Dental care of institutionalized elderly in Singapore.

Previous studies have identified considerable barriers to dental care and unmet dental needs among institutionalized elderly. This study examined physical and financial arrangements for dental care of institutionalized elderly in Singapore. Chief administrators of the 68 homes for the elderly in Singapore were interviewed. Results showed that 48 homes (70.7%) assumed responsibility for arranging dental care and providing access to treatment facilities for its ambulant residents while only 33 homes (48.5%) had similar arrangements for semi- and non-ambulant residents. Four of the homes (5.9%) reported having in-house dental facilities while the rest arranged for its residents to be treated either in public dental facilities (44.2%) or in private dental offices (20.6%). Type of sponsorship of the homes and ambulatory status were closely associated with the type of arrangement for dental care. Over 64.6% of homes (44) required residents to be fully responsible for the costs of their dental care. The availability of subsidies for residents' dental costs was found to be associated with the type of sponsorship and type of arrangement for care. Lack of physical access and financial constraints were found to be potential problems in the utilization of dental services in this population group.

Dental state and needs for episodic care of institutionalized elderly in an Asian community.

This study examined the dental state of institutionalized elderly and their need for care. An oral examination was carried out on 479 elderly persons living in long-term care facilities with a mean age of 74.9 years. Results showed an overall DMF score of 27.0 and the average number of teeth in dentate subjects was 7.5. A large proportion of teeth (76.6%) was lost through dental caries and the loss increased significantly with age. Consequently, 56.1% of subjects were edentulous, of whom 78.8% were without dentures. Among the conditions that required urgent dental care, majority of subjects needed extractions of residual roots and loose teeth. A lesser proportion required treatment for gross caries (4.8%), periodontal disease (5.0%), suspected tumor (0.2%), as well as alleviation of pain and infection arising from mucosal lesions (4.8%), abscesses (3.3%) and TMJ problems (2.8%). The treatment needs for dentures and episodic care are high among institutionalized elderly and need to be addressed.

Gluma dentin adhesive: effectiveness and shelf life.

The purpose of this study was to test the effectiveness and shelf life of a commercially available glutaraldehyde/methacrylate dentin adhesive (Gluma). The measurement of marginal contraction gaps in 320 cavities restored over a period of 415 days was the basis for these determinations. The results showed that Gluma dentin adhesive was more effective with one of the two composite restorative materials used for the study, and that the shelf life of Gluma exceeded 415 days.

Comparison of release of mercury from three dental amalgams.

Mercury release from dental amalgams has generated considerable concern in recent years and is the subject of this study. Specimens of one admixed high-copper amalgam (Contour), one lathe-cut low-copper amalgam (SDI), and a new tin- and copper-free amalgam claimed to be non-mercury-releasing (Composil) were evaluated for release of mercury when incubated in purified water at 37 degrees C. Measurement of mercury was done by cold-vapor atomic absorption spectrophotometry, and the amount released was expressed as micrograms/cm2/24 hr. Study was conducted over a four-week period. Results show that Contour and SDI released similar insignificant amounts (mean release of less than 0.1 microgram/cm2/24 hr) compared with Composil (mean release of 41.0 micrograms/cm2/24 hr). The difference in release by Composil compared with that by Contour and SDI is highly significant (P less than 0.001). The implications of chronic release of mercury from dental amalgams are discussed. Long-term release studies are in progress.

Relationship between contact angles of die stone on elastomeric impression materials and voids in stone casts.

Poor wettability of elastomeric impression materials results in surface defects on stone casts. This study examined the relationship between contact angles of die stone and voids in casts produced from five medium-viscosity impression materials. Contact angles of a die stone material formed against impression specimens made from polyether, addition and condensation silicones were measured by reflex microscope. The contact angle values achieved on the hydrophilic addition silicones were significantly higher than the polyether but lower than other silicone materials. Contact angle values correlated with the number of voids found at margins and line angles of stone casts but not with those on smooth surfaces.

Comparison of two pain rating scales among Chinese cancer patients.

The Simple Descriptive Scale (SDS) has been known to be easier to use, but lacks sensitivity when compared to the Visual Analogue Scale (VAS). In this study, 79 cancer patients quantified the intensity of their pain experience on both the VAS and SDS before receiving pain therapy and on the fifth day after commencing the therapy. High correlations were observed between the two scales in age, sex and types of analgesics. The results demonstrate that the SDS provides a simpler and, perhaps, equally sensitive alternative to the VAS, in measurement of cancer pain among Chinese patients. It would be particularly useful for those with language barriers and/or other factors in understanding the requirements or the VAS.

Assessment of orthodontic treatment needs by teenagers in an Asian community in Singapore.

