Impact of Elderly Masticatory Performance on Nutritional Status: An Observational Study.

Background and Objectives: Masticatory limitations on the dietary habits of edentulous subjects restrict their access to adequate nutrition, exposing them to a greater risk of protein energy malnutrition. The aim of this study is to verify the existence of an association between Masticatory Performance (MP) and nutritional changes in the elderly. Materials and Methods: 76 participants were enrolled. MP testing was performed using the two-color chewing gum mixing test. The system used reveals the extent to which the two differently colored chewing gums mix, and allows discrimination between different MPs. The assessment of the participants' nutritional statuses was carried out through a food interview. Anthropometric parameters were collected, and bioimpedance analysis was performed. Results: Mean MP was 0.448 ± 0.188. No statistically significant differences were detected between male and female subjects (p > 0.05). According to the Body Mass Index (BMI), obese patients had a lower MP than overweight and normal weight subjects (0.408 ± 0.225, 0.453 ± 0.169 and 0.486 ± 0.181, respectively). MP values were lower both in male and female subjects with a waist circumference above the threshold than those below it (0.455 ± 0.205 vs. 0.476 ± 0.110, respectively, in males and 0.447 ± 0.171 vs. 0.501 ± 0.138, respectively, in females). No relationship was noticed between MP and bioimpedance parameters (p > 0.05). Conclusions: A statistically significant relation was observed between MP and the number of missing teeth. A reduced MP could worsen nutritional parameters. A reduced MP did not seem to negatively affect bioimpedance parameters.

Masticatory Function in Stage IV Periodontitis Patients Treated with Fixed Prosthetic Rehabilitations: A Case Series.

The present study assessed the impact of a fixed prosthetic rehabilitation on masticatory function in patients diagnosed with stage IV periodontitis. Eligible participants were adults in need of complex rehabilitation due to masticatory dysfunction. Masticatory function was evaluated using the two-colored chewing gum mixing ability test (VOH) at the diagnostic phase (T0), 1 week after delivery of the prosthetic prototype (T1), and 1 week after delivery of the final prosthetic solution (T2). Ten subjects were treated with a fixed prosthesis following periodontal and implant surgery using an individualized, fully digital workflow. Full-mouth plaque and bleeding scores, pocket depth, and clinical attachment level improved significantly. VOH was 0.472 ± 0.168 at T0, 0.358 ± 0.166 at T1, and 0.250 ± 0.123 at T2. A significant improvement in VOH was observed from T0 to T1 (difference: -0.114; 95% CI: -0.199 to -0.029; P = .014) and from T1 to T2 (difference: -0.108; 95% CI: -0.200 to -0.015; P = .027). From T0 to T2, VOH increased by 44.3%. Self-perceived assessment of masticatory function also improved from T0 to T2 (P = .002). The fixed prosthetic rehabilitation in patients with stage IV periodontitis allowed for a significant improvement in objective and subjective measurements of masticatory function.

Fixed Prosthetic Rehabilitation with Full Digital Workflow Based on Jaw Kinematics Recording. A Case Series.

PURPOSE: The study aims at evaluating the impact of a full digital workflow on the restoration of masticatory function and aesthetic features in subjects rehabilitated with fixed prosthesis. MATERIALS AND METHODS: The study involved 12 adult participants in need of complex rehabilitation due to masticatory dysfunction. They underwent a comprehensive diagnostic examination involving intraoral scan, facial 3D-photos, jaw kinematics recording, and Cone Beam Computed Tomography extended to temporo-mandibular joint. The subjects were consecutively treated with fixed prosthesis following surgical and implant therapy using a full-digital individualized workflow. Three different study moments were set: diagnostic phase (T0), one week after the delivery of the prototype (T1) and one week after the delivery of the final prosthetic solution (T2). RESULTS: Jaw kinematics recording showed a widening of movements at T2 compared to T0. Sagittal movements increased by 5.7±6.4 mm (95%CI from 1.7 to 9.8, P = 0.010), frontal movements increased by 7.2±5.6 mm (95%CI from 3.6 to 10.8, P = 0.001), and horizontal movements increased by 1.7±4.5 mm (95%CI from -1.1 to 4.6, P = 0.210). Occlusal adjustment timing at T1 was 350±175 seconds, while at T2 was 677±286. At T2 functional VAS was 9.4±0.4 while aesthetic VAS was 9.3±0.4. CONCLUSIONS: The rehabilitation process using the full digital workflow showed a widening of the sagittal and frontal masticatory movements with short occlusal adjustment time and with functional and aesthetic satisfaction by all the subjects.

