Dental Caries, Periodontal Disease, and Cardiac Arrhythmias in Community-Dwelling Older Persons Aged 80 and Older: Is There a Link?

Effects of Oral Inflammatory Diseases and Oral Hygiene on Atrial Fibrillation: A Systematic Review

Objective. Research evidence suggests a link between periodontitis (PD) and atrial fibrillation, but the nature of this link is unclear. This study aimed to systematically review and evaluate the association between PD, other oral diseases, and atrial fibrillation and the role of oral hygiene in preventing atrial fibrillation. Methods. We searched the Medline, Embase, Cochrane Library, and Web of Science databases for the clinical study of oral health and atrial fibrillation from inception to November 2022. Oral health conditions included PD and other oral inflammatory diseases, regular oral hygiene, and tooth brushing. The primary outcomes were the risk of new-onset atrial fibrillation in patients with oral disease, the effect of regular oral care on preventing atrial fibrillation, the effect of frequent tooth brushing on preventing atrial fibrillation, and the incidence of atrial fibrillation in PD patients. Results. Eight clinical trials with a total of 4,328,355 patients were included. The result of the research showed that PD and other impaired oral health may be associated with new-onset atrial fibrillation, and its severity was dose-responsive to the risk of atrial fibrillation. The incidence of atrial fibrillation in patients with severe PD was about 16.3%. Moreover, PD may increase the risk of long-term arrhythmia in patients with atrial fibrillation. Regular oral care and frequent tooth brushing can reduce the incidence of atrial fibrillation. Conclusion. Regular and moderate oral hygiene, frequent tooth brushing, and prevention of PD and other oral inflammatory diseases could reduce the occurrence of atrial fibrillation. It is recommended to strengthen the popularization of oral health knowledge in the publicity related to atrial fibrillation.

Periodontitis, dental plaque, and atrial fibrillation in the Hamburg City Health Study

Background/Aim

Atrial fibrillation (AF) is a major health problem and causes heart failure and stroke. Pathophysiological mechanisms indicate a link with oral health including periodontitis (PD), but supporting data are scarce. The aim was to investigate the link between features of oral health and the prevalence of AF.

Methods

This cross-sectional analysis of the Hamburg City Health Study included 5,634 participants with complete data on their PD and AF status. AF was assessed via self-reported questionnaire or medically diagnosed by standard 12-lead resting ECG. The oral health examination included full-mouth measurements of the dental plaque index (PI), the clinical attachment loss (CAL) at 6 sites per tooth, the bleeding on probing (BOP) and the decayed, missing and filled teeth (DMFT) index. Descriptive analyses for all variables stratified by the status of PD were performed. To test for an association between prevalent PD and prevalent AF, multivariable logistic regression models were used. Mediation analysis was used to test if interleukin-6 (IL-6) and/or C-reactive protein (CRP) mediated the association between PD and AF.

Results

Atrial fibrillation (prevalence: 5.6%) and the severity of PD (prevalence: moderate: 57.7%, severe: 18.9%) increased with age in men and women. Prevalent severe PD, CAL ≥3 mm, PI, and BOP were all associated with prevalent AF in unadjusted regression analysis. However, no association except for PI (odds ratio (OR): 1.22, 95% confidence interval (CI): 1.1–1.35, p<0.001) could be observed after adjusting for age, sex, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), body mass index, diabetes, smoking, and educational level. Participants brushing their teeth at least twice daily had a lower AF prevalence compared with those brushing only once daily. Hs-CRP, IL-6, and the odds of AF increased as a function of PD severity grades in unadjusted analysis. However, neither the DMFT index nor IL-6 or CRP was associated with AF after adjusting for age and sex. Mediation analyses could not provide support for the hypothesis that IL-6 or CRP acted as mediator of the association between prevalent PD and prevalent AF.

Conclusion

The study shows an association between prevalent AF and increased dental plaque levels indicated by a higher PI. In contrast, an association of prevalent PD with prevalent AF after adjustments for several confounders could not be demonstrated. Further studies are necessary to investigate the mechanisms underlying poor oral hygiene and AF as well as the influence of improved oral hygiene on AF onset.

Evaluation of lightwand-guided endotracheal intubation for patients with missing or no teeth: a randomized controlled study

Background

Unhealthy teeth can seriously affect general health and increase the risk of death in elderly people. There has been no confirmation of which device is most effective for elderly patients with teeth loss. Therefore, we compared four intubation devices in elderly patients with partial and total tooth loss aiming to reduce risk during anesthesia.

