[Adverse effects of Swedish smokeless tobacco "snus"]. / Nuuskan terveyshaitat.

Selling smokeless tobacco (snus) in Finland is illegal, yet one-third of all males aged 16 to 18 years have tried it. A regular snus user can receive a daily dose of 60 to 150 milligrams of nicotine and become heavily addicted. The first--and easily detectable--lesions appear in the oral mucosa and gingiva. Long-time followup studies of snus use from a young age are, however, still lacking. Evidence exists of increased risk for fatal cardiovascular diseases and increased risk for injuries. Risk for oral cancer is debated, with more studies showing an increased risk than showing no risk; risk also exists for cancer of esophagus, stomach and pancreas. A new and alarming finding among female users is increased risk for preterm birth, preeclampsia and neonatal apnea.

Periodontal health status in the elderly with different levels of education: a 5-year follow-up study.

OBJECTIVE: To assess the association between the periodontal health status and level of education over a 5-year period among the elderly aged 75 years and older. BACKGROUND: Oral health among the higher educated is known to be better than among the less-well educated. On the other hand, the prevalence and severity of periodontal disease has been found to grow with increasing age. METHODS: The participants were derived from a population-based Helsinki Aging Study, a random sample of 76-, 81- and 86-year-old elderly. The 170 dentate elderly who underwent clinical oral examinations at baseline and 71 who participated in the follow-up were included in this study. The data was collected from intraoral and radiological examinations and from a structured questionnaire. RESULTS: Subjects with a higher level of education had more retained teeth than subjects with a lower level of education. According to CPITN index, better-educated participants had more healthy sextants, but they also had more sextants with periodontal pockets. Radiographic examination showed similar results. CONCLUSION: Level of education has a clear effect on the periodontal health status in the elderly. More treatment need seems to polarise into those elderly who are better educated as they retain more teeth into old age.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals.

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Improving the effectiveness of tobacco use cessation (TUC).

This paper includes an update of a Cochrane systematic review on tobacco use cessation (TUC) in dental settings as well as narrative reviews of possible approaches to TUC and a more detailed discussion of referral for specialist TUC services. On the basis of these reviews we conclude that interventions for tobacco users in the dental setting increase the odds of quitting tobacco. However, the evidence is derived largely from patients using smokeless tobacco. Pharmacotherapy (such as nicotine replacements, bupropion and varenicline) is recommended for TUC in medical settings but has received little assessment in dental applications, although such evidence to date is promising. Whether the dental setting or referral to specialist TUC services is the most effective strategy to help people to quit tobacco use is unclear. An effective specialist service providing best available TUC care alone may not be the answer. Clearly, such services should be both accessible and convenient for tobacco users. Closer integration of specialist services with referrers would also be advantageous in order to guide and support oral health professionals make their referral and to maximise follow-up of referred tobacco users. Future research direction may consider investigating the most effective components of TUC in the dental settings and community-based trials should be a priority. Pharmacotherapy, particularly nicotine replacement therapy, should be more widely examined in dental settings. We also recommend that various models of referral to external and competent in-house TUC specialist services should be examined with both experimental and qualitative approaches. In addition to overall success of TUC, important research questions include facilitators and barriers to TUC in dental settings, preferences for specialist referral, and experiences of tobacco users attempting to quit, with dental professionals or specialist services, respectively.

[Association of mandibular angle size with cortical thickness and residual ridge height of the edentulous mandible].

