Toxin exposure and HLA alleles determine serum antibody binding to toxic shock syndrome toxin 1 (TSST-1) of Staphylococcus aureus.

Life-threatening toxic shock syndrome is often caused by the superantigen toxic shock syndrome toxin-1 (TSST-1) produced by Staphylococcus aureus. A well-known risk factor is the lack of neutralizing antibodies. To identify determinants of the anti-TSST-1 antibody response, we examined 976 participants of the German population-based epidemiological Study of Health in Pomerania (SHIP-TREND-0). We measured anti-TSST-1 antibody levels, analyzed the colonization with TSST-1-encoding S. aureus strains, and performed a genome-wide association analysis of genetic risk factors. TSST-1-specific serum IgG levels varied over a range of 4.2 logs and were elevated by a factor of 12.3 upon nasal colonization with TSST-1-encoding S. aureus. Moreover, the anti-TSST-1 antibody levels were strongly associated with HLA class II gene loci. HLA-DRB1*03:01 and HLA-DQB1*02:01 were positively, and HLA-DRB1*01:01 as well as HLA-DQB1*05:01 negatively associated with the anti-TSST-1 antibody levels. Thus, both toxin exposure and HLA alleles affect the human antibody response to TSST-1.

Distribution patterns of occlusal contact areas on natural posterior teeth - Evaluations of a cross-sectional population-based study with the Greifswald Digital Analyzing System (GEDAS).

AIM: The aim of our investigations is to optimize the anatomical basis for the design of a sufficient occlusal relationship, especially in view of the innovative technologies by analyzing the occlusal contact point patterns at cusp structures according to A-, B-, C- localization tooth by tooth on the individual occlusal surfaces in the posterior region in static habitual occlusal position. MATERIALS AND METHODS: In 3300 subjects of the population-based Study of Health in Pomerania (SHIP 1) the interocclusal registration in habitual intercuspation using silicone registration was used and analyzed by using the special evaluation software Greifswald Digital Analyzing System (GEDAS II). Chi square test was used to investigate whether the distribution of contact areas differed in the group of premolars or molars - each considered separately for maxilla and mandible - on the basis of the probability of error p < 0.05. RESULTS: In 709 subjects (446 male with a mean age of 48.9 ± 13.04 years; 283 female with a mean age of 52.4 ± 14.23 years) the antagonistic situation was specifically considered on natural posterior teeth without conservative or restorative-prosthetic interventions, i.e. without caries, fillings, crowns or other restorations. On the basis of these subjects, the silicone registrations were analyzed using GEDAS II. For the first and second upper molars, the ABC contact distribution was the most frequent: 20.4 % for the first and 15.3 % for the second molar. The second most frequent contact area for maxillary molars was area 0. The upper molars had contact areas only at the maxillary palatal cusp (B-/C-contacts). This contact relationship was most frequent in the maxillary premolar (18.1-18.6 %). In mandibular premolars, with the buccal cusps areas A and B were frequently involved (15.4-16.7 %). Mandibular molars showed a frequent contact pattern involving all A-, B-, C- and 0- contact areas (13.3-24.2 %). To capture the possible influence of the antagonistic dentition situation, the antagonistic situation was specifically considered and except for the mandibular premolars (p < 0.05) the contact distribution did not differ for molars and maxillary premolars regarding the dental status of the antagonistic teeth. Natural posterior teeth without occlusal contacts were observed from 20.0 % in the second lower molars to 9.7 % in the first upper molars. CONCLUSION: Our results suggest a clinically relevant due to the fact, that this study is the first population-based epidemiological study to analyze the occlusal contact point patterns at cusp structures according to A-, B-, C- localization tooth by tooth on the individual occlusal surfaces in the posterior region in static habitual occlusal position in order to optimize the anatomical basis for the design of a sufficient occlusal relationship.

Powered tooth brushes are beneficial for long-term oral health: Results from the Study of Health in Pomerania (SHIP-TREND).