Methods

Two hundred patients were randomized to undergo tracheal intubation with the Macintosh laryngoscope, the Glidescope, the Fiberoptic bronchoscope or the Lightwand as part of general anesthesia. A unified protocol of anesthetic medications was used. HR and BP were measured at T₀, T₁, T₂, T₃, T₄ and T₅. Catecholamine (epinephrine and norepinephrine) blood samples were drawn at T₀, T₁ and T₂. Intubation time and postoperative complications, including dental damage and losses, were recorded.

Results

Reduced fluctuations in HR, DBP, and SBP were observed in the Lightwand group. Intubation time was significantly shorter in the Lightwand group (p < 0.05). There was no statistically significant difference between the groups in epinephrine levels, but norepinephrine levels were less volatile in the Fiberoptic bronchoscope and Lightwand groups. Fewer patients in the Lightwand group experienced dental damage and other postoperative complications than in the other three groups. Although a higher success rate on the first attempt was as high as in the Fiberoptic bronchoscope group, shorter intubation time was observed only in the Lightwand group.

Conclusion

The Lightwand offers less hemodynamic stimulation than the Macintosh laryngoscope, Glidescope, and Fiberoptic bronchoscope. Because it had the shortest intubation time, the Lightwand caused the least damage to the teeth and throat of elderly patients. Our findings showed that tracheal intubation with the Lightwand was advantageous for preventing cardiovascular stress responses with short intubation times and fewer postoperative complications.

The Swedish dental health register - validation study of remaining and intact teeth

BACKGROUND

Sweden has a long tradition of nationwide registers enabling population-based research of high quality and validity. We aimed to describe the content and validity of reported number of remaining and intact teeth in the Swedish Dental Health Register and report some descriptive data on dental health care utilization.

METHODS

The Swedish Dental Health Register was initiated in July 1st 2008 and contains individual data on dental health care to the whole adult population of Sweden. The dental care given freely to children and young adults is not included. Descriptive data on remaining, intact teeth and dental health care utilization is presented by proportion of the population stratified by sex and age. We conducted a validation study, by manual review of randomly sampled 1500 dental health visits records, to assess reported number of teeth to the register with what was actually recorded in the dental health care record (gold standard), analyzed by positive predictive value (PPV) and Bland-Altman plots.

RESULTS

Of the Swedish adult population 2014, 2.6 million (69%) men and 2.9 million (76%) women had at least one visit to a dentist during a two-year period 2013 to 2014. More than half of the population up to age 64 have all remaining teeth (28 teeth or more). Of the 1500 requested dental records 1131 (75%) were received. The positive predictive value for patients reported to the register as having at least 1 tooth up to 31 intact teeth was 91.5% (95% confidence interval 89.0-93.5, 567 manually reviewed to be correct out of 620 reported).

CONCLUSIONS

For patients coded as having less than 32 intact teeth but not being edentulous the reported number of remaining and intact teeth is to a very high degree correct. However, the correctness for those coded as edentulous or having 32 remaining intact teeth is low and varies substantially by age.

Periodontal complications with age

The present literature review on periodontal complications in aging focuses on the diagnosis, etiology and development of periodontal complications as a complete entity. In addition, the review also focuses on some of the common systemic diseases that either may further add to periodontal complications or, as result of anti-inflammatory treatment, limit the expression of periodontal disease. There is no evidence to suggest that clinical methods to provide periodontal therapies have been developed especially for older individuals. There is evidence that aging can be associated with periodontally healthy conditions through life and with a high level of tooth retention and function. Periodontal complications that are difficult to manage are usually associated with concurrent medical diseases and complications, or with socio-economic factors that limit the ability to provide dental care for the aging population. Currently, some systemic medical conditions are managed with anti-inflammatory medications with positive effects, while slowing the progression and expression of chronic periodontitis. The lack of data from clinical studies on how to manage periodontal complications in aging is obvious.

Accelerated inflammation in peripheral artery disease patients with periodontitis

Purpose

Peripheral artery disease (PAD) is a form of arteriosclerosis that occurs in the extremities and involves ischemia. Previous studies have reported that patients with periodontitis are at high risk for PAD. However, the relationship between these 2 diseases has not yet been fully elucidated. In this cross-sectional study, we investigated this relationship by comparing patients with PAD to those with arrhythmia (ARR) as a control group.

