using a modified tent pole technique enables the achievement of a good prosthetic solution and the rehabilitation of occlusion, thereby improving the functionality of the prostheses and quality of life.

Radiological signs indicating infection of dental origin in elderly Finns

OBJECTIVE

The aim was to assess the prevalence and background factors of signs of infection of dental origin in elderly Finns.

MATERIALS AND METHODS

Every third birth cohort between 60-78 years of age (n = 1733) in a southern and a northern region in Finland were invited. Altogether, 1069 subjects attended radiographic examination. Of those, 660 were dentate and formed the study sample. In the analysis an index as a sum of points (scale per lesion 0-3, range 0-420) indicating the severity of infection from periapical lesions, furcal lesions, vertical bone pockets, horizontal bone loss and severe dental caries was used.

RESULTS

The index ranged individually from 0-91. Horizontal bone loss was found in 94%, vertical bone loss in 19%, periapical lesions in 46%, furcal lesions in 19% and carious lesions in 39% of the subjects. Only 3% of the subjects were free of dental infections, while 2% had mild, 17% moderate and 78% severe risk of dentogenic infection. Statistically significant background factors were region, level of education, number of regular drugs in use, drugs reducing salivation, alcohol consumption, cardiovascular disease, asthma and rheumatoid arthritis.

CONCLUSIONS

Elderly Finns have high a prevalence of signs of infections of dental origin, which is associated with several socio-demographic and health-related factors.

Evaluation of reasons for extraction of crowned teeth: a prospective study at a university clinic

OBJECTIVE

The aim of this study was to determine and classify the major reasons for extraction of teeth with full crowns belonging to patients admitted to a university clinic within a specific time frame.

METHODS

Two hundred and eight extracted teeth with full crown belonging to 75 patients were included. Apart from demographic information, reasons for presenting to the hospital, the major reason for extraction, the type of the crown (single crown, bridge abutment, abutment for removable prosthesis), presence of posts, age of restorations, presence of an endodontic treatment and quality were recorded. Comparable data were statistically analyzed using the chi-square test.

RESULTS

Forty-three (57.3%) of the patients were females, whereas 32 (42.7%) were males with an average age of 63.21 ± 13.56. A statistically significant relationship was determined between age groups and rate of extractions, with the lowest extractions detected in the 35-44 years age group and the highest in the 55-64 years age group (p = 0.001). Tooth mobility was the predominant reason for patients' initial presentation (52.9%). The most encountered reason for extraction was periodontal reasons with a prevalence of 59.1%, followed by caries (26.9%) and periapical lesions (12%); 35.6% of extracted teeth had endodontic treatment. Sixty teeth (81.1%) had incomplete root fillings. There was a significant relationship between extractions and incomplete root fillings (p = 0.001).

CONCLUSION

Studies comprising other faculty clinics as well as general practices will be complementary in making more generalized statements regarding the etiology of extractions of crowned teeth.

Associations between smoking and tooth loss according to the reason for tooth loss: the Buffalo OsteoPerio Study

BACKGROUND

Smoking is associated with tooth loss. However, smoking's relationship to the specific reason for tooth loss in postmenopausal women is unknown.

METHODS

Postmenopausal women (n = 1,106) who joined a Women's Health Initiative ancillary study (The Buffalo OsteoPerio Study) underwent oral examinations for assessment of the number of missing teeth, and they reported the reasons for tooth loss. The authors obtained information about smoking status via a self-administered questionnaire. The authors calculated odds ratios (ORs) and 95 percent confidence intervals (CIs) by means of logistic regression to assess smoking's association with overall tooth loss, as well as with tooth loss due to periodontal disease (PD) and with tooth loss due to caries.

RESULTS

After adjusting for age, education, income, body mass index, history of diabetes diagnosis, calcium supplement use and dental visit frequency, the authors found that heavy smokers (≥ 26 pack-years) were significantly more likely to report having experienced tooth loss compared with never smokers (OR = 1.82; 95 percent CI, 1.10-3.00). Smoking status, packs smoked per day, years of smoking, pack-years and years since quitting smoking were significantly associated with tooth loss due to PD. For pack-years, the association for heavy smokers compared with that for never smokers was OR = 6.83 (95 percent CI, 3.40 -13.72). The study results showed no significant associations between smoking and tooth loss due to caries.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Smoking may be a major factor in tooth loss due to PD. However, smoking appears to be a less important factor in tooth loss due to caries. Further study is needed to explore the etiologies by which smoking is associated with different types of tooth loss. Dentists should counsel their patients about the impact of smoking on oral health, including the risk of experiencing tooth loss due to PD.