AIM: To determine the long-term effects of the use of powered tooth brush (PTB) in comparison to manual tooth brush (MTB) on periodontitis severity, coronal caries experience, and the number of missing teeth using in a population-based cohort study. MATERIALS AND METHODS: Using 7-year follow-up data of 2214 participants of the Study of Health in Pomerania (SHIP-TREND), comprehensively adjusted linear models using generalized least squares and ordinal regression models estimated the effects of PTB usage on dental outcomes in complete case and imputed data. RESULTS: At follow-up, PTB users had lower medians for mean probing depth (PD; 2.21 mm) and mean clinical attachment levels (1.73 mm) than MTB users (2.30 and 1.96 mm, respectively). Adjusted models revealed the beneficial effects of PTB usage on follow-up levels of plaque, bleeding on probing, mean PD, percentage of sites with PDs ≥4 mm, mean clinical attachment levels (all, interdental, and non-interdental sites, respectively), and the number of missing teeth. For the number of missing teeth, the effects were more pronounced in participants aged ≥50 years. No significant effects of PTB usage on the number of decayed or filled surfaces (all and interdental sites) were found. CONCLUSIONS: A recommendation of PTB usage in dental practice could contribute to the long-term promotion of oral health.

Impact of dental restorations and removable prostheses on potentially malignant oral mucosal disorders in the general population.

STATEMENT OF PROBLEM: Dental restorations and removable dental prostheses have been considered as risk factors for potentially malignant disorders of the oral mucosa. It remains unclear whether amalgam, composite resins, and prosthesis materials can induce potentially malignant disorders. PURPOSE: The purpose of this clinical study was to determine the relationship between the presence of amalgam and composite resin restorations, crowns and fixed partial dentures, and removable prostheses in potentially malignant disorders. MATERIAL AND METHODS: The data of 6041 participants in the population-based Studies of Health in Pomerania (SHIP) were accessed. Potentially malignant disorders had been clinically diagnosed by calibrated dentists and documented with photographs. Dental treatment was subdivided into restored and replaced teeth. Dental restorations were subclassified as buccal composite resin or amalgam restorations. Prosthetic treatment was subclassified into removable partial or complete prostheses and definitive restorations with crowns and fixed partial dentures. RESULTS: In the maxilla, participants with removable prostheses had a higher incidence of potentially malignant disorders than participants not undergoing treatment with removable prostheses (OR 2.12; 95% CI: 1.08-4.18), but not in the mandible (OR 1.30; 95% CI: 0.67-2.53). The surfaces with composite resin restorations were associated with a slightly higher risk of mucosal lesions than those without the restorations (OR 1.04; 95% CI: 1.01-1.07). No significant association was found between amalgam restorations and mucosal lesions. CONCLUSIONS: Participants with removable prostheses have a higher risk of potentially malignant disorders. Composite resin restorations are associated with a higher risk of mucosal lesions, whereas no significant association was found between amalgam restorations and mucosal lesions.

Polypharmacy and saliva volumes in the northeast of Germany - The Study of Health in Pomerania.