Methods

A large-scale survey was conducted of patients with cardiovascular disease who visited Tokyo Medical and Dental University Hospital. We investigated their oral condition and dental clinical measurements, including probing pocket depth, bleeding on probing, clinical attachment level, and number of missing teeth; we also collected salivary and subgingival plaque samples and peripheral blood samples. All patients with PAD were extracted from the whole population (n=25), and a matching number of patients with ARR were extracted (n=25). Simultaneously, ARR patients were matched to PAD patients in terms of age, gender, prevalence of diabetes, hypertension, dyslipidemia, obesity, and the smoking rate (n=25 in both groups). Real-time polymerase chain reaction was performed to measure the bacterial counts, while the enzyme-linked immunosorbent assay method was used to measure anti-bacterial antibody titers and proinflammatory cytokine levels in serum.

Results

PAD patients had more missing teeth (18.4±2.0) and higher serum levels of C-reactive protein (1.57±0.85 mg/dL) and tumor necrosis factor-alpha (70.3±5.7 pg/mL) than ARR patients (12.0±1.7, 0.38±0.21 mg/dL, and 39.3±4.5 pg/mL, respectively). Meanwhile, no statistically significant differences were found in other dental clinical measurements, bacterial antibody titers, or bacterial counts between the 2 groups.

Conclusions

Our findings suggested that PAD patients had poorer oral and periodontal state with enhanced systemic inflammation.

Root surface caries among older Australians

OBJECTIVES

Root caries has increased as a clinical problem in recent decades. However, the use of multiple waves of longitudinal follow-up data in estimating root caries increment has not been previously attempted. The aims of this study were to quantify root caries increment from a longitudinal study of older adults with 4 oral examinations over 11 years and to examine behavioural factors associated with root caries.

METHODS

A secondary analysis was undertaken using data collected in 4 waves (baseline, 2-year, 5-year and 11-year) of the South Australian Dental Longitudinal Study which began in 1991/92. The study group consisted of a stratified random sample of people aged 60+ years at baseline. A total of 358 participants with complete oral examinations in all 4 waves were included. The examinations were performed by trained and calibrated dentists. Baseline behavioural risk factors (toothbrushing frequency, flossing frequency, dental visiting pattern, reason for dental visiting and tobacco smoking status) and time in years across the 4 waves were the main exposures. Baseline clinical oral conditions (gingival condition and gingival recession), demographic and socio-economic risk factors served as covariates. Root caries was measured as mean number of untreated root surfaces (root DS) and decayed/filled root surfaces (root DFS) at each wave of examinations. Multivariable multilevel growth model using linear regression analysis was used to get an estimate for root caries increment and associated oral health-related behaviours adjusting for all the covariates.

RESULTS

Findings from the multivariable models indicated that the annual increment of root DS and root DFS were 0.07 (SE = 0.01) and 0.11 (SE = 0.02) surfaces, respectively. Irregular brushing (E [SE] = 0.25 [0.12]), visiting the dentist only for problems (E [SE] = 0.30 [0.13]) and smoking (E [SE] = 0.33 [0.12]) were risk factors for the increase in root DS. Irregular flossing and more frequent dental visit were associated with the increase in root DFS.

CONCLUSIONS

Root caries increased slowly across time among relatively healthier Australian older adults. Irregular brushing, unfavourable dental visiting and tobacco smoking were risk factors for the increase in untreated root caries, while irregular flossing and more frequent dental visiting were associated with the increase in root DFS.

Detrimental effects of specific Periodontopathic bacterial infection on tachyarrhythmia compared to Bradyarrhythmia

Background

Tachyarrhythmia (TA) and bradyarrhythmia (BA) are cardiac rhythm disorders that result in the decline of quality of life. While patients with periodontitis are at a high risk of cardiovascular disease (CVD), little causal information between TA and BA has been provided to date. To assess the relationship, periodontal bacterial infection in patients with TA or BA was evaluated.

Methods

The subjects were patients with TA (n = 98) or BA (n = 40) who attended Tokyo Medical and Dental University hospital. Periodontal and blood examinations were performed. Periodontopathic bacterial existence in saliva was evaluated.

