Developing an instrument to support oral care in the elderly

BACKGROUND

The dramatic increase in the number of dependent elderly in developed countries has created a great need for their improved oral care. However, optimal oral care by caregivers is not possible because of time constraints, difficulty involved in brushing other individuals' teeth, lack of co-operation, and the lack of perceived need. Therefore, the development of an effective instrument simplifying and supporting oral care to relieve the strain on caregivers is a matter of some urgency.

PURPOSE

In order to clean the mouths of elderly dependent patients, we have developed a new oral care support instrument (an electric toothbrush in combination with an antibacterial-agent supply and suction system). The purpose of the present study was to develop and evaluate a new oral care support instrument.

METHODS

a) Plaque removal study: The plaque- removing ability of this new instrument in 70 outpatients was compared with the Plak Control D9011 (Braun Gillette Japan Inc.) as a control by means of the Turesky modification of the Quigley and Hein plaque index. b) Clinical study: The subjects were 10 dependent elderly who received oral care using the new oral care support instrument for two weeks. The plaque and gingival indices were used for clinical evaluations.

RESULTS

a) Plaque removal study: Brushing with the new oral care support instrument removed significantly more plaque than with the Plak Control D9011. b) Clinical study: The new oral care support instrument allows a more effective removal of dental plaque and shows a significant improvement in the gingival indices in dependent elderly.

CONCLUSION

It is concluded that the new oral care support instrument is effective and can be recommended for oral care in the dependent elderly.

Lasers in a hospital-based dental practice

Lasers have been shown to be excellent additions to the dental armamentarium. When used on medically compromised patients in a hospital-based setting or private practice setting sufficiently equipped to deal with potential medical emergencies, lasers can make treatment of these patients much simpler and safer. As more uses are found for dental lasers and more wavelengths are developed for dentistry, lasers will become an increasingly useful tool for the hospital dental practice.

[Design and development of one-handed denture brush for bedridden people]

Oral care for elderly bedridden people is one of the most necessary forms of care, not only for prevention of oral infection or aspiration pneumonia, but also in order to savor the taste of food and to recover and maintain mental vitality through the improvement in oral function. We designed denture brush that can be handled with one-hand in order to support independence. People require cooperation between medical treatment, health, and welfare services. We introduced the newly designed denture brush as a means to support the improvement of QOL for elderly bedridden people, and we hope to see the spread and promotion of oral care.

Management priorities and treatment strategies for medical emergencies in the dental office

The importance of prioritization in the management of the emergency dental patient cannot be overemphasized. Each dentists' ability to recognize and deal with emergencies depends on the dentists' education, the training of the staff, and the available equipment. This article helps the dentist prioritize the management of medical emergencies by examining preventive protocol and treatment options, as well as preparation and training strategies.

Efficacy of a sonic toothbrush for plaque removal by caregivers in a special needs population

Oral hygiene and oral health are a major concern for long-term-care facility residents who are unable to care for themselves. In this six-week study, the efficacy of a sonic toothbrush (Sonicare) was compared with traditional manual brushing in a setting where hygiene care was provided by caregivers. Evaluations of plaque levels were made at baseline and at 2, 4, and 6 weeks according to the Silness and Löe index. The sonic brush was found to be significantly superior to the manual brush over the trial period (MANCOVA; p = 0.026). Plaque reduction at 6 weeks was found to be 38% with the sonic brush and 6% with the manual brush. The results indicate that the sonic brush may be an effective way to provide improved oral health to nursing home subjects when oral care is caregiver-provided.

Implant-supported overdenture rehabilitation and progressive systemic sclerosis

Progressive systemic sclerosis, or systemic scleroderma, is an autoimmune multisystemic disease associated with vascular abnormalities, connective tissue sclerosis, atrophy, and autoimmune changes. The complex oral problems that may develop in patients with the disease and the difficult oral access necessitate extreme care in preventing dental disease. The oral management of a patient with an edentulous mandible and progressive systemic sclerosis, using an overdenture supported by osseointegrated implants, is presented and discussed.

Use of an electronic apex locator on a cardiac pacemaker patient

Modern cardiac pacemakers are complex and heterogenous devices. The potential effect of electrically powered instruments on a patient's pacemaker function must be carefully evaluated before treatment. Interference with the pacemaker's function by the instrument depends on the specific type of pacemaker placed and the patient's dependence on it. A case is presented in which an electronic apex locator was used on a patient with a pacemaker, despite the manufacturer's written warning to the contrary. The patient's cardiologist was consulted before treatment.

Dental management of neonates requiring prolonged oral intubation

An orotracheal route is frequently the preferred method of intubation for premature infants. Nasal intubation may contribute to airway obstruction and possible hypoxia, further contributing to labored breathing. Additional complications include occlusion of the nasal aperture during a crucial period of development, nasal infections, and hypertrophy of the nasal lining. Oral mucosa is less susceptible to damage than nasal mucosa; however, orotracheal tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Problems associated with rehabilitation of very-low-birth-weight neonates and other infants requiring long-term oral intubation include palatal grooving, acquired cleft palate, and damage to the primary dentition. Various intraoral aids have been used to reduce pressure application from intubation and feeding tubes on the palatal tissues. References to these procedures have yet to be reported in the prosthodontic literature. This article presents a rational for design and construction of an intraoral device which protects the palatal tissues and stabilizes the orotracheal tube.

The safety of dental mini-magnets in patients with permanent cardiac pacemakers

To evaluate the safety of prosthetic mini-magnets, 12 patients treated with implanted cardiac pacemakers were examined. Small cylindric magnets were applied one, two, and three at a time to constant points on the pacemaker under electrocardiographic monitoring. No influence on the pacemaker was detected in nine of the patients, but limited changes were encountered in three patients. However, the changes disappeared when the magnets were moved 1 cm away. The conclusion was that the use of mini-magnets in dental care in patients with implanted pacemakers is safe and acceptable.

Neuropathological chewing: a dental management protocol and treatment appliances for pediatric patients

Neuropathological chewing in hospitalized, comatose patients can occur from severe brain damage following a closed head injury, hypoxia, and septic shock. The dental management protocol developed by the Department of Dentistry at the Royal Children's Hospital, Melbourne, Australia, is presented. Treatment appliances utilizing a mandibular cast-silver cap splint with acrylic bite blocks and a maxillary mouthguard with acrylic bite blocks are discussed.

Advances in portable and mobile equipment systems

Specific efforts need to be directed towards eliminating and/or minimising the significant barriers that threaten the oral health of nursing home and homebound individuals. Exciting new portable dental system options are now available which will help to overcome difficulties associated with meeting the dental needs of this cohort.