Dental status, visits, and functional ability and dietary intake of elderly in Israel.

BACKGROUND: Epidemiological studies have shown deterioration in dental health accompanying the ageing process. Tooth loss increases with age. Chewing ability is closely correlated with number of natural teeth present: there is a threshold of 20-21 teeth, below which chewing ability declines. The government of Israel is currently considering adding dental treatment for elderly to the basket of services of the National Health Insurance Law. Information on the influence of elderly's dental health on nutrition and general health status can contribute to the decision making process. METHODS: Secondary analysis of data collected on a subsample (N = 1776) of the cross-sectional Mabat Zahav - National Health and Nutrition Survey of the Elderly was done. Intakes of energy, fiber, protein, fruits and vegetables, associations with dental visits, dentures presence and functional ability were analyzed. Linear regression adjusted for confounders was performed. RESULTS: Statistically significant differences in dietary intake of energy, fiber, protein and vegetables were found between elderly who visited a dentist in the last year and those who did not. Elderly who possessed dentures had lower dietary intakes than their dentate counterparts. Elderly with functional problems such as impaired chewing had worse dietary intakes than the others. This was so after controlling for education, degree of interest in the relationship between nutrition and health and reading the nutrition label. CONCLUSIONS: The findings in our study suggest that those who visited a dentist in the last year, had natural teeth and no denture/s and reported no chewing problems had better dietary intake. The results emphasize the importance of maintaining adequate dental health, preserving natural teeth and regular dental visits in the elderly to assure adequate nutrient status in this age group.

Critique of the review of 'Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2015.

The Cochrane Review on water fluoridation for the prevention of dental caries was published in 2015 and attracted considerable interest and comment, especially in countries with extensive water fluoridation programmes. The Review had two objectives: (i) to evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries, and (ii) to evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. The authors concluded, inter alia, that there was very little contemporary evidence, meeting the Review's inclusion criteria, that evaluated the effectiveness of water fluoridation for the prevention of dental caries. The purpose of this critique is to examine the conduct of the above Review, and to put it into context in the wider body of evidence regarding the effectiveness of water fluoridation. While the overall conclusion that water fluoridation is effective in caries prevention agrees with previous reviews, many important public health questions could not be answered by the Review because of the restrictive criteria used to judge adequacy of study design and risk of bias. The potential benefits of using wider criteria in order to achieve a fuller understanding of the effectiveness of water fluoridation are discussed.

A pilot project to improve the oral health of orphans and of the elderly in residential care in Constanta, Romania.

AIM: A pilot project to improve the oral health of Romanian orphans and elderly people in residential homes. MATERIAL AND METHODS: The orphanage and old persons' home were in Constanta. After training, 50 fifth-year dental students made 14 weekly residential home visits to improve carers' oral health knowledge and oral hygiene (OH) procedures and to monitor progress in one orphan and one old person. At baseline and after 14 weeks a local dental school staff member examined each orphan and old person's oral health using WHO (1997) criteria and the Simplified Oral Hygiene Index (OHI-S). The carers' knowledge of OH and attitudes to providing and the students' knowledge and attitudes were assessed at baseline and again after 14 weeks with a questionnaire. RESULTS: All 56 orphans (mean age 9.6 years, mean DMFT 2.39) living in the home participated and their mean OHI-S improved (1.40 to 0.80, p < 0.0001). Fifty old people (mean age 75.9 years) participated, of whom 22 (44%) were edentulous. There was no significant improvement in mean OHI-S (p < 0.10). The carers' oral health knowledge improved (mean scores from 65 to 88, p < 0.001) as did their attitude score (p < 0.013). Students noted changes in their understanding of the needs of the carers, orphans and elderly people. Their perception of their capability to provide OH education or train others to do so, or their inclination to do so remained substantially unchanged. CONCLUSIONS: This pilot study met its aims suggesting that with suitable management, senior dental students can play a significant role in residential homes for orphans and old people by training carers and improving the residents' oral hygiene. Further similar studies in other settings are indicated.

