Periodontal disease and systemic diseases in an older population.

OBJECTIVE: To evaluate the relationship between older adults' medical and oral conditions and their self-reports of periodontal conditions with clinically obtained data. BACKGROUND: Concerns about oral health of elders and its association with systemic diseases have been gaining more attention. METHODS: A total of 201 older subjects were interviewed about their previous medical and dental histories and were asked to complete a health questionnaire. Each subject received full mouth exam, including counting number of natural teeth remaining, gingival (GI) and plaque index (PI), CPITN and denture status. RESULTS: Elders who completed health questionnaires had mean age of 62.5. Mean CPITN score was 1.62(± 1.12), PI was 1.57(± 1.48), and GI was 1.55(± 1.31). Women had higher prevalence of CVD and osteoporosis than men (p=0.008, p=0.0001, respectively). Subjects who reported bleeding upon brushing had higher PI and GI scores (p=0.03, p=0.05, respectively). Smokers were more likely to describe their periodontal tissues as unhealthy (72.3% vs. 27.7%, p=0.01), whereas self-reports of healthy vs. unhealthy gums did not differ between non-smokers. CONCLUSION: These findings suggest that a number of systemic conditions are associated with indicators of periodontal disease, and self-reports of oral conditions are independent of systemic diseases.

Discussions on oral health care among elderly Chinese immigrants in Melbourne and Vancouver.

BACKGROUND: This study explored how elderly Chinese immigrants value and relate to how acculturation influences oral health and subsequent service use. METHODS: Elders who had immigrated to Melbourne and Vancouver within the previous 15 years were recruited from local community centres and assigned to focus groups of 5-7 participants in Vancouver (4 groups) or Melbourne (5 groups). RESULTS: Following an iterative process of thematic analysis, the discussions revealed that immigrants care about the comfort and appearance of their teeth, and they value Western dentistry as a supplement to traditional remedies, but they have difficulty getting culturally sensitive information about oral health care. Accessing dentistry, they explained, is distressing because of language problems and financial costs that impose on their children. Consequently, many immigrants obtain dental treatment in China when they return for occasional visits. They felt that separation of dentistry from national health care programmes in Canada and Australia disregards natural links between oral health and general health. CONCLUSIONS: The similarity of concerns in both cities suggests that dissemination of information and availability of services are the important themes influencing oral health, and that, beliefs developed over a lifetime play an important role in interpreting oral health in the host country.

Oral health in a convenience sample of Chinese older adults living in Melbourne, Australia.

OBJECTIVES: To present data on the dental and periodontal status of a convenience sample of 101 ambulant China-born older adults who now live in Melbourne. These older adults participated in a study to assess the prevalence of specific oral diseases. METHODS: Participants were interviewed in Cantonese using a structured questionnaire and received an oral examination to assess dental and periodontal status using the DMFS/T and CPI indices, respectively. RESULTS: This sample was largely a dentate one (94.1%); with a mean Decayed, Filled and Missing tooth surfaces (DMFS) score of 57.5 (SD 37.9). Approximately, 80% of the dentate sample had all their restorative needs met; 25% had a sound periodontium; 41% needed oral hygiene instruction plus scaling, while 6.3% required complex periodontal therapy. Compared with existing data on the oral health of older adults in Australia, Chinese immigrant older adults appear to have lower DMFS scores, a lower number of untreated decayed surfaces, a lower prevalence of gingivitis, and less need for complex periodontal treatment. CONCLUSION: These tentative findings provide an initial assessment of the risk of oral diseases among a group immigrant older adults. This study highlights the need to collect relevant information in order to identify factors that influence the oral health of older immigrants to Australia.

Assessment of the use of xerogenic medications for chronic medical and dental conditions among adult day health participants.

