Demographics and social determinants of oral health for baby boomers.

OBJECTIVE: Age cohorts such as the baby boomers are influenced by historical experiences and the socio-dental events during their lifespan. These events/experiences have impacted their health behavior and consequently, their systemic and oral health. As the baby boomer population is aging, and the majority of them are retaining some of their natural teeth for longer, only fewer are becoming edentulous. This paper discusses the demographics and the social determinants of health of the early baby boomers (1945-1955), as well as the late boomers (1956-1964). METHODS: We have used data from the literature to describe the events which might have impacted these cohorts' attitudes and expectations towards the utilization of health care and dental services. RESULTS: There are variations in the way different age groups perceive dentistry and use dental and other healthcare services, known as cohort differences. Nonetheless, because people are now keeping more of their natural teeth as they age, there is a greater demand for oral healthcare among the baby boomer generation. In order to provide specialized care that addresses their unique needs, there is a need for expanded training programs at both the undergraduate and postgraduate levels. CONCLUSION: A cohort is composed of numerous individuals whose attitudes and behaviors are shaped by their personal life experiences and broader societal trends. Consequently, any information about a particular cohort can only offer generalizations. As healthcare providers, it is important to be aware of the general characteristics of a cohort, but also exercise caution when applying them to individual patients. We should interpret these characteristics in light of each patient's unique circumstances.

Longitudinal Assessment of Denture Maintenance Needs in an Overdenture Population.

PURPOSE: To evaluate the longitudinal denture maintenance needs of a tooth-supported overdenture population. MATERIALS AND METHODS: This prospective cohort study was composed of patients who had received tooth-supported overdentures from 1974 to 1994 in the Department of Prosthodontics, University of Iowa. There were 272 persons with 662 abutments who fulfilled the inclusion criteria. To simplify analysis and reduce the number of confounding variables, only those participants wearing complete maxillary dentures and opposing complete mandibular overdentures supported by teeth #22 and #27 were included in this analysis. The denture maintenance needs of these participants were identified and related to age, gender, length of time wearing overdentures, number of medications, and denture-wearing habits. Descriptive statistics and bivariate analyses were used for the statistical analysis (α = 0.05). RESULTS: Of the 91 participants (mean age = 59.5 ± 10.1 years; 63.7% male) who fulfilled the inclusion criteria at baseline, 48.4% took 1 to 3 medications daily, and 84.6% wore their dentures day and night. The percentages of participants who needed one or more of the following denture treatments were: 91.2% denture base adjustments, 76.9% laboratory processed relines, 61.5% denture remakes, 33% laboratory remount and occlusal adjustment, 22% repaired bases, and 19.8% needed denture teeth replaced. Bivariate analyses indicated that participants who were 65 years and older needed more denture adjustments than patients younger than 65 years (p = 0.0343). Participants who had worn overdentures for more than 5 years were more likely to require denture remakes (p = 0.0304). Participants who wore their dentures only during the day were less likely to require repairs (p = 0.0403). Participants who did not take any medications were significantly less likely to require denture base repairs (p = 0.0258). For the 35 participants who returned for recalls at all 4 time points, males were more likely to need denture teeth repaired or replaced (p = 0.0335) and those aged 50 to 64 were more likely to need 2 or more adjustments (p = 0.0311). No overdenture abutments were lost by the participants in this study. CONCLUSIONS: According to the results of this study, age, medication usage, denture-wearing habits, and age of the overdentures were significant factors associated with denture maintenance needs. Persons wearing overdentures need regular recalls, because they have continuing maintenance needs.

Health trends in a geriatric and special needs clinic patient population.