OBJECTIVE: To evaluate the mandible angle and to investigate the relationship of angle size to gender, age-group, cortical thickness at the mandibular angle (CTMA), height of mandibular residual body, and edentulous period in the elderly edentulous subjects. METHODS: A total of 356 panoramic radiographs of three groups of subjects were evaluated: the young dentate group, 131 subjects (mean age: 27); the older dentate group, 97 (mean age: 64); and the elderly edentulous group, 128 (ages 76, 81, or 86). Mandibular angle size, CTMA, and height of mandibular residual body were measured from panoramic radiographs. A structured questionnaire was used to determine the history of edentulousness. RESULTS: Difference in angle size was found between dentate men and women (P < 0.05, P < 0.001), but not between the elderly edentulous men and elderly women. The elderly edentulous subjects had larger mandibular angles than did older dentate subjects (P < 0.001). The angle size was negatively related to CTMA only among 76-year-old edentulous women (P < 0.01) and negatively associated with average height of the mandibular residual body in the edentulous men and women (P < 0.01). No association existed between angle size and duration of edentulousness. CONCLUSIONS: Elderly edentulous subjects have large mandibular angles and the angle size is correlated with low-height of the mandibular residual body, which suggests that masticatory function of natural dentition and complete denture may influence change of the mandibular angle. The significant relationship of mandibular angle size to CTMA probably indicates the effect of systemic factors on change in the mandibular angle.

Correlation of gonial angle size with cortical thickness, height of the mandibular residual body, and duration of edentulism.

STATEMENT OF PROBLEM: Previous reports on widening of the gonial angle in edentulous patients are conflicting. Aside from age and loss of teeth, other factors may influence change in gonial angle. PURPOSE: This study evaluated gonial angles from panoramic radiographs of young and older dentate subjects and elderly edentulous subjects and investigated the relationship of gonial angle size to gender, age group, cortical thickness at the gonial angle, height of the mandibular residual body, and edentulous period in elderly edentulous subjects. MATERIAL AND METHODS: A total of 356 panoramic radiographs of 3 groups of subjects were evaluated: the young dentate group, 131 subjects (mean age 27 years); the older dentate group, 97 subjects older than age 52 (mean age 64 years); and the elderly edentulous group, 128 subjects aged 76, 81, or 86 (mean age 80 years). The gonial angle, cortical thickness at gonial angle, and height of mandibular residual body were measured from panoramic radiographs made with the same radiographic equipment and selected according to criteria. A structured questionnaire was used to determine the history of edentulism. Paired and unpaired 2-tailed t tests served to test the difference in gonial angle measurements, and a linear regression was performed to study correlations (alpha=.05). RESULTS: Difference in size of the gonial angle was found between dentate men and women (P<.05 in the young and P<.001 in the older dentate group), but not between elderly edentulous men and women. The elderly edentulous subjects had significantly larger gonial angles (128.4 degrees +/- 6.6) than did the young (122.4 degrees +/- 6.6, P<.001) and older dentate subjects (122.8 degrees +/- 6.6, P<.001). The angle size was negatively related to cortical thickness at the gonial angle only among 76-year-old edentulous women (P<.01), and was associated with average height of the mandibular residual body in the edentulous men and women (P<.01). No association existed between angle size and duration of edentulism. No differences were significant in any test of intraexaminer error. CONCLUSION: In this study, elderly edentulous subjects had larger gonial angles than did dentate subjects. The angle size was correlated with low height of the mandibular residual body and with its cortical thickness in edentulous women.

A 5-year follow-up of signs and symptoms of TMD and radiographic findings in the elderly.

PURPOSE: The aim was to clarify the associations among subjective symptoms, clinical signs of temporomandibular disorders (TMD), and radiographic findings in the mandibular condyles of elderly people during a 5-year follow-up. MATERIALS AND METHODS: As part of a comprehensive medical survey of a random sample born in 1904, 1909, and 1914 (Helsinki Aging Study), 364 subjects living in Helsinki participated in the dental part of the examination during 1990 and 1991; after 5 years, 103 of these were reexamined. Comprehensive data on TMD were available for 94 subjects, and radiographic data were available for 88. TMD were assessed by Helkimo's anamnestic and clinical indices, and radiographic status was assessed by panoramic radiographs. RESULTS: During the 5-year follow-up, reported anamnestic symptoms of TMD for men changed little (9%); among women, the change from baseline was 42%. When the unchanged indices were compared, the gender difference was obvious. At baseline, 5% of the women, but no men, had severe signs (clinical index III) of TMD. At the end of follow-up, none showed severe signs. Comparison of radiographic findings between baseline and follow-up showed no differences, nor did differences appear in associations between radiographic findings and anamnestic or clinical indices. CONCLUSION: During the 5-year follow-up, signs and symptoms of TMD in these elderly individuals became milder or vanished. The radiographic status of the condyles remained stable, and no association appeared between radiographic findings and signs and symptoms of TMD.

