Masticatory performance in oral function assessment: Alternative methods.

BACKGROUND: Masticatory function declines with age or disease, implicating a poor chewing efficiency and an often-unconscious change for a less healthy, yet easy to chew diet. Timely screening of masticatory function may foster an early-onset diagnosis and potential treatment. The aim of this study was to compare alternative diagnostic tools for masticatory function to a Jelly-scan test. MATERIALS AND METHODS: Patients aged 70 years and older who were hospitalised for rehabilitation were recruited for this study. A total of four different tests for masticatory function were administered. The Japanese Society of Gerodontology glucose extraction test (Jelly-scan) was used as reference to compare a colour-changing gum test (Gum1-colour) as well as a mixing ability test with a visual (Gum2-visual) and opto-electronical (Gum2-digital) analyses. Receiver operating characteristic (ROC) curves were used to establish the discriminative value, kappa-values were used to estimate individual agreements and correlations were verified using Spearman's tests. RESULTS: Sixty-one patients (Men n = 23, Women n = 38) aged 82.4 ± 6.8 years participated in the experiments. The average number of natural teeth was 16.5 ± 10.5, 34.4% of the participants wore removable dentures. For all tests, the sum of sensitivity and specificity was >150%. All test correlated with Jelly-scan (absolute Rho >0.5). With Jelly-scan 51 participants (83.6%) were diagnosed with "masticatory hypofunction". After reducing the cut-off value of the test from 100 mg/dL to 65 mg/dL, only 33 participants (54%) fulfilled the diagnosis. This post-hoc analysis increased the sensitivity of the Gum2-tests and the agreement to kappa >0.5 for all three tests. CONCLUSION: All three tests can be considered useful screening alternatives. In its original version, Jelly-scan may tend to over-diagnose masticatory hypofunction, hence a novel cut-off with better agreement between tests is suggested.

Extra-oral assessment of conventional and CAD-CAM complete denture appearance by dental professionals and CRDP wearers: A randomized survey.

INTRODUCTION: Complete removable dental prostheses' (CRDPs) appearance may vary between conventional and contemporary CAD-CAM manufacturing techniques. OBJECTIVES: The aim of this randomized survey was to analyze appreciation of CRDPs, manufactured with different techniques, by dental professionals and elder CRDP wearers. METHODS: Four participant groups, comprised of undergraduate students (n=10), postgraduate residents (n=10), dental technicians (n=10) and elder CRDP wearers (n=10), evaluated the appearance of maxillary CRDPs manufactured by six different techniques: three conventional methods 1. flask-pack-press (FP), 2. Injection-molded (IM), 3. intrinsically colored natural gingiva finish before injection-molded (NG) and three CAD-CAM methods 4. milled base with bonded prefabricated teeth (M), 5. fully milled including milled teeth (FM) and 6. rapid-prototyped including printed teeth (P). A randomized, blinded survey included 18 pairwise comparative assessments and 12 individual judgements of the CRDPs on general appearance as well as pink and white aspects. Statistical analyses included parametric- and nonparametric tests as well as linear regression models; the level of statistical significance was set at p<.05. RESULTS: NG was preferred by the professional groups but not by the elder CRDP wearers (p<.05). P was scored lowest by all four participant groups (p<.05). CRDP wearers' ratings were less severe and within a narrower range. The ratings of the two CAD-CAM milled CRDPs (M and FM) were ranked closer to FP and IM); the order of preference was different depending on the participant groups. CONCLUSIONS: The findings of this study revealed marked differences in the assessment of CRDP appearances between dental professionals and older CRDP wearers. CLINICAL SIGNIFICANCE: A shared and informed approach to decision making concerning the CRDP appearance might foster denture acceptance and treatment success.

CAD-CAM removable complete dentures: A systematic review and meta-analysis of trueness of fit, biocompatibility, mechanical properties, surface characteristics, color stability, time-cost analysis, clinical and patient-reported outcomes.