OBJECTIVES: Associations between saliva volumes or salivary flow rates and potentially xerogenic medication are rarely evaluated in cohorts with a wide age range. This cross-sectional cohort study investigated possible relationships between the regular consumption of potentially xerogenic medication and stimulated saliva volumes. METHODS: Data from the German Studies of Health in Pomerania (SHIP-2 and SHIP-Trend-0) were pooled. Potentially xerogenic medications were identified using the Workshop on Oral Medicine VI criteria. Stimulated saliva was sampled using Salivette®, and saliva volumes expressed as µl/min were determined. Applying linear mixed models with adjustment for time point of saliva collection, associations of (a) age and sex with regularly consumed medication, (b) age and sex with saliva volumes, and (c) the number of regularly consumed xerogenic medications with saliva volumes were evaluated. RESULTS: Six thousand seven hundred and fifty-three participants aged 20-83 years (mean 53.4 ± 14.9) were included. The average number of medications did not differ markedly between females (2.21 ± 2.46) and males (2.24 ± 2.83). Males took more potentially xerogenic medication (1.0 ± 1.3) than did females (0.9 ± 1.3). Also, males took more potentially xerogenic cardiovascular medications than did females (0.9 ± 1.2 versus 0.7 ± 1.1), while females were prescribed a higher number of potentially xerogenic medications affecting the nervous system (0.2 ± 0.5 versus 0.1 ± 0.4). The average stimulated saliva volume was 967.0 ± 433.3 µL/min. Regularly consumed and potentially xerogenic medications were associated with lower saliva volumes. Older age correlated not only with a higher number of total medications and a higher number of xerogenic medications affecting either the cardiovascular (in males) or the nervous system (in females), but also with lower saliva volumes. CONCLUSIONS: Ageing was associated with polypharmacy, especially with the intake of potentially xerogenic medication, and lower average saliva volumes. With regard to complications of dry mouth, anamnesis of medication consumption is of high importance.

Routine Data Analyses for Estimating the Caries Treatment Experience of Children.

Oral health surveys are considered the gold standard for assessing the caries experience of children. Analyses of routine data offer additional opportunities not yet fully explored. This study aimed at estimating the caries treatment experience by mining an insurance claims database. Comprehensive claims data sets were extracted from the data warehouse of a major health insurance company (BARMER, Germany). A surrogate variable for caries experience was formed that reflected the proportion of children without any former potentially caries-related treatment (filling, root canal treatment, and extraction) at ages from 1 to 14 years. The statistical calculations were based on Kaplan-Meier survival analyses. The evaluation for the permanent dentition comprised N = 593,330 children at 6 years and N = 114,568 at 12 years. At 12 years of age, 66.8% had not yet experienced potentially caries-related treatments. This value hints at a significantly higher caries experience at 12 years compared to available epidemiological data. For the deciduous dentition, the respective rates were 74.0% at 6 years and 45.8% at 10 years. Although various sources of bias have to be taken into account, the potential of routine data mining is evident. The approach is supplemental to oral health surveys. It can be useful in coming closer to reality when estimating the caries experience of children. From our results, we conclude that the oral health of up to 14-year-olds in Germany remains in urgent need of improvement.

Salivary metabolites associated with a 5-year tooth loss identified in a population-based setting.

BACKGROUND: Periodontitis is among the most common chronic diseases worldwide, and it is one of the main reasons for tooth loss. Comprehensive profiling of the metabolite content of the saliva can enable the identification of novel pathways associated with periodontitis and highlight non-invasive markers to facilitate time and cost-effective screening efforts for the presence of periodontitis and the prediction of tooth loss. METHODS: We first investigated cross-sectional associations of 13 oral health variables with saliva levels of 562 metabolites, measured by untargeted mass spectrometry among a sub-sample (n = 938) of the Study of Health in Pomerania (SHIP-2) using linear regression models adjusting for common confounders. We took forward any candidate metabolite associated with at least two oral variables, to test for an association with a 5-year tooth loss over and above baseline oral health status using negative binomial regression models. RESULTS: We identified 84 saliva metabolites that were associated with at least one oral variable cross-sectionally, for a subset of which we observed robust replication in an independent study. Out of 34 metabolites associated with more than two oral variables, baseline saliva levels of nine metabolites were positively associated with a 5-year tooth loss. Across all analyses, the metabolites 2-pyrrolidineacetic acid and butyrylputrescine were the most consistent candidate metabolites, likely reflecting oral dysbiosis. Other candidate metabolites likely reflected tissue destruction and cell proliferation. CONCLUSIONS: Untargeted metabolic profiling of saliva replicated metabolic signatures of periodontal status and revealed novel metabolites associated with periodontitis and future tooth loss.

Prevalence and risk factors of potentially malignant disorders of the mucosa in the general population: Mucosa lesions a general health problem?