Pro-inflammatory cytokine alterations in recent onset anorexia nervosa adolescent female patients before and after 6 months of integrated therapy: A case-control study.

Anorexia nervosa (AN) is a complex disorder affecting mainly, but not only, teenagers. Researchers agree that AN is deeply associated with a pro-inflammatory state following an impaired immune system, resulting from altered levels of cytokines such as IL-1ß and TNF-α, also impacted by the frequent depressive states. Thus, this case-control study aimed to evaluate the relationship between patients suffering from AN undergoing specialized eating disorder treatment for AN and pro-inflammatory cytokines. To reach our purpose, we assessed eating-related psychopathology and depressive symptoms and measured serum concentration of pro-inflammatory cytokines IL-1ß, IL-6, IL-8, and TNF-α before and after 6 months of integrated therapy (which included psychopharmacotherapy, psychotherapy, and nutritional treatment), to define whether selected pro-inflammatory cytokines could be considered a pathophysiological marker of the disorder. A sample of 16 young female patients with early diagnosis of AN, and without any previous treatment, and 22 healthy controls matched by age, sex, and socioeconomic status were enrolled. After 6 months of integrated therapy, a significant decrease of all selected pro-inflammatory cytokines was detected. In addition, an improvement in the anxiety-depressant aspects was also noted. In conclusion, the results obtained suggest that pro-inflammatory cytokines are indeed related to the pathophysiology of AN. However, further investigations, involving larger samples of patients with distinct subtypes of AN, are essential to confirm the current findings.

Intraoral Scans of Full Dental Arches: An In Vitro Measurement Study of the Accuracy of Different Intraoral Scanners.

The aim of this in vitro study was to evaluate the accuracy of different intraoral scanners (IOS), according to different scanning strategies and to the experience of the operator. Six IOS setups were used in this study. Ten scans of a complete epoxy-resin-made maxillary dental arch were performed with each IOS, using four different scanning techniques (manufacturer-suggested scanning strategy, cut-out rescan technique, simplified scanning technique, novel scanning technique). Scans were also performed by an expert operator in the field of digital dentistry. An operator with no experience in the field of intraoral scans performed 10 scans following each of the scanning strategy suggested by the manufacturer. The master model was scanned with an industrial high-resolution reference scanner to obtain a highly accurate digitized reference model. All the digital models were aligned with the reference model using a software aimed at comparing the STL files. A total of n = 300 scans were performed. Once the data were pooled, Medit i700 and Primescan obtained the best results in terms of both trueness and precision, showing no statistically significative differences (p > 0.05) to the first and the second scanning technique, Medit i700 scanner allowed to obtain the best values both in terms of trueness (24.4 ± 2.1 µm and 21.4 ± 12.9 µm, respectively) and precision compared to other IOS (23.0 ± 1.6 µm and 30.0 ± 18.0 µm, respectively). When considering the third scanning technique, Medit i700 recorded the best values in terms of trueness while Primescan recorded the best values in terms of precision (24.0 ± 2.7 µm and 26.8 ± 13.7 µm, respectively). When considering the two operators, significant differences between the two were found only with Medit i700 (p < 0.001). The examined IOS showed statistically significant differences in terms of trueness and precision. The used scanning strategy is a factor influencing the accuracy of IOS. Considering the expertise of the operators, clinically scanning strategies are not operative sensitive in terms of accuracy.

Heat Generation During Initial Osteotomy for Implant Site Preparation: An In Vitro Measurement Study.