OBJECTIVES: To describe the health conditions, dental problems, and use of xerogenic medications among dental patients in adult day health (ADH) centers. DESIGN: Cross-sectional descriptive study. SETTING: ADH centers in King County, Washington. POPULATION: ADH clients who were patients of a mobile dental service. INTERVENTIONS: Pharmacist-conducted chart reviews and in-person medication reviews with patients. MAIN OUTCOME MEASURES: Demographic description, mean numbers of medical and dental problems, medications, xerogenic medications used per subject, and identification of xerogenic medications by therapeutic class. RESULTS: At five sites, 97 patients were interviewed (average age 73.8 +/- 11.8 years, 61% female); ethnicities included: Asian-American (37.1%), Caucasian (30.9%), Russian (29%), and African-American (3%). Mean numbers of chronic health problems, medications, and xerogenic medications per patient were 5.2 +/- 2.7, 10.9 +/- 4.4, and 3.3 +/- 1.8, respectively. Antidepressants were the most commonly used xerogenic medication, followed by antipsychotics, antiemetics, analgesics, and antihistamines. Among 74 patients who received dental treatment, 33 (44.6%) wore dentures. Among 58 patients with teeth, a mean number of 2.8 dental problems per patient was identified. Dental caries (51.7%) was the most prevalent problem, followed by periodontitis (29.3%), soft tissue lesions (10.3%), gingivitis (5.2%), and candidiasis (3.4%). CONCLUSION: Multiple systemic diseases, use of multiple xerogenic medications, and poor oral health were prevalent among the ADH clients in this study. However, self-reports of dry mouth were unrelated to number of xerogenic medications or oral conditions. Further research is needed to determine the association between self-reported dry mouth, chronic health conditions, use of xerogenic medications, tooth loss, and/or denture use.

Informed consent recall and comprehension in orthodontics: traditional vs improved readability and processability methods.

INTRODUCTION: Low general and health literacy in the United States means informed consent documents are not well understood by most adults. Methods to improve recall and comprehension of informed consent have not been tested in orthodontics. The purposes of this study were to evaluate (1) recall and comprehension among patients and parents by using the American Association of Orthodontists' (AAO) informed consent form and new forms incorporating improved readability and processability; (2) the association between reading ability, anxiety, and sociodemographic variables and recall and comprehension; and (3) how various domains (treatment, risk, and responsibility) of information are affected by the forms. METHODS: Three treatment groups (30 patient-parent pairs in each) received an orthodontic case presentation and either the AAO form, an improved readability form (MIC), or an improved readability and processability (pairing audio and visual cues) form (MIC + SS). Structured interviews were transcribed and coded to evaluate recall and comprehension. RESULTS: Significant relationships among patient-related variables and recall and comprehension explained little of the variance. The MIC + SS form significantly improved patient recall and parent recall and comprehension. Recall was better than comprehension, and parents performed better than patients. The MIC + SS form significantly improved patient treatment comprehension and risk recall and parent treatment recall and comprehension. Patients and parents both overestimated their understanding of the materials. CONCLUSIONS: Improving the readability of consent materials made little difference, but combining improved readability and processability benefited both patients' recall and parents' recall and comprehension compared with the AAO form.

Effects of malocclusion and its treatment on the quality of life of adolescents.

INTRODUCTION: The relationship between malocclusion and quality of life (QoL) is complex and not well understood. The objective of this study was to determine whether malocclusion and its treatment influence an adolescent's general and oral health-related QoL. METHODS: An observational, cross-sectional design with a longitudinal component was used. Clinical and self-reported data were collected from 293 participants aged 11 to 14. The children were recruited from orthodontic and pediatric dental clinics at the University of Washington and a community health clinic in Seattle. The participants were classified into precomprehensive orthodontic (n = 93), postinterceptive orthodontic (n = 44), and nonorthodontic comparison (n = 156) groups. Assessments of dental esthetics and occlusion were evaluated with the Index of Complexity, Outcome, and Need. Three QoL questionnaires were completed: Youth Quality of Life to assess general QoL, Children's Oral Health-Related Quality of Life to assess oral health QoL, and Treatment Expectations and Experiences to evaluate participants' expectations for changes in specific aspects of their lives. Nonparametric tests were used for all analyses. RESULTS: In general, overall and oral health QoL were high in this population. The instruments were correlated so that when oral health QoL improved, so did general QoL. No differences were found in these measurements between the university and community health clinics. Nor were there differences between the 3 study groups on general QoL and oral health QoL. There was little effect of malocclusion complexity on any QoL measure. Both preorthodontic and postorthodontic participants expected improvements in their health, oral function, appearance, and social well-being after orthodontic treatment; the postinterceptive sample's posttreatment experiences were consistent with their pretreatment expectations in all domains. CONCLUSIONS: Malocclusion and orthodontic treatment do not appear to affect general or oral health QoL to a measurable degree, despite subjective and objective evidence for improved appearance, oral function, health, and social well-being.

