Prevalence of factors associated with edentulousness (no natural teeth) in adults with intellectual disabilities.

BACKGROUND: Poor oral health is largely preventable. Prevention includes toothbrushing and regular dental checks. Oral health has important consequences for general nutrition, chewing, communication, wider systemic disease, self-confidence and participation in society. This study investigated the prevalence of edentulousness (no natural teeth) in adults with intellectual disabilities (IDs) compared with the general population and associated factors. METHODS: An adult cohort with IDs residing in Greater Glasgow and Clyde, Scotland, underwent detailed health assessments between 2002 and 2004. Between 2004 and 2006, a subsample had an oral check. Data on edentulousness in the cohort were compared with adult participants from Greater Glasgow and Clyde in the 2008 Scottish Health Survey. Within the IDs cohort, binary logistic regression analyses investigated potential relationships between edentulousness and demographic and clinical factors. RESULTS: Five hundred sixty adults with IDs were examined [53.2% (298) male, mean age = 46.3 years, range 18-81 years] and compared with 2547 general population: edentulousness was 9% vs. 1% aged 25-34 years; 22% vs. 2% aged 35-44 years; 39% vs. 7% aged 45-54 years; 41% vs. 18% aged 55-64 years; and 76% vs. 34% aged 65-74 years. In both groups, edentulousness increased with age. After stratification for age, rates of edentulousness were consistently higher in the ID cohort. Odds ratios within age strata were not homogenous (Mantel-Haenszel test, P < 0.0001). Edentulousness was more likely in those with more severe IDs (adjusted odds ratio (AOR) = 2.36; 95% confidence interval (CI) [1.23 to 4.51]); those taking antipsychotics (AOR = 2.09; 95% CI [1.25 to 3.51]) and those living in the most deprived neighbourhoods (AOR = 2.69; 95% CI [1.11 to 6.50]). There was insufficient evidence for associations with sex, type of accommodation/support, antiepileptics, problem behaviours or autism. CONCLUSIONS: Adults with IDs have a high prevalence of edentulousness and need supported daily oral care to reduce the need for extractions. Despite previous reports on poor oral care and the move towards person-centred care, carers and care-giving organisations need greater support to implement daily oral care. Prescribers need awareness of the potentially contributory role of antipsychotics, which may relate to xerostomia.

Pragmatic care for an aging compromised dentition.

As our population ages, dentists face challenges in maintaining compromised teeth in aging patients. For the most part, elderly patients (i.e., over 65 years of age) prefer to keep their natural teeth and in some cases, avoid removable dentures altogether. Ideally, patients should not be rendered edentate late in life, as they are unlikely to successfully adapt to the limitations of complete replacement dentures. However, this is not always possible and care should ideally be planned to avoid edentulism, or at least, to carefully manage the transition to the edentate state. In the course of planning care, the dentist needs to recognise the need for age appropriate care, factoring in the impact of the elderly patient's health status and social circumstances. For elderly patients with a compromised dentition, the dentist should try to provide care which is minimally invasive and with as low a burden of maintenance as possible. In this paper, principles of pragmatic care for elderly patients with a compromised dentition will be outlined using clinical cases. Three pathways will be outlined: (i) maintenance of a functional natural dentition using adhesive restorative techniques; (ii) use of overlay prostheses and complete replacement overdentures to manage toothwear and toothloss, complete replacement overdentures, and; (iii) staging a transition to the edentate state using transitional removable partial dentures.

RELATIONSHIP BETWEEN GENERAL HEALTH, ORAL HEALTH AND HEALTHY LIFESTYLE IN ELDERLY POPULATION (REVIEW).

This literature review aims to investigate how a poor oral health impacts on general health and healthy lifestyle of elderly people. The literature review was performed using ScienceDirect, Scopus and PubMed databases to identify relevant published studies. The year of publication was limited to over the past 5 years and the language was limited to English. Having considered the relevant articles' abstracts the 36 articles were selected. Systematical literature revision shows that recently, the older population has increased worldwide and it is being predicted to keep growing in near future. As age-related changes are observed in oral cavity, geriatric dentistry becomes more relevant to investigate oral disorders and to take relevant measures in elderly population. There is an urgent need to clarify the correlations between oral and general health. Unsatisfactory oral conditions lead to serious systemic diseases. Based on the currently available evidence, better collaboration between medical and dental fields is required in order to create and maintain healthy elderly population. A special association with professional group is important for implementation of new programs, in order to enhance and maintain satisfactory oral hygiene, oral health and oral health related quality of life.