[Fluoridation of drinking water, why is it needed?].

BACKGROUND: Dental caries is a widespread disease. It causes irreversible damage, pain and considerable expense. Fluoride is the only known substance that raises the tooth's resistance to acid attack. Natural drinking waters contain fluoride at different concentration. The most effective method of fluoride administration to the community level is by adjustng the fluoride concentration in the drinking water to about 1 part per million. AIM: To describe the mode of action of fluoride, methods of administration and to describe water fluoridation, advantages and disadvantages. RESULTS: Fluoridation of drinking water started in 1945 in the world and in 1981 in Israel. Today more then 300 million people in some 60 countries enjoy the defending effect of fluoride in drinking water. This is the most effective method for decreasing incidence of caries, as well as being cost effective. Over the years there were many attempts to 'blame' fluoridation with negative side effects to human health. Till today, none of the allegations passed scientific scrutiny. CONCLUSIONS: There is overwhelming scientific support for the Regulations that oblige the Water supplier to adjust fluoride levels to 1 ppm in every town or municipality with more then 5,000 inhabitants.

Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel.

The aim of the study was to examine the oral health and treatment needs of chronically hospitalized psychiatric patients in Israel. Ten percent of the patients hospitalized for more than 2 years in the 18 psychiatric institutions in Israel were selected at random. The dental status (DMF-T index) was calculated, demographic and medical data were retrieved from the files. Of the 431 patients examined (250 men, 181 women, average age 54 years) 312 patients had only partial natural dentition. The average DMF-T score was 26.74 (out of 32), one of the highest in the literature. The caries component accounted for 2.3% of the DMF-T, the missing teeth component 72% and the restored teeth component 5%. There was an adverse correlation between age and caries and between duration of hospitalization and number of teeth. The average number of carious and missing teeth was higher than in the healthy population. No all-edentulous patients had dentures. These findings confirm the urgent need for an intervention program to improve dental health care in high-risk, difficult-to-treat, psychiatric chronic inpatients.

Licensing exams in dentistry Israel 1996-2001.

AIMS AND OBJECTIVES: To describe the experiences with licensing exams in the years 1996-2001 for the Dentist Ordinance in Israel, an exam which it is required for each candidate to pass before being allowed to practice. SUBJECTS: The candidates in large numbers and with a wide variety of professional education applying to take the exam in dentistry in Israel. RESULTS: The exams are conducted in several languages and consist of two parts. 3,612 candidates were examined for Part I, out of which 1,598 passed (44%), while 3,298 candidates were examined for Part II, and 1,558 passed (47%). CONCLUSION: It is feasible and practical to conduct uniform exams for a multinational group of candidates from various dental educational backgrounds in several languages and in large numbers.

[Saliva secretion and oral health in a hospitalized geriatric population in Israel].

Saliva secretion decreases with age, although not regarded as caused solely by age. The decrease is associated among others, with diseases and medications. The aim of the study was to assess saliva secretion, dentition and oral pathologies in a hospitalized geriatric population in a genera hospital. The secretion was measured by 2 methods: saliva collection at rest and sugar cube test. 125 patients agreed to participate, with an average age of 75. They had an average of 6 diagnoses, and took 6 medications. They had 6 teeth in average, with 52% edentulous. Salivary excretion was found to be 15% low according to the saliva secretion and According to the sugar cube test, 20% suffer from xerostomia. However, no statistically significant correlations were found to age, medications, diagnoses, or number of teeth. The study population was hospitalised for short term in a general hospital, and quickly returned to the community. Therefore, we can conclude that salivary excretion is low in the geriatric population in the community, especially among those who suffer from illnesses, who need short terms hospitalization. The health care personnel should be aware of this situation and recommend saliva substitutes and stimulants.

[Emergencies evolving from local anesthesia].