OBJECTIVES: This review compared Computer-aided designand Computer-aided manufactured (CAD-CAM) and conventionally constructed removable complete dentures (CDs). DATA: Seventy-three studies reporting on CAD-CAM (milled/3D-printed) CDs were included in this review. The most recent literature search was performed on 15/03/2021. SOURCES: Two investigators searched electronic databases [PubMed (MEDLINE), Embase, CENTRAL], online search engines (Google) and research portals. Hand searches were performed to identify literature not available online. STUDY SELECTION: Studies on CAD-CAM CDs were included if they reported on trueness of fit, biocompatibility, mechanical, surface, chemical, color , microbiological properties, time-cost analysis, and clinical outcomes. Inter-investigator reliability was assessed using kappa scores. Meta-analyses were performed on the extracted data . RESULTS: The kappa score ranged between 0.897-1.000. Meta-analyses revealed that 3D-printed CDs were more true than conventional CDs (p = 0.039). Milled CDs had a higher flexural-strength than conventional and 3D-printed CDs (p < 0.0001). Milled CDs had a higher flexural-modulus than 3D-printed CDs (p < 0.0001). Milled CDs had a higher yield-strength than injection-molded (p = 0.004), and 3D-printed CDs (p = 0.001). Milled CDs had superior toughness (p < 0.0001) and surface roughness characteristics (p < 0.0001) than other CDs . Rapidly-prototyped CDs displayed poor color-stability compared to other CDs (p = 0.029). CAD-CAM CDs d displayed better retention than conventional CDs (p = 0.015). Conventional CDs had a higher strain at yield point than milled CDs (p < 0.0001), and had superior esthetics than 3D-printed (p < 0.0001). Fabrication of CAD-CAM CDs required less chairside time (p = 0.037) and lower overall costs (p < 0.0001) than conventional CDs. CONCLUSIONS: This systematic review concludes that CAD-CAM CDs offer a number of improved mechanical/surface properties and are not inferior when compared to conventional CDs. CLINICAL SIGNIFICANCE: CAD-CAM CDs should be considered for completely edentulous patients whenever possible, since this technique offers numerous advantages including better retention, mechanical and surface properties but most importantly preserves a digital record. This can be a great advantage for older adults with limited access to dental care.

CAD/CAM milled removable complete dentures: time and cost estimation study.

OBJECTIVE: This study compared the clinical time spent and the costs incurred whilst constructing complete dentures (CDs) using a two-visit digital-denture protocol with the conventional complete denture protocol, in a university setting. METHODS: Twelve undergraduate final-year dental students utilized both the digital denture protocol and the conventional complete denture protocol to construct two sets of CDs for patients requiring either an upper CD opposing a partial natural dentition restored using a partial removable prosthesis [Group#1: students: n = 6, upper CD: n = 12 (6-digital complete dentures +6-conventional complete dentures)] or both upper and lower CDs [Group#2: students: n = 6, upper and lower CDs: n = 24 (12-digital complete dentures+ 12-conventional complete dentures)]. Overall time spent and costs (clinical, materials, and laboratory) were calculated. A cost minimization analysis was performed to compare the economic costs of the two protocols. Paired t-tests were applied for the statistical analyses (p < 0.05). RESULTS: Conventional complete denture protocol required longer clinical time than digital complete dentures for both Group#1 (p = 0.0206) and Group#2 (p = 0.0020). The materials costs were higher for the digital complete dentures in both groups (Group#1 p < 0.0001; Group#2: p = 0.0002). The overall costs, were significantly higher for the conventional complete denture protocol than for the digital denture protocol (Group#1: p = 0.0032; Group 2: p = 0.0080). CONCLUSIONS: In a university setting student clinic in Geneva in Switzerland, the digital denture protocol is less costly when compared with the conventional complete denture protocol. The costs for clinical chairside time, laboratory and the overall costs were significantly lower for the digital denture protocol, even though the materials costs for this protocol were higher. CLINICAL SIGNIFICANCE: The digital denture protocol might prove highly beneficial to the elderly and/or the compromised edentulous patient, as it can help decrease the treatment burden on the patient by reducing the clinical procedures, number of visits, treatment time and incurred costs.

Professional oral health care for preventing nursing home-acquired pneumonia: A cost-effectiveness and value of information analysis.