PURPOSE: To quantify differences and recent changes in health status among patients attending the Geriatric and Special Needs Dentistry (GSND) and Family Dentistry (FAMD) clinics at the University of Iowa College of Dentistry. METHODS: A total of 388 randomly selected records from patients attending the GSND or FAMD clinics from 1996-2000 or from 2006-2010 were reviewed. Univariate and bivariate analyses were conducted, followed by multivariable logistic regression analyses to compare characteristics of patients across clinics. RESULTS: Between the two GSND cohorts, the mean number of medications reported increased from 4.0 to 6.5 (p < 0.001).  Within both cohorts, mental health conditions were significantly more prevalent among patients attending the GSND than FAMD clinic (p < 0.001). CONCLUSIONS: Within cohorts, patients seen in the GSND clinic tended to have more medical problems than patients attending the FAMD clinic, particularly mental health conditions; and medication use was more common in the recent cohort in both GSND and FAMD clinics.

In vitro assessment of 3 dentifrices containing fluoride in preventing demineralization of overdenture abutments and root surfaces.

STATEMENT OF PROBLEM: Caries development under overdentures has been a continuing problem and requires the daily use of fluoride to prevent demineralization. PURPOSE: The purpose of this in vitro study was to compare the effectiveness of dentifrices containing tricalcium phosphate or calcium phosphosilicate in combination with fluoride to prevent the demineralization of overdenture abutments and root surfaces. MATERIAL AND METHODS: A total of 56 caries-free extracted teeth were prepared as overdenture abutments. The teeth were painted with acid-resistant varnish, leaving one 1×4-mm window on occlusal and root surfaces. The teeth were randomly divided into 4 groups: a control group treated with distilled/deionized water only, a group treated with ClinPro 5000, a group treated with ReNew, and a group treated with Prevident 5000 gel. Each tooth was subjected to a demineralizing/remineralizing cycling protocol for 12 days with the appropriate treatment products. The teeth were sectioned longitudinally through both windows. Photomicrographs were made of 3 representative sections from each tooth. A representative section was defined as one that included both windows and was cut from the part of the tooth that had the flattest surface to reduce the edge effect. The depths of the lesions were measured on representative sections from each group. A 1-way MANOVA and a 1-way ANOVA with the post hoc Tukey-Kramer test were used to evaluate the treatment effects on the criterion variables (α=.05). RESULTS: The total lesion depths of the control teeth on the occlusal surface were not statistically significantly deeper than for the 3 dentifrices (P=.7705). However, all 3 dentifrices had narrower cavitation depths than the control (mean cavitation band depth, 43.59 [ReNew] versus 37.99 [Prevident 5000 gel] versus 36.70 [ClinPro 5000] versus 246.86 [control]) (P<.001). The mean remineralization band depth for ClinPro 5000 was significantly greater than for the other 2 treatment groups (118.03 [ClinPro 5000] versus 107.80 [ReNew] versus 102.28 [Prevident 5000 gel]) (P<.001). On root surfaces, the total lesion depth for the control group was statistically significantly deeper than for the 3 dentifrices (mean total lesion depth, 150.31 [control] versus 82.05 [ReNew] versus 68.10 [ClinPro 5000] versus 56.97 [Prevident 5000 gel]) (P<.001). The data indicated that teeth treated with Prevident 5000 gel had the shallowest total lesion depth and were statistically significantly different from those treated with ReNew and ClinPro 5000. Moreover, teeth treated with ReNew were found to have the largest remineralization band depth, which was statistically significantly different compared with ClinPro 5000 and Prevident 5000 gel (mean remineralization band depth, 49.66 [ReNew] versus 36.14 [ClinPro 5000] versus 23.27 [Prevident 5000 gel]) (P<.001), but no difference was found in cavitation depth of the root lesions between the 3 dentifrices. CONCLUSIONS: The addition of tricalcium phosphate or calcium phosphosilicate to fluoride-containing dentifrices (5000 ppm) does not significantly improve their ability to prevent demineralization of the cut dentin surface of overdenture abutments. However, on root surfaces, ReNew, which contains calcium phosphosilicate, was found to improve remineralization of the lesions compared with Prevident 5000 gel or ClinPro 5000.

Prevention and nonsurgical management of dental caries over the life course for individuals with special health care needs.