Results

We found that specific periodontopathic bacteria, Porphyromonas gingivalis and Prevotella intermedia, were highly detected in saliva from TA patients compared to BA subjects. The rates of hypertension and dyslipidemia were comparable between the two groups.

Conclusion

Specific periodontal bacterial infection might affect TA progression.

Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study

OBJECTIVE

To investigate the risk of atrial fibrillation or atrial flutter in patients with periodontitis (PD) in comparison with individuals without PD.

METHODS

We used the 1999-2010 Taiwanese National Health Insurance Research Database to identify cases of PD in the year 2000 matching (1:1) with persons without PD during 1999-2000 according to sex and individual age as the control group. Using Cox proportional regression analysis adjusting for potential confounders, including age, sex, and comorbidities at baseline, and average annual number of ambulatory visits and dental scaling frequency during the follow-up period, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to examine the risk of atrial fibrillation or flutter in PD patients in comparison with the control group. Subgroup analyses according to age, gender, or comorbidities were conducted to study the robustness of the association and investigate possible interaction effects.

RESULTS

We enrolled 393,745 patients with PD and 393,745 non-PD individuals. The incidence rates of atrial fibrillation or flutter were 200 per 105 years among the PD group and 181 per 105 years in the non-PD group (incidence rate ratio, 1.10; 95% CI, 1.06-1.14). After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% CI, 1.25-1.36). The greater risk of atrial fibrillation or flutter in the PD group remained significant across all disease subgroups except hyperthyroidism and sleep apnea.

CONCLUSION

The present study results indicate an increased risk of atrial fibrillation or flutter in patients with PD. Lack of individual information about alcohol consumption, obesity, and tobacco use was a major limitation.

Incidence of periodontitis in Japanese patients with cardiovascular diseases: a comparison between abdominal aortic aneurysm and arrhythmia

Although there is a link between periodontitis and cardiovascular disease (CVD), the influence of periodontitis on CVD is unclear. The aim of this study was to assess the relationship between periodontal bacterial burden and CVD. We studied 142 patients with tachyarrhythmia (TA) and 25 patients with abdominal aortic aneurysm (AAA). We examined periodontitis and the presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Prevotella intermedia in the patients' saliva and subgingival plaque using PCR. We also measured serum antibody titers against the pathogens using ELISA. We found that the patients with AAA had fewer remaining teeth (14.6 ± 2.0 vs. 20.9 ± 0.7, P < 0.05) and deeper pocket depth (3.01 ± 0.26 vs. 2.52 ± 0.05 mm, P < 0.05) compared to the TA patients. The existence of each periodontal bacterium in their saliva or subgingival plaque and serum antibody titers was comparable between the two groups. Periodontitis may have a larger affect on aneurysm progression compared to arrhythmia.

Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association

A link between oral health and cardiovascular disease has been proposed for more than a century. Recently, concern about possible links between periodontal disease (PD) and atherosclerotic vascular disease (ASVD) has intensified and is driving an active field of investigation into possible association and causality. The 2 disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus. Patients and providers are increasingly presented with claims that PD treatment strategies offer ASVD protection; these claims are often endorsed by professional and industrial stakeholders. The focus of this review is to assess whether available data support an independent association between ASVD and PD and whether PD treatment might modify ASVD risks or outcomes. It also presents mechanistic details of both PD and ASVD relevant to this topic. The correlation of PD with ASVD outcomes and surrogate markers is discussed, as well as the correlation of response to PD therapy with ASVD event rates. Methodological issues that complicate studies of this association are outlined, with an emphasis on the terms and metrics that would be applicable in future studies. Observational studies to date support an association between PD and ASVD independent of known confounders. They do not, however, support a causative relationship. Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes.

Healthy eating index in southern Brazilian older adults and its association with socioeconomic, behavioral and health characteristics

OBJECTIVE

The objective of this study was to assess factors associated with the diet quality of brazilian older adults.

DESIGN

Cross-sectional study.

SETTING

City of Carlos Barbosa, Brazil.

PARTICIPANTS

228 participants aged 60 and older.

MEASUREMENTS

A questionnaire with questions on socioeconomic and behavioral variables and health characteristics was used. The body mass index was calculated and the waist circumference was measured to provide information in respect to abdominal fat accumulation. Dietary data were collected via 24-hour recall and the diet quality was assessed using the Healthy Eating Index, an instrument that attributes scores to the diet according to the adequacy of intake of the main food and nutrient groups. Participants were divided into three categories, according to the Healthy Eating Index scores: under 51--poor diet; between 51 and 80--diet that needs improvement; over 80--good diet. The evaluation employed the analysis of variance, t test and non-conditional logistic regression to assess the association between the Healthy Eating Index and the other variables.