[Preventive strategies in prosthetic dentistry]. / Präventionsorientierte Strategien in der prothetischen Zahnmedizin.

Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.

The current and future treatment of edentulism.

The purpose of this review and summary is to focus the clinician's attention on existing potential limitations regarding the management of edentulism. The current published data and opinions concerning the need for treating edentulism, the quality of dentures, related morbidity, and alternative or related therapeutics (e.g., dental implants) suggest there are opportunities for improvement in the treatment of the edentulous population. This may be achieved by adopting a broader therapeutic strategy focused not solely on technical aspects of an oral prosthesis. Instead, a wider array of clinical features of the edentulous patient should be addressed. A contemporary strategy may include concerns for prevention of tooth loss, evaluation of residual alveolar ridge resorption, and related issues of denture function, continual evaluation of oral mucosal health, compassionate management of maladaptive patients, a rationale for timely replacement of dentures, and continued development of dental implant therapies. The importance of therapeutic technical quality can be underscored, but should not overwhelm the broader concerns for assuring the overall health and well-being of the edentulous population.

General dental practitioners' perceptions of removable prosthodontics in the undergraduate curriculum.

The undergraduate dental curriculum is undergoing rapid change and revision in dental schools worldwide. Decreasing edentulism, the advent of the clinical dental technician, and advances in technology (such as dental implantology) have led to changes in patient management and treatment options for general dental practitioners in New Zealand. The current undergraduate removable prosthodontic curriculum has seen very little change in past years at the School of Dentistry, University of Otago, and is under review to facilitate the teaching of general dental practice in the Final Year. A questionnaire-based survey of 150 general dental practitioners (response rate 74.6 percent) supported modification of the existing removable prosthodontics curriculum to improve its relevance to modern general dental practice. Integration of fixed and removable prosthodontic teaching was recommended.

The unique oral health needs of an aging population.

Over the last century, the number and percentage of older adults has increased dramatically. In the last 30 years, the percentage of older edentulous adults has declined significantly but the total number is expected to remain constant at 9 million until the year 2020. The increasing number of and percentage of dentate adults will have more teeth at risk for caries and periodontal disease. Many of these adults will have multiple medical problems and be taking various pharmacotherapies which will complicate oral disease and its treatment. New concepts in prevention of oral disease will be required, as will more accurate diagnostic procedures, especially to identify the at-risk older adults.

Periodontal care.

Prevalence of periodontal disease increases with increasing age. Recent surveys show a decline in edentulism, resulting in an increase in the number of teeth at risk for moderate periodontal disease, with more severe disease restricted to a small portion of the population. Most evidence indicates that age associated increases in disease prevalence and severity is not caused by the process of aging, but is related to past disease history, social, and behavioral factors. Chronologic age is not a contradiction to any modality of periodontal treatment. Diagnosis and treatment of older patients may be modified by the increasing prevalence of chronic diseases, and by concomitant use of multiple medications.

Tooth loss and chewing capacity among older adults in Adelaide.

This study aimed to identify sociodemographic factors associated with edentulism (loss of all teeth) and the average number of teeth lost, and to investigate relationships between tooth loss and chewing capacity. Data were obtained in 1991-92 from a cross-sectional oral epidemiological survey of Adelaide residents aged 60+ years. Interviews with 1160 participants provided information on edentulism while oral examinations among 560 dentate participants and 313 edentulous participants provided information on the number of missing teeth. People were asked if they could chew or bite six common foods. Some 41.1 per cent of persons were edentulous, and nearly half the natural teeth (mean 15.2) were missing among dentate people. Multivariate analyses revealed higher rates of edentulism (P < or = 0.05) for people who were older, female, Australian-born, or holders of pensioner health benefit cards, and for people who left school at an early age, or who did not own their residence. Among dentate people there were more (P < or = 0.05) missing teeth among those who were older, Australian-born, health benefit card holders, and who left school at an early age. Some 37.9 per cent of people reported difficulty chewing at least one food, although 57 per cent of dentate people and virtually all edentulous people wore dentures. Difficulty chewing was associated with tooth loss: 6.1 per cent of people with fewer than nine missing teeth reported difficulty compared with S8.6 per cent of edentulous people (P < 0.01). The findings show substantially compromised oral health among older adults, particularly the oldest-old and disadvantaged groups.

Edentulousness in Iceland in 1990. A national questionnaire survey.