A video feedback-based tobacco cessation counselling course for undergraduates-preliminary results

BACKGROUND

Hungary has one of the highest rates of tobacco use and decayed, missing and filled teeth in Europe, and the number of lung cancer-related deaths per annum is amongst the highest globally. As it is estimated that the rate of smokers who see their dentist or physician annually is about 70%, to involve all healthcare providers in tobacco intervention seems to be a promising strategy to reduce tobacco use in countries like Hungary. Such an intervention should obviously include the dental health team. It has already been suggested by experts on this topic that instruction in tobacco use prevention and cessation counselling for dental professionals and students of dentistry should be included in under- and postgraduate curricula.

OBJECTIVES

To present a novel, video feedback-based undergraduate cessation counselling programme, which has recently been introduced to the dental curriculum at the Faculty of Dentistry, Szeged, Hungary.

METHODS

Applying a problem-based learning approach, the programme consists of three main activities: a small-group interactive training session led by a faculty member, where students learn about the basic science and clinical aspects of tobacco use, including counselling skills; student interactions with professional actors (i.e. standardised patients) simulating real-life dental situations, which are recorded for post hoc evaluation; and finally an evaluation of the recorded performance of each student, with the participation of the actor, the student and a faculty member.

RESULTS

With the help of this new approach, students had the chance to learn about and develop a deeper understanding of tobacco-related professional dental communication in realistic, case-based dental scenarios. Students have reported increased confidence in tobacco counselling after having participated in this programme. Furthermore, this method appears to be an ideal tool for the evaluation of both verbal and non-verbal tobacco counselling skills.

CONCLUSION

To our knowledge, we are the first to have applied video feedback combined with behavioural modification methods in the teaching of tobacco cessation counselling. We conclude that teaching method can help dentists better understand smokers, gain confidence in tobacco cessation counselling and become more effective promoters of a smoke-free lifestyle. In addition, this method can be easily adapted to other healthcare educational settings, including other oral health training programmes.

Effects of complete dentures on respiratory performance: spirometric evaluation

OBJECTIVES

There is a lack of data regarding whether edentulous subjects should remove dentures during spirometric measurements or not. The purpose of this study is to determine influences of complete dentures on spirometric parameters in edentulous subjects.

MATERIALS AND METHODS

A total of 46 complete denture wearers were included in this study. Respiratory functions of the subjects were evaluated by spirometric tests that were performed in four different oral conditions: without dentures (WOD), with dentures, lower denture only and upper denture only. Forced vital capacity (FVC), peak expiratory flow, forced expiratory volume in 1 s and forced expiratory flow between 25% and 75% were evaluated. The data were analyzed with Friedman, Wilcoxon and paired-samples t tests (α = 0.05).

RESULTS

Significant differences were found between spirometric parameters in different oral conditions (p < 0.05). In all spirometric parameters, the most important significant differences were found between conditions WOD, FVC and with lower dentures (FVC), and WOD (forced expiratory volume in 1 s) and with upper dentures (forced expiratory volume in 1 s) (p < 0.001).

CONCLUSION

It was observed that complete dentures may unfavourably affect spirometric values of edentulous subjects. However, current findings need to be confirmed with advanced respiratory function tests.

Factors associated with edentulousness in an elderly population in Valencia (Spain)

OBJECTIVE

To determine the prevalence of edentulism and its association with various socioeconomic factors and oral health habits in the population aged 65-74 years old in the region of Valencia.

METHODS

A cross sectional study was designed. Thirty-four primary health centers and five nursing homes were chosen at random in the region of Valencia (10-15 voluntary participants per sampling point). Clinical examinations were carried out by three calibrated dentists (kappa>0.85) in the same centers. The total sample consisted of 531 individuals (235 men and 296 women).

RESULTS

The percentage of toothlessness was 20.7% and the mean number of natural teeth present was 14.92. The prevalence of edentulism was significantly higher (p <0.05) in men, institutionalized persons, those with no schooling, those with poor oral hygiene, those who visited the dentist regularly and those living in peri-urban/rural areas. In a multivariate logistic regression model with edentulism as the dependent variable, the following factors were identified as significant independent variables: institutionalization (odds ratio [OR]=2.88), poor oral hygiene (OR=2.35), regular visits to the dentist (OR=2.34) and age (OR=1.19).

CONCLUSION

Edentulousness is a complex phenomenon that involves distinct social and economic factors.

Tooth loss and edentulism in the Turkish elderly

The aim of this study was to evaluate partial and complete tooth loss and some related demographic factors, and oral health behaviors among Turkish elderly. According to recent censuses, elderly population of Turkey is rapidly growing. There is no nationwide information related to edentulism and natural teeth retention among 65-74 year-old people in Turkey. In this nationwide representative cross-sectional study, 1545 subjects aged 65-74 years were evaluated using the proportional stratified cluster sampling method. The data were collected via a structured, pre-tested face to face administered questionnaire and an oral examination. Chi-square test and binary logistic regression analyses were used to determine the significance of explanatory variables. 48.0% of elderly were edentate. The mean DMF-T was 25.8±8.5. These values were higher in women (p=0.016), older age (p<0.001) and rural individuals (p<0.001). Only 12.4% of the subjects had functional dentition. Age, visiting dentist, and health security were associated with edentulism. Female sex (OR=1.37), 70-74 age group (OR=2.08) and illiteracy (OR=3.25) were the independent factors of not having functional dentition. A reduction in edentulism in elderly may be achieved by the implementation of community programs promoting oral health for the prevention and treatment.

Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study

 

OBJECTIVE

While risk factors for tooth loss in adults have been identified, limited studies describing factors associated with incident tooth loss in postmenopausal women exist. This study assessed both clinical and non-clinical risk factors for incident tooth loss.

METHODS

Postmenopausal women (N = 1341) were recruited between 1997 and 2000 from 1847 eligible Observational Study participants of the Buffalo, NY center of the Women's Health Initiative who had complete dental examinations to assess alveolar bone height, soft tissue attachment and general oral health, and completed questionnaires concerning demographics, general health, lifestyle and oral health (72.6% participation rate). Five years later (2002-2005), 1021 women (76.1%) repeated these examinations and questionnaires. Incident tooth loss was determined by oral examination.

RESULTS

After an average 5.1 years of follow-up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7% of women with incident loss of at least one tooth. In multivariable models, diabetes history, gum disease history, smoking, previous tooth loss, BMI and plaque index, baseline clinical measures including alveolar crestal height (ACH) (OR = 1.22 per mm loss, 95% CI 1.11, 1.35), clinical attachment loss (CAL) (OR = 1.13 per mm loss, 95% CI 1.05, 1.23), and pocket depth (PD) (OR = 1.26 per mm loss, 95% CI 1.13, 1.41) were significant risk factors of incident tooth loss. In a community model that included no clinical measures, diabetes history (OR = 2.45, 95% CI 1.26, 4.77), prior gum disease (OR = 1.97, 95% CI 1.43, 2.70), ever smoking (OR = 1.42, 95% CI 1.06, 1.89), number of teeth lost at baseline (OR = 1.05 per tooth, 95% CI 1.02, 1.08), and BMI (OR = 1.15 per 5 km/m(2) increase, 95% CI 1.01, 1.33) were associated with an increased risk of incident tooth loss.

CONCLUSIONS

Clinical and questionnaire-based models were found to provide similar risk estimates for incident tooth loss in postmenopausal women. These models identified high-risk postmenopausal women where preventive strategies may be targeted.

Prevalence of single crowns and fixed partial dentures in elderly citizens in the southern and northern parts of Finland

The epidemiology of oral rehabilitation using fixed prosthodontics has received little attention. The aim of this study was to evaluate the prevalence of single crowns, fixed partial dentures (FPDs), resin-bonded FPDs and implants in elderly Finnish patients and to identify factors that might be associated with the findings. The survey was carried out in the southern and northern parts of Finland. The target population consisted of all persons born in 1919, 1922, 1925, 1928, 1931, 1934 and 1937, who lived in Kirkkonummi and in Lakeus (n=1733) in 1996. The age range of the subjects was 60-78years. In addition to a clinical examination, panoramic radiograph was taken. Data on background factors were obtained using questionnaires and/or interviews. The presence of single crowns, FPDs, resin-bonded FPDs and implants were determined from the panoramic radiographs. Overall, 12·4% of men and 12·1% of women had single crowns, while 4·8% of men and 8·0% of women had FPDs. A logistic regression analysis showed that the presence of crowns and FPDs was significantly associated with a southern place of residence, high and middle levels of education and high frequency of dental visits.

Influence of edentulousness on gonial angle, ramus and condylar height

It has been shown that the shape of the mandible correlates with occlusal condition and the function of the masticatory muscles. Edentulous subjects have a wider gonial angle than dentate subjects, and a gender difference has also been shown. However, some studies have reported differing results. Less is known about the effect of dental status and gender on the ramus and condylar height. The aim of this study was to evaluate the association of tooth loss on the shape of mandible (i.e., gonial angle, ramus height and condylar height) in subjects aged 60 years and older. A total of 1036 subjects (667 dentate, 389 edentulous; 554 women and 482 men) were included in the study. Interviews and clinical and panoramic radiographic examinations were carried out. The gonial angle of the mandible and the mandibular and condylar height were measured using panoramic radiographs. In edentulous subjects, the gonial angle was significantly larger, while the ramus and condylar height was significantly smaller on both sides compared with dentate subjects. Women had a significantly larger gonial angle and smaller ramus and condylar height on both sides compared with men. In conclusion, the morphology of the mandible changes as a consequence of tooth loss, which can be expressed as a widening of the gonial angle and shortening of the ramus and condylar height. These findings highlight the importance of rehabilitation of the masticatory system to maintain good functioning of the masticatory muscles for as long as possible.