Introduction: Controlling temperature generation during implant site preparation is important to prevent implant early failure. Aim: The present in vitro study aimed at measuring temperature variation generated during the initial osteotomy using both rotatory and piezo-surgical inserts. Methods: Nine groups were defined according to drill and insert type, cooling volume (mL/min) and cooling temperature. A total of 315 implant site preparations were performed in an artificial bone sample and the temperature was measured using an infrared camera. Drills' wear was assessed using scanning electron microscopy at baseline and after 10 and 35 utilizations. Results: Piezo-surgical insert groups determined a temperature increase that was significantly higher than the one generated by rotatory drills groups (p < 0.001). When considering rotatory drills groups a temperature ≥ 40 °C was never recorded. Conclusion: Lower saline temperature implied a significant temperature decrease (p < 0.001), while the increase in cooling volume did not imply a temperature decrease. The scanning electron microscopy analysis of the drills demonstrated that little drill wear occurred up to 35 utilization times.

A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia.

Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients' reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.

The Impact of Coronavirus Information-Seeking Behavior on Dental Care Access: A Cross-Sectional Questionnaire-Based Study.

Health information-seeking behavior provides a variety of benefits, such as reducing knowledge gaps and educating individuals outside the medical office. This study aimed at evaluating if different sources used to gather information on COVID-19 could affect the willingness to undergo dental appointments. An anonymous survey was posted on social media. The 1003 respondents used several channels of communication, clearly distinguishing reliable from unreliable ones. Multiple logistic regression estimated the effect of different information channels on the probability of being strongly influenced by COVID-19 in accessing upcoming dental appointments. Newspapers were the most-used channel of information (61.2%), blogs and forums the least used (11.2%). Overall, the more an individual was informed, the higher was the risk of missing upcoming dental care appointments (OR 2.05, CI 1.45-2.90, p < 0.001). The two most reliable channels of communication were identified in journals/websites of medicine and healthcare professionals. Women proved to be more active in gathering information and relying on less secure but more personal channels, such as social media and friends and family, thus having an increased risk of being influenced by COVID-19 information regarding upcoming dental care appointments (OR 3.62, CI 0.85-15.52, p < 0.1 and OR 1.60, CI 1.00-2.58, p < 0.1, respectively). Social media should have a greater presence on the side of medical service providers to avoid distortions of information and fake news that ultimately cause fear among citizens and compromise their health. Healthcare professionals and institutions should adapt their communication channels based on the audience they want to address to optimize the education and information of the final users.

The Influence of Age and Oral Health on Taste Perception in Older Adults: A Case-Control Study.

Declining gustatory function, nutrition, and oral health are important elements of health in older adults that can affect the aging process. The aim of the present work was to investigate the effect of age and oral status on taste discrimination in two different groups of elderly subjects living either in an Italian residential institution (TG) or in the community (CG). A total of 90 subjects were enrolled in the study (58 CG vs. 32 TG). Masticatory performance (MP) was assessed using the two-color mixing ability test. Taste function was evaluated using cotton pads soaked with six taste stimuli (salty, acid, sweet, bitter, fat and water). A positive correlation between age and missing teeth (r = 0.51, C.I. [0.33; 0.65], p < 0.0001), and a negative correlation between age and MP (r = -0.39, C.I. [-0.56; -0.20], p < 0.001) were found. Moreover, significant differences for salty taste, between TG and CG were detected (p < 0.05). Significant differences in bitter taste sensitivity between subjects wearing removable and non-removable prosthesis were also determined (p < 0.05). In addition, significant gender differences and between males in TG and CG were identified (p < 0.05). The best understanding of the relationship between MP, taste sensitivity, and nutritional factors is a necessary criterion for the development of new therapeutic strategies to address more effectively the problems associated with malnutrition in elderly subjects.

A Pilot Cross-Sectional Study on Oral Health and Nutritional Status of Institutionalized Older Adults: A Focus on Sarcopenia.

The global population aged over 60 will double by 2050. This pilot cross-sectional study aims at evaluating nutritional and oral health status and the prevalence of sarcopenia in older adults living in an Italian residential aged care facility. Thirty-two adults aged ≥65 years were included. Individual sociodemographic data and nutritional and oral health data were collected. For sarcopenia diagnosis, muscle mass, physical performance, muscle strength and anthropometric parameters were recorded. Participants underwent a nutritional screening and a dental examination. Mini Nutritional Assessment and masticatory mixing ability test were performed. The results showed that men recorded a hand strength significantly higher than that of women, 25.5 ± 7.2 Kg vs. 12.8 ± 5.9 Kg (p < 0.01), respectively. Gait speed test showed that only 20.8% of the participants had a speed of more than 0.8 m/s. A strong negative correlation between masticatory performance and the number of missing teeth was detected (r = -0.84, 95% C.I. [-0.92; -0.69], p < 0.01). Overall, a high percentage of institutionalized older adults were diagnosed as being sarcopenic. Poor oral health in older adults is a major general health problem as it may restrict both food selection and nutrient intake, representing a risk factor for sarcopenia, although longitudinal studies are needed to confirm this relationship.