AIM: Oral cancer mostly develops from oral mucosa regions with morphological alterations transforming malignant. These visible precancerous mucosa lesions are named potentially malignant disorders (PMD). We aimed to analyze the prevalence of PMD and its risk factors for PMD in a population-based sample in Northern Germany. MATERIAL AND METHODS: Data of 6078 individuals from the population-based Study of Health in Pomerania (SHIP) was used. PMD were photographically documented and periodontal health was assessed in a standardized procedure. RESULTS: PMD were observed in 54 individuals (0.9%). The most prevalent PMD was homogenous leukoplakia (n = 37) followed by Lichen ruber (n = 9). Smoking (Odds Ratio (OR) 2.70; 95% confidence interval (CI): 1.24-5.87), male sex (OR 3.32; 95%-CI: 1.77-6.21), type 2 diabetes mellitus (OR 2.07; 95%-CI: 1.08-3.98) and body mass index (OR 1.09; CI 1.04-1.14) were significantly associated with PMD, with the corresponding area under the curve (AUC) being 0.696 (CI: 0.655; 0.737). CONCLUSION: Our results suggest a clinically relevant prevalence of PMD in the population. We identified male sex, type 2 diabetes mellitus, current smoking, and obesity as risk factors. We recommend photographic documentation and intensified training of medical and dental staff to detect and monitor PMD.

SHIP-MR and Radiology: 12 Years of Whole-Body Magnetic Resonance Imaging in a Single Center.

The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented.

Associations of plasma YKL-40 concentrations with heel ultrasound parameters and bone turnover markers in the general adult population.

OBJECTIVE: YKL-40, also known as chitinase-3-like protein 1, is a new proinflammatory biomarker, that might play a role in tissue remodeling and bone resorption. Here we evaluated the associations of the YKL-40 plasma concentration with heel ultrasound parameters and bone turnover markers (BTMs) in adult men and women from the general population. We tested for a causal role of YKL-40 on bone metabolism using published single nucleotide polymorphisms (SNPs) with consequences for YKL-40 expression and function. METHODS: Data were obtained from two population-based cohorts: the Study of Health in Pomerania (SHIP) and SHIP-Trend. Quantitative ultrasound (QUS) measurements at the heel were performed and bone turnover was assessed by measurement of intact amino-terminal propeptide of type I procollagen (PINP) and carboxy-terminal telopeptide of type I collagen (CTX). Associations between the YKL-40 plasma concentration and the QUS-based parameters, bone turnover marker (BTM) concentrations and 44 SNPs, including the lead SNP rs4950928, were evaluated in 382 subjects. Furthermore, we assessed the associations between the same SNPs and the QUS-based parameters (n = 5777) or the BTM concentrations (n = 7190). RESULTS: Sex-specific linear regression models adjusted for a comprehensive panel of interfering covariantes revealed statistically significant inverse associations between YKL-40 and all QUS-based parameters as well as positive associations with CTX in women. The rs4950928 polymorphism was associated with YKL-40 in men and women but none of the tested SNPs was associated with the QUS-based parameters or the BTMs after correction for multiple testing. CONCLUSIONS: Plasma YKL-40 concentrations are associated with QUS-based parameters as well as CTX concentrations in women but these associations are probably not causal.

[Design and quality control of the oral health status examination in the German National Cohort (GNC)]. / Design und Qualitätskontrolle der zahnmedizinischen Untersuchung in der NAKO Gesundheitsstudie.