AIM: Professional oral health care (POHC) prevents nursing home-acquired pneumonia (NHAP) and its related mortality. We assessed the cost-effectiveness of POHC versus no POHC (nPOHC) and the monetary value of eliminating uncertainty by future research. METHODS: A German public-private payer perspective was adopted. A Markov model was used, following long-term care residents from admission to death. Cost-effectiveness was estimated as Euro/disability-adjusted life year (DALY) using Monte Carlo microsimulations. Value-of-information analyses were performed. The willingness-to-pay threshold/DALY was assumed to be 66% (range 50%-100%) of per-capita gross domestic product (GDP). RESULTS: nPOHC was less costly (€3,024) but also less effective (0.89 DALYs) than POHC (€10,249, 0.55 DALYs). For most presumed payers, POHC was cost-effective. The cost-effectiveness of POHC was higher in smokers, underweight or pulmonary disease patients. Eliminating uncertainty about the NHAP costs, NHAP incidence/mortality, and POHC effectiveness would result in an expected net value of 47 million €/year (and even higher values at lower GDP thresholds), and is likely to decrease with time. CONCLUSIONS: Within the chosen setting and on the basis of current evidence, POHC was cost-effective. Given the detected uncertainty, further research seems warranted.

Knowledge and attitude of elderly persons towards dental implants.

BACKGROUND: Despite their unrivalled place in restorative treatment, dental implants are still scarcely used in elderly patients. INTRODUCTION: The aim of this survey was therefore to identify potential barriers for accepting an implant treatment. MATERIALS AND METHODS: Participants were recruited from a geriatric hospital, two long-term-care facilities and a private clinic. The final study sample comprised 92 persons, 61 women and 31 men with an average age of 81.2 ± 8.0 years. In a semi-structured interview, the participants' knowledge of implants and attitude towards a hypothetical treatment with dental implants were evaluated. RESULTS: Twenty-seven participants had never heard of dental implants, and another 13 participants could not describe them. The strongest apprehensions against implants were cost, lack of perceived necessity and old age. Univariate and multiple linear regression analysis identified being women, type and quality of denture, having little knowledge on implants and being hospitalised as the risk factors for refusing implants. However, old age as such was not associated with a negative attitude. CONCLUSION: The acceptance of dental implants in the elderly population might be increased by providing further information and promoting oral health in general. Regardless of the age, dental implants should be placed when patients are still in good health and live independently.

Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients--the York Consensus Statement.

The Annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on 6 and 7 April 2009. At the symposium on mandibular overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible. Emphasis was given to both qualitative and quantitative research based on patient-centred outcomes of treatment. A draft consensus was circulated to all presenters and to the Council members of the BSSPD and to BSSPD members on the Society's website. The statement was modified in the light of their comments, audience feedback following the presentations and members' feedback. We hope that this consensus statement will be a useful guide for patients and clinicians and that it will act to stimulate wider debate. We also hope that it will prove useful to other patient and professional organisations and will inform discussions with providers of national healthcare and with independent funders.

Utilisation of dental services in a university hospital palliative and long-term care unit in Geneva.

OBJECTIVES: Dental care plays an important role in the multidisciplinary approach, which is used in palliative and long-term care to address the complex needs of terminally ill patients. The aim of this study was to assess the utilisation of dental services in a University Hospital Palliative and Long-term Care Unit. MATERIAL AND METHOD: Over an observation period of 13 months, structured questionnaires were filled in after each dental appointment. The survey covered three main topics: the initiation and incentive from the dental consultation, particular difficulties because of the patient's health or the hospital's organisation as well as the accomplished treatment. RESULTS: Two hundred and seventy-five questionnaires from a total of 102 patients were available for analysis. The patients' median age was 83 years (SD 10.3, range 49-101 years), 63 were female, 39 male. A majority of first appointments were initiated by a physician (n = 49 of 102), mainly because of pain (n = 62 of 275). 10.5% of the appointments were cancelled on the same day. Only one-fifth of the patients were able to reach the practice on foot. Six used a walking stick and 54 relied on a wheelchair. Eighteen patients needed to be seen in their bed. The most frequently performed procedures were extractions and removal of denture sore spots (n = 67 of 275) followed by the manufacturing of new dentures (n = 38 of 275). In more than 17% of the appointments, no particular treatment was performed. CONCLUSION: The utilisation of dental services in terminally ill and severely compromised elderly patients shown justifies a dental service in a palliative care or geriatric hospital setting. The particular dental work profile requires a practitioner with empathy and professional experience.