Local anesthesia is without doubt the most frequently used drug in dentistry and in medicine. In spite of records of safety set by using these drugs, there is evidence to adverse reactions ranging from 2.5%-11%. Most of the reactions originate from the autonomic system. A recent, well-planned study indicates that adverse reactions are highly correlated to the medical status of the patient: the higher the medical risk, the greater the chance to experience an adverse reaction. This study also found that adverse reactions highly correlated to the concentration of adrenalin. Another recent study found a direct relationship between adverse reactions and the level of anxiety experienced by the patient and to the dental procedure. Most of the reactions in this study occurred either immediately at injection time and within 2 hours following the injection. Since the beginning of last century, vasoconstrictors have been added to local anesthesia solutions in order to reduce toxicity and prologue activity of the LA. However, today it is commonly agreed that this addition to local anesthesia should not be administered to cardiac patients especially those suffering from refractory dysrhythmias, angina pectoris, post myocardial infarction (6 months) and uncontrolled hypertension. Other contraindications to vasoconstrictors are endocrine disorders such as hyperthyroidism, hyperfunction of the medullary adrenal (pheochromocytoma) and uncontrolled diabetes mellitus. Cross reactivity of local anesthetic solutions can occur with MAO inhibitors, non specific beta adrenergic blockers, tricyclic antidepressants, phenothiazides and cocaine abusers. Noradrenaline added to local anesthetics as a vasoconstrictor has been described as a trigger to a great increase in blood pressure and therefore has been forbidden for use in many countries. This paper describes 4 cases of severe complications following the injections of local anesthesia of which three ended in fatality.

[Syncope in the dental environment].

Syncope or Fainting is, by far, the most common emergency situation in the dental practice. Syncope is defined as an abrupt, transient, short term loss of consciousness and postural tone, followed by spontaneous and complete recovery. The pathophysiology of syncope consists of a sudden cessation or decrease in cerebral perfusion. Differential diagnosis of these medical conditions is of paramount importance in uncovering unrecognized systemic diseases. The dental team plays an important role in the process of establishing the correct diagnosis by its ability to recognize and document all the clinical symptoms and signs evident at the time of fainting. The dental surgeon is expected to be familiar with the various etiologies of syncope and should be able to differentiate between them. This article provides the essentials of the diagnostic procedure and an approach to the evaluation of the unconscious patient.

[Respiratory distress].

Dental treatment is usually conducted in the oral cavity and in very close proximity to the upper respiratory airway. The possibility of unintentionally compromising this airway is high in the dental environment. The accumulation of fluid (water or blood) near to the upper respiratory airway or the loosening of teeth fragmentations and fallen dental instruments can occur. Also, some of the drugs prescribed in the dental practice are central nervous system depressants and some are direct respiratory drive depressors. For this reason, awareness of the respiratory status of the dental patient is of paramount importance. This article focuses on several of the more common causes of respiratory distress, including airway obstruction, hyperventilation, asthma, bronchospasm, pulmonary edema, pulmonary embolism and cardiac insufficiency. The common denominator to all these conditions described here is that in most instances the patient is conscious. Therefore, on the one hand, valuable information can be retrieved from the patient making diagnosis easier than when the patient is unconscious. On the other hand, the conscious patient is under extreme apprehension and stress under such situations. Respiratory depression which occurs during conscious sedation or following narcotic analgesic medication will not be dealt with in this article. Advanced pain and anxiety control techniques such as conscious sedation and general anesthesia should be confined only to operators who undergo special extended training.

[Chest pains in the dental environment].

Chest pain does not necessarily indicate cardiac disease. The most common causes of acute chest pain encountered in dental situations include hyperventilation, pulmonary embolism, angina pectoris and myocardial infarction. Stress and fear often cause rapid breathing or hyperventilation. This usually occurs in young adults and although the hyperventilating patient often complains of chest pain, this is rarely a manifestation of cardiac disease. Pulmonary embolism usually indicates the occlusion of a pulmonary artery causing severe chest pain. The primary clinical manifestation of angina pectoris is chest pain. Although most instances of anginal pain are easily terminated, the dentist must always consider the possibility that the supposed anginal attack is actually a sign of acute myocardial infarction (AMI). AMI is a clinical syndrome caused by a deficient coronary arterial blood supply to a region of myocardium that results in cellular death. There is a high incidence of mortality among AMI with death often occurring within 2 hours of the onset of signs and symptoms. The initial clinical manifestations of all types of chest pain can be similar. Therefore the dentist must develop proficiency in constituting a differential diagnosis and an efficient management protocol. As in most medical situations prevention is the most powerful tool. However, if chest pains do occur, measures such as airway management, oxygen supplementation, coronary artery dilation, analgesis and in extreme cases, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.