Traditional approaches to caries prevention and management are unlikely to result in successful outcomes for individuals with special health care needs. Intensive prevention-oriented and minimally invasive restorative approaches have the greatest potential to address oral health disparities affecting vulnerable populations. This paper introduces readers to oral health-related issues for patients with special health care needs across the life course and outlines clinical strategies to prevent and manage caries in high-risk patients.

A 30-year review of a geriatric dentistry teaching programme.

OBJECTIVE: To review the development of the Geriatric Dental and Special Needs Education programme at the University of Iowa over the last 30 years. BACKGROUND: The programme at Iowa evolved from a didactic elective programme taught by a single faculty person to a required didactic and clinical programme, which includes a Special Care Clinic in the dental school and a mobile unit with portable dental equipment which serves ten area nursing homes with comprehensive care. MATERIALS AND METHODS: Changes have been made in the programme over time based on formal and informal feedback from students and graduates, and we have also looked at the impact of the programme on dental services to our target population. RESULTS: The factors influencing the curriculum development are identified and discussed. CONCLUSION: As no dental schools are the same, some general applications are suggested from the Iowa experience.

The involvement of Iowa dentists in hospice care.

The relationships between dentist characteristics and professional education with involvement of Iowa dentists in hospice care were investigated. Using the 1999 Iowa Health Professional database, a survey requesting information regarding involvement in and training for care of hospice patients was mailed to all licensed dentists (N = 1,210). Two mailings yielded a 54.6% response rate. Of the 638 dentist respondents, the mean age was 47, 86% were male, 88% general dentists, and 295 (46%) reported providing some treatment for hospice patients. At least one dentist reported providing hospice patient care in 72 of Iowa's 99 counties. About 90% of dentists treating hospice patients were general practitioners. Males were more likely to provide treatment (p < 0.0313). Neither dentist age nor years in practice were significant predictors. Dentists were more likely to treat hospice patients in the office (IO, 40%). The most prevalent treatments were denture relines (31% IO; 71% OO), examinations (16% IO; 68% OO), and emergency treatment (12.5% IO; 53% OO). More than 86% of surveyed dentists indicated that their professional education did not adequately train them to meet the clinical, psychosocial, communication, or spiritual needs of hospice patients.

The development of geriatric dental education programs in Canada: an update.

The Canadian population is aging, and the oral health needs of this aging population have changed. The majority of older people are now dentate, which means that they continue to need the services of a dentist, specifically dentists who have been trained in geriatric oral health care. This paper reviews the history of geriatric training in Canada. Such training remains inadequate at both the predoctoral level and the postdoctoral or fellowship level. If geriatric or special needs dentistry were to be accepted as a specialty program, it might become more attractive as a career path for dentists.

Iowa intermediate care facilities: an evaluation of care providers'attitudes toward oral hygiene care.

This study investigated the oral hygiene care (OHC) activities and attitudes of care providers in Intermediate Care Facilities for the Mentally Retarded (ICF/MR) in the state of Iowa. Questionnaires were distributed to care providers employed at three ICF/MRs. About 98% of the staff ranked OHC as important to extremely important for residents. Twenty-three percent disliked OHC occasionally or more frequently. Lack of time and lack of staff were the main reasons preventing care providers from assisting residents with OHC. Residents' behaviors resulted in inadequate OHC for 64.9%, and 49% of residents required complete assistance with OHC. Most common OHC difficulties reported were residents biting the toothbrush, refusing OHC, or not opening their mouths. Subjects reported spending 3.0 minutes brushing a resident's teeth and 3.0 minutes cleaning dentures. Care providers experienced significant behavioral and physical difficulties while providing OHC, but still found OHC important. Training programs for care providers are needed to address these difficulties.

Meeting oral health needs to promote the well-being of the geriatric population: educational research issues.

This article reviews some of the more recent demographic changes affecting aging populations. The author expands the concept of aging to include persons who may be chronologically young but biologically old because they are medically compromised or developmentally disabled. It is not known how many persons can be included in this definition who will need care, and the question is what are their needs and how are we going to teach dental students and dentists to care for them. These problems are discussed, and some models of care are described.