BACKGROUND: Caries and periodontitis are highly prevalent worldwide. Because detailed data on these oral diseases were collected within the framework of the German National Cohort (GNC), associations between oral and systemic diseases and conditions can be investigated. OBJECTIVES: The study protocol for the oral examination was designed to ensure a comprehensive collection of dental findings by trained non-dental staff within a limited examination time. At the mid-term of the GNC baseline examination, a first quality evaluation was performed to check the plausibility of results and to propose measures to improve the data quality. MATERIALS AND METHODS: A dental interview, saliva sampling and oral diagnostics were conducted. As part of the level­1 examination, the number of teeth and prostheses were recorded. As part of the level­2 examination, detailed periodontal, cariological and functional aspects were examined. All examinations were conducted by trained non-dental personnel. Parameters were checked for plausibility and variable distributions were descriptively analysed. RESULTS: Analyses included data of 57,967 interview participants, 56,913 level­1 participants and 6295 level­2 participants. Percentages of missing values for individual clinical parameters assessed in level 1 and level 2 ranged between 0.02 and 3.9%. Results showed a plausible distribution of the data; rarely, implausible values were observed, e.g. for measurements of horizontal and vertical overbite (overjet and overbite). Intra-class correlation coefficients indicated differences in individual parameters between regional clusters, study centres and across different examiners. CONCLUSIONS: The results confirm the feasibility of the study protocol by non-dental personnel and its successful integration into the GNC's overall assessment program. However, rigorous dental support of the study centres is required for quality management.

Erratum to "Comparison of Oral Microbe Quantities from Tongue Samples and Subgingival Pockets".

[This corrects the article DOI: 10.1155/2018/2048390.].

Validation of a purpose-built chewing gum and smartphone application to evaluate chewing efficiency.

OBJECTIVES: To validate a purpose-built two-coloured chewing gum (Hue-Check Gum® ), and to test the accuracy of a custom-built smartphone application for a colour-mixing ability test to assess chewing function. METHODS: Fully dentate participants (28D-group) and edentulous participants with implant overdentures (IOD-group) were recruited. They chewed a Hue-Check Gum® for 5, 10, 20, 30 and 50 chewing cycles, respectively. Maximum voluntary bite force (MBF) was assessed with a digital gauge. The specimens were analysed according to their colour mixture (variance of hue, VOH) with a validated software (VOH_scan) and a newly developed smartphone application (VOH_app). RESULTS: Participants segregated by dental state were significantly different regarding the number of occluding pairs of teeth, age and MBF. VOH_scan showed a negative logarithmic association with the number of chewing cycles, and VOH could be predicted from chewing cycles, MBF and gender. The clearest discrimination between the IOD and the 28D groups was observed for n = 20 chewing cycles; at this point, VOH was distinguishably different with a P-value < 0.0001. The VOH_app was a very good predictor for VOH_scan with 0.80 < pseudo-R2  < 0.83, depending on light exposure and measuring distance. There was, however, a systematic error in the accuracy of the app for inadequately chewed specimens. CONCLUSIONS: The use of the two-coloured chewing gum would provide a fast, simple and inexpensive method for the assessment of masticatory performance, which could be used in geriatric wards or in private practices without the requirement of specialised equipment or trained staff.

Reducing uncertainty in estimating associations of oral exposures with Helicobacter pylori serology in the general population.

AIM: Evidence for reducing Helicobacter (H.) pylori by periodontal therapy comes from small studies in China, limiting generalizability. To estimate the association between periodontal disease and anti-H. pylori IgG titer levels in a European country, we used population-based data from the Study of Health in Pomerania. MATERIALS AND METHODS: For pocket depth as the primary exposure, we restricted the age range to participants younger than 60 years (n = 2,481) to avoid selection bias due to edentulism in this cross-sectional study. For the full age range up to 81 years, we chose the number of missing teeth (n = 3,705). RESULTS: The association between pocket depth and the outcome was weak. Given the ceiling effect for the number of missing teeth (ordinal logistic regression; odds ratio of the interquartile range effect = 1.6; 95% CI: 1.3-1.9; p-value for linearity = 0.005), we checked whether wearing removable dental prosthesis was associated with higher anti-H. pylori IgG titer levels (odds ratio = 1.3; 95% CI: 1.1-1.5). CONCLUSIONS: Tooth loss and wearing removable dental prosthesis were weakly to moderately associated with higher anti-H. pylori IgG titer levels in the general population of a European country.