RESULTS

Most participants (80.9%) presented diet that needs improvement and the marital status showed an independent association with the Healthy Eating Index--married individuals showed higher odds of presenting good diet.

CONCLUSION

The results of this study suggest that, in general, the diet quality of this group needs improvement and that the marital status is a factor that can be considered for the development of activities to promote health and healthy food intake habits.

Elderly at greater risk for root caries: a look at the multifactorial risks with emphasis on genetics susceptibility

Root caries is one of the most significant dental problems among older adults today. Many studies have demonstrated that older adults are at greater risk for developing root caries. Here we examine what risk factors older adults are prone to and explain how they contribute to higher rates of oral disease, in particular root caries. The elderly are at risk for root caries due to dentures, lack of dexterity, a shift from complex to simple sugars, and poor oral hygiene. Decreased salivary flow and its manifestations with other social/behavioral and medical factors may provide a more comprehensive explanation to a higher frequency of root caries in older adults.

Detection of Streptococcus mutans Genomic DNA in Human DNA Samples Extracted from Saliva and Blood

Caries is a multifactorial disease, and studies aiming to unravel the factors modulating its etiology must consider all known predisposing factors. One major factor is bacterial colonization, and Streptococcus mutans is the main microorganism associated with the initiation of the disease. In our studies, we have access to DNA samples extracted from human saliva and blood. In this report, we tested a real-time PCR assay developed to detect copies of genomic DNA from Streptococcus mutans in 1,424 DNA samples from humans. Our results suggest that we can determine the presence of genomic DNA copies of Streptococcus mutans in both DNA samples from caries-free and caries-affected individuals. However, we were not able to detect the presence of genomic DNA copies of Streptococcus mutans in any DNA samples extracted from peripheral blood, which suggests the assay may not be sensitive enough for this goal. Values of the threshold cycle of the real-time PCR reaction correlate with higher levels of caries experience in children, but this correlation could not be detected for adults.

Edentulism, use of dentures and consumption of fruit and vegetables in south Brazilian community-dwelling elderly

There is evidence suggesting that edentulous older persons modify their diet, avoiding foods that are difficult to chew, such as fruit and vegetables; meanwhile, the consumption of these foods is associated with prevention of chronic diseases. However, few studies evaluated whether a poor oral status without prosthetic rehabilitation is associated with a reduction in the consumption of fruit and vegetables in community-dwelling older persons. We evaluated the association of oral status with emphasis on complete dentures use with the daily consumption of at least 400 g of fruit and vegetables, following the recommendations of the WHO. A random sample of 282 south Brazilians ≥60 years of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behaviour, and health data; consume of fruit and vegetables by means of a 24-h diet recall, and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prosthesis. Multivariate Poisson regression showed that the only variable significantly associated with inadequate consumption of fruit and vegetables was edentulism with the use of only one denture [PR=1·75 (1·11-2·74)]. Edentulous participants wearing only one denture were less likely to consume at least 400 g day(-1) of fruit and vegetables. These results indicate that, in edentulous community-dwelling elderly, oral health rehabilitation might play an important role in the maintenance of consumption of adequate amounts of fruit and vegetables, which is an important component of a healthy diet and also in the prevention of chronic diseases.

Dental health of community-living older people attending secondary healthcare: a cross-sectional comparison between those with and without diagnosed mental illness

BACKGROUND

Mental illness and cognitive impairment are risk factors for poor dental health.

METHODS

We conducted a cross-sectional study to compare the dental health of older patients attending out-patient clinics and day hospitals of old age psychiatry services (the psychiatry group, n = 103) with those attending general/geriatric medical services (the medical group; n = 99). Those living in care homes, and those with diagnosed mental illness (in the medical group) were excluded. A registered mental health nurse assessed mental and general health using validated and previously published instruments. A registered dentist made an independent assessment of dental health (examination to assess oral pathology, status of remaining teeth, and dentures) and made an overall judgment about whether the patient needed any dental treatment (a "normative" need).