The purpose of this study was to determine (1) the preference of dental occlusion types among teenagers, and (2) their assessment of the necessity for orthodontic treatment. A total of 1189 teenagers (mean age 15.3 +/- 3.2 years) were asked to rank a series of colour photographs of seven occlusion types. Their ranking, in descending order of attractiveness, were as follows: Class I occlusion, anterior open bite, Class III occlusion, Class II occlusion, anterior spacing, anterior crowding and deep bite occlusion. The perceived need for treatment was found to be inversely correlated with the rank order of attractiveness. There appeared to be no statistical difference (P less than 0.05) in the perception for treatment among different racial and income groups. However, with the exception of anterior open bite and deep overbite occlusions, a statistically significant (P less than 0.05) greater number of females than males perceived a need for treatment. Assessment of occlusal disharmonies among teenagers could provide clinicians and health care personnel with an indication of the relative attractiveness among occlusion types and hence the establishment of treatment priorities.

Contraction patterns in cavities tested with two dentin bonding agents.

Differences in microleakage at occlusal and cervical margins have been attributed to variations in the microstructure of enamel. The lack of homogeneity in dentin may have similar influences on the effectiveness of composite bonding. This study examined marginal contraction gaps occurring at the occlusal, cervical, mesial, and distal margins of dentin cavities restored with a composite restorative material, with and without the use of dentin bonding agents. Results showed that marginal contraction gaps at the dentin-restoration interface among the four sites in both treated and untreated cavities are not statistically different in size. Adhesion of composite restorative materials to dentin is not affected by the location of the margins.

Effect of dentin age on effectiveness of dentin bonding agents.

The purpose of this research effort was to investigate the effect of age changes in dentin on the effectiveness of two dentin adhesives in minimizing microleakage at the tooth-restoration interface. Cavities were prepared in permanent teeth extracted from patients below 20 years or over 55 years of age. Wedge-shaped cervical preparations were made with the gingival cavosurface margin on dentin. Treatment groups were randomly restored with one of two composite restorative materials, together with the appropriate dentin adhesives. The control group specimens were restored with the respective composite restorative materials without the adhesives. All specimens were thermocycled, then placed in 0.5% basic fuchsin dye solution for 24 hours and subsequently sectioned longitudinally. Microleakage at the tooth-restoration interface was assessed by dye penetration. The results showed that the use of adhesives significantly reduced microleakage along the tooth-restoration interface. The adhesive formulated with glycidyl methacrylate was significantly more effective in reducing microleakage in dentin of the over-55 age group.

Porosities in five automixed addition silicone elastomers.

Five automixed and one hand-mixed addition silicones were evaluated by counting the number of voids produced in impressions made. It was concluded that although automixing produced fewer voids than hand-mixing, certain automixed materials were better than others.

Disparity between medical and dental care of institutionalised elderly in Singapore.

Elderly persons tend to give dental care a lower priority than medical care. This study examined existing arrangements for and financial support of dental and medical care to elderly persons living in 68 long-term care facilities in Singapore. The chief administrators of all the homes for the aged were interviewed regarding the provision of physical and financial access to dental and medical care for their residents. Information was verified with a random selection of their residents. Results showed that a significantly higher number of homes (93 per cent) assumed responsibility for the provision of medical care than for dental care (70.7 per cent). A significantly greater proportion of them offered in-house medical care (42.6 per cent) than in-house dental care (5.9 per cent). Financial support for payment of providers' fees, hospitalisation and the transportation costs of ambulatory visits for both medical and dental care was found to be similar but generally inadequate. Greater commitment towards improving physical and financial access to dental care for the institutionalised elderly is necessary.

Racial differences in perception of oral health and oral health behaviours in Singapore.

Knowledge of prevention can influence preventive dental behaviours. This study surveyed knowledge and preventive dental behaviours on the prevention of dental caries and gum disease among the adult population of the three major racial groups in Singapore. Respondents were asked to rate the importance of several preventive measures against dental caries and gum disease. Questions were also fielded on dental behaviours such as preventive visits to the dentist, toothbrushing and flossing. Results showed that there was a general lack of appreciation for the use of flossing, dental sealants and fluoride supplements. Although a majority of respondents thought that regular dental checkups would be essential for prevention, the proportion who actually saw the dentist for preventive care was significantly lower. Respondents provided inappropriate reasons for brushing their teeth. Differences in both preventive knowledge and preventive dental behaviours among racial groups were evident although these were attributed to differences in education and exposure to product information rather than to racial or cultural factors.

Effect of interchanging automatic mixing tips on void formation for an automixed addition silicone impression.