Periodontal disease and mortality in an aged population.

We investigated the relationship between periodontitis and mortality in home-dwelling individuals aged (75+ years), considering potential confounders including C-reactive protein levels. This study involved 364 individuals, originally part of the Helsinki Ageing Study cohort, who underwent medical and dental examinations in 1990 and were followed for five years. After five years, 52 of the 175 dentate subjects had died. Using univariate analysis, the association between baseline periodontitis and mortality was of borderline significance. After controlling for the common risk factors, periodontitis more than doubled the risk of cardiovascular disease-related mortality (HR 2.28, CI 1.03-5.05). The increase in total mortality was, however, not statistically significant (HR 1.43, CI 0.81-2.50). Subjects who were edentulous had higher mortality than those who were dentate without periodontitis, but the difference was not statistically significant. A baseline CRP level above 3 mg/l was associated with high mortality; but this effect was significant only among individuals with periodontitis. These results suggest that periodontitis influences the pathogenesis and outcome of cardiovascular disease, especially in individuals who also have evidence of a systemic inflammatory reaction.

Oral and nutritional status in frail elderly.

This article describes associations between oral health and nutritional status among chronically ill older adults who were living at home and receiving regular professional home care services. A structured questionnaire, oral examination, and Mini-Nutritional Assessment were completed for 51 subjects (mean age 83.7 years). Two-thirds of the sample were edentulous, and one-third had between 2 and 23 teeth (mean 10.59, SD +/- 6.92). Sixty percent of subjects complained of xerostomia, while dentists found only 48% to have clinical signs of dry mouth. More than half of the subjects had stimulated saliva rates of < 0.8 ml/min. Stimulated saliva secretion rates were lower for persons with no functional natural dentition or prostheses (p = 0.012). Subjects assessed their dentures to be more functional than did the dentist (Kappa 0.338). No one was considered malnourished. 47% were at risk of malnutrition, and 52% were well nourished. The dentist's estimation of dry mouth and eating problems were significantly associated to lower MNA scores (p = 0.049 and p = 0.015, respectively). Subjects with a natural functioning dentition had higher BMI scores (p = 0.0485).

A 5-year follow-up of occlusal status and radiographic findings in mandibular condyles of the elderly.

PURPOSE: The aim of the present 5-year follow-up was to clarify the nature of occlusal support status and radiographic changes in condyles of the elderly, and the association between these two variables. MATERIALS AND METHODS: The present study is part of a comprehensive medical survey of a random sample born in 1904, 1909, and 1914. A total of 364 subjects living in Helsinki participated in the dental part of the examination during 1990 to 1991, and after 5 years a total of 103 were reexamined. Comprehensive data on occlusal support status were available for 94 subjects, and radiographic data were available for 88 subjects. Occlusal support status was assessed on the basis of the Eichner index, radiographic changes were assessed from panoramic radiographs, and symptoms of temporomandibular disorders were assessed using Helkimo's anamnestic index. RESULTS: The most frequent radiographic finding in the mandibular joint was flattening of the articular surface of the condyle associated with osteoarthrosis, found at baseline in 17% and during follow-up in 13% of the subjects. During the 5-year follow-up, Eichner index for natural dentition remained unaltered in 94% of the subjects and in 85% of the subjects when removable dentures were included. There were no radiographic changes in 92% of the cases. No differences based on age or gender were found. A logistic regression model revealed associations between the selected baseline factors. The odds ratio for baseline Helkimo's anamnestic index was 4.1, 5.7 for Eichner index with the support of removable dentures, and 356 for radiographic findings. CONCLUSION: Radiographic changes in condyles of elderly people were small during the 5-year follow-up, but baseline radiographic findings, Helkimo's anamnestic index, and Eichner index with removable dentures were risk factors for radiographic findings at the end of the follow-up.