RESULTS

The normative need for dental treatment was significantly higher among the psychiatry group compared to the medical group (85% vs 52%; p<0.001); even after taking account of the effect of age, gender, teeth status, physical comorbidity, cognition, depressive symptoms, and overall mental and social health [adjusted odds ratio, OR (95% confidence interval): 4.32 (2.09, 8.91)]. The presence of any natural remaining teeth [OR: 4.44 (2.10, 9.42)] and Barthel Index [OR: 0.96 (0.93, 0.99)] were the two other independent predictors of the need for treatment.

CONCLUSION

Dental problems are common in community-living older people, especially those with some natural remaining teeth and those with mental illness. There is a need to develop integrated mental health and dental care services for older people with emphasis on prevention of dental problems.

Potentially modifiable risk factors for dementia in identical twins

BACKGROUND

The purpose of this study was to test nongenetic factors that might explain discordance for dementia in monozygotic twin pairs. Risk factors included education, engaged lifestyle in midlife, and early life circumstances indexed by tooth loss, short adult height, and parental social class.

METHODS

Data are from the HARMONY study, including members of the Swedish Twin Registry age 65 and older and alive in 1998, who were screened and assessed clinically for dementia. Analyses included a case-control design to evaluate the risk factors and a co-twin control design that permits testing nongenetic risk factors while controlling for genetic influences. Case-control analyses included 310 dementia cases and 3,063 nondemented controls. There were 106 monozygotic twin pairs discordant for dementia. Risk factors were assessed independently by the Swedish Twin Registry three decades previously.

RESULTS

Case-control findings showed that history of tooth loss before age 35 and low educational attainment were significant risk factors for Alzheimer's disease, with short adult height also contributing to risk for total dementia. In co-twin control analyses, only history of tooth loss before age 35 was a significant risk factor for Alzheimer's disease, whereas low educational attainment also contributed to risk for total dementia and lack of physical exercise to risk for non-Alzheimer's dementias.

CONCLUSIONS

Potentially modifiable risk factors from early and midlife, with a cumulative detrimental effect on the brain, contribute to risk of dementia. Based on the association with tooth loss, further investigation of inflammatory load as a risk factor for Alzheimer's disease is warranted.

Oral status and its association with general quality of life in older independent-living south-Brazilians

BACKGROUND

There are few studies assessing the importance of oral status, particularly tooth loss, edentulism and satisfaction with mastication, on the perception of quality of life (qol) in general. The objective of this study was to evaluate if oral status was associated with lower ratings in the WHO Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) domains.

METHODS

In this cross-sectional study, a random sample of 872 Southern-Brazilians aged 60 years or more was evaluated using a structured questionnaire to assess sociodemographic data, qol (WHOQOL-BREF), and depressive symptoms (Geriatric Depression Scale). Oral examinations assessing the number of teeth and saliva flow were performed. Additionally, participants were asked to rate their satisfaction with the ability to chew. Correlates of poorer qol (i.e. values of the WHOQOL-BREF < or = median) were assessed by means of multivariate logistic regressions.

RESULTS

Poorer qol in the physical domain was associated with increasing age, income, living in rural areas, >2 chronic conditions, intake of medications, depressive symptoms, edentulism, and reporting difficulty for chewing food. Poorer qol in the psychological domain was associated with income, schooling, >2 chronic conditions, intake of medications, depressive symptoms, and difficulty for chewing. Poorer qol in the environment domain was associated with income, living in urban areas, depressive symptoms, and difficulty for chewing. Poorer qol in the social relations domain was associated with living in urban areas, depressive symptoms, and difficulty for chewing.

CONCLUSION

In the studied population, oral status was associated with the perception of quality of life in general.

Association between oral health status and nutritional status in south Brazilian independent-living older people

OBJECTIVE

Evidence suggests that older people with partial tooth loss and edentulism change their diet and lack specific nutrients, but few studies have assessed whether poor oral status is associated with risk of malnutrition and malnutrition in independent-living older people. We evaluated if poor oral status was associated with risk of malnutrition and malnutrition in this population.

METHODS

A random sample of 471 south Brazilians > or =60 y of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behavioral, general, and oral health data; nutritional status assessment, according to the Mini-Nutritional Assessment (MNA); and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prostheses. Correlates of risk of malnutrition/malnutrition according to the MNA were assessed by means of multivariate logistic regression.