Rational dental care: part 1. Has the concept changed in 20 years?

The concept of "rational dental care" was developed 20 years ago when it became clear that idealized treatment plans for frail and functionally dependent older adults were often inappropriate. This first in a series of 2 articles reviews the reasons for developing the concept.

Application of short-form oral health impact profile on elderly Japanese.

OBJECTIVES: The purpose of this study was to use the oral health impact profile (OHIP-14) to evaluate the impact of oral disease on the quality of life of a group of independently-living elderly persons in an urban area of Japan. SUBJECTS: A total of 1244 participants of the Senior Citizen's College, who attended the lectures once a week. They were community-dwelling, independently-living people over 60 years of age. MEASUREMENTS: Japanese version of the short-form OHIP-14. RESULTS: Internal reliability for the 14 items overall was very high (Cronbach's alpha = 0.95). Report of 'painful aching' and 'uncomfortable to eat' were the two most highly scored items using the mean sum OHIP-14 score. A multiple logistic regression analysis indicated that the sum OHIP-14 score had significant associations with self-assessment of general health, dental status, and a perceived need for dental treatment. However, age, gender, dissatisfaction with financial status or education level was not significantly associated with the sum OHIP-14. Compared with that of other countries, the items were ranked similarly, whereas the perceived magnitudes of the problems were quite different from other population. CONCLUSIONS: The OHIP-14 in Japanese had a high internal reliability, was significantly associated with dental status and comparable ranking for items when compared with studies from other countries.

Oral health: perceptions of need in a rural Iowa county.

Several studies have shown that oral health problems impact the quality of life of older adults. However, few data are available to describe the oral health status, barriers to care, and patterns of care for adults and older populations living in rural areas. The purpose of this study was to evaluate the perceived need for treatment of oral health problems by adult residents in a rural county in Iowa. The oral health component was part of a larger longitudinal health study of the residents. The sample was stratified into three groups by residence, that is, farm households, rural non-farm households and town households. The sample was subsequently post-stratified by gender and age group into young elderly, 65-74 years old, and old elderly, 75 years and older. Dentition status varied according to age and was related to the perception of treatment needs. Edentulous persons had fewer perceived treatment needs and utilized a dentist less frequently. Place of residence, education, and marital status were not associated with the subjects' perceived problems with eating and chewing. However, persons with difficulty chewing were more likely to have some missing upper teeth, have a perceived need to have denture work, and have smoked for a number of years. The results suggest that this rural population is retaining more teeth and consequently may need and may seek dental services more often than previous more edentulous cohorts.

Current status of predoctoral geriatric education in U.S. dental schools.

The elderly constitute the fastest growing segment of the U.S. population. Dental schools must educate dental students so that they are competent and confident in managing the treatment needs of elderly patients. Programs in geriatric dentistry have been developed in response to the changing oral health needs of growing numbers of older adults. The purpose of this online survey was to identify the current status of predoctoral geriatric dental education in U.S. dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the World Wide Web, and fifty-four US. dental schools were invited to complete the form. Data from completed questionnaires were submitted to the investigators via email. Following repeated phone calls and emails to urge school administrators to respond to the electronic questionnaire, a 100 percent response rate was achieved. All schools reported teaching at least some aspects of geriatric dentistry, and 98 percent had curricula that contain required didactic material. Sixty-seven percent of schools reported having a clinical component to geriatric dental teaching. Of these schools, the clinical content was required in 77 percent and elective in the rest. Thirty percent of schools reported a specific geriatric dentistry clinic within the school, and 11 percent had a remote clinical site. Sixty-three percent of schools have a geriatric program director or a chairman of a geriatric section. Over a third of schools indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has continued to expand over the last twenty years and has established itself in the U.S. predoctoral dental curriculum. The format of teaching the subject varies considerably among the dental schools. Although didactic teaching of geriatric dentistry has increased markedly in the last two decades, clinical experience, both intramurally and extramurally, did not keep pace.