Levels of edentulousness were established for seven age groups by means of self-administered questionnaires. The percentage of edentulousness in the Icelandic adult population (18 years and over) was 20.7%. Edentulousness was first reported in the 35- to 44-year-olds and increased rapidly with age. Women had a higher level of edentulousness than men, and the percentage of edentulous people in Reykjavík was significantly lower than in towns, villages, and rural areas. The proportion of edentulous 35- to 44-year-olds and those 65 years old or older was significantly lower than in a similar study in 1985. The percentage of 18- to 79-year-old edentulous Icelanders in 1990 decreased considerably from the results of a national survey on oral health performed in 1962, mainly as a result of a major reduction of edentulousness in the younger age groups and among women.

Prognosis of and factors associated with dental status in the adult Swedish population, 1975-1989.

The aim was to describe changes in dental status in the Swedish population during the period 1975-89 and to make a prognosis based on these data for the year 2000. This study is based on investigations of the living conditions in 1975, 1977, 1980/81 and 1988/89 performed by The National Central Bureau of Statistics. The samples varied for each year from 11,500 to 15,000 participants and a response rate from 80 to 86%. The odontological questions of the interview were focused on dental status, utilization of dental services and chewing ability. The prevalence of edentulism in age group 16-74 yr decreased from 15% in 1975 to 6% in 1988/89. In 1988/89 19% of the 65-74-yr-old inhabitants of the big cities were edentulous and 45% in rural populations, indicating a 15-20-yr delay of the development in rural areas. The prognosis for the year 2000 indicates a further decrease of edentulism to 3-4% in age groups 45-64 yr and in age 75-84 yr more than 60% will be dentate. As a consequence of the reduction in edentulism and changes in populations the number of dentate inhabitants in age group 25-74 yr increased by about 800,000 from 1975 to 1989 and a further increase of 400,000 will occur up to the year 2000. The consequences of these changes for the dental care services are discussed.

Caries prevalence in Australasia.

The prevalence of caries in Australian children has decreased markedly since its peak in the 1950s. More than half the child population has no experience of caries. However, a small minority, approximately one in sixteen, may be considered still at high risk with an unacceptably large number of teeth with caries experience. This is leading to the addition of high risk strategies to programmes for caries prevention and management. While the prevalence of caries in children has decreased, caries experience in adults has remained widespread and extensive. The majority of teeth in dentate adults have experienced caries. Comparisons over time indicate little change in caries experience in middle-aged adults, but an increase in filled teeth and decrease in missing teeth. The prevalence of caries has not changed substantially, but the management of the disease has moved towards maintenance and repair of teeth. Tooth retention has increased over recent decades. Edentulism has decreased markedly and dentate adults are retaining more teeth. Sizeable increases in the pool of teeth at risk of caries give emphasis to the continued need for preventive measures to reduce caries activity in adults.

[Treatment of (pre)-edentulous patients. After care and directives]. / Traitement des patients (pré-)édentés. Arrière-plans et directives.

It can be expected that the percentage of edentulous people wil decrease in the coming decades as a result of an improved oral health, whereas the number of edentulous people will not decrease as a result of the strong increase of the ageing population. If the preservation of the natural dentition is no longer possible, the remaining teeth of a mutilated dentition have to be extracted according to some specific principles. But also the aftercare of the edentulous patient has to be extended according to some specific guidelines, within the framework of the so-called "preventive-prosthetic-treatment-strategy". Preservation of the alveolar process is the main goal in both cases.

Edentulism and preventive goals in the treatment of mutilated dentition.

The percentage of edentulous people is expected to decrease in the coming decades as a result of improved oral health, whereas the number of edentulous people will increase as a result of the strong increase in the ageing population. If the preservation of the natural dentition is no longer possible, the remaining teeth of a multilated dentition have to be extracted according to specific principles. Within the framework of the so-called 'preventive-prosthetic-treatment strategy', preservation of the alveolar ridge is the main goal.

Regularity of dental attendance in the Netherlands related to preference for preservation of teeth.

In order to study the relationship between regularity of dental attendance and the value attached to the retaining of the teeth, a survey has been carried out among 25-yr-olds in Amsterdam. The value attached to retention was operationalized threefold and was analyzed with, among others, principal component analysis for discrete variables (HOMALS). It has been found that regular dental attenders, compared to irregulars, give a higher priority to retention of the teeth than to other items, are willing to spend a larger amount of money to prevent loss of the teeth, and have a greater aversion to full dentures at both the present age and when 50 yr old. These findings are discussed. Based upon measures of association between the three operationalizations of the value attached to retention of the teeth, it is suggested that these operationalizations deal with different aspects of the attitude towards full dentures.