Comparison of Oral Microbe Quantities from Tongue Samples and Subgingival Pockets.

OBJECTIVES: To improve understanding of periodontitis pathology, we need more profound knowledge of relative abundances of single prokaryotic species and colonization dynamics between habitats. Thus, we quantified oral microbes from two oral habitats to gain insights into colonization variability and correlation to the clinical periodontal status. METHODS: We analyzed tongue scrapings and subgingival pocket samples from 237 subjects (35-54 years) with at least 10 teeth and no recent periodontal treatment from the 11-year follow-up of the Study of Health in Pomerania. Relative abundances of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Streptococcus sanguinis, total bacteria, and Archaea were correlated to clinically assessed pocket depths (PD) and clinical attachment levels (CAL). RESULTS: Increased relative abundances of P. gingivalis, A. actinomycetemcomitans, and F. nucleatum were linked to increased levels of PD and CAL (i) on the subject level (mean PD, mean CAL) and (ii) in subgingival pockets. Relative abundances of Archaea from tongue samples correlated negatively with mean PD or mean CAL. Detection and quantity of bacterial species correlated weakly to moderately between the tongue and subgingival pocket, except for Archaea. CONCLUSIONS: Relative abundances of specific oral species correlated weakly to moderately between habitats. Single species, total bacteria, and Archaea were linked to clinically assessed severity of periodontitis in a habitat-dependent manner.

Prosthetic Tooth Replacement in a German Population Over the Course of 11 Years: Results of the Study of Health in Pomerania.

PURPOSE: To evaluate changes in distribution of teeth and in prosthodontic tooth replacement during an 11-year period in an adult population. MATERIALS AND METHODS: Information on prosthetic status was collected from 4,288 participants aged 20 to 81 years at baseline in the Study of Health in Pomerania (SHIP-0) and from 2,244 participants aged 30 to 92 years who reappeared in the 11-year follow-up (SHIP-2). The tooth distribution per arch was classified into one of the six following classes: class 0 (edentulous), class 1 (one to three remaining teeth), class 2 (extended tooth-bounded space or extreme shortened dental arch), class 3 (small anterior space), class 4 (small posterior space with one or more missing premolars), or class 5 (functional dentition). RESULTS: Longitudinally, the most pronounced change in class was the transition from class 1 to class 0 (maxilla: 54.5%, mandible: 58.3%). The percent change from other higher classes to lower classes ranged between 10% and 40%. In the same age groups of 40 to 79 years, the number of edentate arches was cut in half, with a corresponding increase in functional dentitions. The proportion of unrestored arches decreased in all classes. Double crown-retained partial removable dental prostheses (PRDPs) showed the highest increase (a 15% to 20% increase) at the expense of acrylic PRDPs in classes 1 and 2. In small spaces, the proportion of fixed dental prostheses (FDPs) also increased by 15% to 20%. Seven participants of SHIP-0 (0.16%) and 56 participants of SHIP-2 (2.5%) had dental implants. CONCLUSION: Similar age groups showed improvement in oral conditions. The proportion of higher-end restorations (FDPs and double crown-retained PRDPs), including the frequency of dental implants, increased.

Cross-sectional association between oral health and retinal microcirculation.