[Allergy-related emergencies].

Allergic reactions can develop to any of the drugs or materials commonly used in dentistry. They exhibit a broad range of clinical signs and symptoms ranging from mild, delayed reactions to immediate and life-threatening reactions developing within seconds. Allergies usually manifest themselves in reactions that are related to histamine release in one of three ways: skin reactions, respiratory problems and anaphylaxis. Anaphylaxis is the most critical allergic reaction in the dental environment. Measures such as airway management, oxygen supplementation, antihistamine, adrenaline and corticosteroid medication, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.

[The potential dangers of endocrinal disorders].

The symptoms of most endocrine system diseases are usually clearly recognizable and most of the times are accompanied by a rich medical history. Many general practitioners are reluctant to treat such cases and prefer to refer these patients to specialists who are trained in management of the medically compromised thus increasing the chances of dental treatment without complications. However, sometimes endocrinal diseases develop slowly and their clinical manifestations are hidden or subclinical in nature. In these cases, neither the patient nor the dentist are aware of the condition and there is the potential of life threatening, emergency situations in what at first seem as simple, straightforward dental procedures. Therefore, the dentist must be able to recognize the clinical problem, differentiate between the different symptoms and initiate the proper management protocol. The most unstable endocrinal disorders that should be treated with great care are diabetes mellitus, mainly hypoglycemia, hyperthyroidism and adrenal insufficiency. The general practitioner dentist can treat patients suffering from these disorders providing the disease is well controlled and balanced and that the dental treatment is not very traumatic.

[Legal and ethical considerations of emergencies in the dental office].

The dentist has the ethical and legal responsibility to anticipate emergency situations in correlation with the patient's medical status. He has the obligation to do all in his power to prevent emergencies from happening and to be prepared to manage any emergency that might occur. This article also discusses the importance of monitoring and documentation.

[Patient satisfaction, quality indicators and utilization of dental services in Israel].

Lack of dental data induced JDC-Brookdale Institute to undertake a wide scope research in the general population. The present paper is part of this research and its main objective is to pinpoint differences in accessibility, availability and quality of services by service type. The sampling basis was the Israeli population over 22 years of age. Data was gathered by telephone interviews during March-May 1998. In Kupot Holim clinics, the proportion of people reporting presence of auxiliary personnel (RDH, DSA, etc.) was highest as well as those reporting that the dentist explained their problem and the treatment. In the Kupot clinics, the waiting time to receive an appointment is longest, while in public clinics the waiting time in the clinic is the longest. However, the waiting time in the Kupot clinic till treatment is received is shortest. The findings show that satisfaction with dentists attitude (81%), order and cleanliness in the Kupot clinics (90%) is highest, compared to private (79% and 78% accordingly) and public (55% and 46% accordingly) clinics. When overall satisfaction with the dentist was requested, highest proportion that gave 'very good mark was in private and kibbutz clinics (63% and 67% accordingly), compared to kupot clinics (49%) public clinics (55%) and to company/commercial clinics (43%). It is pertinent to mention that price is regarded as high among patients of kupot clinics than in private clinics. The findings of the research imply that in a competitive market, such as the dental market, providers that want to survive have to adjust their practices to the patients expectations. This means providing more explanations of their medical problem and its treatment. Waiting time in public clinics should be shortened, and furthermore, geographical distribution should be improved.

The prevalence and treatment of dental caries among Israeli permanent force military personnel.