Caregiving and gingival symptom reports: psychophysiologic mediators.

OBJECTIVE: We first assessed the association of caregiving with gingival symptom reports. We then assessed whether the observed relationship was mediated by psychophysiologic host factors. METHODS: Caregivers of spouses with Alzheimer's disease (n = 123) were compared with demographically similar noncaregiver spouses (n = 117). RESULTS: The percentage of caregivers (17%) who reported gingival symptoms was twice that of noncaregivers (8.5%) (p < .05), despite the fact that caregivers and noncaregivers did not differ in oral health care. The relationship between caregiving and gingival symptom reports was mediated by psychophysiologic variables. Caregivers were higher on hassles (p < .05), depressed mood (p < .05), and metabolic risk (insulin, glucose, obesity; p < .05) than were noncaregivers. Greater gingival symptom reports were also associated with greater hassles (p < .01), depressed mood (p < .001), and metabolic risk (p < .001). Measures of subcutaneous fat, inflammation, and frank diabetes were related to gingival symptom reports but not to caregiver status. CONCLUSIONS: A higher percentage of caregivers reported gingival symptoms than noncaregivers. These results have implications for research on aging, psychophysiology, and chronic stress.

Smoking, a weak predictor of periodontitis in older adults.

BACKGROUND: The impact of smoking habits on periodontal conditions in older subjects is poorly studied. AIMS: To assess if a history of smoking is associated with chronic periodontitis and medical history in older subjects. MATERIAL AND METHODS: The medical and dental history was collected from 1084 subjects 60-75 years of age. Smoking history information was obtained from self-reports. Periodontal variables [clinical probing depth (PD)>/=5.0 mm, clinical attachment levels (CALs) >/=4.0 mm], and radiographic evidence of alveolar bone loss were assessed. RESULTS: 60.5% had never smoked (NS), 32.0% were former smokers (FS) (mean smoke years: 26.1 years, SD+/-13.1), and 7.5% were current smokers (CS) (mean smoke years 38.0 years, (SD+/-12.1). The proportional distribution of CAL >/=4.0 mm differed significantly by smoking status (NS and CS groups) (mean difference: 12.1%, 95% confidence interval (CI): 1.5-22.6, p<0.02). The Mantel-Haenszel common odds ratio between smoking status (CS+FS) and periodontitis (>20% bone loss) was 1.3 (p<0.09, 95% CI: 0.9-2.0) and changed to 1.8 (p<0.02, 95% CI: 1.3-2.7) with 30 years of smoking as cutoff. A weak correlation between number of years of smoking and CAL>/=4.0 mm was demonstrated (r(2) values 0.05 and 0.07) for FS and CS, respectively. Binary logistic forward (Wald) regression analysis demonstrated that the evidence of carotid calcification, current smoking status, gender (male), and the number of remaining teeth were explanatory to alveolar bone loss. CONCLUSIONS: A clinically significant impact on periodontal conditions may require 30 years of smoking or more. Tooth loss, radiographic evidence of carotid calcification, current smoking status, and male gender can predictably be associated with alveolar bone loss in older subjects.