This study examined the effect of interchanging mixing tips on void formation for impressions of an automixed addition silicone material. The impressions were made of a series of stainless-steel cylinders by two dentists. The voids were counted at a predetermined site with a binocular microscope. The results showed that there were no significant variations in the number of voids in impressions of the automixed addition silicone using the three different mixing tips. However, one dentist made impressions that had substantially less voids for all three mixing tips.

Phases of dental fear for four treatment procedures among military personnel.

Dental fear is a significant problem in the delivery of dental care. This study examined the phases of dental fear in 488 military conscripts scheduled to receive four categories of dental treatment for the first time. Results showed that the level of fear increased gradually from the day before treatment and peaked while receiving it. A significant reduction occurred after completing the treatment. Among the different types of procedures, tooth extraction elicited the highest degree of fear, while having the teeth cleaned registered the lowest. Military servicemen showed a pattern of dental fear similar to those other population groups.

Assessment of dental care delivery to institutionalised aged in Singapore.

Evaluating dental care of institutionalised aged presents numerous problems largely associated with communication and cooperation. This study used administrators' assessment to evaluate cost, accessibility, availability, quality, and efficiency of existing arrangements for dental care. In-house dental care had been rated favourably in all aspects although administrators were less satisfied with it. Generally, public dental facilities received 'favourable' ratings for cost, accessibility, and availability, and self-arranged care the least 'favourable'. Administrators encountered the greatest amount of difficulty when assessing quality and efficiency. Administrators' assessment seemed to be consistent with, and reflective of, the strengths and weaknesses of the various arrangements for dental care.

Applications of computer technology in dentistry.

Technological advances in industrial manufacturing have contributed to improvement in productivity and quality of dental care. However, computer technology has also been exploited but not to the same extent as other forms of technology. This paper examines computer applications that have been utilised by various groups of dental professionals in the provision of dental care and in dental education. The benefits derived from existing applications and future possibilities are seen in the following fields. In practice management, besides the usual collecting, sorting and searching of data, productivity and efficiency are greatly increased through computer appointments, recall and practice analysis programmes. In patient education, the use of computer graphics has enabled simulation of cosmetic changes to be presented to the patient with before and after possibilities. Dental education and communications have moved forward with the introduction of Computer Assisted Instruction programmes, and bibliographic databases including electronic transmission of Continuing Dental Education which are now easily available. In the field of Diagnostics and Treatment planning, the advent of CAD-CAM has made possible the use of cutting devices which mills a 3-dimensional model of the designed restoration from solid blocks of gold. Computer applications has also been used in forensic dentistry where identification systems describe tooth conditions and other oral characteristics besides automated screening and matching of antemortem databases.

The development of a composite restorative system.

Composite resin restorative materials have been used in dental practice for over 25 years. The original composite resins were subjected to discolouration and marginal breakdown. These problems have largely been overcome with the exception of marginal gaps at the dentine-restoration interface. The introduction of dentine adhesives has reduced but not eliminate this problem. This study shows how the marginal gaps at the dentine-restoration interface were significantly reduced firstly by the introduction of an intermediate resin and then further by using a dentine adhesive.

The prevalence of unilateral mastication in a non-patient population: a pilot study.

One hundred and twenty-seven dental undergraduates participated in a questionnaire survey containing questions relating to their experience with craniofacial pain, jaw function, oral habits and other predisposing factors. The prevalence of chronic habitual unilateral chewers (10%) in the above selected non-patient population was significantly lower than that reported in the patients suffering from craniomandibular disorders (CMD). Lateral masticatory preference was also shown to be significantly associated with symptoms such as "noises from the joints", "difficulty in opening the mouth wide", "an uncomfortable bite", "neckpains", "soreness in the teeth", "painful cheek muscles", "pain in the temples" and/or "tension in the muscles of the face and jaws". The interrelationship between unilateral mastication and CMD is discussed.

Effect of operator variability on void formation in impressions made with an automixed addition silicone.

This study examined voids produced in impressions of an automixed addition-reaction silicone. Two operators took the impressions using material dispensed from either intra-oral tips or an impression syringe. The material was also hand-mixed for comparison. There were no differences in the number of voids in the automixed material dispensed using the intra-oral tip or impression syringe. Automixing produced substantially fewer voids than hand-mixing. There was a significant difference in the number of voids in the impressions made by the two operators.

Dental health of disabled children in Singapore.

The oral health status of the disabled has generally been poorer than the general population as the treatment and care afforded to them has been minimal. This paper examines the relationship of the various types of disabilities to dental health status. The dental status of a random sample of 322 disabled children aged between 6 and 18 years was assessed. The children had various disabilities: intellectual, hearing, visual, and musculo-skeletal. Most differences in the prevalence and severity of the dental conditions assessed among the children in the various disability groups were not significant. However, in comparison with normal schoolchildren aged 6 to 18, the disabled children had higher levels of disease and received less dental attention.