A survey was conducted to determine dental caries prevalence and treatment among 1,095 25- to 44-year-old permanent force Israeli military personnel. Caries experience, by decayed, missing, and filled permanent teeth (DMFT), was 11.66, with an average of 1.37 untreated caries, 2.40 extracted teeth, and 7.90 treated teeth. Caries was positively associated with age (p < 0.001). Females demonstrated statistically higher DMFT levels than males (p = 0.009). Negative associations were detected for education levels and untreated and extracted components (p < 0.001), and a positive association was detected for the treated caries component (p < 0.001). Permanent military personnel treated by private dentists exhibited 17.6% untreated caries, compared with 9.4% among personnel treated in the army. Officers had lower levels of untreated caries (8.6%) than others (13.3%). Among the present population, 77% had attended a dental clinic in the preceding 2 years. Permanent force personnel are offered free, comprehensive, and accessible dental treatment. The data emphasize a need for further dental health education.

Immediate complications of local anesthetic administered to 1,007 consecutive patients.

BACKGROUND: Probably the most common procedure in dentistry is the administration of local anesthetic, or LA. Immediate complications of LA administration include positive blood aspiration, blanching of the tissue and burning sensation on impingement of the nerve. Because studies about the immediate complications of LA administration were conducted before 1980, more recent data regarding this procedure are needed. MATERIALS AND METHODS: In this prospective study, an experienced dentist administered, 2,528 LA injections to 1,007 consecutive patients with 1-inch 27-gauge needles, using a solution of 2 percent lidocaine and 1:100,000 nordefrine hydrochloride. RESULTS: The authors observed positive blood aspiration in 73 injections (2.9 percent) without any further complications. The most severe immediate complication-syncope-occurred only in one case. In 63 injections (2.5 percent), the dentist touched the nerve, and the patient reported feeling an electric current sensation (40 times with inferior alveolar nerve blocks, 18 times with lingual nerve blocks, four times with mental nerve blocks and one time with a second injection to the same site) without any further complications. CONCLUSIONS: The results confirm that LA injections that are properly carried out appear to be safer today than they were in the past. CLINICAL IMPLICATIONS: LA is a safe procedure when the appropriate technique is used. It is even safer when an inferior alveolar nerve block is administered.

Caries prevalence in Ashkelon children in 1994.

In the five-year-old group, 182 children were examined, ninety males and ninety-two females. Forty-three percent of the children were found to be caries-free with a dmf(t) of 2.08 + 2.64 (mean +/- S.D.). More boys than girls were caries-free (46 percent vs 41 percent). In general, caries prevalence is lower and dental health is better in boys than girls. The f(t) component is 0. Children at this age are not treated. In the twelve-year-olds group, 129 boys and 132 girls (total of 261) were examined. Forty-one percent of the children were found to be caries-free with a DMF(T) of 1.43 + 1.70. In this group more girls than boys were caries-free (43 percent vs 39 percent). In general caries prevalence is higher, treatment levels are lower in boys than in girls in this age-group. The results show that dental health is better in Ashkelon children than in other partly fluoridated areas in Israel. Dental treatment levels are higher and caries prevalence is lower in Ashkelon than in comparable places in the country. The WHO goals for 2000 were achieved in Ashkelon by 1994.

Changes in caries prevalence in Ashkelon, Israel, children 1980-1994.

During the 14 years from 1980 to 1994, a marked reduction in caries prevalence was noted in Ashkelon. In the 7-year-old age group, the percentage of caries free children increased from 21 per cent to 29 per cent and the dmft dropped from 3.5 to 2.7. In the 13-year-old group there was also a marked improvement. The percentage of caries free children increased by 16 per cent (from 30 per cent to 35 per cent) with a marked reduction in the DMFT, from 2.3 to 1.9. The DT component halved from 1.8 to 0.9, with a marked rise in the FT component from 0.4 to 1.1. There is less decay and much less untreated dental decay in Ashkelon today than in 1980.