RESULTS

Participants who reported dissatisfaction with their gingival health and edentulous persons wearing only one denture were more likely to be at risk of malnutrition, according to the screening MNA. Dissatisfaction with gingival health was a risk indicator, whereas having one to eight natural teeth was protective against the risk of malnutrition/malnutrition according to the full MNA.

CONCLUSION

In the present study, older people with a compromised oral status had higher odds for risk of malnutrition. The maintenance of a few teeth had a crucial role in increasing the chance of maintaining an adequate nutritional status in the studied population. In cases where edentulism was present, complete dental prosthetic use was associated with better nutritional status.

The epidemiology, consequences and management of periodontal disease in older adults

BACKGROUND

This review summarizes the literature on periodontal disease (PD) in older adults. The authors focused on significant sequelae of PD and therapy in this population.

TYPES OF STUDIES REVIEWED

The authors conducted a search on PubMed for human studies using the terms "periodontal disease OR periodontitis" and "older adults." They retrieved 649 articles and excluded studies that had poor experimental design. For each topic of the review, they selected one to three of the most recent studies or reviews for inclusion and cited classic articles where appropriate.

RESULTS

PD is a common oral chronic inflammatory disease often found in older adults. In older patients, PD may lead to root caries, impaired eating and socialization. It also may increase patients' risk of developing systemic diseases such as diabetes mellitus, lung disease, heart disease and stroke. Treatment is not limited by chronological age but depends on the patient's medical and emotional status and the availability of financial resources.

CLINICAL IMPLICATIONS

General dentists usually can treat the majority of older people with mild or moderate PD. For older adults who are medically compromised and dependent, the literature supports treatment that prevents PD progression.

The Impact of a Low-Frequency Chlorhexidine Rinsing Schedule on the Subgingival Microbiota (the TEETH clinical trial)

BACKGROUND

Information on the efficacy of chlorhexidine (CHX) rinsing on the subgingival microbiota is limited. This study tested if intermittent CHX rinsing over 5 years had an impact on the subgingival microbiota.

METHODS

Subgingival plaque samples were analyzed by the checkerboard DNA-DNA hybridization method in a double-blind randomized CHX rinse study.

RESULTS

A total of 210 subjects were included. The mean age of the subjects was 71.7 (+/- 4.1) years, and 56.2% were women. Evidence of alveolar bone loss was found in 39% of subjects. Bacterial loads were not correlated significantly with probing depth. At year 5, subjects in the CHX rinse group with no evidence of bone loss presented with lower total bacterial counts than control subjects with no bone loss. The levels of the following bacteria were significantly lower in the CHX group: Lactobacillus acidophilus (P <0.05), Eikenella corrodens (P <0.05), Fusobacterium nucleatum sp. nucleatum (P <0.01), Treponema denticola (P <0.05), Leptotrichia buccalis (P <0.05), and Eubacterium saburreum (P <0.05). No differences in bacterial loads were found between CHX and control rinse subjects with alveolar bone loss.

CONCLUSIONS

Older subjects with or without periodontitis carry a large variety of bacteria associated with periodontitis. Intermittent rinsing with CHX may provide a preventive benefit in reducing levels of bacteria but only in subjects without alveolar bone loss.

Periodontal disease in the oldest-old living in Kungsholmen, Sweden: findings from the KEOHS project

AIMS

The Kungsholmen Elders Oral Health Study evaluated the oral health status of generally healthy, community-dwelling persons aged 80 years and over living in Stockholm, Sweden. This paper reports periodontal disease findings and evaluates the distribution by sociodemographic factors.

METHODS

Eligible persons were identified through the Kungsholmen Project, an ongoing, longitudinal, population-based study of older adults. A total of 121 study subjects received a periodontal examination.

RESULTS

The mean pocket probing depth was 2.6 mm and the mean clinical attachment loss was 3.7 mm. Gingival bleeding was common. Over half of all study participants met the criteria used for "serious periodontitis" (SP). In the best fit adjusted odds ratio (OR) model, males were 3.1 times more likely than females to have "SP" (OR=3.1, 95% CI 1.2, 8.0), a statistically significant observation. A sub-analysis of the differences in proportion of participants with SP revealed that the difference by sex also increased by age.

CONCLUSIONS

These findings document the substantial and ongoing impact of periodontal disease in a sample of generally healthy, community dwelling older adults and underscore the importance of continued periodontal disease prevention and treatment in the oldest-old.