Dental Care Access and the Elderly: What Is the Role of Teledentistry? A Systematic Review.

A high level of unmet oral health needs is very common among elderly people. In a society that is getting older and that has been hit so hard by the coronavirus pandemic, the development of new strategies aimed at enhancing general and oral health status should be crucial in order to promote healthy aging. The aim of this systematic review is to assess the feasibility of Teledentistry in communities or in a domiciliary setting where elderly people live. A structured and systematic research was performed on the major electronic databases for studies published in English until 30 June 2020: the PubMed, Cochrane Library, Web of Science, Scopus, and CINAHL databases. A total of 13 articles were identified through database searching using combinations of keywords. Out of 13 papers, eight abstracts were reviewed to assess if they were coherent with the aim of the study, and full texts were retrieved. After abstract reviews, seven articles were selected for closer inspection. Of these, six were assessed for eligibility. Four papers were aimed at assessing patients and health practitioners experiences about Teledentistry, three studies reported a cost analysis and cost description of Teledentistry in residential aged care facilities, and two studies investigated the feasibility and accuracy of Teledentistry for diagnosis dental pathology. The implementation of Teledentistry in residential aged care facilities and in home-assistance programs could be a viable tool for the management of oral care in people who cannot access dental care.

Italian Response to Coronavirus Pandemic in Dental Care Access: The DeCADE Study.

The aim of the study was to evaluate the impact of the coronavirus pandemic on the willingness, anxiety and concerns of Italian people on undergoing dental appointments. An anonymous survey was posted online on social media on 11 May 2020 and was completed by 1003 respondents in one week. Multiple correspondence analysis and multiple logistic regression were used to evaluate the association between socio-demographic characteristics, dental care access, contagion fear of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), trust in dentists regarding sanitization procedures and perception of the impact of the risk of contagion on dental care. Subjects with a high level of education, attending public dental offices and that are used to go to dental offices for urgent care would not feel comfortable in undergoing a dental appointment and would prefer to postpone or cancel dental visits, waiting for a decrease in the number of the contagions. Moreover, the risk of canceling or postponing the appointment at the dentist was 1.59 times greater in those who claimed to be strongly influenced by SARS-CoV-2. Fear of coronavirus disease (COVID-19), new cases decrease and the not urgent nature of dental visits influenced more than the lowered income household on upcoming or resuming dental appointments. In the next months, despite the forecasted economic crisis caused by coronavirus pandemic, fear and anxiety generated by the spread of the virus will impact more than the lowered familiar income with regards to access to dental care.

Anorexia, Oral Health and Antioxidant Salivary System: A Clinical Study on Adult Female Subjects.

The aim of this study was to compare the oral health status and salivary antioxidant system between patients diagnosed with anorexia nervosa (AN) and healthy controls. A total of 25 female AN patients and 25 matched healthy controls were enrolled. Clinical parameters and saliva samples were collected for each patient. Two questionnaires to investigate oral health and hygiene were administered. Superoxide Dismutase (SOD) activity and High Reactive Oxygen Species (hROS) were evaluated. Salivary concentration of SOD was significantly higher in subjects with AN compared with control group (1.010 ± 0.462 vs. 0.579 ± 0.296 U/mL; p = 0.0003). No significant differences between groups were identified for hROS (233.72 ± 88.27 vs. 199.49 ± 74.72; p = 0.15). Data from questionnaires indicated that, although most of the patients recognized the oral hygiene importance in maintaining a good oral health, more than half of them had poor oral hygiene. Altered biochemical composition of saliva in patients with AN could be interpreted as an effective defence mechanism against oxidative stress. Moreover, despite the discrepancy between clinical findings and perception of the oral health in AN population arose, the quality of life of these patients appears not to be significantly affected by their dental condition.