AIM: To investigate the relation between oral health status and microcirculation, we analysed the association between periodontitis and number of teeth with retinal vessel diameters in a population-based study. METHODS: We analysed data from the Study of Health in Pomerania-TREND (SHIP-TREND). All subjects (3,183 for number of teeth, 3,013 for mean probing depth and 2,894 for mean attachment level) underwent nonmydriatic funduscopy and dental examination. We measured central retinal arteriolar (CRAE), venular (CRVE) vessel diameters and calculated arterio-venous ratio (AVR) from static vessel analysis (SVA). Periodontal status was assessed using the case definition of the Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Data were analysed by linear (CRAE, CRVE, AVR) and logistic regression (AVR < 0.8) adjusted for age, sex, smoking status, alcohol consumption, body mass index, systolic blood pressure, hsCRP and type-2-diabetes mellitus. RESULTS: Only in men, significant associations were found between periodontal and retinal conditions. Severe periodontitis [ß = -0.0120 (-0.0218; -0.0007 95%-CI)] and mean probing depth [ß = -0.0054 (-0.0105; -0.0002 95%-CI)] were inversely associated with AVR; severe periodontitis [ß = 3.80 (0.61; 6.98 95%-CI)], mean probing depth [ß = 1.86 (0.23; 3.49 95%-CI)] and mean attachment level [ß = 1.31 (0.34; 2.27 95%-CI)] with CRVE and mean attachment level with CRAE [ß = 0.91 (0.14; 1.69 95%-CI)]. CONCLUSIONS: Our results point towards an association between periodontal conditions and AVR in men. Periodontitis may impact microvascular endothelium function. Improving oral health to reduce periodontitis might lead to reduced risk for other age-related diseases.

Impact of prosthodontic rehabilitation on the masticatory performance of partially dentate older patients: Can it predict nutritional state? Results from a RCT.

OBJECTIVES: With a decreased number of teeth, a reduction in chewing function can contribute to changes in food choices and ultimately impact on overall nutritional status. This study compared the impact of two tooth replacement strategies for partially dentate older patients on masticatory performance and nutritional status. METHODS: Patients aged 65 years and older were randomly allocated to two different treatment groups. For the RPDP-group (removable partial dental prostheses) each participant was restored to complete dental arches with cobalt-chromium removable prostheses. For the SDA-group (shortened dental arch), participants were restored to 10 occluding pairs of natural and replacement teeth using adhesive bridgework. Masticatory performance was assessed with a colour-mixing ability test. Each patient provided haematological samples that were screened for biochemical markers of nutritional status. Patients were also assessed using the Mini Nutritional Assessment (MNA). RESULTS: Eighty-nine patients completed the test for masticatory performance and provided blood samples and MNA scores at baseline (BL) and after 12 months (12m). Masticatory performance (p<0.001) and MNA (p<0.05) increased significantly in both groups, but no significant between group differences were noted. A mixed picture was observed for nutrition biomarkers. Mixed-effect linear regression models did not demonstrate that nutritional status could be predicted from masticatory performance. CONCLUSIONS: These results indicate that prosthodontic rehabilitation according to the principles of the SDA is equivalent to RPDPs in terms of restoration of chewing capacity for partially dentate older patients. However, masticatory performance may only have minor associations with nutritional status for this patient group. CLINICAL SIGNIFICANCE: Replacing teeth with either RPDPs or SDA provides a prerequisite for efficient chewing. Further research is required to determine the impact of oral rehabilitation coupled with nutritional counselling for this patient population.

Development and testing of satisfaction questionnaires for patients with removable dental prostheses.

OBJECTIVE: To develop and test self-administered satisfaction questionnaires for patients with removable dental prostheses (RDPs) in the German language. METHOD AND MATERIALS: A three-phase methodology was used. A pilot questionnaire was developed in phase one. At the end of phase two, the final version of the questionnaires were reached. In phase three, 192 questionnaires were distributed to evaluate the psychometric properties of the final version of the questionnaires. Construct validity, content validity from the patients' perspective, and questionnaire reliability were estimated. RESULTS: At the end of phase two, the final versions of the questionnaires were defined as instruments with good face validity. At the end of phase three, content validity from the patients' perspective was assessed and found to be good. Exploratory factor analysis identified a one-factor model for each questionnaire. Consequently, each questionnaire was summed to create a single index. Internal consistency of the indexes was assessed using Cronbach's α and found to be excellent (α > 0.9). A high repeatability of all the items was identified through a test-retest. Intra-class correlation coefficient (ICC) values ranged from 0.80 to 0.99. CONCLUSION: The questionnaires and indexes are valid and highly reliable instruments, and can be used to measure patient satisfaction with RDPs.